The risks and consequences of a motor vehicle crash in older adults with Alzheimer's Disease and Related Dementias

患有阿尔茨海默病和相关痴呆症的老年人发生车祸的风险和后果

• 批准号: 10524893
• 负责人: Nina Joyce
• 金额: $ 78.4万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10524893
• 关键词: Address; Affect; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Assisted Living Facilities; Automobile Driving; Caring; Characteristics; Clinical; Clinical Course of Disease; Cognitive; Data; Data Sources; Dementia; Diagnosis; Disease; Elderly; Event; Goals; Health; Healthcare; Hospitalization; Impaired cognition; Individual; Intervention; Knowledge; Licensing; Link; Literature; Long-Term Care; Longitudinal trends; Masks; Measures; Medical; Medicare; Medicare claim; Modeling; New Jersey; Outcome; Pattern; Patterns of Care; Phase; Policies; Population Study; Provider; Reporting; Research; Risk; Risk Estimate; Safety; Sensory; Sentinel; Services; Source; Suspensions; Time; Variant; Vehicle crash; base; care outcomes; clinical diagnosis; comorbidity; dementia risk; driving behavior; driving safety; evidence base; experience; functional status; health care service utilization; high risk; improved; individual variation; insurance claims; mild cognitive impairment; novel; older driver; psychologic; residential care facility; social; unsafe driving

PROJECT SUMMARY Older adults with Alzheimer's Disease (AD) and related dementia disorders are at increased risk of a motor vehicle crash due to impairment of the cognitive and sensory functions necessary for safe driving.1 Because there are few sources of long-term longitudinal data on dementia and motor vehicle crashes, and even fewer that include the prodromal stage of AD related dementia called mild cognitive impairment (MCI), very little is known about how the risk of a crash changes over the course of AD and how a crash may change the clinical course of disease. Here, we propose to use a novel data source of Medicare insurance claims linked to licensing, citation, and crash data for more than 1.5 million older drivers over a 13-year period to evaluate longitudinal changes in the risk of a crash and changes in the trajectory of health, health care utilization, and long-term care assistance following a crash, among older drivers with AD. The lack of information on the longitudinal risks and consequences of a crash among older adults with AD represents a critical gap in the literature for two reasons. First, research suggests that there is substantial individual variation in driving ability by stage of disease. While some individuals demonstrate a significant increase in unsafe driving behaviors early in the course of disease, before they are even diagnosed, others are able to drive safely with MCI through the mild to moderate stage of AD.2 As the number of older drivers with AD grows, providers and organizations that serve older adults are increasingly focused on developing interventions to promote “safe-mobility,” allowing older adults to drive for as long as is safely possible. However, to be effective, interventions need to account for longitudinal changes in the risk of a crash over time, and how these trajectories may vary across individual characteristics. Second, the effects of a crash can have long-lasting physical, psychological and social consequences. Current studies have identified short term effects of a crash,5 but no study has followed crash-involved-drivers with AD for long enough to understand how the impact of a crash manifests over time. Individuals with AD are already at higher risk of comorbidity, hospitalization, and early transition to long term care. Thus, given the rise in licensed drivers with AD, it is critical to understand how a crash may compound these risks. A major barrier to identifying periods of high crash risk and the contributing factors is the lack of longitudinal data on motor vehicle crashes. Instead, most studies have evaluated individuals retrospectively at a particular stage of the disease or followed older adults for relatively short periods of time and without knowledge of their cognitive status, making it difficult to identify longitudinal patterns of crash risk. Here, we propose to use 13 years of Medicare claims data linked to licensing, crash and citations for all drivers with a license in New Jersey between 2007 and 2019 to (1) characterize the longitudinal trajectories of crash risk over time (2) identify sentinel points in these trajectories where the risk of crash is highest and thus interventions would be most effective and (3) evaluate the impact of a crash on the health and health care outcomes for cognitively impaired older drivers.

项目摘要 患有阿尔茨海默病（AD）和相关痴呆症的老年人患运动性痴呆的风险增加。 由于安全驾驶所需的认知和感觉功能受损而导致的车辆碰撞。 关于痴呆症和机动车碰撞的长期纵向数据来源很少，甚至更少 包括AD相关痴呆的前驱期，称为轻度认知障碍（MCI），很少有 我们知道在AD的过程中撞车的风险如何变化，以及撞车如何改变临床症状。 病程。在这里，我们建议使用与许可相关的医疗保险索赔的新数据源， 引用，以及超过150万名老年驾驶员在13年内的碰撞数据，以评估纵向 崩溃风险的变化以及健康、医疗保健利用和长期护理轨迹的变化 事故后的援助，在老年司机与AD。缺乏关于纵向风险的信息， 由于两个原因，在AD老年人中发生撞车事故的后果代表了文献中的一个关键空白。 首先，研究表明，在疾病的不同阶段，驾驶能力存在很大的个体差异。而 一些个体在病程早期表现出不安全驾驶行为的显著增加， 在他们被诊断出来之前，其他人能够安全地驾驶MCI通过轻度到中度的阶段， AD.2随着患有AD的老年驾驶员数量的增加，为老年人提供服务的提供者和组织 越来越多地关注发展干预措施，以促进“安全流动性”，让老年人驾驶作为 只要安全可行。然而，为了有效，干预措施需要考虑到经济增长的纵向变化。 随着时间的推移，碰撞的风险，以及这些轨迹如何在个体特征之间变化。二是 坠机的影响可能会产生长期的生理、心理和社会后果。目前的研究 确定了碰撞的短期影响，5但没有研究足够长时间地跟踪与AD有关的碰撞驾驶员 来了解崩溃的影响如何随着时间的推移而显现。AD患者已经处于更高的风险中， 合并症，住院治疗和早期过渡到长期护理。因此，鉴于持牌司机的增加， AD，了解崩溃如何加剧这些风险至关重要。确定死亡时间的主要障碍是 事故风险高，造成事故的因素是缺乏关于机动车事故的纵向数据。相反地， 大多数研究回顾性地评估了处于疾病特定阶段的个体， 成年人在相对较短的时间内，不知道他们的认知状态，使其难以 确定事故风险的纵向模式。在这里，我们建议使用13年的医疗保险索赔数据， 2007年至2019年期间，所有在新泽西拥有驾照的司机的驾照、撞车事故和引文，以（1） 描述一段时间内碰撞风险的纵向轨迹（2）确定这些轨迹中的警戒点 （3）在事故风险最高的地方，干预措施将是最有效的;（4）评估 对认知受损的老年驾驶员的健康和医疗保健结果的影响。