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

驾驶不适是道路交通事故的主要诱因，与年龄相关的神经退行性疾病越来越受到道路安全的关注。随着预期寿命的不断延长，老年司机的数量将按比例增加(70岁以上的人占英国所有驾照的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能与开车的灵活性相匹配的农村地区。交通部(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，在这些情况下，DVLA指导是由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，就可能会开车，而且不需要通知DVLA。与衰老相关的一种非常常见的疾病是轻度认知障碍(MCI)，一种介于正常衰老和脑功能以及异常衰老和痴呆症之间的状态。为了应对2008年的《国家痴呆症战略》和总理的挑战，2008/9至2014年间，向记忆诊所求助的人数从每个诊所202人增加到每个诊所1579人(增加了682%)。2019年国家记忆诊所审计发现，17%的记忆诊所就诊者被诊断为MCI。因此，在每个记忆诊所大约诊断出270例新的MCI病例。目前，驾驶风险的评估是通过自我报告或医学报告来进行的，这些报告考虑了诸如个人是否表现出较差的短期记忆、定向障碍、缺乏判断力和注意力障碍等因素。，这并不能准确反映驾驶的安全性。对于那些受到认知障碍影响的人，只有少数人进行了详细、耗时和昂贵的神经心理测试，这些测试在预测驾驶能力方面的用处尚不清楚。在专家或全科医生的推荐下，可以进行专家驾驶评估测试。在英国，专门的驾驶评估中心为有可能影响驾驶的健康状况的人进行详细的驾驶评估。DVLA的指导将MCI分为“无可能的驾驶损伤”和“可能的驾驶损伤”两类。年长的司机或患有MCI的人不会增加事故风险，但他们可能会在某些情况下挣扎，如高速路口、高速环形交叉路口和高速公路上的支路，这些情况下司机需要环顾四周并迅速做出决定。因此，研究了解个人驾驶风险的新方法是很重要的。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衡量标准，而且可能比认知功能更好。此外，它还可以检测特定的关注区域，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，我们将收集来自MCI患者和健康老年人的真实世界驾驶行为数据，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，引入更好地支持不断演变的情况的毕业驾照。我们会考虑不同持份者的意见，为一群健康长者和一群MCI患者安排一系列工作坊，以及意见和意见，并传播其他持份者，如英国交通部、DVLA、保险公司、Age UK和痴呆症慈善机构，如阿尔茨海默氏症研究英国和阿尔茨海默氏症协会和谢菲尔德痴呆症顾问小组。

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.