Prevalence and determinants of driving habits in the oldest old: Results of the multicenter prospective AgeCoDe-AgeQualiDe study

AimTo present data on the prevalence of driving habits and to identify the determinants of driving habits among the oldest old in Germany.MethodsCross-sectional data were used from the “Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe), including primary care patients aged 85 years and above (n = 549 at FU 9, mean age was 90.3 years; 86–101 years). Driving habits were measured (driving a car; frequency of driving a car and driving duration). Correlates were quantified using widely established scales (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale). Multiple regression models were used to identify the determinants of driving habits.ResultsSixteen percent (87 out of 549) drove a car. Among the car-drivers, about 80% drove at least several times a week and about two-thirds drove longer distances (>15 min). Multiple logistic regressions showed that among the oldest old being a male was more likely to be a current driver compared to being a female. Other significant factors were subjective memory impairment, severe visual impairment, functional and cognitive impairment. Correlates of frequency of driving a car and driving duration were further identified.ConclusionAbout one in six very old Germans is still a regular car driver. Several determinants of driving habits among the oldest old were identified. Future longitudinal studies are required to clarify the factors leading to changes in driving habits.     

Effects of Alcohol on Performance on a Distraction Task During Simulated Driving

Background:  Prior studies report that accidents involving intoxicated drivers are more likely to occur during performance of secondary tasks. We studied this phenomenon, using a dual-task paradigm, involving performance of a visual oddball (VO) task while driving in an alcohol challenge paradigm. Previous functional MRI (fMRI) studies of the VO task have shown activation in the anterior cingulate, hippocampus, and prefrontal cortex. Thus, we predicted dose-dependent decreases in activation of these areas during VO performance.
Methods:  Forty healthy social drinkers were administered 3 different doses of alcohol, individually tailored to their gender and weight. Participants performed a VO task while operating a virtual reality driving simulator in a 3T fMRI scanner.
Results:  Analysis showed a dose-dependent linear decrease in Blood Oxygen Level Dependent activation during task performance, primarily in hippocampus, anterior cingulate, and dorsolateral prefrontal areas, with the least activation occurring during the high dose. Behavioral analysis showed a dose-dependent linear increase in reaction time, with no effects associated with either correct hits or false alarms. In all dose conditions, driving speed decreased significantly after a VO stimulus. However, at the high dose this decrease was significantly less. Passenger-side line crossings significantly increased at the high dose.
Conclusions:  These results suggest that driving impairment during secondary task performance may be associated with alcohol-related effects on the above brain regions, which are involved with attentional processing/decision-making. Drivers with high blood alcohol concentrations may be less able to orient or detect novel or sudden stimuli during driving.     

Occupational Therapy and Older Drivers: Research,Education, and Practice

ABSTRACT

Occupational therapists facilitate independence and support participation in occupations that are personally meaningful to clients to enhance well-being and quality of life. Among the occupations addressed by occupational therapists is the instrumental activity of daily living (IADL) of driving. Occupational therapists are particularly concerned with older adult engagement in driving because of the vital contributions driving and community mobility make to engagement in other activities and subsequently quality of life. This article includes the current status of occupational therapy research, education, and practice and presents the role of the occupational therapist as a member of the team with regard to older drivers.     

Continued Driving and Time to Transition to Nondriver Status through Error-Specific Driving Restrictions

ABSTRACT

We developed driving restrictions that are linked to specific driving errors, allowing cognitively impaired individuals to continue to independently meet mobility needs while minimizing risk to themselves and others. The purpose of this project was to evaluate the efficacy and duration expectancy of these restrictions in promoting safe continued driving. We followed 47 drivers age 60 years and older for 18 months, evaluating driving performance at 6-month intervals. Results demonstrated restricted drivers had safety profiles similar to safe drivers and gained additional driving time to transition to nondrivers.     

Attitudes to driving among patients with diabetes mellitus in Punjab (ADD-Punjab study)

AimCurrently there are no regulations regarding diabetes and driving licensing in India. The study was planned to gather information about attitudes to driving among patients with diabetes mellitus.MethodsAdult patients with diabetes mellitus holding a current valid driving license on treatment with insulin or secretagogue were interviewed using a validated structured questionnaire.Results150 patients were interviewed with a mean age of 52 years, males (86%), insulin users (34%) and only secretagogue users (66%). 16 (10.6%) patients had severe hypoglycemia in the past year with 9.3% having hypoglycemic unawareness. Only 32% patients were aware of the relation between hypoglycemia and driving, 88.6% never checked glucose prior to driving and only 23% patients carried carbohydrates for treatment of hypoglycemia during driving. 25 (16.7%) of subjects had hypoglycemia during driving and in 6 (4%) this involved a traffic accident in the past one year.ConclusionsAround 4% of patients on hypoglycemia causing treatment have a traffic accident/event every year. In the absence of regulations currently, focus should be on patient education. However, on the long-term appropriate regulations will make the roads safer for patients with diabetes.     

