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Driving assessment and driving behaviour
Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction

Driving is an important part of everyday life and represents independence. Activities, both productive and social, may be affected if a person can no longer drive. Older drivers, as a group, have a low crash rate. On the other hand, driving may be affected by medical conditions in this group, for example dementia or stroke, which often call into question a person’s fitness to drive. However, there are older drivers who may benefit from compensatory strategies to prevent driving cessation.

Aim

The aim of the thesis was to examine driving assessments methods, both off-and on-road tests, and if an intervention may improve driving behaviour for older adults.

The specific aims were to:

  • examine how occupational therapists (OTs) are involved in driving assessments in Sweden, what methods are used and how these assessments are performed;
  • determine whether the commonly used cognitive test battery, the NorSDSA, could predict an on-road test results for stroke and cognitive deficits/dementia participants;
  • investigate driving errors characteristic in older drivers without cognitive impairments and identify relationships between off-road and on-road tests results;
  • investigate whether automatic transmission, compared with manual transmission, may improve driving behaviour of older and younger drivers.

Methods

In Study I, a questionnaire was sent to 154 geriatric, rehabilitation and neurological clinics and additionally directly to 19 OTs. In Study II, data consisted of test results from 195 clients who had completed a fitness to drive assessment. In Study III, 85 older volunteer drivers were assessed regarding their vision, cognition and driving behaviour. In Study IV, 31 older drivers and 32 younger drivers were assessed twice on the same fixed route; once in a car with manual transmission and once in a car with automatic transmission.

Results

Driving assessments were carried out by OTs in various manners and diverse methods were used. Most OTs used off-road tests; tests developed specifically for driving assessments or un-standardised activity assessments. Even though few off-road tests can predict driving performance, only 19 % of the OTs used on-road test. The off-road test NorSDSA could neither predict an outcome of an on-road test for stroke clients, nor for cognitive deficits/dementia clients. Some of the older volunteer drivers displayed questionable driving behaviour, although they were fit to drive and a total of 21 % failed the on-road test. Using automatic instead of manual transmission was shown to improve older, but not younger drivers’ driving behaviour.

Conclusions

For OTs in Sweden, driving assessments are challenging, since there are no specified guidelines regarding the appropriate assessment tools. Assessors often solely rely on cognitive test(s) when assessing their clients. NorSDSA should not be used as a stand-alone test when determining fitness to drive. The lack of guidelines can be problematic for OTs, but also for the clients, since there is a risk that they do not receive a valid and reliable assessment. To perform these kinds of assessments there is a need for specialised training. On-road assessments are seen as the gold standard but that standard needs to encompass driving problems or errors that are “normal” driving behaviours in older persons. To switch from manual to automatic transmission may be a way to assist older drivers to continue driving and maintain the quality of their transport mobility.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2012. , 100 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 36
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-19841ISBN: 978-91-85835-35-5 (print)OAI: oai:DiVA.org:hj-19841DiVA: diva2:570186
Supervisors
Available from: 2012-11-16 Created: 2012-11-16 Last updated: 2015-12-22Bibliographically approved
List of papers
1. A Swedish Survey of Occupational Therapists' Involvement and Performance in Driving Assessments
Open this publication in new window or tab >>A Swedish Survey of Occupational Therapists' Involvement and Performance in Driving Assessments
2007 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 14, no 4, 215-220 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to examine the extent to which occupational therapists (OTs) are involved in driving assessments in Sweden and how these assessments are performed. A questionnaire was sent to 154 geriatric, rehabilitation, and neurological clinics, and additionally directly to 19 OTs who had purchased a test battery specifically used for driving assessments. The response rate was 60%. Of those responding, 57% reported being involved in fitness-to-drive assessments. However, such assessments were carried out in various manners and diverse methods were used, ranging from unstandardized activity assessments to a test developed specifically for driving assessments. Only 19% used on-road driving tests as a complement to the clinical assessments. Apart from the lack of appropriate methods, the respondents said that they did not have sufficient knowledge to perform driving assessments and expressed a need for further education. In the future it seems necessary for OTs in Sweden to undergo specialized training and perform the assessments on a regular basis to maintain a high level of competence as driving assessors.

