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Medically At-Risk DriversEvidence-Based Decisions
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Change of Focus: Older Drivers
vs. Medically At-Risk Drivers
In 2008 WA introduced new laws requiring the Mandatory Reporting of Medical Conditions.
All drivers with a long term medical condition that has the potential to impair driving ability must notify the licensing department.
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Cra
sh In
volv
emen
t Rat
e
Driver Age Group
Rate of MVAs per Kilometre Driven
Sources: COTA National Seniors, ACT (2004) Cerrelli , E. (1989) Older Drivers: The Age Factor in Traffic Safety.
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Australians Aged 65+
• 80 % have at least 1 chronic
condition
• 50% have at least 2 chronic
conditions
• Co-morbidities & poly- pharmacy are the norm
Age - Illness Association
Sources: ABS (2008); Freedman, Martin & Schoeni (2002)
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Incr
ease
d A
t Fau
lt C
rash
Ris
kAt Fault Crash Risk By Diagnosis
Source: Diller, E et al. (1998)
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Prevalence of Cognitive Impairment
Source: *(CSHA, 1991)
1 in 4 people over 65 years have cognitive impairment
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Diagnosis Inadequate For Fitness To Drive Decisions
eg. In the early stages of dementia:
2/3 will be unsafe to drive
but 1/3 remain safe to drive
Revoking licence based on diagnosis alone is discriminatory to those who are still safe
But... how do you best determine at what point someone becomes unsafe?
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This publication is intended for use by any health professional involved in assessing fitness to drive, including:
Medical Practitioners (GPs & Specialists)
Occupational Therapists
Physiotherapists
Psychologists
Optometrists
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EPISODIC(eg. MI, Epilepsy, Hypoglycaemia)
PERSISTENT(eg. Head injury, dementia)
No question about driving ability when an event occurs
Assessment question is “likelihood of the event”
Assessment Issue:Judgement about the risk level
Science unlikelyConsensus guidelines =Suggested best practice
No question about likelihood of event - it is ongoing
Assessment question is “competence of the driver”
Assessment Issue:Measurable outcome impairment
Evidence based driving evaluations = best practice
Categories of Medical Conditions
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S.I.M.A.R.D. Screen for Identifying Medically At -Risk Drivers
D.C.A.T. DriveABLE Cognitive Assessment Tool
D.O.R.E.DriveABLE On-Road Evaluation
DriveABLE™
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Assesses the time between the appearance of a visual stimulus in an unpredictable location & driver’s response.
Shifting of attention, response speed, and accurate movements are involved in task performance.
Measures: Reaction time
Motor speed
Movement Accuracy
Motor Speed and Control
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Driving requires an ability to attend to the road ahead while simultaneously responding to events occurring in the periphery.
Measures:Ability to maintain focus on centrally presented items;
While simultaneous identifying peripheral visual stimulus
Span of Attentional Field
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Turns, merges, & crossing traffic are associated with high crash rates
Difficult for cognitively impaired drivers due to impaired judgement & decision making
Complex task requiring speed, gap & acceleration judgments
Measures:• Spatial judgement
• Response time
• Collision rate
Spatial Judgement & Decision Making
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Assesses how quickly the driver can shift focus of attention from one stimulus to another.
Measures: Time to respond when attention is
• Correctly focused
• Inappropriately focused
• Left unfocused
Disengagement of attention
Speed of Attentional Shifting
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Higher cognitive function related to our ability to organise, plan, prioritise, manage & make decisions.
Evaluates how well driver can hold information in working memory while responding to other stimuli.
Executive Function
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Series of short videos of real driving scenes
The driver makes decisions about each driving scenario
Provides information about the driver’s interpretation ofroad situations
Measure:
Ability to identify hazardous situations & take appropriate action
Identification of Driving Situations
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DriveABLE On Road Evaluation
Specifically designed to identify the errors known to be related to competence decline
Protects those drivers who remain competent from being unfairly penalised
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DriveABLE Driven by Research
Assessment Date: May 27, 2004 Assessment Language: English Name: The Driver Date of birth: June 22, 1927 Address: 123 My Road Age: 73 Anytown, Anywhere Health Care #: 1234567 Driver's License #: 99999 Phone: 555-5555 Referred by: Physician, MD Phone: 555-5555 Fax: 555-5555 ________________________________________________________________________________________
Cognitive Assessment Report Performance Outcome: Age-normed performance was commensurate with a decline in driving ability. Summary of Findings: In-Office Competence Assessment:
Mr. Driver was given sufficient individualized practice on each task to enable a valid assessment and appeared cooperative and effortful during testing.
Assessment Outcome Measures (in Standard Scores)
Well Below Below Average Above Motor Speed/Control 0.0 Span of Attentional Field *-5.2 Spatial Judgment and Decision Making *-1.6 Speed of Attentional Shifting *-3.4 Executive Function *-2.7 Identification of Driving Situations *-10.7
Overall Performance: 99% predicted probability of road test failure. Mr. Driver’s overall performance outcome indicates cognitive abilities have declined and driving performance may be compromised.
DriveABLE Assessment Centres Inc. Suite 304, 10050 – 112 Street * Edmonton, Alberta * T5K 2J1
Phone: (780) 433-1494 * Fax: (780) 433-1531
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Validation Field TestingAccuracy of predicting Road Test Results
Road Test ResultsIn Office Pass Fail
Predict Pass
30% 3%
In-determinant 25% 18%
PredictFail
2% 21%
51%Pass/Fail Identified
*Florida
5% Error Rate
43%Needed road
test to resolve competence 95% Accuracy
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www.DriveABLE.com.au