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Original article

Vol. 148 No. 2728 (2018)

Adherence to guidelines when evaluating fitness-to-drive in the elderly: a practice review of Swiss physicians

  • Paul Sebo
  • Dagmar M. Haller
  • Bernard Favrat
  • Philippe Huber
  • Yolanda Mueller
  • Paul Vaucher
DOI
https://doi.org/10.57187/smw.2018.14632
Cite this as:
Swiss Med Wkly. 2018;148:w14632
Published
12.07.2018

Summary

OBJECTIVE

We aimed to explore the extent to which general practitioners (GPs) in Western Switzerland adhere to Swiss recommendations when assessing fitness-to-drive in the elderly.

METHODS

A random sample of 500 GPs practicing in Vaud, Neuchatel and Jura, and all GPs certified to conduct fitness-to-drive assessments in Geneva (“experts”, n = 69) were invited to participate. They were asked how often they performed twenty procedures (recommended in Swiss guidelines developed by experts in traffic medicine) when assessing older drivers during the previous year, scored on a five-point Likert scale ranging from “never” to “always performed”. The GPs were considered to be adhering to the recommended procedure if they performed it often or always. We computed the proportion of GPs adhering to each procedure, and compared GPs with or without specialised expertise.

RESULTS

A total of 268 GPs completed the questionnaire (participation rate 47%). The most frequently reported procedures were asking for current medication (96%), cardiovascular (94%) and neurological diseases (91%), and screening for visual acuity impairment (93%), whereas the least frequently reported procedures were screening for cognitive impairment in drivers aged between 70 and 80 years (44%) and for mood disorder (31%), asking for a history of driving license withdrawal (38%), and interviewing close relatives (10%). Six procedures were statistically significantly more frequently performed by the experts than by the other GPs. In general, GPs reported using validated tools, except when screening for at-risk drinking and mood disorder (tools used by 26 and 28%, respectively).

CONCLUSIONS

Many Swiss GPs seem not to systematically follow the current Swiss recommendations. Although several important procedures appear to routinely be part of older drivers’ assessment, others are infrequently performed. Further research should identify how GPs select the recommended items to which they adhere and those they never apply, and how to facilitate the use of recommended procedures to help them decide if a person is fit, unfit or requiring further evaluation.

