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Assessment of Driving‐Related Skills Prediction of Unsafe Driving in Older Adults in the Office Setting
Author(s) -
Ott Brian R.,
Davis Jennifer D.,
Papandonatos George D.,
Hewitt Scott,
Festa Elena K.,
Heindel William C.,
Snellgrove Carol A.,
Carr David B.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12306
Subject(s) - medicine , cognition , logistic regression , receiver operating characteristic , poison control , test (biology) , montreal cognitive assessment , cognitive skill , injury prevention , cognitive impairment , psychiatry , medical emergency , paleontology , biology
Objectives To examine the sensitivity and specificity of the A ssessment of D riving‐ R elated S kills ( ADR e S ), a clinical tool recommended by the A merican M edical A ssociation for identifying potentially unsafe older drivers that includes tests of vision, motor function, and cognition. Design Cross‐sectional observation study. Setting Memory assessment outpatient clinic of a university hospital. Participants Drivers with normal cognition (n = 47) and cognitive impairment (n = 75). Measurements A neurologist completed the ADR e S during an office visit. Additional cognitive tests of executive, visuospatial, and visuomotor function were also performed. On a separate day, participants completed a standardized on‐road test, assessed by a professional driving instructor using a global safety rating and a quantitative driving score. Results In this sample of currently active older drivers with and without cognitive impairment, measures of cognition—particularly the T rail‐ M aking T est P art B —were more highly correlated with driving scores than other measures of function. Using recommended scoring procedures, the ADR e S had a sensitivity of 0.81 for detecting impaired driving on the road test, with a specificity of 0.32 and an area under the receiver operating characteristic curve ( AUC ) of 0.57. A logistic regression model that incorporated computerized maze task and M ini‐ M ental S tate E xamination scores improved overall classification accuracy, yielding a sensitivity of 0.61, a specificity of 0.84, and an AUC of 0.80. Conclusion In its present form, the ADR e S has limited utility as an office screen for individuals who should undergo formal driving assessment. Improved scoring methods and screening tests with greater diagnostic accuracy than the ADR e S are needed for general office practice.