National Category
Occupational Therapy
Identifiers
urn:nbn:se:hj:diva-6295 (URN)10.1080/11038120601110983 (DOI)
Available from: 2007-11-13 Created: 2007-11-13 Last updated: 2012-11-22Bibliographically approved
2. The Nordic Stroke Driver Screening Assessment as predictor for the outcome of an on-road test.
Open this publication in new window or tab >>The Nordic Stroke Driver Screening Assessment as predictor for the outcome of an on-road test.
2010 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 17, no 1, 10-17 p.Article in journal (Refereed) Published
Abstract [en]

The use of the cognitive test battery Nordic Stroke Driver Screening Assessment (NorSDSA) has increased, sometimes as a stand-alone test to evaluate fitness to drive, also for non-stroke patients such as patients suffering from cognitive deficits/dementia, approaches that may be questioned. The objective of the study was to determine whether the NorSDSA could predict an on-road test result, for large sets of stroke ( n=74) and cognitive deficits/dementia participants ( n=116), respectively. The percentage of correctly classified was 62% for the stroke group and 50% for the cognitive deficits/dementia group. A discriminant analysis with pass/fail on the on-road test as grouping variable could classify 62% of the stroke participants and the cognitive deficit/dementia participants. Hence, the NorSDSA could not predict the outcome of the on-road test. Therefore, NorSDSA should not be used as a stand-alone test to determine the fitness to drive of individual participants. Also, its use with participants suffering from cognitive deficits/dementia appears to be less successful than for clients with stroke.

Keyword
Cognitive deficits, dementia, driving assessment, NorSDSA, off-road test, stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-11827 (URN)10.3109/11038120802714898 (DOI)
Available from: 2010-05-31 Created: 2010-03-24 Last updated: 2015-12-22Bibliographically approved
3. Older drivers: On-road and off-road test results
Open this publication in new window or tab >>Older drivers: On-road and off-road test results
2011 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 43, no 4, 1348-1354 p.Article in journal (Refereed) Published
Abstract [en]

Eighty-five volunteer drivers, 65–85 years old, without cognitive impairments impacting on their driving were examined, in order to investigate driving errors characteristic for older drivers. In addition, any relationships between cognitive off-road and on-road tests results, the latter being the gold standard, were identified. Performance measurements included Trail Making Test (TMT), Nordic Stroke Driver Screening Assessment (NorSDSA), Useful Field of View (UFOV), self-rating driving performance and the two on-road protocols P-Drive and ROA. Some of the older drivers displayed questionable driving behaviour. In total, 21% of the participants failed the on-road assessment. Some of the specific errors were more serious than others. The most common driving errors embraced speed; exceeding the speed limit or not controlling the speed. Correlations with the P-Drive protocol were established for NorSDSA total score (weak), UFOV subtest 2 (weak), and UFOV subtest 3 (moderate). Correlations with the ROA protocol were established for UFOV subtest 2 (weak) and UFOV subtest 3 (weak). P-Drive and self ratings correlated weakly, whereas no correlation between self ratings and the ROA protocol was found. The results suggest that specific problems or errors seen in an older person's driving can actually be “normal driving behaviours”.

National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:hj:diva-15375 (URN)10.1016/j.aap.2011.02.007 (DOI)21545864 (PubMedID)
Available from: 2011-06-14 Created: 2011-06-14 Last updated: 2015-12-22Bibliographically approved
4. Does Automatic Transmission Improve Driving Behavior in Older Drivers?
Open this publication in new window or tab >>Does Automatic Transmission Improve Driving Behavior in Older Drivers?
2012 (English)In: Gerontology, ISSN 0304-324X, E-ISSN 1423-0003, Vol. 58, no 2, 181-187 p.Article in journal (Refereed) Published
Abstract [en]

Background: Most older drivers continue to drive as they age. To maintain safe and independent transport, mobility is important for all individuals, but especially for older drivers.

Objective: The objective of this study was to investigate whether automatic transmission, compared with manual transmission, may improve the driving behavior of older drivers.

Method: In total, 31 older drivers (mean age 75.2 years) and 32 younger drivers – used as a control group (mean age 39.2 years) – were assessed twice on the same fixed route; once in a car with manual transmission and once in a car with automatic transmission. The cars were otherwise identical. The driving behavior was assessed with the Ryd On-Road Assessment driving protocol. Time to completion of left turns (right-hand side driving) and the impact of a distraction task were measured.

Results: The older group had more driving errors than the younger group, in both the manual and the automatic transmission car. However, and contrary to the younger drivers, automatic transmission improved the older participants’ driving behavior as demonstrated by safer speed adjustment in urban areas, greater maneuvering skills, safer lane position and driving in accordance with the speed regulations.

Conclusion: Switching to automatic transmission may be recommended for older drivers as a means to maintain safe driving and thereby the quality of their transport mobility.

National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-16181 (URN)10.1159/000329769 (DOI)21865668 (PubMedID)
Available from: 2011-09-26 Created: 2011-09-26 Last updated: 2015-12-22Bibliographically approved

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