[Driving competence in older age: psychological assessment and interventions]. / Fahrkompetenz im Alter: Psychologische Diagnostik und Interventionen.

The article introduces the issue of psychological assessment and training for driving safety, driving competence, and the mobility of older drivers. The psychological methods for assessing driving competence and the training approaches for maintaining mobility in old age are outlined and illustrated with examples. Preserving driving ability in old age remains a task for which development needs and research gaps must be specified. Although periodic mandatory examinations based on age do not yield any relevant improvement in enhancing traffic safety, they do not cause harm and are widely accepted. It is desirable to move away from a theory focusing on deficits of older age and instead develop an assessment of the comprehensive functions, abilities, and resources of elderly drivers to help preserve the mobility and participation of that specific demographic in traffic.

Australian medical practitioners' perspectives about current practice relating to fitness to drive assessment for older people with dementia and mild cognitive impairment: A qualitative study.

OBJECTIVES: To describe the perspectives of Australian medical practitioners about current practice, and the potential benefit of tools and resources to support fitness to drive assessment for older people with dementia and mild cognitive impairment (MCI). METHODS: Semi-structured interviews with 22 medical practitioners from cognitive/memory clinics, hospitals, general practice and driving fitness assessment services in Australia. Reflexive thematic analysis was conducted. RESULTS: Two overarching themes were generated: (1) Uncomfortable decisions, describing feelings of discomfort expressed by practitioners about making fitness to drive recommendations, with two subthemes: (a) 'Feeling uncertain' and (b) 'Sticking your neck on the line'; and (2) Easing the discomfort, describing participants' desire for tools/resources to support practitioners to increase comfort with fitness to drive recommendations, with two subthemes: (a) 'Seeking certainty' and (b) 'Focusing on the process' conveying two different perspectives about how this may be achieved. There was a desire for a new in-office assessment tool capable of accurately predicting fitness to drive outcomes and views that an evidence-based clinical pathway could improve practitioners' confidence in decision-making. CONCLUSIONS: Perceptions of discomfort relating to fitness to drive assessment of older people with dementia and MCI exist amongst medical practitioners from health-care settings across Australia. In the absence of a well-validated in-office assessment tool, practitioners may benefit from an evidence-based clinical pathway to guide driving recommendations.

Fatores sociodemográficos e clínicos associados à força de preensão manual de idosos condutores de veículos / Sociodemographic and clinical factors associated with handgrip strength in elderly automobile drivers / Factores sociodemográficos y clínicos asociados a la fuerza de prensión de la mano en conductores de vehículos de ancianos

Objetivo: investigar a associação entre força de preensão manual e características sociodemográficas e clínicas de idosos condutores de veículos automotores. Método: estudo transversal, realizado em clínicas de medicina de tráfego na cidade de Curitiba/Paraná, com 421 idosos (≥ 60 anos). Realizou-se análise estatística pelo modelo de Regressão Logística e Teste de Wald, considerando intervalo de confiança de 95% e valores de p <0,05 como significativos. Resultados: oitenta e quatro (20%) idosos apresentaram força de preensão manual reduzida. A força de preensão manual reduzida foi associada à faixa etária (p=0,001) e à hospitalização no último ano (p=0,002). Conclusão: houve associação significativa entre a força de preensão manual de idosos motoristas e as variáveis idade e hospitalização no último ano. Dessa forma, torna-se essencial a inclusão de avaliações específicas, centradas nas variáveis sociodemográficas e clínicas próprias da pessoa idosa, durante o exame de aptidão para dirigir veículos automotores.(AU)

Objective: to investigate the association between handgrip strength and sociodemographic and clinical characteristics of elderly automobile drivers. Method: cross-sectional study, carried out in traffic medicine clinics in the city of Curitiba/Paraná, with 421 elderly people (≥ 60 years old). Statistical analysis was performed using the Logistic Regression model and the Wald Test, considering a 95% confidence interval and p values <0.05 as significant. Results: eighty-four (20%) seniors had reduced handgrip strength. Reduced handgrip strength was associated with age group (p=0.001) and hospitalization in the last year (p=0.002). Conclusion: there was a significant association between the handgrip strength of elderly drivers and the variables age and hospitalization in the last year. Thus, it is essential to include specific assessments, centered on sociodemographic and clinical variables specific to the elderly person, during the aptitude test to drive automobiles.(AU)

