S3-05-03: Fitness to drive in early stage dementia: An instrumented vehicle study

Over 25 percent of people age 80 and older suffer from some form of dementia, with Alzheimer’s Disease accounting for around 75 percent of all instances. It is estimated that around one-third of people with dementia continue to drive. Compared to the general driving population, drivers with dementia are at an increased risk of unsafe motor vehicle operation. Physicians and other health care professionals are often faced with making recommendations about their patients’ fitness to drive, based on driver self-screening, recommendations by family members, and, if available, formal driving assessment. Recent advances in sensor, computer, and telecommunication technologies provide a method for automatically collecting detailed, objective information about a person’s driving performance. Providing compelling data on driving performance in naturalistic settings will help those involved with the driving cessation decision plan a timely and appropriate transition toward community mobility options. The study had several specific aims including: demonstrate the feasibility of using in-vehicle data collection to monitor driving actions of individuals with early stage dementia; compare the validity of multiple forms of assessment of driving skills with naturalistic driving in individuals with early stage dementia; and increase understanding of behaviors and issues of drivers with dementia and their families. The study involved recruitment of 10 “triads” consisting of a licensed driver with a diagnosis of early stage dementia, a family member involved in the care of the driver, and a certified driving rehabilitation specialist who assessed the driver. Each driver’s vehicle was instrumented with a variety of technologies so that driving behavior could be monitored for 1 month. These driving data were compared to the driving of an older adult sample without dementia. A series of surveys were also conducted to gather subjective assessments of the drivers. The study found: the dementia group drove as safely as the general older adult population sample; had a smaller driver activity space; and got lost more frequently. The authors found a lack of insight on the part of both drivers and family members when reported driving behaviors were compared to actual driving and that there was poor agreement among the various subjective assessments of the driver. Recommendations are provided for conducting a larger-scale study of the effects of early stage dementia on driving using instrumented vehicle technology.