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

在美国，有超过5000万老年人获得驾驶执照。驾驶是一项复杂的任务 需要认知和感觉运动技能。危重病的幸存者经历认知，心理 以及被称为重症监护后综合征（PICS）的身体损伤， 在重病之后。在整个生命周期中，ICU恢复对独立的 功能，就业和医疗保健利用，每年花费数十亿美元。老年人有ICU的风险- 获得性认知能力下降，可从临床、生物学和成像相关的大脑变化中辨别 精神错乱和病危之后类似于其他形式的痴呆症，正常衰老配对的组合 认知缺陷与危重病生存率相关，使这些老年人处于高风险状态， 车祸。为了解决ICU获得性认知下降，推动评估以表征风险 驾驶行为有希望指导驾驶康复和干预的发展。严格和 可重复的驾驶安全评估项目已经证明在中风后和痴呆症中取得了成功， 上下文，通过车载和虚拟模式建立。我们假设车内驾驶评估 和监测是一个可行的和可接受的方法来评估和解决ICU幸存者驾驶安全。 我们寻求实施我们团队开发的新型车载云数据收集技术。我们建议 将神经认知评估与车内运动学驾驶数据配对，以进行必要的形成性工作 开发基于数据的见解，以了解患有ICU获得性认知下降的老年人的驾驶行为。我们 旨在确定神经认知评估和车载传感器的方案可行性和可接受性 部署（目标1）。我们将招募一组年龄较大的ICU幸存者（n=24），这些患者具有ICU获得性 认知障碍，以完成神经认知测量并通过车载参与驾驶数据收集 传感器在出院后6个月的时间内。接下来，我们将评估 老年ICU幸存者的神经认知评估、驾驶行为和安全性（目标2）。最后，我们将 就推动评估的优先事项和数据列报需要举办利益攸关方咨询小组， 老年ICU幸存者（目标3）。利益攸关方咨询小组的见解将提供科学依据， 方案可行性，以评价招募、可接受性和未来全面实施的损耗。为 老年驾驶员的人口增长，从2012年到2040年几乎翻了一番，这是一个紧迫和关键的问题。 我们需要解决这个有影响力的问题。这项工作是根据国家信息评估战略计划（目标C-1-9）设计的 老年驾驶员的安全），以弥补健康促进方面的重大差距， 车辆驾驶评估系统，提供可操作的驾驶安全数据和定制的康复策略 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.