Older Road Users, Myths and Realities: A Guide for Medical and Legal Professionals Book

Introduction

Chapter 1. Older Driver Crashes
Jim Langford
1.1 Introduction
1.2 Current Older Driver Crash Levels
A. Contribution to the Road Toll
B. Contribution to Hospital Admissions
C. Contribution to All Deaths
D. Conclusions
1.3 Do Older Drivers Have a Characteristic Crash Pattern?
A. Some Overseas Studies
B. Some Australian Studies
C. Conclusions
1.4 Are Older Drivers Likely to be Overly Responsible for Their Crashes?
A. The Difficulties in Attributing Crash Responsibility
B. Findings from the Research
C. Conclusions
1.5 Do Older Drivers Have a Heightened Crash Involvement?
A. Older Drivers' High Crash Rates per Distance Driven
B. Frailty Bias
C. Limitations in the Exposure Measurements-Low Mileage Bias
D. Conclusions
1.6 Are Older Drivers a Heightened Crash Risk to Other Road Users?
A. Findings from the Research
B. Conclusions
1.7 Summary and Conclusions

Chapter 2. Managing Older Driver Crash Risk
Judith Charlton, Ph.D., Sjaanie Koppel, Ph.D., Jim Langford, and Justine Irving
2.1 Introduction
2.2 What Are the Current Older Driver Licensing Practices?
A. Australian Licensing Procedures
B. International Licensing Procedures
C. Summary
2.3 Is There Evidence for Universal Licence Testing, Based on Age, as an Effective Strategy for Managing Older Driver Risk?
A. Summary
2.4 Alternative Approaches to Licensing
A. Outline of the Proposed Australasian Model
B. Assessment of Functional Ability
C. Levels of Assessment of the Model Procedure
D. Use of Valid and Reliable Testing Instruments
E. Community Referral
F. Range of OutcomeOptions for Older Drivers
G. Establishment of a Case Officer Position
H. Assessment Undertaken by Government and Non-government Agencies
2.5 Use of Conditional Licences
2.6 Balancing Safety and Mobility
2.7 Self-regulation as a Means of Reducing Risk
A. Findings from Research on Self-regulatory Practices
2.8 Summary and Conclusions

Chapter 3. Vision and the Ageing Driver
Joanne M. Wood, Ph.D.
3.1 Introduction
3.2 Normal Age-Related Vision Changes
3.3 Visual Function, Ageing and Driving
A. Visual Acuity
B. Visual Fields
C. Contrast Sensitivity
D. Dynamic Visual Acuity
E. Monocular Vision
F. Useful Field of View
3.4 Ocular Diseases in Older Populations
A. Cataracts
B. Glaucoma
C. Age-Related Maculopathy
D. Diabetic Retinopathy
E. Stroke
3.5 Implications for Licensing
3.6 Conclusions

Chapter 4. Older Road Users-Effects of Dementia and Cognitive Changes
Peteris Darzins, BMBS, Ph.D. and Michel B dard, Ph.D.
4.1 Introduction
4.2 Dementia and Other "Brain Failure Syndromes"
4.3 Pathology of the Dementing Processes
A. Alzheimer Dementia-Pathology
B. Vascular Dementia-Pathology
4.4 Dementia with Lewy Bodies-Pathology
4.5 Fronto-Temporal Dementia-Pathology
4.6 Clinical Features of the Dementing Illnesses
A. Alzheimer Dementia-Clinical Features
4.7 Vascular Dementia-Clinical Features
4.8 Mixed Dementia-Clinical Features
4.9 Dementia with Lewy Bodies-Clinical Features
4.10 Fronto-Temporal Dementia-Clinical Features
4.11 Other Dementing Illnesses
4.12 The Driving Task
4.13 Driving and Cognition
A. Stages of Alzheimer Dementia
B. Driving and Stage of Dementia Syndromes Other than Alzheimer Dementia
4.14 Incidence of Crashes in People with Dementia
4.15 Crash Patterns of Older Drivers
4.16 Driving Patterns of People with Cognitive Impairment
4.17 Differentiating "Safe" from "Unsafe" Drivers with Dementia
4.18 Management of Driving by People with Dementia
4.19 Conclusion

