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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
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.
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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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