|Date added||June 17, 2014|
|Category||2014 CMRSC XXIV Vancouver|
|Tags||Research and Evaluation, Session 6B|
|Author/Auteur||Michel Bédard and Bruce Weaver|
|Stream/Volet||Research and Evaluation|
Slidedeck Presentation Only (no paper submitted)
Identifying senior drivers who may have a cognitive impairment affecting their ability to drive safely is a focus of many researchers. Some researchers have claimed to have found tools that achieve this goal with precision - we dispute such claims.
The focus of this presentation will be to highlight some of the major impediments towards identifying unsafe senior drivers while successfully supporting those who are safe.
We have reviewed the literature on cognition and driving in seniors.
We identified six important issues:
- We must focus on specificity (labeling safe drivers as “safe”) over sensitivity (identifying truly “unsafe” drivers). It is accepted that driving cessation can have negative consequences, that we are not facing a tsunami of unsafe senior drivers, that crashes are relatively rare events, and that senior drivers pose a greater risk to themselves (due to their frailty) than to others. Focusing first on specificity is the logical extension of these statements.
- We must understand the added value of tests over chronological age. Understanding the contribution of age to test results and ensuring that tests are more than just a proxy measure for age is necessary to justify their use.
- We must identify the most appropriate “gold standard” of “cognitive fitness to drive”. Current gold standards (e.g., on-road evaluations, crashes) are multi-factorial and best explained by more than just cognitive capacity. Hence, the assessment of cognition alone should be contrasted to a gold standard that represents the appropriate operationalization.
- We must use the word “classification” rather than “screening” when referring to brief tests of cognition. “Screening” as currently used in the driving literature is a misnomer. Tests are used to “classify” by determining whether one should be allowed to drive or not, or be required to undergo further evaluation. There is no attempt to identify proactively issues before they become a problem (as would be done in the Public Health sense of “screening”).
- We must follow the testing of senior drivers with actions that support their well-being. Testing serves a greater purpose than just “labeling” and taking away licenses. As such, we need to consider the beneficial nature of tests. For example, tests should highlight potential areas for remediation. License revocation should be followed by transportation mobility interventions.
- We must pay attention to “cargo-cult science” and conflicts of interest. “Cargo-cult science”, the conduct of flawed research under the guise of “science-based” research and/or the inability to objectively assess one’s own results, is not science. It may arise because of a lack of training, by being overly enthusiastic about one’s findings, or because of conflicts of interest.
We have presented six important issues that may help us make further progress on how to identify senior drivers who have a cognitive impairment that prevents them from driving safely, while avoiding false positives, and supporting safe drivers. Attention to these issues does not represent a drastic change in current practice but may spark a much-needed conversation to move the field forward.
Michel Bédard and Bruce Weaver