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Background:
An estimated one in five drivers will be over 65 by 2030. Compared with their younger counterparts, older adults are more likely to experience health and functional impairments, including cognitive dysfunction, which may interfere with their ability to drive safely. Law enforcement officers, as part of the public safety community, need...
Context in source publication
Context 1
... complement the training officers received and help them implement it in their day-to-day traffic work, the TREDS group developed an easy-to-use screening tool for disorientation (Fig. 1), called the DOSCI. The tool was to be used to help clarify whether the confused and possibly disheveled patient was disoriented, and to provide a re- minder and guidance for reporting medically impaired drivers. The expert interviews and focus group (described above) produced recommendations that the ...
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Motor performance and cognitive function both decline with aging. Older adults for example are usually less steady for a constant-force task than young adults when performing low-intensity contractions with limb muscles. Healthy older adults can also show varying degrees of cognitive decline, particularly in executive function skills. It is not kno...
Citations
... There are nine total questions asked in the DOSCI and a failure of three or more is considered inadequate by the Iowa DOT. The DOSCI has been used to identify individuals with possible cognitive impairment during roadside assessments [10]. Safe Driving BASICS is a computer-administered testing battery that combines aspects of trail-making, visual memory, and visual closure (ability to visualize missing information). ...
... In our study, drivers with dementia were less likely to pass IDOT's screening battery (the Safe Driving BASICS) as well as the individual DOSCI test and the on-road driving test. The DOSCI was developed to identify drivers with cognitive impairment [10]. As expected, drivers with dementia had a much higher likelihood of failing the DOSCI. ...
Cognitive and physical impairment can occur with dementia and reduce driving ability. In the United States, individual states have procedures to refer and evaluate drivers who may no longer be fit to drive. The license review process is not well understood for drivers with dementia. This study uses comprehensive data from the Iowa Department of Transportation to compare the referral process for drivers with and without dementia from January 2014 through November 2019. The likelihood of failing an evaluation test was compared between drivers with and without dementia using logistic regression. The risk of motor-vehicle crash after referral for review of driving ability was compared using a Cox proportional hazard model. Analysis controlled for the age and sex of the referred driver. Drivers with dementia performed worse on all tests evaluated except the visual screening test. After the referral process, the risk of crash was similar between those with and without dementia. Drivers with dementia were denied their license more frequently than referred drivers without dementia. However, drivers with dementia who successfully kept their license as a result of the license review process were not at an increased risk of crash compared to other referred drivers.
... Before the pilot study, the DOSCI was initially developed by the Training, Research and Education for Driving Safety (TREDS) program at University of California San Diego. Detailed methods for developing the DOSCI tool have been published in Hill, Rybar, Stowe, and Jahns (2016). Validation testing of the DOSCI tool was conducted in collaboration with the University of California San Diego Alzheimer's Research Center. ...
... The DOSCI was validated as a tool that can differentiate between cognitively-health individuals and those with dementia. The questions most frequently answered incorrectly by participants with dementia were those related to date and time (Hill, Rybar, Stowe, & Jahns, 2016). ...
... Intended for use by personnel outside of medical and research settings, the DOSCI tool comprised of a total of nine questions assessing orientation to place and time and memory of personal information. Scoring criteria were based on the number of questions answered incorrectly (Hill et al., 2016). For the current study, analysis was conducted using total number of incorrect responses on the DOSCI from 0-9. ...
Background and Purpose: Aging is associated with cognitive impairment, which interferes with safe driving ability. Cognitively-impaired drivers may present as confused and belligerent, creating challenges in differentiating these drivers from intoxicated or metabolically-impaired drivers. The Driver Orientation Screen for Cognitive Impairment (DOSCI) was developed to assist identification of disorientation and was piloted in the Iowa Department of Transportation. This study examined the feasibility, acceptability, and usefulness of the DOSCI at licensing agency offices, and to investigate the association between DOSCI performance and driver licensing outcomes. Methods: A sample of 2,510 DOSCI screens from 2,399 individuals was assessed. Data included the acceptability of the DOSCI among staff and clients, time to complete assessments, DOSCI outcomes, and final driver license status. Results: On a 5-point scale, mean score was 4.76 (SD=0.67) for Ease of Administration, 4.67 (SD=0.80) for Acceptance by Client, and 3.81 (SD=1.57) for Useful in Assessment. Clients who failed the assessment had significantly higher odds of not receiving a driver’s license than clients who passed (OR=2.556). Conclusion: The DOSCI was quick to administer, well-accepted, and was associated with licensing outcome. The tool has potential to contribute to traffic injury prevention by identifying potentially impaired drivers requiring closer examination in a licensing agency setting.
... 4 Nationally, several educational programs aim to improve officers' knowledge and skills in specific aspects of their interactions with older adults, such as responding to elder abuse 16 and identifying unsafe drivers. 17 However, these programs do not address officers' requests to learn basic knowledge about aging-related health that would allow them to more effectively assess and triage older adults. A brief geriatrics training was developed, implemented, and evaluated to address these educational needs. ...
