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Predicting On‐Road Assessment Pass and Fail Outcomes in Older Drivers with Cognitive Impairment Using a Battery of Computerized Sensory‐Motor and Cognitive Tests
Author(s) -
Hoggarth Petra A.,
Innes Carrie R. H.,
DalrympleAlford John C.,
Jones Richard D.
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.12540
Subject(s) - medicine , logistic regression , generalizability theory , cognition , poison control , dementia , cognitive test , injury prevention , cognitive impairment , physical medicine and rehabilitation , physical therapy , psychiatry , medical emergency , psychology , developmental psychology , disease
Objectives To generate a robust model of computerized sensory‐motor and cognitive test performance to predict on‐road driving assessment outcomes in older persons with diagnosed or suspected cognitive impairment. Design A logistic regression model classified pass–fail outcomes of a blinded on‐road driving assessment. Generalizability of the model was tested using leave‐one‐out cross‐validation. Setting Three specialist clinics in N ew Z ealand. Participants Drivers (n = 279; mean age 78.4, 65% male) with diagnosed or suspected dementia, mild cognitive impairment, unspecified cognitive impairment, or memory problems referred for a medical driving assessment. Measurements A computerized battery of sensory‐motor and cognitive tests and an on‐road medical driving assessment. Results One hundred fifty‐five participants (55.5%) received an on‐road fail score. Binary logistic regression correctly classified 75.6% of the sample into on‐road pass and fail groups. The cross‐validation indicated accuracy of the model of 72.0% with sensitivity for detecting on‐road fails of 73.5%, specificity of 70.2%, positive predictive value of 75.5%, and negative predictive value of 68%. Conclusion The off‐road assessment prediction model resulted in a substantial number of people who were assessed as likely to fail despite passing an on‐road assessment and vice versa. Thus, despite a large multicenter sample, the use of off‐road tests previously found to be useful in other older populations, and a carefully constructed and tested prediction model, off‐road measures have yet to be found that are sufficiently accurate to allow acceptable determination of on‐road driving safety of cognitively impaired older drivers.