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Candrive—Development of a Risk Stratification Tool for Older Drivers
BACKGROUND: Assessing an older adult’s fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692431/ https://www.ncbi.nlm.nih.gov/pubmed/36794785 http://dx.doi.org/10.1093/gerona/glad044 |
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author | Marshall, Shawn Bédard, Michel Vrkljan, Brenda Tuokko, Holly Porter, Michelle M Naglie, Gary Rapoport, Mark J Mazer, Barbara Gélinas, Isabelle Gagnon, Sylvain Charlton, Judith L Koppel, Sjaan MacLeay, Lynn Myers, Anita Mallick, Ranjeeta Ramsay, Tim Stiell, Ian Wells, George Man-Son-Hing, Malcolm |
author_facet | Marshall, Shawn Bédard, Michel Vrkljan, Brenda Tuokko, Holly Porter, Michelle M Naglie, Gary Rapoport, Mark J Mazer, Barbara Gélinas, Isabelle Gagnon, Sylvain Charlton, Judith L Koppel, Sjaan MacLeay, Lynn Myers, Anita Mallick, Ranjeeta Ramsay, Tim Stiell, Ian Wells, George Man-Son-Hing, Malcolm |
author_sort | Marshall, Shawn |
collection | PubMed |
description | BACKGROUND: Assessing an older adult’s fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. METHODS: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. RESULTS: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81–9.84) compared to the lowest risk group. CONCLUSIONS: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation. |
format | Online Article Text |
id | pubmed-10692431 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106924312023-12-03 Candrive—Development of a Risk Stratification Tool for Older Drivers Marshall, Shawn Bédard, Michel Vrkljan, Brenda Tuokko, Holly Porter, Michelle M Naglie, Gary Rapoport, Mark J Mazer, Barbara Gélinas, Isabelle Gagnon, Sylvain Charlton, Judith L Koppel, Sjaan MacLeay, Lynn Myers, Anita Mallick, Ranjeeta Ramsay, Tim Stiell, Ian Wells, George Man-Son-Hing, Malcolm J Gerontol A Biol Sci Med Sci THE JOURNAL OF GERONTOLOGY: Medical Sciences BACKGROUND: Assessing an older adult’s fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. METHODS: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. RESULTS: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81–9.84) compared to the lowest risk group. CONCLUSIONS: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation. Oxford University Press 2023-02-16 /pmc/articles/PMC10692431/ /pubmed/36794785 http://dx.doi.org/10.1093/gerona/glad044 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | THE JOURNAL OF GERONTOLOGY: Medical Sciences Marshall, Shawn Bédard, Michel Vrkljan, Brenda Tuokko, Holly Porter, Michelle M Naglie, Gary Rapoport, Mark J Mazer, Barbara Gélinas, Isabelle Gagnon, Sylvain Charlton, Judith L Koppel, Sjaan MacLeay, Lynn Myers, Anita Mallick, Ranjeeta Ramsay, Tim Stiell, Ian Wells, George Man-Son-Hing, Malcolm Candrive—Development of a Risk Stratification Tool for Older Drivers |
title | Candrive—Development of a Risk Stratification Tool for Older Drivers |
title_full | Candrive—Development of a Risk Stratification Tool for Older Drivers |
title_fullStr | Candrive—Development of a Risk Stratification Tool for Older Drivers |
title_full_unstemmed | Candrive—Development of a Risk Stratification Tool for Older Drivers |
title_short | Candrive—Development of a Risk Stratification Tool for Older Drivers |
title_sort | candrive—development of a risk stratification tool for older drivers |
topic | THE JOURNAL OF GERONTOLOGY: Medical Sciences |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692431/ https://www.ncbi.nlm.nih.gov/pubmed/36794785 http://dx.doi.org/10.1093/gerona/glad044 |
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