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

了解老年人和轻度认知障碍患者对驾驶和健康驾驶的看法

• 批准号: ES/V009826/1
• 负责人: Daniel Blackburn
• 金额: $ 6.9万
• 依托单位: University of Sheffield
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FV009826%2F1
• 关键词: Understanding; views; older; adults; people

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.

不适合驾驶是道路碰撞的主要促成因素，与年龄相关的神经退行性疾病是道路安全日益受到关注的领域。随着预期寿命的不断增加，老年驾驶员的数量将按比例增加（70岁以上的人占英国所有驾驶执照的6%）。与此同时，驾驶是保持独立性的关键部分，特别是在公共交通不太能与驾驶汽车的灵活性相匹配的农村地区。运输部（DfT）和DVLA对老年驾驶员没有任何限制，也没有证据表明老年驾驶员发生交通事故的风险增加。然而，年龄与其他医疗条件相关，其中DVLA指南由症状或医疗报告确定。例如，患有某些类型心力衰竭的人可以驾驶，如果症状稳定，不太可能分散驾驶员的注意力或以其他方式影响安全驾驶，并且不需要通知DVLA。与衰老相关的一种非常常见的疾病是轻度认知障碍（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。为响应2008年的《国家痴呆症战略》和总理的挑战，2008/2009年至2014年期间，转介到记忆诊所的人数从每家诊所202人增加到每家诊所1 579人（增加了682%）。2019年国家记忆诊所审计发现，17%的人参加记忆诊所被诊断患有MCI。因此，每个记忆诊所大约诊断出270例新的MCI病例。目前，驾驶风险是通过自我报告或医疗报告来评估的，这些报告考虑到了一些因素，如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。，不能准确反映驾驶的安全性。对于那些受认知障碍影响的人，少数人进行了详细，耗时和昂贵的神经心理学测试，这些测试在预测驾驶能力方面的有用性尚不清楚。经专家或全科医生转介，可以进行专业驾驶评估测试。在英国，专业驾驶评估中心为有可能影响驾驶的医疗条件的人进行详细的驾驶评估。根据DVLA指南，MCI分为“不可能有驾驶障碍”和“可能有驾驶障碍”。老年驾驶员或MCI患者发生事故的风险不会增加，但他们可能会在某些情况下挣扎，例如高速路口，高速环岛和高速公路上的支路，驾驶员需要环顾四周并做出快速决定。因此，研究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，测量真实世界的驾驶可能是一种更便宜、更准确的道路驾驶行为测量方法，并且可以更好地与认知功能进行比较。此外，它还可以检测出特定的关注区域，如高速路口、高速公路等，以便提供建议和潜在的驾驶意识教育课程，以降低事故风险。在这个项目中，我们将从MCI患者和健康老年人那里收集真实的驾驶行为数据，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。这可以帮助发现那些风险最高的人，并制定干预措施，以引入更好地支持不断变化的情况的毕业驾驶执照。我们将考虑不同利益相关者的意见，安排一系列与一组健康老年人和一组MCI患者的研讨会，以及意见和观点，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Alzheimer Research UK和Alzheimer Society以及谢菲尔德痴呆症咨询小组。

项目成果

Keeping patient and public partnership at the heart of medical technology development during Covid-19: examples of adaptive practice

在 Covid-19 期间，将患者和公共伙伴关系置于医疗技术发展的核心：适应性实践示例

• 发表时间: 2022
• 期刊: Journal of Medical Engineering & Technology
• 作者: Lise Sproson