Special Issue "Impaired Driving Skills in Older Adults"

A special issue of Geriatrics (ISSN 2308-3417).

Deadline for manuscript submissions: closed (15 May 2016)

Special Issue Editor

Guest Editor
Dr. Max Toepper

Department of Gerontology/Research Department, Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld (EvKB), Bielefeld, Germany
Website | E-Mail
Interests: cognitive neuroscience; fMRI; neuropsychology; working memory; executive functioning; inhibition; symbol comprehension; driving abilities; Alzheimer's disease; mild cognitive impairment (MCI); aging

Special Issue Information

Dear Colleagues,

Aging goes along with functional and structural cerebral changes that lead to cognitive decline. This decline includes various cognitive sub-functions, some of which are closely related to driving skills. As a result, driving skills increasingly become impaired with advancing age, and this particularly applies to seniors suffering from neurodegenerative and psychiatric disorders. Nevertheless, depending from the respective national legislation, many of these people still drive. To protect these drivers and the driving public, it is very important to identify impaired drivers and to inform them about possible training methods or transport alternatives.

This Special Issue focuses on potential risk factors for impaired driving skills, neuropsychological tests that allow the identification of impaired drivers, and cognitive interventions that improve driving skills in older adults. The Special Issue provides an Open Access opportunity to publish research articles, reviews, opinions, letters, and case reports related to this important and increasingly noticed field of research.

Dr. Max Toepper
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access quarterly journal published by MDPI.

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Keywords

  • driving skills
  • dementia
  • aging
  • neuropsychology
  • training

Published Papers (12 papers)

