Date Presented 04/06/19
This study compared performance in 101 drivers age 65 and older on the Useful Field of View and Trail Making Test–Part B to blinded ratings on the 4Cs screening tool completed by the driver’s personal physician. Previous studies reported the 4Cs showed promise predicting fitness to drive of at-risk drivers. Current results indicate the Trails-B may be a better office-based assessment for physicians to use to determine the need to recommend a comprehensive fitness to drive evaluation.
Primary Author and Speaker: Kathleen Golisz
Additional Authors and Speakers: Jeanine Stancanelli
PURPOSE: Physicians question if they can identify those older adults with diminished fitness to drive using a quick and simple office based assessment. An interview-based screening tool, the 4Cs Screening Tool (crash history, family concerns, clinical condition, and cognitive function; O’Conner, Kapust, Lin, Hossis, & Jones, 2010), has shown promise predicting behind-the-wheel performance. Occupational therapists performing clinic-based assessment of driving capabilities have relied on the Useful Field of View (UFOV; Owsley, McGwin, & Ball, 1998) and the Trail Making Test Part-B (TMT-B) test as these tools have strong evidence supporting their ability to predict behind-the-wheel driving performance (Classen, Wang, Crizzle, Winter, & Lanford, 2013). In this study, we compared performance on the UFOV and TMT-B to blinded ratings on the 4Cs by the driver’s personal physician.
DESIGN: The exploratory study involved a descriptive research design. A convenience sample of 101 drivers age 65 and older was recruited from a large physicians practice in a suburban metropolitan area.
METHOD: The participants completed components of the American Medical Association Assessment of Driving Related Skills (ADReS; visual acuity test, visual fields, Trail Making Test Part B, clock drawing test, Rapid Pace Walk, and manual tests of range of motion and motor strength; Carr, 2010) and the UFOV. Participants’ personal physicians completed the 4Cs screening. Descriptive statistics were used to examine demographic data and assessment results. Spearman’s rank correlation coefficient was used to explore correlations between results of the UFOV, TMT-B, and physicians’ blinded ratings of the 4Cs screening.
RESULTS: 4Cs screening results were completed by physicians on only 50 participants. No significant differences in performance were found between those participants on whom 4Cs results were obtained and those missing results in demographic data or performance on the UFOV or Trails-B. The 4Cs did not correlated to performance on the UFOV (r= .095, p=.512) or TMT-B (r= .267, p=.063). Scores on the 4Cs were in a narrow range suggesting the recruitment of a well-elderly population. Performance on the Trails-B was correlated to the UFOV performance Subtest 2 (r= .443, p=.001).
CONCLUSION: Although a behind-the-wheel assessment of driving performance would have strengthened this study, both the UFOV and TMT-B have strong predictive validity of on-road performance (Classen, Wang, Crizzle, Winter, & Lanford, 2013). The recruitment of a well elderly population may have also impacted study results. The results indicate that the Trails-B may be a better office-based assessment for physicians to recommend potentially at risk older drivers for a comprehensive fitness to drive evaluations than the 4Cs.
IMPACT STATEMENT: Occupational therapy should partner with physicians to identify older drivers who should be referred for comprehensive fitness to drive evaluations. The clinical usefulness and validity of the 4Cs screening tool should be questioned and further explored.
References
Carr, D. B. (2010). Physicians guide to assessing and counseling older drivers (2nd ed.). Chicago: American Medical Association
Classen, S., Wang, Y., Crizzle, A. M., Winter, S. M., & Lanford, D. N. (2013). Predicting older driver on-road performance by means of the Useful Field of View and Trail Making Test Part B. American Journal of Occupational Therapy, 67, 574–582. doi:10.5014/ajot.2013.008136.
O’Connor, M. G., Kapust, L.R., Lin, B., Hollis, A.M., & Jones, R. N. (2010). The 4Cs (crash, history, family concerns, clinical condition, and cognitive functions): A screening tool for evaluation of the at risk driver. Journal of the American Geriatrics Society, 61, 1164-1169. doi:10.1111/j.1532-5415.2010.02855.x
Owsley, C., McGwin, G., Jr. & Ball, K. (1998). Vision impairment, eye disease, and injurious motor vehicle crashes in the elderly. Ophthalmic Epidemiology, 5, 101–113. http://dx.doi.org/10.1076/opep.5.2.101.1574