Age-Related Differences in Risks of Drinking and Driving in Gender and Ethnic Groups

We examine the extent to which empirically observed age-related differences in rates of drinking and driving can be explained by concurrent differences in drinking patterns. Building on previous research showing significant age differences in drinking patterns between men and women and among three ethnic groups, Whites, Blacks, and Hispanics, our study considers whether there are unique gender and ethnic group differences in patterns of drinking and driving. Data were from 4395 respondents 12 to 80 years old in a general population survey of 20 urban areas in the United States. During the month preceding the interview, 1130 (25.7%) of all respondents had driven after having one or more drinks. Drinking pattern measures included drinking frequency, average drinking quantity, and the variance in the number of drinks consumed per occasion. To assess the relationships of drinking patterns to drinking and driving across age groups, two sets of analyses were conducted, one set in which age differences in drinking patterns were statistically controlled and one set in which they were not Although the statistical control for drinking patterns reduced age differences between gender and ethnic groups, it did not eliminate them. The reduction demonstrated that part of observed group differences in driving after drinking over age among gender and ethnic groups is due to age-related differences in drinking patterns. However, despite controlling drinking patterns young respondents remained more likely to drink and drive. A supplementary analysis of self-reported incidents of driving while intoxicated (i.e., driving after having five or mora drinks) further indicated that, controlling for drinking patterns, young respondents are most at risk.     

Assessing Alcohol Problems in Female DWI Offenders

The severity of alcohol problems in a sample of 812 women driving while intoxicated (DWI) offenders enrolled in a Drinking Driver Program in New York State was assessed through the use of multiple measures. These women voluntarily provided information through a self-administered questionnaire completed at the beginning of the program. Classification of alcohol problems based on DSM-III-R criteria was compared with classification based on the use of alcohol-specific and nonalcohol-specific measures of alcohol-related problems. Greater hostility and a larger number of drinks ever consumed accounted for nearly 12% of the variance between no diagnosis and alcohol abuse women, whereas these two variables plus age, race, depression, and having a relative with alcohol problems accounted for nearly 41% of the variance between alcohol abuse and dependent women. A subsample of women within each DSM-III-R diagnostic group showed high risk for later, more severe alcohol problems. Multiple measures of alcohol problems help to elucidate subtle differences in alcohol problems within each of the broad categories specified by the DSM, and should facilitate more appropriate intervention and treatment plans for women DWI offenders with alcohol-related problems.     

A PC-Based Software Test for Measuring Alcohol and Drug Effects in Human Subjects

A new software-based visual search and divided-attention test of cognitive performance was developed and evaluated in an alcohol dose-response study with 24 human subjects aged 21–62 years. The test used language-free, color, graphic displays to represent the visuospatial demands of driving. Cognitive demands were increased over previous hardware-based tests, and the motor skills required for the test involved minimal eye movements and eye-hand coordination. Repeated performance on the test was evaluated with a latin-square design by using a placebo and two alcohol doses, low (0.48 g/kg/LBM) and moderate (0.72 g/kg/LBM). The data on 7 females and 17 males yielded significant falling and rising impairment effects coincident with moderate rising and falling breath alcohol levels (mean peak BrALs = 0.045 g/dl and 0.079 g/dl). None of the subjects reported eye-strain or psychomotor fatigue as compared with previous tests. The high sensitivity/variance relative to use in basic and applied research, and worksite fitness-for-duty testing, was discussed. The most distinct advantage of a software-based test that operates on readily available PCs is that it can be widely distributed to researchers with a common reference to compare a variety of alcohol and drug effects.     

Diabetes,Ramadan, and driving - Ensuring patient safety while respecting religious autonomy: A qualitative study

Background and aimsHypoglycaemia due to fasting during Ramadan may affect the ability to perform complex activities among people with type 2 diabetes mellitus (T2D), but it is unclear how this affects one's ability to drive. This study aims to explore driving experiences and coping strategies to ensure safe driving among people with T2D who fast during Ramadan.MethodsWe conducted an exploratory qualitative study and purposefully selected people with T2D who drove and fasted during the past Ramadan period in 2019. In-depth face-to-face interviews were conducted and transcribed verbatim. Data were analysed thematically using a constant comparative method until saturation was achieved (n = 16).ResultsTwo major themes were identified, namely: (1) knowing oneself and (2) voluntary self-restriction. Participants described the importance of understanding how Ramadan fasting affected them and their level of alertness. As such, participants often adjusted their daily activities and tested their blood glucose levels to prevent experiencing hypoglycaemia. Other coping strategies reported include adjusting their medications and driving restrictions or driving in the mornings when they were more alert. Findings from this study shed light on participants' experiences and coping mechanisms while driving during Ramadan.ConclusionGiven the risks and effects of hypoglycaemia among those who fast, there is a need to provide appropriate and focused patient education during Ramadan to people with T2D to ensure they can perform complex activities such as driving safely, especially in Muslim majority countries.