Understanding the views of older adults and people living with Mild Cognitive Impairment on driving and fitness to drive

不适合驾驶是道路交通事故的一个主要因素，与年龄有关的神经退行性疾病是道路安全日益关注的一个领域。随着预期寿命的不断增加，老年司机的数量将成比例地增加（70岁以上的人占英国所有驾驶执照的6%）。与此同时，开车是保持独立性的关键部分，特别是在公共交通无法与开车的灵活性相匹配的农村地区。英国运输部（DfT）和DVLA对老年司机没有限制，也没有证据表明老年司机发生交通事故的风险增加。然而，年龄与其他医疗条件有关，而DVLA指南是根据症状或医疗报告确定的。例如，患有某些类型心力衰竭的人，如果症状稳定，不太可能分散司机的注意力或以其他方式影响安全驾驶，也不需要通知DVLA，就可以开车。与衰老相关的一种非常常见的情况是轻度认知障碍（MCI），这是一种介于正常衰老和大脑功能与异常衰老和痴呆之间的状态。为了响应2008年的国家痴呆症战略和总理的挑战，在2008/9至2014年间，到记忆诊所就诊的人数从每家诊所202人增加到每家诊所1579人（增长了682%）。2019年全国记忆诊所审计发现，17%的记忆诊所患者被诊断患有轻度认知障碍。因此，每家记忆诊所诊断出大约270例MCI新病例。目前，驾驶风险是通过自我报告或医疗报告来评估的，这些报告会考虑到诸如个人是否表现出短期记忆力差、定向障碍、缺乏判断力、注意力障碍等因素。，这并不能准确反映行车安全。对于那些受认知障碍影响的人，只有少数人进行了详细、耗时和昂贵的神经心理学测试，而这些测试在预测驾驶能力方面的有用性尚不清楚。经专科医生或全科医生转介，可进行专科驾驶评估测试。在英国，专门的驾驶评估中心为患有可能影响驾驶的疾病的人进行详细的驾驶评估。DVLA指南将轻度认知障碍分为“不可能有驾驶障碍”和“可能有驾驶障碍”。老年司机或轻度认知障碍患者发生事故的风险并不会增加，但他们可能会在某些情况下遇到困难，比如高速交叉路口、高速环形交叉路口和通往高速公路的支路，在这些情况下，司机需要环顾四周并迅速做出决定。因此，探索新的方法来了解个人驾驶风险是很重要的。在汽车监控技术中，测量真实驾驶可能是一种更便宜、更准确的道路驾驶行为测量方法，可能更好地与认知功能进行比较。此外，它还可以检测高速路口、高速公路等特定区域，以便提供建议和潜在的驾驶意识教育课程，以减少事故风险。在这个项目中，我们将收集MCI患者和健康老年人的真实驾驶行为数据，以了解他们的诊断、标准化认知功能测试和驾驶行为之间的任何联系。这有助于发现那些风险最大的人，并制定干预措施，以引入更好地支持不断变化的条件的毕业生驾驶执照。我们将考虑不同利益相关者的意见，安排一系列与一群健康的老年人和一群MCI患者的研讨会，加上意见和观点，我们传播其他利益相关者，如DfT， DVLA，保险公司，Age UK和痴呆症慈善机构，如阿尔茨海默研究英国和阿尔茨海默协会和谢菲尔德痴呆症咨询小组。

Unfitness to drive is a major contributing factor of road crashes and age-related neurodegenerative conditions are a growing area of concern for road safety. With life expectancy constantly increasing, the number of elderly drivers will increase proportionally (people aged over 70 represents 6% of all UK driving licences). At the same time, driving is a key part of maintaining independence especially in rural areas where public transport is less able to match the flexibility of driving one's car. The Department for Transport (DfT) and DVLA places no restrictions on elderly drivers and there is no evidence that older drivers are at increased risk of traffic accidents. However, age is associated with other medical conditions where the DVLA guidance is determined by symptoms or medical reports. For example, people with certain types of heart failure may drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving and need not notify the DVLA. A very common condition associated with ageing is Mild Cognitive Impairment (MCI), a state in between normal ageing and brain function and that of abnormal ageing and dementia. In response to the National Dementia Strategy in 2008 and the Prime Minister's Challenge there has been an increase in people referred to memory clinics from 202 per clinic to 1579 per clinic between 2008/9 and 2014 (a 682% increase). The 2019 national memory clinic audit found that 17% of people attending memory clinics are diagnosed with MCI. Therefore approximately 270 new cases of MCI are diagnosed in each memory clinic. Currently driving risk is assessed by self reports or by medical reports, that take into account factors such as whether the person presents poor short-term memory, disorientation, lack of judgment, attention disorders. , that do not accurately reflect safety to drive. For those with affected by cognitive impairments, detailed, time-consuming and expensive neuropsychological testing are undertaken in a minority and the usefulness of these in terms of predicting driving ability is unknown. On referral from a specialist or GP, specialist driving assessment tests can be carried out. In the UK specialist driving assessment centres carry out detailed driving assessments for people with a medical condition which can affect their driving. The DVLA guidance divides MCI into those with, "No likely driving impairment' and those with, 'Possible driving impairment'. Elderly drivers or people with MCI are not at an increased risk of accident, however they might struggle in certain circumstances such as high speed junctions, high-speed roundabouts and slip roads onto motorways, where drivers are required to look around and make quick decisions. Therefore it is important to investigate new means to understand individual driving risks. In car monitoring technology to measure real-world driving may be a cheaper and more accurate measure of on the road driving behaviour and may better compare with cognitive function. Furthermore, it can detect particular areas of concern such as high-speed junctions, motorways etc so that advice and potentially driving awareness education sessions could be delivered to reduce risk of accidents. In this project we will collect real world driving behaviour data from patients with MCI and healthy elderly to understand any links between their diagnosis, standardised cognitive function tests and driving behaviour. This could help detect those at most risk and develop interventions to introduce graduate driving licenses that better support an evolving condition. We will take into account the views of different stakeholders by arranging a series of workshops with a group of healthy elderly and a group of people with MCI, plus opinions and views and we disseminate other stakeholders such as DfT, DVLA, insurance companies, Age UK and dementia charities such as Alzheimer research UK and Alzheimer Society and Sheffield Dementia advisory group.