References

  1. Rapport SINUS. 2017 – Niveau de sécurité et accidents dans la circulation routière en 2016.pdf [Internet]. [cited 2018 Apr 22]. Available from: https://www.bfu.ch/sites/assets/Shop/bfu_2.331.02_Rapport%20SINUS%202017%20%E2%80%93%20Niveau%20de%20s%C3%A9curit%C3%A9%20et%20accidents%20dans%20la%20circulation%20routi%C3%A8re%20en%202016.pdf
  2. Vaucher P, Cardoso I, Veldstra JL, Herzig D, Herzog M, Mangin P, et al. A neuropsychological instrument measuring age-related cerebral decline in older drivers: development, reliability, and validity of MedDrive. Front Hum Neurosci. 2014;8:772. doi:.https://doi.org/10.3389/fnhum.2014.00772 DOI: https://doi.org/10.3389/fnhum.2014.00772
  3. Wagner JT, Müri RM, Nef T, Mosimann UP. Cognition and driving in older persons. Swiss Med Wkly. 2011;140:w13136. doi:.https://doi.org/10.4414/smw.2011.13136 DOI: https://doi.org/10.4414/smw.2011.13136
  4. Braver ER, Trempel RE. Are older drivers actually at higher risk of involvement in collisions resulting in deaths or non-fatal injuries among their passengers and other road users? Inj Prev. 2004;10(1):27–32. doi:.https://doi.org/10.1136/ip.2003.002923 DOI: https://doi.org/10.1136/ip.2003.002923
  5. Langford J, Bohensky M, Koppel S, Newstead S. Do older drivers pose a risk to other road users? Traffic Inj Prev. 2008;9(3):181–9. doi:.https://doi.org/10.1080/15389580801975632 DOI: https://doi.org/10.1080/15389580801975632
  6. Accidents de la circulation routière: objets impliqués selon le genre d’objet, l’âge de la personne à pied ou conduisant, le sexe, l’ancienneté du permis de conduire, la responsabilité présumée et la gravité de l’accident - 1992-2016 [Internet]. [cited 2018 Apr 22]. Available from: https://www.bfs.admin.ch/bfs/fr/home/statistiques/mobilite-transports/accidents-impact-environnement/accidents-transports/route.assetdetail.2683733.html
  7. Kim YJ, An H, Kim B, Park YS, Kim KW. An International Comparative Study on Driving Regulations on People with Dementia. J Alzheimers Dis. 2017;56(3):1007–14. doi:.https://doi.org/10.3233/JAD-160762 DOI: https://doi.org/10.3233/JAD-160762
  8. Vetsch M, Gantcheva N, Favrat B, Perron NJ. Aptitude au volant: comment ne pas perdre les pédales? [Driving ability: how not to lose control?]. Rev Med Suisse. 2014;10(443):1746, 1748–52. Article in French.
  9. Seeger R. Verkehrsmedizin in der Grundversorger-Praxis [Traffic medicine in basic medical practice]. Ther Umsch. 2011;68(5):235–41. Article in German. doi:.https://doi.org/10.1024/0040-5930/a000157 DOI: https://doi.org/10.1024/0040-5930/a000157
  10. Büla C, Eyer S, von Gunten A, Favrat B, Monod S. [Driving and cognitive impairment: how best to anticipate?]. Rev Med Suisse. 2011;7(316):2184–9. Article in French.
  11. Favrat B, Pasche C. [Aptitude to drive: what road to take?]. Rev Med Suisse. 2012;8(325):176–7. Article in French.
  12. Kramer G, Bonetti C, Mathis J, Meyer K, Seeck M, Seeger R, et al. Epilepsie et permis de conduire. Swiss Medical Forum. 2015;15:157–60. Article in French. DOI: https://doi.org/10.4414/fms.2015.02170
  13. Lehmann R, Fischer-Taeschler D, Iselin HU, Pavan M, Pralong F, Seeger R, et al. Richtlinien bezüglich Fahreignung bei Diabetes mellitus. Swiss Med Forum. 2011;11:273–5. Article in German. DOI: https://doi.org/10.4414/smf.2011.07489
  14. Mathis J, Seeger R, Kehrer P, Wirtz G. Fahreignung bei Schläfrigkeit. Swiss Med Forum. 2007;7:328–32. Article in German. DOI: https://doi.org/10.4414/smf.2007.06161
  15. Mérour A, Favrat B, Borruat F-X, Pasche C. [Requirements on vision for driving: to see more clearly]. Rev Med Suisse. 2014;10(452):2252–4, 2256–7. Article in French.
  16. Serra A-L, von Gunten A, Mosimann U, Favrat B. [Driving ability, mental illness and psychotropic medication in the elderly]. Rev Med Suisse. 2014;10(428):981–5. Article in French.
  17. Diabete_et_Conduite.pdf [Internet]. [cited 2016 Jan 28]. Available from: https://cabinetzimmermann.ch/images/med-infos/Diabete/Diabete_et_Conduite.pdf
  18. HQIP-Guide-for-Clinical-Audit-Research-and-Service-Review-Revised. 2011.pdf [Internet]. [cited 2018 Jan 4]. Available from: https://www.hqip.org.uk/public/cms/253/625/19/190/HQIP-Guide-for-Clinical-Audit-Research-and-Service-Review-Revised%202011.pdf?realName=x5QijA.pdf
  19. Applied Survey Data Analysis in Stata 13 [Internet]. IDRE Stats. [cited 2018 Jan 5]. Available from: https://stats.idre.ucla.edu/stata/seminars/applied-svy-stata13/
  20. Statistique_mdicale_2016_de_la_FMH1.pdf [Internet]. [cited 2017 Jun 24]. Available from: https://contens30.fmh.ch/fmh/_files/pdf18/Statistique_mdicale_2016_de_la_FMH1.pdf
  21. Jang RW, Man-Son-Hing M, Molnar FJ, Hogan DB, Marshall SC, Auger J, et al. Family physicians’ attitudes and practices regarding assessments of medical fitness to drive in older persons. J Gen Intern Med. 2007;22(4):531–43. doi:.https://doi.org/10.1007/s11606-006-0043-x DOI: https://doi.org/10.1007/s11606-006-0043-x
  22. Marshall SC, Gilbert N. Saskatchewan physicians’ attitudes and knowledge regarding assessment of medical fitness to drive. CMAJ. 1999;160(12):1701–4.