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Research

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Open AccessArticle Assessment of Drivers with Alzheimer’s Disease in High Demand Driving Situations: Coping with Intersections in a Driving Simulator
Geriatrics 2016, 1(3), 21; doi:10.3390/geriatrics1030021
Received: 10 June 2016 / Revised: 5 August 2016 / Accepted: 17 August 2016 / Published: 31 August 2016
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Abstract
Intersections are one of the most complex and cognitively demanding driving situations. Individuals with dementia and, more precisely, Alzheimer’s disease (AD), may face additional challenges negotiating intersections given the nature of their cognitive decline, which often includes deficits of attention. We developed a
[...] Read more.
Intersections are one of the most complex and cognitively demanding driving situations. Individuals with dementia and, more precisely, Alzheimer’s disease (AD), may face additional challenges negotiating intersections given the nature of their cognitive decline, which often includes deficits of attention. We developed a comprehensive evaluation scheme to assess simulated driving performance at intersections. The evaluation scheme captured all types of errors that could occur during preparation (i.e., prior to the intersection), execution (i.e., during the intersection), and recovery (i.e., after the intersection). Using the evaluation scheme, intersection behaviour in a driving simulator among 17 drivers with mild AD was compared to that of 21 healthy controls. The results indicated that across all types of intersections, mild AD drivers exhibited a greater number of errors relative to controls. Drivers with mild AD made the most errors during the preparation period leading up to the intersection. These findings present a novel approach to analyzing intersection behaviour and contribute to the growing body of research on dementia and driving. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessArticle Enhancing Older Drivers’ Safety: On Effects Induced by Stereotype Threat to Older Adults’ Driving Performance, Working Memory and Self-Regulation
Geriatrics 2016, 1(3), 20; doi:10.3390/geriatrics1030020
Received: 9 June 2016 / Revised: 7 August 2016 / Accepted: 18 August 2016 / Published: 24 August 2016
Cited by 1 | PDF Full-text (957 KB) | HTML Full-text | XML Full-text
Abstract
In a study concerned with driving behaviors of older drivers (mean age 70 years) in a driving simulator, our findings indicate that telling older drivers that they are more at risk of accidents because of their age and their driving performance-related decline (i.e.,
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In a study concerned with driving behaviors of older drivers (mean age 70 years) in a driving simulator, our findings indicate that telling older drivers that they are more at risk of accidents because of their age and their driving performance-related decline (i.e., exposing them to a stereotype threat concerning older drivers) severely impairs their self-regulatory skills. Moreover, our results show that this is at least partly due to exhaustion of the executive resources (older drivers under stereotype threat tended to contradict the stereotype of being slow by driving faster), appearing also through working memory overload (older drivers under stereotype threat performed markedly less well in a modular arithmetic task than drivers in the control condition). We thus complete the existing evidence that older drivers’ performance may be affected by socially-grounded factors, suggesting that simply being investigated may be enough to tax many capabilities in older people. We also propose that stereotype threat might be at least a partial explanation for why older drivers sometimes have poorer self-regulation performances after attending rehabilitation programs designed to make older drivers safer ones. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessArticle Motor Vehicle Collision Involvement among Persons with Hemianopia and Quadrantanopia
Geriatrics 2016, 1(3), 19; doi:10.3390/geriatrics1030019
Received: 17 June 2016 / Revised: 12 July 2016 / Accepted: 14 July 2016 / Published: 18 July 2016
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Abstract
Persons with homonymous quadrantanopia and hemianopia experience driving restrictions, yet there is little scientific evidence to support driving prohibition among persons with these conditions. This retrospective cohort study compares motor vehicle collision (MVC) rates among 27 current licensed drivers with hemianopic and quadrantanopic
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Persons with homonymous quadrantanopia and hemianopia experience driving restrictions, yet there is little scientific evidence to support driving prohibition among persons with these conditions. This retrospective cohort study compares motor vehicle collision (MVC) rates among 27 current licensed drivers with hemianopic and quadrantanopic field defects, who were ≥6 months from the brain injury date with that of 27 age-matched drivers with normal visual fields. Information regarding all police-reported MVCs that occurred over a period of nine years was obtained. MVC rates per year and per mile travelled were calculated and compared using conditional Poisson regression. Drivers with hemianopia or quadrantanopia had more MVCs per mile driven compared to drivers with normal visual fields; specifically their overall MVC rate was 2.45-times (95% confidence interval (CI) 0.89–3.95) higher and their at-fault MVC rate was 2.64-times (95% CI 1.03–6.80) higher. This study indicates that drivers with hemianopia or quadrantanopia have elevated MVC rates. This is consistent with previous research despite studies showing wide individual variability from excellent to poor driving skills. Future research should focus on the functional and driving performance characteristics associated with superior driving skills and/or those that may be amenable to improvement via behavioral and/or engineering interventions. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessArticle Driving Simulator Training Is Associated with Reduced Inhibitory Workload in Older Drivers
Geriatrics 2016, 1(3), 16; doi:10.3390/geriatrics1030016
Received: 20 February 2016 / Revised: 23 June 2016 / Accepted: 29 June 2016 / Published: 4 July 2016
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Abstract
Background: In demanding cognitive tasks, older people mostly experience more problems than younger people, and their brain workload is higher. An overloaded or exhausted mental workload is frequently associated with unsafe driving behavior. In this paper, we hypothesize that 10 active training sessions
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Background: In demanding cognitive tasks, older people mostly experience more problems than younger people, and their brain workload is higher. An overloaded or exhausted mental workload is frequently associated with unsafe driving behavior. In this paper, we hypothesize that 10 active training sessions in a driving simulator positively influence brain workload, which relates to a beneficial increase in on-road driving performance. Methods: Ninety-one healthy active drivers (62–87 years) were randomly assigned to: (a) a driving simulator-training group; (b) an attention-training group; or (c) a control group. The dependent variables of this training study were brain workload (theta Fz/alpha Pz), and performance in three tasks, for which inhibition of inadequate responses (Stroop, Negative Priming, and Flanker) is required. Seventy-seven participants (85% of the total sample) completed the training. Training gains were analyzed by using a multiple regression analysis with planned comparisons. Results: The results revealed that the driving simulator training reduced brain workload during performance of the inhibition tasks. The performance of the simulator group during the inhibition tasks did not improve, but the participants completed the tasks with less brain workload compared to the attention-training group. Conclusion: Adding to our first paper on the Drive-Wise project, this paper now focuses on the superiority of the driving simulator training, compared to attention-training in regards to reducing brain workload. The change in brain workload seems to be associated with a positive change in drivers’ behavior on the road. Hence, a driving simulator training lasting only ten sessions leads to beneficial neuroplastic changes. This demonstrates brain plasticity of older people and its possible positive influence in real driving behavior. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessArticle Correspondence between Simulator and On-Road Drive Performance: Implications for Assessment of Driving Safety
