Why Older Drivers have Difficulty

 It may surprise you to know that older driver's actually see more than younger drivers.  And that is why they have difficulty driving.

It turns out that as the brain ages, the visual intake gets bigger.  Older brains attempt to take in the background of all motion in their field of vision.  This makes the brain's ability to focus on relevant movement, important when reacting to driving movements, more difficult.

In a healthy, young person, a brain region called the middle temporal visual area, or MT, actively suppresses often irrelevant background motion so that he or she can concentrate on t

he more important motions of smaller objects in the foreground.

But this above average motion perception is not something to look forward to as we age. Because the brain is spending its limited resources constantly paying attention to the unimportant motions of background objects, it has a harder time noticing the motions of smaller objects.

Fellow blogger, Dr. Virginia Campbell, recently posted an interview the authors of "Sleights of Mind: What the Neuroscience of Magic Reveals about Our Everyday Deceptions" by Stephen L. Macknik, Susana Martinez-Conde, Sandra Blakeslee.  This book is the result of the authors' yearlong, world-wide exploration of magic and how its principles apply to our behavior. Magic tricks fool us because humans have hardwired processes of attention and awareness that are hackable—a good magician uses your mind's own intrinsic properties against you in a form of mental jujitsu.

You can read about the findings in the Journal of Neuroscience.

 

Dementia and Driving

When my grandmother got old enough to officially be considered "blind" we decided it was time to take away her car and driving ability.  First off, I bought her the car a few years ago and so she spent her last years driving a new sporty car as opposed to the 20 year old Toyota her late husband left her.  And second, I moved her in with me to help make up for the transportation burden.  We drive her wherever she needs to go.  But a responsible decision needed to be made to get her less than safe driving skills off the road.  For her sake, our sake, and most importantly, for the sake of other drivers and passengers including little babies.

But taking away an elder's ability, or right, to drive is a dire move.  It supports the reality that as we age, more and more is taken away from us.

Dementia from normal aging also requires difficult decisions regarding driving.  Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.And since, statistically, those who suffer brain injury are more likely than not to develop dementia, driving may be an issue for those with mild and moderate brain injury.

Caregiver.org blogs "As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Individuals with moderate or severe dementia should not drive."

Insurance Company studies state Yes, there is enough small-scale research to tell us that over time, driving and dementia don't mix. The harder question is exactly when driving skills deteriorate? This question is harder to answer and the research is not clear enough to give a simple answer. That is why we recommend an approach that includes observation of driving skills right from the point of diagnosis and planning ahead for the time when the person must stop driving.

The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Dementia reveals itself in many ways.  For example Dementia symptoms include difficulty with many areas of mental function, including:

Language
Memory
Perception
Emotional behavior or personality
Cognitive skills (such as calculation, abstract thinking, or judgment)

 The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.

Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:

Decreased miles being driven

Collisions

Moving violations

Avoiding certain driving situations, such as driving at night or in the rain

Aggressive or impulsive personality traits.

Read the full report and guidelines at www.neurology.org/cgi/rapidpdf/WNL.0b013e3181da3b0fv1.pdf.

Driving After TBI

One of the problems associated with TBI is the person's ability to drive and lack of insight as to that ability.  I came across this interesting article on the topic of evaluating driving following a TBI.  Keep in mind that statistics tell us that 10% of TBI's are severe or moderate.  80% are mild.  The following is a summary of the study.

 OBJECTIVE. We conducted a literature review of assessment tools predicting driving performance for people with traumatic brain injury (TBI).

METHOD. Data sources were Web of Science, EBSCOhost, PubMed, and recently published literature from experts and team members not yet catalogued in the databases. We used the American Academy of Neurology's classification criteria to extract data from 13 studies, and we assigned a class (I-IV, with I being the highest level of evidence) to each study. We grouped primary studies into categories of driving assessment (neuropsychological; simulator; off-road; self-report, other report, and postinjury disability status; and comprehensive driving evaluation) and synthesized the predictability of these tools as it relates to driving performance for people with TBI.

CONCLUSIONS. To assist clinicians and researchers in making decisions regarding testing the driving performance of people with TBI, we provide recommendations for neuropsychological tests; off-road tests; self-report, other report, and postinjury disability status; and comprehensive driving evaluation.
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Read the entire article with references here:  C; Charles Levy; Dennis McCarthy; William C Mann; Desiree Lanford; J Kay Waid-Ebbs. "Traumatic Brain Injury and Driving Assessment: An Evidence-Based Literature Review." The American Journal of Occupational Therapy. The American Occupational Therapy Assn, Inc. 2009. HighBeam Research. 29 Sep. 2009 <http://www.highbeam.com>.