Visual-cognitive tools used to determine fitness-to-drive may reflect normal aging.

BACKGROUND: Scores on many visual-cognitive tools are proposed as indicators of fitness-to-drive. A purported feature of some tools and one believed to be important is that they are 'age-independent'. Specifically, scores are not correlated with age and poor scores represent a pathological process rather than normal aging. Yet, we know that several cognitive abilities are associated with age. One potential reason for the apparent age-independence of some tools is that focusing on older drivers leads to 'range restriction', a statistical issue that reduces the magnitude of correlations when values for one variable are restricted to a smaller range than naturally occurs. Hence, the purpose of this study was to investigate whether age is correlated with scores on visual-cognitive tests when we examine the full age range. METHODS: We recruited 114 drivers aged 18 to 89 years (mean: 42.30 ± 26.50 years). Participants completed several visual-cognitive tools often used to examine fitness-to-drive (Trail Making Tests A and B, Attention Network Test and 'useful field of view'). RESULTS: Correlations between age and test scores for drivers 65 years and older only ranged from 0.03 to 0.48. With the whole age range, correlations ranged from 0.56 to 0.84. We also compared ordinary Pearson correlations among visual-cognitive tests scores to the corresponding partial correlations after removing the effect of age. Whereas ordinary Pearson correlations ranged from 0.40 to 0.69, partial correlations ranged from 0.01 to 0.30. CONCLUSION: Test scores may reflect age-associated normal biological changes. These results have implications for predicting fitness-to-drive among older drivers and suggest caution in using these scores.

Self-rated confidence and on-road driving performance among older adults: Autoévaluation de la confiance et de la performance au volant chez les personnes âgées.

BACKGROUND.: Driver confidence can be measured through concepts such as driving frequency, situational avoidance, and self-perceptions. However, it is not clear how well confidence aligns with actual driving performance. PURPOSE.: We examined the relationship between subjective measures of confidence in driving ability and on-road performance. METHOD.: We report findings from two studies. The first compared scores from the Older and Wiser Driver Questionnaire to an on-road driving evaluation. The second looked at the Day and Night Driving Comfort Scales and Driving Habits and Intentions Questionnaire in relation to an on-road driving evaluation. FINDINGS.: No measures of confidence in driving ability were related to on-road driving performance. IMPLICATIONS.: Confidence in driving ability bears little relationship to on-road performance. Future research should examine approaches to foster a better match between self-assessments and actual abilities among drivers.

Development of a tool to investigate caregiving issues from the perspective of family physicians and discussion of preliminary results.

AIM: The aim of our study was to develop a survey for family physicians to better understand family physicians' beliefs, level of knowledge and sense of accountability regarding their support of informal (i.e., unpaid) caregivers of older adults. BACKGROUND: Seniors with dementia can be supported to 'age in place'. However, this requires assistance from family and friends, who are often seniors themselves and may have health issues of their own. Although family physicians are well positioned to assist older adult caregivers, there is a paucity of data regarding this role. METHODS: After a literature review, we created a questionnaire to examine these issues. It was reviewed by experts and, after revision, was appraised by health planners/decision makers and pre-tested with family physicians. A final questionnaire was created using this feedback. FINDINGS: The next important step would be to administer the questionnaire to Canadian family physicians using appropriate survey methodology.

Roadwise Review has limited congruence with actual driving performance of aging drivers.

The Roadwise Review (RR) CD-ROM has been proposed as one way for older drivers to self-evaluate the skills that support safe driving. To better gauge the utility of RR for that purpose, further validation of RR vis-à-vis measures of driving performance is needed. We carried out this study to provide such validation. We correlated the results of the standard Useful Field of View subtest 2 (UFOV-2) and Trail Making Test (TMT) parts A and B to the corresponding RR subsections on visual information processing and visual search. We further examined the correlations between on-road performance (based on demerit points) and RR results (absolute scores and number of problems identified). The correlations between UFOV-2, TMT and the relevant RR sections ranged from .46 to .61. The correlations between demerit points and RR absolute values ranged from -.40 to .50. The correlations between demerit points and the number of problems identified by RR ranged from -.24 to .45. Using a "pass/fail" approach we also failed to find a relationship with the number of problems. These results indicate limited convergence between findings obtained with RR and actual performance using standardized approaches. Such results emphasize the importance of developing a rigorous data synthesis process before attempting knowledge translation of material aimed at older drivers.