... The 2015 President's Task Force on 21st Century Policing called on police departments to develop policies and procedures for working with older adults. 26 Nationally, training programs exist that focus on improving officers' knowledge and skills in specific interactions with older adults, such as identifying impairment in aging drivers, 17 responding to wandering in dementia, 27 preventing crimes, 28 and responding to elder abuse. 16 This training provides a critical foundation for such programs by educating police more broadly about the role that agingrelated health plays in the safe and effective policing of older adults and in approaches to mobilizing local resources. ...
Objectives:
To develop, implement, and evaluate a training program in aging-related health for police officers.
Design:
Cross-sectional.
Setting:
Crisis intervention training program for police officers in San Francisco.
Participants:
Police officers attending one of five 2-hour trainings (N = 143).
Intervention:
A lecture on aging-related health conditions pertinent to police work followed by three experiential trainings on how it feels to be "old."
Measurements:
Participants evaluated the quality of the training and the likelihood that they would apply new knowledge to their work and rated their knowledge using a retrospective pre-post evaluation. In open-ended responses, participants reported work-related changes they anticipated making in response to the training.
Results:
All 143 participants completed the evaluation. Eighty-four percent reported interacting with older adults at least monthly; 45% reported daily interactions. Participants rated the training quality at 4.6/5 and the likelihood they would apply new knowledge to their work at 4.4/5. Retrospective pre-post knowledge scores increased for all domains, including how to identify aging-related health conditions that can affect safety during police interactions (2.9/5 to 4.2/5; P < .001). In open-ended responses, participants anticipated having more empathy for and awareness of aging-related conditions and greater ability to provide older adults with appropriate community referrals.
Conclusion:
A brief training in aging-related health significantly increased police officers' self-reported knowledge and skills. Clinicians have an important opportunity to help enhance safe and effective community policing for older adults.
There are doubts about vehicle driving restriction for patients with Alzheimer's disease. A scoping review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Protocols (PRISMA‐ScR) methodology. Relevant databases were searched for articles published between 2000 and 2022 in English, Spanish, or Portuguese. Articles were included if they specifically addressed driving, risk of accidents, permission or licence to drive a motor vehicle in a context of important cognitive decline, or if addressed traffic legislation on driving and dementia. Twenty‐three articles were selected for full reading, six of which were observational studies and only one with an interventionist method. All articles were carried out in high‐income countries such as the UK, the US, and Australia. As a conclusion, there is no psychometric test in the literature sensitive enough to assess vehicle driving competence in older adults with cognitive deficits. Based on selected studies, there is no robust evidence to make recommendation for or against the cessation of vehicular driving for patients with mild cognitive decline or with mild dementia. In some situations, vehicle driving cessation can impact patients and their families. In addition, legal regulations regarding vehicle driving for older adults and people with dementia are scarce worldwide. Despite the scarcity of studies addressing the theme of vehicle driving in the context of dementia, there is some level of consensual reasoning that patients with moderate to severe dementia should halt driving activities, but the same does not apply for patients with mild levels of cognitive impairment, including mild dementia.
With aging, physical and cognitive changes can affect driving safety. Emergency nurses can provide education for seniors that can create awareness of these changes and ways to mitigate the changes, allowing the older driver to remain independent and a safer driver.
Introduction:
Driver retirement and determination of fitness-to-drive are important aspects of reducing the risk of motor-vehicle collision for an older driver. A lack of information about the review process may lead to poor evaluation of drivers or an increased testing burden to referred drivers.
Methods:
This paper evaluates the license review process for the state of Iowa. We evaluated data from January 2014 to January 2018 and described the source of referral, testing process, and ultimate license disposition. Cox proportional hazards for competing risk were used to determine the risk of having a change in restrictions on the license and the risk of license denial.
Results:
20,742 individuals were followed through the medical referral process. The most common source of referrals was licensing officials (39.7%). Drivers referred by licensing officials were less likely to be denied their license when compared to drivers from other sources (HR = 0.92 95%CI: 0.87-0.98); however, licensing official referrals were more likely to result in license restrictions compared to other sources (HR = 1.91, 95%CI: 1.82-2.00). Drivers referred by either law enforcement or a physician were more likely to ultimately have their license denied.
Conclusions:
Physician and law enforcement referred the drivers most likely to have their license denied. A smaller proportion of drivers were referred by physicians and law enforcement compared to licensing officials. Practical Applications: Licensing agencies should work with physicians and law enforcement to identify drivers who may need a review of their license. Comprehensive tracking of all medical referrals for a driver's license review is important for individual states to understand the burden of their driver referral process and for identifying referral sources with a high proportion of referrals with no licensing change for targeted outreach and education.
