Cognition and driving in older persons

In Switzerland, approximately 350,000 people aged 70 years or older own a valid driving license. By law, these drivers are medically assessed every other year, most commonly by their general practitioner, to exclude that a medical condition is interfering with their driving skills. A prerequisite for driving is the integration of high-level cognitive functions with perception and motor function. Ageing, per se, does not necessarily impair driving or increase the crash risk. However, medical conditions, such as cognitive impairment and dementia, become more prevalent with advancing age and may contribute to poor driving and an increased crash risk. The extent to which driving skills are impaired depends on the cause of dementia, disease severity, other co-morbidities and individual compensation strategies. Dementia often remains undiagnosed and therefore general practitioners (GPs) can find themselves in the difficult situation to disclose a suspicion about cognitive impairment and queries about medical fitness to drive, at the same time. In addition, the literature suggests that cognitive screening tests, most commonly used by GPs, have a limited role in judging whether an older person remains fit to drive. Further specialist assessment, for example in a memory clinic or on the road testing (ORT), may be helpful when the diagnosis or its implication for driving remain unclear. Here, we review the literature about cognition and driving, for GPs who advise older drivers who wish to continue driving.

Non-illness-related factors contributing to traffic safety in older drivers: a litterature review

Background/Study Context: Older drivers are at increased risk of becoming involved in car crashes. Contrary to well-studied illness-related factors contributing to crash risk, the non-illness-related factors that can influence safety of older drivers are underresearched. METHODS: Here, the authors review the literature on non-illness-related factors influencing driving in people over age 60. We identified six safety-relevant factors: road infrastructure, vehicle characteristics, traffic-related knowledge, accuracy of self-awareness, personality traits, and self-restricted driving. RESULTS: The literature suggests that vehicle preference, the quality of traffic-related knowledge, the location and time of traffic exposure, and personality traits should all be taken into account when assessing fitness-to-drive in older drivers. Studies indicate that self-rating of driving skills does not reliably predict fitness-to-drive. CONCLUSIONS: Most factors discussed are adaptable or accessible to training and collectively may have the potential to increase traffic safety for older drivers and other road users.