Driving performance and susceptibility to simulator sickness: are they related?

We examined whether participants who failed to complete a simulated drive because of simulator sickness (dropouts) differed from those who completed the simulation (completers). Thirteen healthy older adult dropouts (mean age = 74.8 yr) and 12 comparable completers were compared on the following variables: on-road driving performance, the Useful Field of View test, the Attention Network Test, and the Trail Making Test Part A. Results showed that completers scored more demerit points during the on-road drive than did dropouts. In addition, only 1 of 13 comparisons based on participants' cognition was statistically significant. These results suggest that in healthy senior drivers, simulator sickness does not prevent examination of those who need it most (i.e., those with the poorest on-road driving performance) and that cognitive differences are not associated with dropping out because of simulator sickness.

Assessment of driving performance using a simulator protocol: validity and reproducibility.

We examined the validity and reproducibility of simulator-based driving evaluations. In Study 1, we examined correlations among Trails A and B, demerit points for simulated drives, and simulator-recorded errors. With one exception, correlations ranged from .44 (p = .103) to .83 (p = .001). In Study 2, we examined correlations among Trail Making Test Part A, Useful Field of View, and demerit points for simulated drives; correlations ranged from .50 to .82 (all ps < .001). The correlation between demerit points for on-road and simulated drives was .74 (p = .035). We examined reproducibility of simulator assessments using the playback function; intraclass correlation coefficients ranged from .73 to .87 (all ps < .001). These results suggest that simulators could be used to facilitate the evaluation of fitness to drive.

The combination of two training approaches to improve older adults' driving safety.

OBJECTIVE: An increasing number of older adults rely on the automobile for transportation. Educational approaches based on the specific needs of older drivers may help to optimize safe driving. We examined if the combination of an in-class education program with on-road education would lead to improvements in older drivers' knowledge of safe driving practices and on-road driving evaluations. METHODS: We used a multisite, randomized controlled trial approach. Participants in the intervention group received the in-class and on-road education; those in the control group waited and were offered the education afterwards. We measured knowledge of safe driving practices before and after the in-class component of the program and on-road driving skills before and after the whole program. RESULTS: Participants' knowledge improved from 61% of correct answers before the in-class education component to 81% after (p < .001). The on-road evaluation results suggested improvements on some aspects of safe driving (e.g., moving in roadway, p < .05) but not on others. CONCLUSIONS: The results of this study demonstrate that education programs focused on the needs of older drivers may help improve their knowledge of safe driving practices and actual driving performance. Further research is required to determine if these changes will affect other variables such as driver confidence and crash rates.

Incidents in a psychiatric forensic setting: association with patient and staff characteristics.

Patient-related incidents are of particular concern for those working with forensic psychiatric populations. Evidence suggests that personality, stress, and burnout of nursing staff are predictive of incidents. However, the exact relationship of these factors with staff-patient interactions and the incidents that occur within these interactions have not been thoroughly explored. The authors collected data on the nature of incidents on a forensic unit within a psychiatric hospital over a 1-year period, as well as data on the characteristics of 13 staff members. They found that 10% of patients were responsible for 58% of the incidents. Patients with a diagnosis of schizophrenia were disproportionately involved in incidents. The frequency of non-violent incidents varied among nursing teams to an extent greater than that expected by chance. A relationship between incidents and some staff characteristics was also found. These results highlight the need for further research into the incidents that occur in situations where patient attributes, nurse attributes, and environmental factors produce complex interactions.