Research Update: Driving Safety for Older Adults: Uc, Rizzo, Anderson, Shi and Dawson (1) address driver landmark and traffic sign identification in early Alzheimer's disease. Reviewed by Barbara Resnick, PhD,CRNP, FAAN,FAANP According to estimates from the Insurance Institute of Highway Safety (2), there are 23 million current drivers over the age of 65 today, and twenty years from now 25% of drivers will be over 65. Adults over the age of 85 are nine times more likely to be in a fatal car accident than persons between 25 and 69 years of age. Dobbs, Heller, and Schopflocher (3) concluded that drivers over 65 years old with cognitive impairment made more hazardous errors than both "normal" older drivers over 65 years of age and "normal" younger drivers between 30 and 40 years of age. Fifty percent of the errors occurred during lane changes, merges, and while approaching intersections. A recent study (1) in the Journal of Neurology and Neurosurgical Psychiatry adds to our understanding of driving safety among older adults with cognitive impairment. Uc et al identified specific problems that seem to occur among older adults with cognitive changes when they continue to drive. Specifically, Uc et al explored visual search and recognition of roadside targets and safety errors during a landmark and traffic sign identification task in drivers with Alzheimer's disease. There were 33 drivers with probable Alzheimer's disease of mild severity included in the study and 137 neurologically normal older adults. All of these individuals underwent a battery of visual and cognitive tests and were asked to report detection of specific landmarks and traffic signs along a segment of an experimental drive. The research team found that drivers with mild Alzheimer's disease identified significantly fewer landmarks and traffic signs and made more at-fault safety errors during the task than control subjects. Roadside target identification performance and safety errors were predicted by scores on standardized tests of visual and cognitive function. The research team concluded that drivers with Alzheimer's disease are impaired in a task of visual search and recognition of roadside targets. It is anticipated that the demands of these targets on visual perception, attention, executive functions, and memory probably increase cognitive load and thereby worsen driving safety. Mandatory revoking of an elder's license can result in increased dependence on others, a decrease in activity level, loss of social contact, depression, functional impairment, and isolation (4,5). Clinical implications of this work support the utility of screening older adults for cognitive functioning, among other screenings, when attempting to establish driving safety. Abnormal findings should be discussed with the patient, family, and as appropriate to the state Motor Vehicle Association (www.dmv.org). Providers should check with their local Department of Motor Vehicles (DMV) as states vary in terms of who can report unsafe driving practices related to health, whether reporting is required, and if reporting can be done anonymously. Addressing driving safety with patients and families and reporting driving concerns to the DMV should be done so that a comprehensive evaluation of driving safety can be initiated if so indicated, and the individual helped to optimize their safety when driving. (Author/publisher) 1. Uc EY, Rizzo M, Anderson SW, Shi Q, Dawson JD. Driver landmark and traffic sign identification in early Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2005;76(6):764-8. http://jnnp.bmjjournals.com/cgi/content/abstract/76/6/764 2. National Highway Traffic Safety Administration. Traffic Safety Facts, Research Note. Motor Vehicles Crashes as a Leading Cause of Death in the United States, 2000. From: http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2003/809-661.pdf. Retrieved June 2005. 3. Dobbs, A., Heller, R., & Schopflocher, D. (1998). A comparative approach to identifying unsafe older drivers. Accident Analysis and Prevention, 30 (3), 363-370. http://dx.doi.org doi:10.1016/S0001-4575(97)00110-3 4. Fain, M. (2003). Should older drivers have to prove that they are able to drive? Archives of Internal Medicine, 163(18), 2126-2128. http://archinte.ama-assn.org/cgi/content/extract/163/18/2126 5. Ragland DR, Satariano WA, MacLeod KE. Driving cessation and increased depressive symptoms. J Gerontol A Biol Sci Med Sci. 2005;60(3):399-403. http://biomed.gerontologyjournals.org/cgi/content/abstract/60/3/399
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