title: Family reports of medically impaired drivers in Missouri: cognitive concerns and licensing outcomes.
abstract: This study investigated reasons why older adults (n=689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimer's disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n=187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness.
authors.affiliation: University of Missouri - St. Louis, Gerontology Program, School of Social Work, 133-134 Bellerive Hall, 1 University Blvd., St. Louis, MO 63121, USA. Electronic address: meusert@umsl.edu.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Meuser
authors.affiliation: Washington University School of Medicine, Department of Medicine and Neurology, 4488 Forest Park Blvd., St. Louis, MO 63108, USA. Electronic address: dcarr@wustl.edu.
authors.forename: David B
authors.initials: DB
authors.lastname: Carr
authors.affiliation: University of Iceland, Civil and Environmental Engineering, Hjardarhagi 2-6, IS-107 Reykjavik, Iceland. Electronic address: eau1@hi.is.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Unger
authors.affiliation: University of Iceland, Civil and Environmental Engineering, Hjardarhagi 2-6, IS-107 Reykjavik, Iceland. Electronic address: gfu@hi.is.
authors.forename: Gudmundur F
authors.initials: GF
authors.lastname: Ulfarsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001333:Automobile Driver Examination / Q000706:statistics & numerical data*; D001334:Automobile Driving / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D003072:Cognition Disorders; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008004:Licensure / Q000331:legislation & jurisprudence*; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D008923:Missouri; D011596:Psychomotor Disorders
keywords: Aging; Alzheimer’s disease; Dementia; Family input; Fitness-to-drive; Medical impairments; Older drivers