Geriatric assessment and driver functioning.
In this article, the sensory, cognitive, and motor function relevant to driving, their measurement, the epidemiology of age-associated functional impairments, and the relationship of functional impairments to both self-reported driving and the imposition of legal restrictions are reviewed. A number of issues remain to be resolved before the scientific basis for public policy recommendations on aging drivers is sufficiently sound. For example, although an association between various functional impairments and the imposition of restrictions was found, with the exception of visual impairments, which under Iowa law may require the imposition of restrictions, those aspects of functional impairment that precipitate state-imposed license restrictions cannot be identified by the authors. The authors' measures of functional status may serve as surrogates for other, more important variables. If so, it has implications for both prevention of impairment-associated restrictions and interventions occurring after restrictions have been imposed. One of the most important issues confronting clinicians, researchers, and regulators is the development of appropriate tests to screen for dysfunctional driving with safety risks. Whether an appropriate battery could be created from already-existing tests and questionnaires is unclear. Certainly it seems desirable to consider the issue of face validity and explore items more clearly related to driving, such as self-reported loss of concentration or difficulty with manipulating controls. Many of the current tests focus on low levels of cognitive and physical performance. Relatively severe impairments are clearly related to driving behavior, as the authors found. Relatively minor impairments also may have an impact on driving performance, however, and it is important to explore tests sensitive to these mild impairments. Finally, it is critical to conduct appropriate studies of the reliability, validity, sensitivity, and specificity of any proposed batteries. These studies should include representative samples of drivers and not just clinic populations or community volunteers. It is also important to include a number of assessments of driving. Although state records of accidents and violations are useful, not all accidents or violations are included in state records. From a public health standpoint, crashes are the outcome of interest, but their relatively low rates require large number s of research participants or relatively long study periods. More detailed driver assessments similar to those included in state on-the-road testing or course testing are also important.(ABSTRACT TRUNCATED AT 400 WORDS)
Colsher
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PL
Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City.
Wallace
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RB
D000368:Aged; D000375:Aging; D001334:Automobile Driving; D003071:Cognition; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D011597:Psychomotor Performance; D014785:Vision, Ocular