Older adults are at greater risk for unsafe driving, due in large part to the increased risk for pathological cognitive decline. Neuropsychologists frequently address driving safety in their clinical evaluations. In this episode, we discuss these issues with Dr. Jennifer Davis, a board-certified clinician-researcher with knowledge of the impact of neurocognitive performance on driving safety.
A pdf of the transcript for this episode is available here.
- The impact of demographic factors (age, gender, education) on driving abilities
- The impact of common medical, neurological, and neurodegenerative conditions on driving abilities
- Medication effects on driving abilities
- Relationship between specific cognitive abilities and driving safety
- The effectiveness of compensatory strategies (e.g., driving only in good weather, driving only in familiar locales) used by aging adults
- Available methods for assessing driving abilities, including advantages and disadvantages of each
- Driving Rehabilitation Specialists and their evaluations
- Aspects of a neuropsychological evaluation that are particularly relevant to driving performance
- Neuropsychological tests with the greatest predictive power with respect to driving abilities
- The role of a clinical neuropsychologist when an evaluation suggests concern for poor driving performance
- Relevant legal issues pertaining to driving in the elderly
- Useful neuropsychological recommendations pertaining to driving safety in older adults
- How to conduct neuropsychological feedback with patients and their families when driving safety is a concern
- The negative psychological consequences of limiting/eliminating driving in an older adult and how to mitigate these consequences
Jennifer Davis, Ph.D., ABPP-CN, earned her doctorate from the University of Utah in Clinical Psychology (Neuropsychology track). She completed a neuropsychology-focused internship at the Alpert Medical School of Brown University. She then did two postdoctoral fellowships, a Clinical Neuropsychology fellowship at Brown and an NIH-funded T32 research fellowship in Dementia, also at Brown. Her current positions are:
-Associate Professor, Clinician Educator in the Department of Psychiatry & Human Behavior at Alpert Medical School of Brown University
-Associate Director of the Clinical Neuropsychology Specialty Program in the Postdoctoral Fellowship Training Consortium at Alpert Medical School of Brown University
-Staff Neuropsychologist in the Department of Psychiatry at Rhode Island Hospital, where she specializes in Alzheimer’s disease and related disorders
Appendix 1 and 2 in Iverson et al. (2010). Practice Parameters update: Evaluation and management of driving risk in dementia. Neurology. https://doi.org/10.1212/WNL.0b013e3181da3b0f
Useful handout for patients and caregivers:https://s0.hfdstatic.com/sites/the_hartford/files/cmme-crossroads.pdf
Resources for alternative transportation: https://one.nhtsa.gov/people/injury/olddrive/alzheimers/index.html
A guide to vehicle safety technology: https://s0.hfdstatic.com/sites/the_hartford/files/vehicle-technology.pdf
Alzheimer’s Association Driving and Dementia Position/Bibliography: https://www.alz.org/national/documents/statements_driving.pdf
AAA Senior Driving Professional Assessment https://seniordriving.aaa.com/evaluate-your-driving-ability/professional-assessment/
AARP Resources https://www.aarp.org/auto/driver-safety/
Finding Driving Evaluation Locations in Your Area:
http://www.aota.org/older-driver (American OT Association)
https://www.aded.net/search/custom.asp?id=1984 (Association for Driver Rehabilitation Specialists)
Neuropsychological Recommendation Samples:
Although neuropsychological measures do not directly test for driving ability, Mr./Mrs. XXXX’s visuospatial deficits, slowed processing speed, and executive dysfunction are concerning for driving safety. Consider a referral to occupational therapy for a formal driving evaluation. Local options include [list name and contact information].
Mr./Mrs. XXXX is no longer driving. Although neuropsychological testing does not directly measure driving ability, performance on testing was concerning for driving safety and suggests that continuing to abstain from driving is prudent.
Driving ability should be queried periodically. On-road or driving simulator testing might be prudent if driving ability becomes more concerning.
Davis, J. D., et al. (2012). Road test and naturalistic driving performance in healthy and cognitively impaired older adults: Does environment matter? Journal of the American Geriatrics Society. DOI: 10.1111/j.1532-5415.2012.04206.x
Ott, B. R., Davis, J. D., et al. (2013). Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting. Journal of the American Geriatrics Society. DOI: 10.1111/jgs.12306
Ott, B. R.,…Davis, J. D., et al. (2008). A longitudinal study of drivers with Alzheimer disease. Neurology. DOI: https://doi.org/10.1212/01.wnl.0000294469.27156.30
Ott, B. R., …Davis, J. D., et al. (2008). Computerized maze navigation and on-road performance by drivers with dementia. J. Geriatr Psychiatry Neurol. DOI: 10.1177/0891988707311031
Wolf, P. L., & Lehockey, K. A. (2016). Neuropsychological Assessment of Driving Capacity. Archives of Clinical Neuropsychology. DOI: https://doi.org/10.1093/arclin/acw050