Chapter 5. Respiratory and Sleep Disorders in the Older Driver
Matthew T. Naughton, F.R.A.C.P.
5.1 Introduction
5.2 Respiratory Illnesses
A. Cigarette Smoking
B. Chronic Obstructive Pulmonary Disease
C. Pulmonary Fibrosis
D. Cough Syncope
E. Lung Cancer
F. Deep Venous Thrombosis and Pulmonary Emboli
G. Pneumothorax
H. Post Thoracotomy
I. Asthma
5.3 Sleep Disorders
A. Sleep Deprivation
B. Sleep Apnoea
5.4 Summary

Chapter 6. Driving and the Elderly: Neurological Conditions
Mark Cook, M.D.
6.1 Introduction
6.2 Stroke
6.3 Dementia
6.4 Parkinson's Disease (PD)
6.5 Head Injury
6.6 Drugs
6.7 Epilepsy
6.8 Conclusions

Chapter 7. Road Safety Effects of Prescription Drugs in the
Older Driver
Olaf H. Drummer, Ph.D.
7.1 Introduction
7.2 Terminology Used in Epidemiological Studies
7.3 Baseline Culpability
7.4 Alcohol
7.5 Drugs Other than Alcohol
A. Benzodiazepines
B. Anti-Depressants and Other Mood Altering Drugs
C. Anti-Diabetic Drugs
D. Anti-Coagulants
E. Opiates
F. Other Drugs
7.6 Conclusions

Chapter 8. Diabetes and the Older Road User
Trisha Dunning, Ph.D.
8.1 Diabetes
8.2 Incidence of Traffic Crashes in Older People with Diabetes
8.3 Effects on Driving Ability Related to Diabetes
8.4 Functional Impairment and Disability
A. Physical
B. Depression and Cognitive Functioning
C. Hyperglycaemia
D. Hypoglycaemia
8.5 Self-Care Knowledge and Behaviours
8.6 Improving Driving Safety in Older People with Diabetes
8.7 Summary

Chapter 9. Walking for Older Road Users: A Safe Alternative to the Car?
Jennie Oxley, Ph.D.
9.1 Introduction
9.2 Walking: Benefits and Drawbacks
9.3 Crash Types
9.4 Why the Over-Involvement of Older Adults in Pedestrian Crashes?
A. Vulnerability
B. Pedestrian Behaviour
C. Vehicle Design
D. The Road and Traffic Environment
9.5 Achieving Safe Pedestrian Environments
9.6 Safer Road Users
9.7 Safer Vehicles
9.8 Safer Roads
A. Moderating Vehicle Speeds
B. Separation of Vehicles and Pedestrians
C. Simplification
9.9 Summary and Conclusions

Chapter 10. Medical Review of Older Road Users
Morris Odell, M.B., B.S.
10.1 Introduction
10.2 Licensing Guidelines
10.3 The Role of Health Professionals
10.4 Medical Assessment of Fitness to Drive
10.5 Principles of Medical Driver Assessment
A. History
B. Examination
C. Investigations
D. Specialist Assessment
10.6 Driving Restrictions and Licence Conditions
10.7 Conclusion

Chapter 11. Assessing Older Drivers with Health-Related Problems:
An Occupational Therapy Approach
Carolyn Unsworth, Ph.D.
11.1 Introduction
11.2 Who Are OT Driver Assessors and What Do They Do?
11.3 Occupational Therapy Driver Assessment Processes and Reporting: Systems in Australia (Victoria), the U.S., U.K. and Sweden 241
11.4 Profile of Older Drivers Evaluated by Occupational Therapists
11.5 The Skills Needed to Be a Safe Driver, and the Impact of Age on
These Skills
11.6 Off-Road Driver Assessment for Older Adults
A. Driving Simulators
11.7 On-Road Driver Assessment for Older Adults
11.8 Rehabilitation and Strategies to Maintain Driving Independence
11.9 Future Directions in Driver Assessment and Rehabilitation Research
11.10 Summary and Conclusion

Chapter 12. Older Drivers Killed on the Road-Analysis of Data from Coroner's Files
Morris Odell, M.B., B.S., and Olaf H. Drummer, Ph.D.
12.1 Background
12.2 Method
12.3 Results
A. Alcohol and Drugs
B. Medical Diseases
C. Culpability Analysis
12.4 Discussion

Chapter 13. The End of Driving
Nadia Mullen, Ph.D. and Michel B dard, Ph.D.
13.1 The End of Driving
13.2 Depressive Symptoms
13.3 Impact on Daily Activities
13.4 Impact on Others
13.5 Positive Effects
13.6 Moderating Factors
13.7 Managing Transport Needs
13.8 Preparation
13.9 Conclusion