Caregivers Hold Keys to the Car for Seniors

By Charles Bankhead, Staff Writer, MedPage Today

Published: December 28, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

·         The impressions of caregivers overwhelmingly topped all other reasons for ending the driving privileges of older people with dementia.

·         Note that the study also showed that more than a third of patients with clinically diagnosed dementia continued to drive.

The impressions of caregivers overwhelmingly topped all other reasons for ending the driving privileges of older people with dementia, results of a cohort study showed.

Among patients who had stopped driving, 93.8% did so because caregivers considered the risk unacceptable. Car accidents and suspension of driver's license followed far behind.

However, the study, reported online in PLOS One, also showed that more than a third of patients with clinically diagnosed dementia continued to drive.

"In multivariate analysis, none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects ... were significantly associated with driving cessation," Reinhold Schmidt, MD, of the Medical University of Graz in Austria, and co-authors noted in their summation of the results.

Studies have indicated that as many as 46% of patients with mild or moderate dementia continue to drive, and almost every previous study showed an increased risk of driving accidents among patients with dementia, according to the authors' background information. However, little is known about factors that influence driving cessation in patients with dementia.

License-renewal policies vary substantially by country and even by state in the U.S., they continued. Clinicians have little guidance for assessing patients' fitness to drive, most of which is based on consensus opinion.

Several medical organizations have suggested certain assessment tools and tests as potentially useful for evaluating patients' ability to drive, including assessment of cognition, function, and medical status; the clinical dementia rating (CDR); and the Mini-Mental State Examination (MMSE).

"The MMSE is of dubious value because recent data assessing the predictive role of this dementia screening test on simulated driving ability failed to demonstrate a significant association," Schmidt and colleagues noted.

In an effort to bring some clarity to the discussion, they studied 240 patients enrolled in a dementia registry in Austria, evaluating the potential usefulness of parameters traditionally used to assess the driving ability of older people.

The study population comprised patients who met diagnostic (DSM-IV) criteria for dementia, had ever driven a car, were not institutionalized, and had caregivers (current or former) willing to provide information about their condition. The patients had a mean age of 74.2.

The population consisted of 194 patients with Alzheimer's disease, 12 with vascular dementia, 16 with frontotemporal dementia, 11 with Lewy body dementia, and seven with other dementia diagnoses.

The investigators assessed each patient by the MMSE, CDR, Neuropsychiatric Inventory (behavior/symptoms of dementia), Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-Plus test battery, and tests evaluating cognition, function, and medical status. If a patient had stopped driving, information about the reasons was obtained from caregivers and categorized as unacceptable risk, involvement in a car accident, or revocation of driver's license.

Overall, 145 of the 240 patients had stopped driving, including 58.2% of patients with Alzheimer's disease, 66.7% of those with vascular dementia, 56.3% of those with frontotemporal dementia, and 90.9% of those with Lewy body disease.

In 136 of 145 cases (93.8%), the patient stopped driving because of a caregiver's risk assessment, followed by eight cases related to auto accidents, and one patient whose driver's license was revoked.

Patients who had stopped driving were older, more likely to be retired women, more often had at-home assistance, and had more severe dementia and greater disability. They also had lower MMSE and CERAD scores.

By logistic regression analysis, factors significantly associated with driving cessation were female sex (OR 5.1, P=0.002), impaired constructional abilities by CERAD (OR 0.611, P=0.02), and impaired activities of daily living (OR 0.941, P<0.001).

Acknowledging limitations of the study, the authors noted that they included only patients who attended memory clinics and who had caregivers willing to participate. They could not rule out the possibility that factors influencing driving cessation might differ between patients who had caregivers and those who did not.

The study was supported by the Austrian Alzheimer Society and the Austrian National Bank.

The authors had no relevant disclosures.

Primary source: PLOS ONE
Source reference:
Seiler S, et al "Driving cessation and dementia: Results of the Prospective Registry on Dementia in Austria (PRODEM)" PLOS One 2012; 7: e52710.

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n Up

Charles Bankhead Staff Writer

Working from Houston, home to one of the world's largest medical complexes, Charles Bankhead has more than 20 years of experience as a medical writer and editor. His career began as a science and medical writer at an academic medical center. He later spent almost a decade as a writer and editor for Medical World News, one of the leading medical trade magazines of its era. His byline has appeared in medical publications that have included Cardio, Cosmetic Surgery Times, Dermatology Times, Diagnostic Imaging, Family Practice, Journal of the National Cancer Institute, Medscape, Oncology News International, Oncology Times, Ophthalmology Times, Patient Care, Renal and Urology News, The Medical Post, Urology Times, and the International Medical News Group newspapers. He has a BA in journalism and MA in mass communications, both from Texas Tech University.

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