Geriatrics 2016, 1(1), 8; doi:10.3390/geriatrics1010008
Received: 14 January 2016 / Revised: 7 March 2016 / Accepted: 9 March 2016 / Published: 10 March 2016
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Abstract
Forty-two younger (Mean age = 35) and 37 older drivers (Mean age = 77) completed four similar simulated drives. In addition, 32 younger and 30 older drivers completed a standard on-road drive in an instrumented vehicle. Performance in the simulated drives was evaluated
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Forty-two younger (Mean age = 35) and 37 older drivers (Mean age = 77) completed four similar simulated drives. In addition, 32 younger and 30 older drivers completed a standard on-road drive in an instrumented vehicle. Performance in the simulated drives was evaluated using both electronic drive data and video-review of errors. Safety errors during the on-road drive were evaluated by a certified driving instructor blind to simulator performance, using state Department of Transportation criteria. We examined the degree of convergence in performance across the two platforms on various driving tasks including lane change, lane keeping, speed control, stopping, turns, and overall performance. Differences based on age group indicated a pattern of strong relative validity for simulator measures. However, relative rank-order in specific metrics of performance suggested a pattern of moderate relative validity. The findings have implications for the use of simulators in assessments of driving safety as well as its use in training and/or rehabilitation settings. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessArticle The Older Driver with Cognitive Impairment: Perceptions of Driving Ability and Results of a Behind the Wheel Test
Geriatrics 2016, 1(1), 6; doi:10.3390/geriatrics1010006
Received: 13 November 2015 / Revised: 14 December 2015 / Accepted: 29 January 2016 / Published: 4 February 2016
Cited by 2 | PDF Full-text (181 KB) | HTML Full-text | XML Full-text
Abstract
Older adult drivers with cognitive impairment pose a potential safety risk to themselves and others. Providers are often uncertain about when to request a formal evaluation of driving ability, leaving subjective reports of concerns by the patient or family as common initiators of
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Older adult drivers with cognitive impairment pose a potential safety risk to themselves and others. Providers are often uncertain about when to request a formal evaluation of driving ability, leaving subjective reports of concerns by the patient or family as common initiators of objective driving evaluation referral. This observational study evaluated the correspondence of patient and caregiver report of driving concerns relative to objective behind-the-wheel (BTW) testing. Data were analyzed from occupational therapy driving evaluations of older adult U.S. Veterans referred from cognitive disorder specialty clinics between 2005 and 2015 (n = 151). Driving ability was evaluated with a pre-testing interview of the patient and a knowledgeable caregiver, followed by objective BTW testing. Patients referred had a mean age of 77.6 (SD = 8.1) years, were 97% male, and 98% white. Results demonstrated that most patients are evaluated for driving concerns far too late, with only 3% of the sample being evaluated as independent to drive without restrictions, and 38% recommended to retire from driving. Although both patients and caregivers denied specific driving concerns (obey signs and lights) relative to objective testing, caregiver concerns were greater than their respective patient’s concerns (p < 0.001) and were associated with road test outcome (p = 0.001). Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessArticle Preliminary Validation of a Questionnaire Covering Risk Factors for Impaired Driving Skills in Elderly Patients
Geriatrics 2016, 1(1), 5; doi:10.3390/geriatrics1010005
Received: 30 October 2015 / Revised: 7 December 2015 / Accepted: 16 December 2015 / Published: 8 January 2016
Cited by 2 | PDF Full-text (397 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Due to rather unspecific statutory regulations in Germany, particularly for patients with neurodegenerative disorders, many seniors still drive despite severe driving-related cognitive deficits. An accurate assessment of driving fitness requires immense financial, personnel and temporal resources which go beyond daily clinical routines. In
[...] Read more.
Due to rather unspecific statutory regulations in Germany, particularly for patients with neurodegenerative disorders, many seniors still drive despite severe driving-related cognitive deficits. An accurate assessment of driving fitness requires immense financial, personnel and temporal resources which go beyond daily clinical routines. In cooperation with a working group from Switzerland, we therefore developed the questionnaire Safety Advice For Elderly drivers (SAFE), an economic instrument covering different risk factors for driving safety. The main aim of the current work was a first validation of the SAFE. Twenty-two driving seniors performed the Corporal A, a test battery permitted by law to assess driving-related cognitive functions. Based upon the Corporal results and the percentile rank 16 criterion, participants were divided into cognitively impaired and unimpaired drivers. Moreover, participants were assessed using the SAFE and an extensive neuropsychological test battery. The results revealed high sensitivity and specifity scores for the SAFE suggesting that the SAFE may be a valuable and economical instrument to quantify and document individual risk factors for driving safety and to differentiate between impaired and unimpaired drivers. Notably, the results must be replicated in future studies including a larger sample, different clinical subgroups, and a practical driving lesson. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessArticle Preliminary Investigation on the Association between Depressive Symptoms and Driving Performance in Heart Failure
Geriatrics 2016, 1(1), 2; doi:10.3390/geriatrics1010002
Received: 18 August 2015 / Revised: 3 December 2015 / Accepted: 7 December 2015 / Published: 23 December 2015
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Abstract
Heart failure (HF) patients commit many errors on driving simulation tasks and cognitive dysfunction appears to be one important contributor to impaired driving in HF. Clinical modifiers of cognition may also play a key role. In particular, depression is common in HF patients,
[...] Read more.
Heart failure (HF) patients commit many errors on driving simulation tasks and cognitive dysfunction appears to be one important contributor to impaired driving in HF. Clinical modifiers of cognition may also play a key role. In particular, depression is common in HF patients, linked with cognitive dysfunction, and contributes to reduced driving fitness in non-HF samples. However, the associations among depressive symptoms, cognition, and driving in HF are unclear. Eighteen HF patients completed a validated simulated driving scenario, the Beck Depression Inventory-II (BDI-II), and a cognitive test battery. Partial correlations controlling for demographic and medical confounds showed higher BDI-II score correlated with greater number of collisions, centerline crossings, and % time out of lane. Increased depressive symptoms correlated with lower attention/executive function, and reduced performance in this domain was associated with a greater number of collisions, centerline crossing, and % time out of lane. Depressive symptoms may be related to poorer driving performance in HF, perhaps through association with cognitive dysfunction. However, larger studies with on-road testing are needed to replicate our preliminary findings before recommendations for clinical practice can be made. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)

