Online Program

Development of a valid office-based screening tool to identify unsafe older drivers

Sunday, November 3, 2013

James Haynes, MPH, MBA, School of Public Health, Eastern Virginia Medical School, Norfolk, VA
Hamid Okhravi, MD, The Glennan Center for Geriatrics and Gerontology, Norfolk, VA
Davithoula Petrakos, MPH, The Glennan Center for Geriatrics and Gerontology, Norfolk, VA
Tina D. Cunningham, PhD, The Center for Health Analytics and Discovery, Eastern Virginia Medical School-Old Dominion University, Norfolk, VA
Background: The aging US population is increasing the prevalence of cognitively impaired drivers on the roads. A rapid, accurate, cost-effective and easily accessible screening method is needed to identify unsafe drivers before they cause accidents. This study is designed to determine which components of readily-available cognitive screening tools are accurate predictors of unsafe driving. Methods: Subjects completed a battery of four cognitive tests; Mini Mental State Exam(MMSE), Clock Drawing Tests 08:20 or 11:10(CDT), Trail-Making Tests A and B(TMT-A, TMT-B), followed by participation in the STISIM driving simulator. Logistic regression was used to obtain the Odds Ratio and 95% confidence interval for each test and test question based on the outcome of “safe” or “unsafe” driving. Results: Subjects who could not repeat the statement, “No ifs ands or buts,” were 8.78 times more likely to be unsafe drivers on the simulator. Subjects making intrusive marks on CDT(11:10), were 24.96 times more likely to be unsafe drivers. TMT-B showed subjects designated into the lowest tertile were 5.95 times more likely to be unsafe drivers. Additionally, subjects that committed two or more errors on TMT-B were 4.76 times more likely to be unsafe drivers. Conclusions: The simplicity of these tests enable a physician's staff to administer only a select few predictive questions to determine a patient's ability to continue driving safely. Upon failure of an office-based screening, physicians may refer patients for further evaluation by road test, the gold standard, before the decision is made to recommend or invoke driving cessation.

Learning Areas:

Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Explain the importance of screening the elderly for cognitive impairment as it relates to driving ability. Identify the limitations of current cognitive screening methods available to physicians. Assess the driving safety of an elderly individual.

Keyword(s): Elderly, Motor Vehicles

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Over the past year I have observed the operations of the Glennan Center as they conducted driving evaluations of elderly patients. I conducted the majority of the data entry from patient records and performed the statistical analysis for this study. I have a background in law enforcement and a strong interest in public safety.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.