Driving Rehabilitation and Innovation for Evaluating Risk in Post-Intensive Care Unit Survivors (DRIVE-PICS)

在美国，有5000多万老年人有驾照。开车是一项复杂的任务 需要认知和感觉运动技能。危重病幸存者经历认知、心理 以及被称为重症监护后综合症(PICS)的身体障碍，可能会持续几个月到几年 在得了重病之后。在整个生命周期内，ICU的康复对独立自主具有深远的影响 功能、就业和医疗保健利用，每年花费数十亿美元。老年人有患重症监护室的风险- 获得性认知衰退可从临床、生物学和脑成像相关的变化中辨别出来 在精神错乱和危重疾病之后。与其他形式的痴呆症类似，正常衰老的组合配对 患有与危重疾病相关的认知缺陷的生存使这些老年人处于患 车祸。解决ICU获得性认知下降问题，推动评估以表征风险 驾驶行为有望指导驾驶康复和干预发展。严谨和 可重复的驾驶安全评估计划在中风后和痴呆症中证明是成功的 通过车载和虚拟模式建立的环境。我们假设车载驾驶评估 监测是评估和解决ICU幸存者驾驶安全的一种可行和可接受的方法。 我们寻求实施我们团队开发的新颖的车载云数据收集技术。我们建议 将神经认知评估与车载运动学驾驶数据配对，以进行基本的形成性工作 对ICU获得性认知下降的老年人的驾驶行为进行基于数据的洞察。我们 目的确定神经认知评估和车载传感器方案的可行性和可接受性。 部署(目标1)。我们将招募一组有ICU获得性危险因素的老年ICU幸存者(n=24) 通过车内完成神经认知测量和参与驾驶数据收集的认知障碍 出院后6个月的传感器。接下来，我们将评估两国之间的关系。 老年ICU幸存者的神经认知评估和驾驶行为及安全性(目标2)。最后，我们将 就推动评估的优先事项和数据呈现需求进行利益相关者咨询小组 老年ICU幸存者(目标3)。利益相关者咨询小组的见解将提供科学的理由和 评估招聘、可接受性和自然减员的议定书可行性，以便今后全面实施。作为 老年司机人口不断增长，从2012年到2040年几乎翻了一番，这是一个迫在眉睫的关键问题 需要解决这个有影响力的问题。这项工作是为了响应NIA战略计划(目标C-1-9 老年司机的安全)，以促进健康促进方面的关键差距，以制定以证据为基础的、在 车辆驾驶评估系统提供可操作的驾驶安全数据和量身定做的康复策略 对ICU幸存者、他们的护理伙伴和临床医生。

There are more than 50 million older adults licensed to drive in the United States. Driving is a complex task requiring cognitive and sensorimotor skills. Survivors of critical illness experience cognitive, psychological and physical impairments, known as Post-Intensive Care Syndrome (PICS), that can last months to years following critical illness. Across the lifespan, ICU recovery has far-reaching implications for independent functioning, employment, and healthcare utilization, costing billions annually. Older adults are at risk for ICU- acquired cognitive decline discernible from clinical, biological, and imaging-related changes in the brain following delirium and critical illness. Similar to other forms of dementia, the combination of normal aging paired with cognitive deficits associated with critical illness survivorship places these older adults at high risk of automobile crashes. To address ICU-acquired cognitive decline, driving assessments to characterize risky driving behaviors are promising to guide driving rehabilitation and intervention development. Rigorous and reproducible driving safety assessment programs have demonstrated success in post-stroke and dementia contexts, established via in-vehicle and virtual modes. We hypothesize that in-vehicle driving assessment and monitoring is a feasible and acceptable approach to assess and address ICU survivor driving safety. We seek to implement novel in-vehicle cloud-data collection technology developed by our team. We propose to pair neurocognitive assessments with in-vehicle kinematic driving data to conduct essential formative work to develop data-based insights into driving behaviors of older adults with ICU-acquired cognitive declines. We aim to determine protocol feasibility and acceptability of neurocognitive assessments and in-vehicle sensor deployment (Aim 1). We will enroll a cohort of older ICU survivors (n=24) with risk factors for ICU-acquired cognitive impairment to complete neurocognitive measures and participate in driving data collection via in-vehicle sensors over a 6-month post-hospital discharge period. Next, we will evaluate the relationship between neurocognitive assessments and driving behavior and safety in older ICU survivors (Aim 2). Lastly, we will conduct stakeholder advisory panels on the priorities and data presentation needs of driving assessments for older ICU survivors (Aim 3). The stakeholder advisory panel insights will provide scientific justification and protocol feasibility to evaluate recruitment, acceptability and attrition for future full-scale implementation. As the population of older drivers grows, almost doubling in size from 2012 to 2040 there is an immediate and critical need to address this impactful issue. This work is designed in response to the NIA Strategic Plan (Goal C-1-9 Safety of Older Drivers) to contribute to a critical gap in health promotion to develop an evidence-based, in- vehicle driving assessment system to provide actionable driving safety data and rehabilitation strategies tailored to ICU survivors, their care partners and clinicians.