Review

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Open AccessReview Evidence Based Review of Fitness-to-Drive and Return-to-Driving Following Traumatic Brain Injury
Geriatrics 2016, 1(3), 17; doi:10.3390/geriatrics1030017
Received: 5 April 2016 / Revised: 1 July 2016 / Accepted: 1 July 2016 / Published: 7 July 2016
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Abstract
The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published
[...] Read more.
The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published before June 2016 using MeSH search terms. Using the American Academy of Neurology’s classification criteria, 24 articles were included after reviewing 1998 articles. Studies were rated by class (I–IV), with I being the highest level of evidence. Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator and surveys). There were no Class I studies. Based on Class II studies, only Post-traumatic amnesia (PTA) duration was found to be probably predictive of on-road driving performance. There is limited evidence concerning predictors of return to driving. The findings suggest further evidence is needed to identify predictors of on-road driving performance in persons with TBI. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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Open AccessReview Functional Changes and Driving Performance in Older Drivers: Assessment and Interventions
Geriatrics 2016, 1(2), 12; doi:10.3390/geriatrics1020012
Received: 6 May 2016 / Revised: 12 May 2016 / Accepted: 12 May 2016 / Published: 20 May 2016
Cited by 5 | PDF Full-text (250 KB) | HTML Full-text | XML Full-text
Abstract
With the increasing aging of the population, the number of older drivers is rising. Driving is a significant factor for quality of life and independence concerning social and working life. On the other hand, driving is a complex task involving visual, motor, and
[...] Read more.
With the increasing aging of the population, the number of older drivers is rising. Driving is a significant factor for quality of life and independence concerning social and working life. On the other hand, driving is a complex task involving visual, motor, and cognitive skills that experience age-related changes even in healthy aging. In this review we summarize different age-related functional changes with relevance for driving concerning sensory, motor, and cognitive functions. Since these functions have great interindividual variability, it is necessary to apply methods that help to identify older drivers with impaired driving abilities in order to take appropriate measures. We discuss three different methods to assess driving ability, namely the assessment of (i) functions relevant for driving; (ii) driving behavior in real traffic; and (iii) behavior in a driving simulator. We present different measures to improve mobility in older drivers, including information campaigns, design of traffic and car environment, instructions, functional training, and driving training in real traffic and in a driving simulator. Finally, we give some recommendations for assessing and improving the driving abilities of older drivers with multi-modal approaches being most promising for enhancing individual and public safety. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
Open AccessReview Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model
Geriatrics 2016, 1(1), 3; doi:10.3390/geriatrics1010003
Received: 11 August 2015 / Revised: 14 December 2015 / Accepted: 17 December 2015 / Published: 23 December 2015
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Abstract
In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be
[...] Read more.
In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)

Other

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Open AccessCase Report Advice for Elderly Drivers in a German Memory Clinic: A Case Report on Medical, Ethical and Legal Consequences
Geriatrics 2016, 1(1), 9; doi:10.3390/geriatrics1010009
Received: 21 December 2015 / Revised: 10 March 2016 / Accepted: 14 March 2016 / Published: 19 March 2016
Cited by 1 | PDF Full-text (226 KB) | HTML Full-text | XML Full-text
Abstract
We report on a 75-year-old female who consulted our Memory Clinic because of subjective memory complaints that she first recognized three months previously. Next to the standard detailed patient history, neuropsychological assessment, psychopathological status, the patient’s driving history played an important role in
[...] Read more.
We report on a 75-year-old female who consulted our Memory Clinic because of subjective memory complaints that she first recognized three months previously. Next to the standard detailed patient history, neuropsychological assessment, psychopathological status, the patient’s driving history played an important role in the diagnostic process. In this case report, we illustrate the diagnostic process starting with the first consultation, including a short neuropsychological examination and communicating its results, reporting on further work-up (detailed neuropsychological assessment, MRI scan and cerebrospinal fluid (CSF) analysis) up to the final consultation, including advice for the patient. We will focus on several medical, ethical and legal difficulties that may occur when consulting elderly drivers with initial cognitive decline. Full article
(This article belongs to the Special Issue Impaired Driving Skills in Older Adults)
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