  23. O’Caoimh R, Timmons S, Molloy DW. Screening for Mild Cognitive Impairment: Comparison of “MCI Specific” Screening Instruments. J Alzheimers Dis. 2016;51(2):619–29. doi:.https://doi.org/10.3233/JAD-150881 DOI: https://doi.org/10.3233/JAD-150881
  24. Horton DK, Hynan LS, Lacritz LH, Rossetti HC, Weiner MF, Cullum CM. An Abbreviated Montreal Cognitive Assessment (MoCA) for Dementia Screening. Clin Neuropsychol. 2015;29(4):413–25. doi:.https://doi.org/10.1080/13854046.2015.1043349 DOI: https://doi.org/10.1080/13854046.2015.1043349
  25. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9. doi:.https://doi.org/10.1111/j.1532-5415.2005.53221.x DOI: https://doi.org/10.1111/j.1532-5415.2005.53221.x
  26. Cullen B, O’Neill B, Evans JJ, Coen RF, Lawlor BA. A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatry. 2007;78(8):790–9. doi:.https://doi.org/10.1136/jnnp.2006.095414 DOI: https://doi.org/10.1136/jnnp.2006.095414
  27. Vaucher P, Choi M, Gélinas I, Harries P, Margot-Cattin I, Mazer B, et al. Development of the International Expert Advisory Panel on Community Health and Transport (I-CHaT) to coordinate research on transport mobility. Br J Occup Ther. 2017;81(5):245–6. DOI: https://doi.org/10.1177/0308022617733389
  28. Oudman E, Postma A, Van der Stigchel S, Appelhof B, Wijnia JW, Nijboer TCW. The Montreal Cognitive Assessment (MoCA) is superior to the Mini Mental State Examination (MMSE) in detection of Korsakoff’s syndrome. Clin Neuropsychol. 2014;28(7):1123–32. doi:.. Correction in: Clin Neuropsychol. 2014;28(8):1398–9https://doi.org/10.1080/13854046.2014.960005 DOI: https://doi.org/10.1080/13854046.2014.960005
  29. Alagiakrishnan K, Zhao N, Mereu L, Senior P, Senthilselvan A. Montreal Cognitive Assessment is superior to Standardized Mini-Mental Status Exam in detecting mild cognitive impairment in the middle-aged and elderly patients with type 2 diabetes mellitus. BioMed Res Int. 2013;2013:186106. doi:.https://doi.org/10.1155/2013/186106 DOI: https://doi.org/10.1155/2013/186106
  30. Larner AJ. Screening utility of the Montreal Cognitive Assessment (MoCA): in place of--or as well as--the MMSE? Int Psychogeriatr. 2012;24(3):391–6. doi:.https://doi.org/10.1017/S1041610211001839 DOI: https://doi.org/10.1017/S1041610211001839
  31. Hoops S, Nazem S, Siderowf AD, Duda JE, Xie SX, Stern MB, et al. Validity of the MoCA and MMSE in the detection of MCI and dementia in Parkinson disease. Neurology. 2009;73(21):1738–45. doi:.https://doi.org/10.1212/WNL.0b013e3181c34b47 DOI: https://doi.org/10.1212/WNL.0b013e3181c34b47
  32. Piersma D, Fuermaier ABM, de Waard D, Davidse RJ, de Groot J, Doumen MJA, et al. Prediction of Fitness to Drive in Patients with Alzheimer’s Dementia. PLoS One. 2016;11(2):e0149566. doi:.https://doi.org/10.1371/journal.pone.0149566 DOI: https://doi.org/10.1371/journal.pone.0149566
  33. Bowers AR, Anastasio RJ, Sheldon SS, O’Connor MG, Hollis AM, Howe PD, et al. Can we improve clinical prediction of at-risk older drivers? Accid Anal Prev. 2013;59:537–47. doi:.https://doi.org/10.1016/j.aap.2013.06.037 DOI: https://doi.org/10.1016/j.aap.2013.06.037
  34. Manning KJ, Davis JD, Papandonatos GD, Ott BR. Clock drawing as a screen for impaired driving in aging and dementia: is it worth the time? Arch Clin Neuropsychol. 2014;29(1):1–6. doi:.https://doi.org/10.1093/arclin/act088 DOI: https://doi.org/10.1093/arclin/act088
  35. Vaucher P, Herzig D, Cardoso I, Herzog MH, Mangin P, Favrat B. The trail making test as a screening instrument for driving performance in older drivers; a translational research. BMC Geriatr. 2014;14(1):123. doi:.https://doi.org/10.1186/1471-2318-14-123 DOI: https://doi.org/10.1186/1471-2318-14-123
  36. Bennett JM, Chekaluk E, Batchelor J. Cognitive Tests and Determining Fitness to Drive in Dementia: A Systematic Review. J Am Geriatr Soc. 2016;64(9):1904–17. doi:.https://doi.org/10.1111/jgs.14180 DOI: https://doi.org/10.1111/jgs.14180
  37. Mathias JL, Lucas LK. Cognitive predictors of unsafe driving in older drivers: a meta-analysis. Int Psychogeriatr. 2009;21(4):637–53. doi:.https://doi.org/10.1017/S1041610209009119 DOI: https://doi.org/10.1017/S1041610209009119
  38. Silva MT, Laks J, Engelhardt E. Neuropsychological tests and driving in dementia: a review of the recent literature. Rev Assoc Med Bras (1992). 2009;55(4):484–8. doi:.https://doi.org/10.1590/S0104-42302009000400027 DOI: https://doi.org/10.1590/S0104-42302009000400027
  39. Batool S, Roberts AP, Kalra L, Manawadu D. Health professionals’ knowledge of driving restrictions following stroke and TIA: experience from a hyperacute stroke centre. Postgrad Med J. 2014;90(1065):370–6. doi:.https://doi.org/10.1136/postgradmedj-2012-131395 DOI: https://doi.org/10.1136/postgradmedj-2012-131395
  40. Vogtle LK, Martin R, Russell Foushee H, Edward Faught R. A comparison of physicians’ attitudes and beliefs regarding driving for persons with epilepsy. Epilepsy Behav. 2007;10(1):55–62. doi:.https://doi.org/10.1016/j.yebeh.2006.09.003 DOI: https://doi.org/10.1016/j.yebeh.2006.09.003

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