Title: Understanding the views of older adults and people living with Mild Cognitive Impairment on driving and fitness to drive
Funder: Economic and Social Research Council

Abstract: Whilst population aged over 70 continues to increase, with associated increased multi-morbidities (especially neurological and cognitive) there is a need to assess safety of driving more accurately, and at scale so that those at high risk of driving accidents can be detected without unduly affecting the majority who remain safe to drive with very low risk of causing an accident. Finding new means to evaluate fitness to drive that are accurate, reflect real world driving conditions and are scalable is crucial. This is especially daunting in the context of an aging population in which the burden of co-morbidity and polypharmacy are growing. Currently driving risk is assessed by self-reports or by medical reports, that take into account factors such as whether the person presents poor short-term memory, disorientation, lack of judgment, attention disorders, that do not accurately reflect safety to drive. For those with affected by cognitive impairments, detailed, time-consuming and expensive neuropsychological testing are undertaken in a minority and the usefulness of these in terms of predicting driving ability is unknown. Identifying new means of assessing driving behaviour and feeding back to drivers will provide support and foster self-management, which in turn will help keep more safe drivers on the road. The project will conduct a stakeholder's identification and user requirement phase to elicit requirements and specifications for the identification and evaluation of driving behaviour; its relationship with fitness to drive and of potential feedback mechanisms to the drivers. The focus will be first a small population of participants as representatives of healthy drivers aged over 70 and people living with MCIs (pwMCI). Data collected from participants will then be analysed and correlated to their medical diagnosis. Specific behaviour and patterns that might indicate risk will be identified.

Lay abstract: Unfitness to drive is a major contributing factor of road crashes and age-related neurodegenerative conditions are a growing area of concern for road safety. With life expectancy constantly increasing, the number of elderly drivers will increase proportionally (people aged over 70 represents 6% of all UK driving licences). At the same time, driving is a key part of maintaining independence especially in rural areas where public transport is less able to match the flexibility of driving one's car. The Department for Transport (DfT) and DVLA places no restrictions on elderly drivers and there is no evidence that older drivers are at increased risk of traffic accidents. However, age is associated with other medical conditions where the DVLA guidance is determined by symptoms or medical reports. For example, people with certain types of heart failure may drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving and need not notify the DVLA. A very common condition associated with ageing is Mild Cognitive Impairment (MCI), a state in between normal ageing and brain function and that of abnormal ageing and dementia. In response to the National Dementia Strategy in 2008 and the Prime Minister's Challenge there has been an increase in people referred to memory clinics from 202 per clinic to 1579 per clinic between 2008/9 and 2014 (a 682% increase). The 2019 national memory clinic audit found that 17% of people attending memory clinics are diagnosed with MCI. Therefore approximately 270 new cases of MCI are diagnosed in each memory clinic. Currently driving risk is assessed by self reports or by medical reports, that take into account factors such as whether the person presents poor short-term memory, disorientation, lack of judgment, attention disorders. , that do not accurately reflect safety to drive. For those with affected by cognitive impairments, detailed, time-consuming and expensive neuropsychological testing are undertaken in a minority and the usefulness of these in terms of predicting driving ability is unknown. On referral from a specialist or GP, specialist driving assessment tests can be carried out. In the UK specialist driving assessment centres carry out detailed driving assessments for people with a medical condition which can affect their driving. The DVLA guidance divides MCI into those with, "No likely driving impairment' and those with, 'Possible driving impairment'. Elderly drivers or people with MCI are not at an increased risk of accident, however they might struggle in certain circumstances such as high speed junctions, high-speed roundabouts and slip roads onto motorways, where drivers are required to look around and make quick decisions. Therefore it is important to investigate new means to understand individual driving risks. In car monitoring technology to measure real-world driving may be a cheaper and more accurate measure of on the road driving behaviour and may better compare with cognitive function. Furthermore, it can detect particular areas of concern such as high-speed junctions, motorways etc so that advice and potentially driving awareness education sessions could be delivered to reduce risk of accidents. In this project we will collect real world driving behaviour data from patients with MCI and healthy elderly to understand any links between their diagnosis, standardised cognitive function tests and driving behaviour. This could help detect those at most risk and develop interventions to introduce graduate driving licenses that better support an evolving condition. We will take into account the views of different stakeholders by arranging a series of workshops with a group of healthy elderly and a group of people with MCI, plus opinions and views and we disseminate other stakeholders such as DfT, DVLA, insurance companies, Age UK and dementia charities such as Alzheimer research UK and Alzheimer Society and Sheffield Dementia advisory group.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH