Cognition in Motion: A Hard Look at Aging Drivers

Summary: A recent study found a majority of cognitively impaired older adults in South Texas are still driving, raising safety concerns.

Of the over 600 individuals assessed, 61.4% of those with cognitive impairment were active drivers. While some with mild impairment may be able to safely drive, for others, it may be inappropriate.

The study emphasizes the importance of early and open conversations between patients, caregivers, and healthcare providers about safe driving practices.

Key Facts:

  1. 61.4% of older adults with cognitive impairment, surveyed in the study, continue to drive.
  2. The likelihood of driving decreases with the degree of cognitive impairment, irrespective of ethnicity.
  3. Around 35% of caregivers expressed concern about their care recipient’s ability to drive safely.

Source: University of Michigan

The majority of older adults with cognitive impairment are still driving, despite concerns raised by caregivers and others, a Michigan Medicine study in a South Texas community finds.

Researchers assessed more than 600 adults over 65 years old in Nueces County, Texas, who had cognitive assessment scores that indicated a likelihood of impairment.

This shows an older man driving.
Approximately one in nine Americans aged 65 and older, or 6.7 million people, are estimated to live with Alzheimer’s disease and millions more have related dementias. Credit: Neuroscience News

Of those people with cognitive impairment, 61.4% were current drivers, and around one-third of all caregivers had concerns about their care-recipient driving.

The results are published in the Journal of the American Geriatrics Society.

“It is likely appropriate that some with mild cognitive impairment are still driving, but for some it may not be,” said senior author Lewis B. Morgenstern, M.D., professor of neurology, neurosurgery and emergency medicine at University of Michigan Medical School and professor of epidemiology at the U-M School of Public Health.

“Patients and caregivers should discuss these issues with their health care providers and consider on the road driving evaluations to ensure safety.”

Approximately one in nine Americans aged 65 and older, or 6.7 million people, are estimated to live with Alzheimer’s disease and millions more have related dementias.

These conditions may affect neuropsychological and visual skills that reduce the ability to drive safely. A 2017 review of motor vehicle crash risk found that dementia had medium to large effects on driving impairment and that people with dementia have an increased likelihood of failing a road test compared to those without.

Investigators initially set out to study the driving prevalence of older Latino and non-Latino white adults, finding no significant differences between the two populations. However, the more cognitive impairment any individual had, the less likely they were to be driving.

Just over 35% of caregivers had concerns about their care recipient’s ability to drive safely, even though many study participants limited their total amount of driving and avoided driving at night or in the rain.

The discussions between caregivers and people with cognitive impairment about driving are difficult, with concerns over the loss of autonomy and potential embarrassment. When a person with cognitive impairment stops driving, that may also increase the workload of a caregiver.

Researchers say it’s best to start conversations surrounding driving earlier while the care recipient is able to understand and actively participate in the discussion.

“Close family may have discussions with aging loved ones about Advance Driving Directives,” Morgenstern said.

“These are agreements between an aging person and a loved one about having conversations about driving cessation.”

Additional authors include Madelyn Malvitz, Darin B. Zahuranec, M.D., Wen Chang, Steven G. Heeringa, Ph.D., Emily M. Briceño, Ph.D., Roshanak Mehdipanah, Ph.D., Deborah A. Levine, M.D., Kenneth M. Langa, M.D., Ph.D., Nelson Garcia, all of University of Michigan, and Xavier F. Gonzales, Ph.D., of Texas A&M, Corpus Christi.

Funding: This research was supported by the National Institute of Neurological Disorders & Stroke and the National Institute on Aging at the National Institutes of Health (grants R01NS100687, R01AG069148, and P30AG024824)

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Kenneth M. Langa receives grant funding from the NIA and Alzheimer’s Association and consults on NIH-funded projects related to identifying dementia in population-based studies. Lewis B. Morgenstern, Emily M. Briceño, Roshanak Mehdipanah, Deborah A. Levine, Darin B. Zahuranec, and Steven G. Heeringa receive grant funding from the NIH.

About this aging and cognitive decline research news

Author: Noah Fromson
Source: University of Michigan
Contact: Noah Fromson – University of Michigan
Image: The image is credited to Neuroscience News

Original Research: Open access.
Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals” by Lewis B. Morgenstern et al. Journal of the American Geriatrics Society


Abstract

Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals

Background

Individuals with Alzheimer’s disease and Alzheimer’s disease-related dementias may lose the ability to drive safely as their disease progresses. Little is known about driving prevalence in older Latinx and non-Hispanic White (NHW) individuals. We investigated the prevalence of driving status among individuals with cognitive impairment in a population-based cohort.

Methods

This was a cross-sectional analysis of the cohort BASIC-Cognitive study in a community of Mexican American (MA) and NHW individuals in South Texas. Participants scored ≤25 on the Montreal Cognitive Assessment (MoCA), indicating a likelihood of cognitive impairment. Current driving status was assessed by the Harmonized Cognitive Assessment Protocol informant interview. Logistic regression was used to assess driving versus non-driving adjusted for pre-specified covariates. Chi-square and Mann–Whitney U tests were used to compare NHW and MA differences in driving outcomes from the American Academy of Neurology (AAN) questions for evaluating driving risk in dementia.

Results

There were 635 participants, 77.0 mean age, 62.4% women, and 17.3 mean MoCA. Of these, 360 (61.4%) were current drivers with 250 of 411 (60.8%) MA participants driving, and 121 of 190 (63.70%) NHW participants driving (p = 0.50). In fully adjusted models age, sex, cognitive impairment, language preference, and Activities of Daily Living scores were significant predictors for the likelihood of driving (p < 0.0001). Severity of cognitive impairment was inversely associated with odds of driving, but this relationship was not found in those preferring Spanish language for interviews. Around one-third of all caregivers had concerns about their care-recipient driving. There were no significant differences in MA and NHW driving habits and outcomes from the AAN questionnaire.

Conclusions

The majority of participants with cognitive impairment were currently driving. This is a cause for concern for many caregivers. There were no significant ethnic driving differences. Associations with current driving in cognitively impaired persons require further research.

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