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 Laws requiring doctors to report dementia patients and get their
licenses revoked didn’t appear to influence the proportion of crash
hospitalizations involving people with dementia, however,
researchers report in the journal Neurology.
The study team analyzed state laws designed to keep cognitively
impaired drivers off the road, including mandates that doctors
report patients to state licensing officials as well as requirements
for people to renew licenses in person, get vision exams or take
road tests. Researchers also looked data on 136,987 crash
hospitalizations for drivers age 60 or older in 37 U.S. states from
2004 to 2009.
In states with in-person license renewal, hospitalized crash victims
were up to 38 percent less likely to have dementia than in other
states. When states had vision testing as part of in-person
renewals, crash victims were up to 28 percent less likely to have
dementia.
“In-person renewals and vision testing offered the most significant
safety benefit,” said lead author Yll Agimi, who conducted the
research while at the University of Pittsburgh.
The results suggest that families shouldn’t rely on physicians
reporting a patient with dementia to the Department of Motor
Vehicles to keep their loved one safe, Agimi, a health data
scientist with Salient CRGT in Silver Spring, Maryland, said by
email.
“The message for older drivers and their families is that the key to
safe driving may be a combination of methods, that includes
self-monitoring of one’s driving ability, continued self-regulation
of driving, discussions with family and doctor on safe driving as
well as the key role of the DMV and its licensing requirements,”
Agimi added.
Dementia affects about 9 percent of adults age 65 or older and 30
percent of people over 80, the study team writes. More than 30
percent of people with Alzheimer’s disease, the most common type of
dementia, continue to drive even while experiencing impairments in
cognitive function and memory.
Three states in the study mandated physician reporting of drivers
with Alzheimer’s or other disorders thought to impair driving,
regardless of patient age. Twenty-seven states provided legal
protection to reporting physicians.
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State laws required drivers to present in-person for a license
renewal at least once within two or three renewal cycles. Only five
states did not require in-person renewals.
Two states required road testing at license renewal, and 36 states
mandated vision tests.
The study wasn’t a controlled experiment designed to prove whether
or how specific laws might influence crash rates among people with
dementia. Other limitations include the lack of data on how often
doctors might have actually reported patients to the DMV or how
often drivers might have been in crashes that didn’t result in
hospitalization.
It’s also possible that physician reporting might make a bigger
difference if it was required in more states, said Russell Griffin,
a researcher at the University of Alabama at Birmingham who wasn’t
involved in the study.
Even so, the results add to growing evidence suggesting that
licensing laws, particularly with vision screening, can limit
crashes and related fatalities for older adults, Griffin said by
email.
When an older adult has dementia, families have to strike a balance
between the safety of letting the driver on the road and the lack of
independence and social isolation that can result from revoking a
license, Griffin said.
“Driving is strongly linked to independence,” Griffin added. “If a
patient is not willing to give up their keys because of loss of
independence, the family can speak with the individual and develop a
plan on how to make sure that he/she can still have independence
while not driving.”
SOURCE: http://bit.ly/2ELnGEQ Neurology, online January 31, 2018.
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