Cognative Impairment & Older Drivers

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I'm hoping i can get some help from anyone who has experienced this with their older parent(s) (80+). Where I live the province enacted laws/procedures for older drivers. Essentially, when a person reaches the age of 84 there is a process they must go through. People under the age may also be subject to this (if so deemed for whatever reason) and it starts with their physicians.

The program was sold to the province (lobbied) by a company called Driveable – many countries are getting on board it seems.

_http://www.driveable.com/

From what can be gathered, it was developed first in the 70’s upon fears of an aging driver profile. The stats used don’t seem to have been realized and of course some people no matter what age should not drive, yet this is having troubling implications on many good older drivers’ lives. It can often pit patient and physicians against each other or crush a person’s well being if facts are subjective and unfounded.

Here is a group that has come out against Driveable with their thinking:

_http://www.bcrta.ca/news-items/DriveAble.pdf

I am meeting with my mom’s physician late this week to ask questions and here is her background:

She is 84, an excellent driver (bias aside) and not once has she had an accident in her life of driving. She drives 20 – 25 thousand km. a year and can handle cities like Montreal. Her driving environs however are rural generally (easy).

The Process:

She gives her GP physician many pages of documents back and the physician (assumed they have been trained) then delivers a cognitive test. The test, i think, is called “Word List Recall Task (immediate recall).” Here is what she said happened:

Note: physical report was excellent, eyesight 20/20. She reads extensively; even SotT and many of the books from the forum and can recall points easily.

Q.#1 I am going to name ten words and you repeat them to me in any order. I started getting nervous and yet was able to come up with at least 6 or 7 out of 10.

Q.2 you are filling a shopping cart: name all the things you would buy. I kept going until the list was complete and my grocery cart was full according to the requirements of this question.

Q.3 okay now name some of the words that were on Q#1- I went completely blank and could not remember any. My brain kind of shut down as it does when I get nervous.

In her words:

So now I am in the Drivable BC. category of having a cognitive inability and have to go and take an hour computer test. Statistics show that only 11% pass. You can move on to a road test (this is new) which will be scored in with the computer score. I asked (Dr.) if failure leads to restricted driving and she said “No, they take your license away.”



This was a shock to me...blow to my self-confidence and joy of life. I know it will happen at some point as I move through my later eighties, but now it’s too early. I actually feel clearer on the road than a few years ago. Seniors are being targeted and there is a lot of controversy on this Driveable B.C testing. Also the label cognitive impairment is rather a blow…

According to this: _http://www.docstoc.com/docs/21652574/WORD-LIST-MEMORY-TASK-%28IMMEDIATE-RECALL%29

The list is supposed to be read off slowly, a word every 2 seconds and then the patient is asked to repeat it back (one variant).

She has a hard time with physicians as she has an alternative Homeopath (who also is a Dr. of Medicine in a different province) and the home town Dr. doesn’t really like this; this has caused much tension (e.g., Dr. says take Statins - that cholesterol game - while the H-path says you don’t need that, type of thing).

So researching, it has been noticed that the Drivable FAQ discusses Physicians being Liable, yet case law says otherwise (this likely is scaring physicians). Also, in the EU (certain places) where they tried this out, apparently there was a big backlash even from scientists.

So I’m meeting with the Dr. later this week to ask questions, perhaps see if there were errors of test administration, discuss her nervousness and see if this can be done again (negative results like cognitive impairment are now a subject of medical file records and may be very unfair – driving test aside). If anyone has had some experience with this type of matter or can offer some advice, it would be greatly appreciated.

Thanks.
 
Meet with the Dr. yesterday and mostly listened. The Dr. did admit that the test is flawed, yet felt it was (as the Drivable link erroneously suggests) a liability if not reported. The Dr. did say that the results do not match what is observed and therefore would write a letter should the secondary results not pass for whatever reason. This would also correct any file notes that may leave, lets say an insurance company for traveling insurance, with the initial cognitive bias of this test, based on what the Dr. knows differently from objective observations.

As for the test (which I did not posses at the time of the meeting), it is called "The SIMARD MD test" and from an Alberta link called 'Elder Advocates Of Alberta Society', there is an interesting discussion about it under "Senior Driving Issues":

_http://elderadvocates.ca/

[b said:
Beware of the Simard MD[/b]]
The SIMARD MD test purports to be a screening tool for

the identification of cognitively impaired medically at-risk drivers.

It consists of three questions that supposedly identifies if a person

is cognitively fit to drive.

At the beginning of the test the person is given 10 words. He/she

must repeat as many as possible. The words are totally unrelated.

The procedure is repeated once more. No points are given for this part.

Question #1 – Patient must write two given numerals in their word

form as on a cheque.

Question #2 – Patient is asked to name as many things as possible one

can buy at a supermarket in one minute.

(Patient is not told that the expected number is 30 items).

Question #3 – After being distracted by the first two questions, the person

is then asked to recall as many words that were read to him/her at

the beginning of the test. The words are totally unrelated.

(Most people fail this part or score very low.) The total score for the three

questions is 42.

However, SIMARD MD uses a scoring guide that almost sets up the senior

or anyone else for failure. For example, a raw score of 21over 42 yielding

50% becomes 44 over 130 giving a percentage of 34. This is achieved by

multiplying each correct answer in question #2 by 8 and each correct recalled

word in question #3 by 10 now the total becoming 130.

A number of community leaders and educators, all actively employed

have taken the test, including one MLA. All but two failed.
 
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