Relationship Between Driver's License Renewal Policies and Fatal Crashes Involving Drivers 70 Years or Older. David T. Levy, et al. JAMA, October 4, 1995 - Vol 274, No. 13
Epilepsy and Driving: A Survey of Canadian Neurologists. Richard McLachlan et al. Can. J. Neurol. Sci. 1997; 24:345-349
Eight question survey of neurologists across Canada. Main findings: neurologists report seizures much more than other neurological conditions; mandatory reporting legislation does make a difference in terms of the frequency of reporting by the provinces' neurologists; disagreement exists among neurologists on minimum length of time a patient should be seizure free to be given 'clearance'. No reason given as to why seizures are treated differently, other than suggesting a possible common misperception that seizures specifically is reportable.
Epilepsy, driving laws, and patient disclosure to physicians. MC Salinsky et al. Epilepsia 1992; 33:459-472.
Consensus statements, sample statutory provisions and model regulations regarding driver licensing and epilepsy. American Academy of Neurology, American Epilepsy Society, Epilepsy Foundation of America Epilepsia 1994; 35:696-705.
Knowledge, Attitudes, and Practices of Geriatricians Regarding Patients with Dementia Who are Potentially Dangerous Automobile Drivers: A National Survey Greg Cable et al. J. American Geriatrics Society 2000; 48:14-17.
Four question survey of geriatricians in the U.S. Compares Californian geriatricians vs. geriatricians in other states, b/c California has a well established mandatory reporting system for physicians. Nearly 30% of geriatricians across the U.S. do not know the steps required to report unfit drivers. In California, this number is reduced to 9%, indicating that legislation can make a difference wrt knowledge, but perhaps not the behaviour (as the rates of whether Californian geriatricians who would contact the appropriate authority is not that much higher compared to non-Californian practitioners).
(But is the better knowledge due to mandatory legislation or b/c of better educational campaigns by the state medical body? Or there could be an indirect effect, as the latter could be as a result of the former.)
A survey of attitudes and knowledge of geriatricians to driving in elderly patients. Neil D. Gillespie et al. Age and Ageing 1999; 28:53-57.
Questionnaire of British geriatricians consisting of 5 questions and 5 brief case histories (mild dementia; severe dementia; Parkinson's disease; cardiac arrythmia; patient with pacemaker). In the UK, only the patient is responsible for reporting the medical condition, not the physician. Accordingly, the geriatricians see themselves as advisors to their patients and not as 'enforcers of the road'. Many geriatricians have a poor knowledge of current legislation, and reporting patients is only done reluctantly (only as a last resort).
Ethical Challenges Posed by Dementia and Driving. Jeffrey T. Berger et al. The Journal of Clinical Ethics 2000;
Review/Opinion paper. Argues that a breach of confidentiality (ie. reporting) is only justifiable if it only translates into "meaningful safety enhancements". The main thrust (as far as I understand it) is that instead of sticking to blanket policies, physicians should make decisions on a case-by-case basis when deciding to report in order to be optimally ethical. However, it seems that current mandatory legislation such as those in Ontario might preclude this, as physicians are bound to report a patient with any condition that may affect his/her driving.
A Survey of the Impact of Driving Cessation on Older Drivers. Nahid Azad et al. Geriatrics Today 2000; 5:170-174.
Telephone survey of 79 elderly individuals who had received recommendations to stop driving from doctors. Among those who did cease driving, they relied to on family and friends to perform some of their activities of daily living (ADL). However, it was found that driving cessation had a more negative impact on their leisure than their ADL -- a possible reason cited is that the patients might have felt reluctant to ask for help in "non-essential" activities. The lack of helpful public transportation in many communities was noted.
7.6% had gone against the recommendation and had not stopped driving.
The Demented Driver: The Doctor's Dilemma. L. Jaime Fitten et al. Alzheimer Disease and Associated Disorders 1997; 11 Suppl 1:57-61.
Review paper on dementia and driving. Presents evidence from other studies that even those with mild dementia cannot drive safely. Mentions the Sepulveda Road Test (SRT), a special road test that they developed as having a good correlation to real world safe driving performance.
Alzheimer and Vascular Dementias and Driving. A prospective road and laboratory study. L. Jaime Fitten et al. JAMA 1995; 273:1360-5.
Are Elderly Drivers A Road Hazard?: Problem Definition and Political Impact. Roger W. Cobb et al. Journal of Aging Studies 1998; 12:411-427.
Review paper of the political landscape surrounding the elderly driver. Provides a social science framework to understand the issues, as presented by the expanders (ie. those who want stricter controls) and the containers (ie. those who want minimal or no controls such as the American Association of Retired Persons)
Attitudes of Primary Care Physicians Toward Older Drivers: A Finnish-Swedish Comparison. Liisa Hakamies-Blomqvist et al. The Journal of Applied Gerontology 2002; 21:58-69.
Survey of primary care physicians in the two countries. In Finland, strict health controls (periodic mandatory health checks) exist for elderly drivers, whereas in Sweden, they don't. In both countries, reporting by physicians is not required. So this study attempts to see if different health controls make any difference. Their findings are that both groups do not differ in terms of their knowledge, but that Finnish are (unjustifiably) more confident in their own abilities to determine medical fitness to drive.
Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive. Shawn C. Marshall et al. CMAJ 1999; 1701-1704.
Survey of Saskatchewan physicans (both family doctors and specialists). An interesting finding is that most of the doctors (85.5%) support the idea of restricted licensing as a fair alternative to those who would be denied the full licence. But, as far as I know, there are no studies that can show restricted licencing is effective in decreasing the number of crashes. And where does the idea of restricted licencing come from? Is it in effect anywhere?
Created on ... June 3, 2003
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