Objetivo: investigar la asociación entre la fuerza de prensión de la mano y las características sociodemográficas y clínicas de los ancianos conductores de vehículos automotores. Método: estudio transversal, realizado en clínicas de medicina de tránsito de la ciudad de Curitiba/Paraná, con 421 ancianos (≥ 60 años). El análisis estadístico fue realizado por el modelo de Regresión Logística y Test de Wald, considerando intervalo de confianza de 95% y valores de p <0,05 como significativos. Resultados: 84 (20%) sujetos ancianos presentaron reducción de la fuerza de prensión de la mano. La reducción de la fuerza de prensión de la mano se asoció al grupo de edad (p=0,001) y a la hospitalización en el último año (p=0,002). Conclusión: hubo una asociación significativa entre la fuerza de prensión de la mano de los conductores ancianos y las variables edad y hospitalización en el último año. Así pues, es esencial incluir evaluaciones específicas, centradas en las variables sociodemográficas y clínicas de los ancianos, durante el examen de aptitud para conducir vehículos automotores.(AU)

Driving Errors Predicting Pass/Fail On-Road Assessment Outcomes Among Cognitively Impaired Older Drivers.

Older drivers with cognitive impairment (CI)/dementia make significantly more driving errors than healthy controls; however, whether driving errors are predictive of pass/fail outcomes in older drivers with CI/dementia are unclear. This study determined the driving errors that predicted failing an on-road assessment in drivers with CI. We retrospectively collected comprehensive driving evaluation data of 80 participants (76.1 ± 9.3 years) from an Ontario driving assessment center. Adjustment to stimuli (area under the curve [AUC] = 0.88), lane maintenance (AUC = 0.84), and speed regulation errors (AUC = 0.85) strongly predicted pass/fail outcomes. Worse performance on the Trails B (time) and Useful Field of View® (Subtest 2, Subtest 3, and risk index) were significantly correlated with adjustment to stimuli (p < .05), lane maintenance (p < .05), and speed regulation errors (p < .05). Adjustment to stimuli, lane maintenance, and speed regulation errors may be critical indicators of failing an on-road assessment in older drivers with CI. Prioritizing these errors may help identify at-risk drivers.

Fitness to Drive: It is Time for Evidence-Based Consensus and Italian Guidelines for Medical Driving Assessment.

European Union (EU) and non-EU countries have adopted different medical procedures for the issuance and renewal of a driver's license showing relevant matters of concern. In Europe, EU directives have been only partially supplemented with national laws, and there is a paucity of evidence-based criteria and methods for fitness-to-drive assessment. For instance, there is no agreement on standards for establishing which is the competent authority charged with the medical examination. Furthermore, license conditions, restrictions, or vehicle modifications, which appear as "limited use" codes on the driver's license are not regulated. This may generate confusion and deformity when it comes to the medico-legal evaluation, with potential ethical implications due to lack of transparency and equity and legal disputes between citizens and competent authorities. In this article, Italian experts on fitness-to-drive medical assessment highlight some major issues concerning the medical driving assessment activity in the EU. The Italian experience is shown as a case study, which is representative of other EU member states, for launching a call for evidence-based consensus documents and scientific guidelines on this topic, which may be helpful to international regulators and medico-legal stakeholders.

A safety score for the assessment of driving style.

OBJECTIVE: Road traffic laws explicitly refer to a safe and cautious driving style as a means of ensuring safety. For automated vehicles to adhere to these laws, objective measurements of safe and cautious behavior in normal driving conditions are required. This paper describes the conception, implementation and initial testing of an objective scoring system that assigns safety indexes to observed driving style, and aggregates them to provide an overall safety score for a given driving session. METHODS: The safety score was developed by matching safety indexes with maneuver-based parameter ranges processed from an existing highway traffic data set with a newly developed algorithm. The concept stands on the idea that safety, rather than suddenly changing from a safe to an unsafe condition at a certain parameter value, can be better modeled as a continuum of values that consider the safety margins available for interactions among multiple vehicles and that depend on present traffic conditions. A sensitivity test of the developed safety score was conducted by comparing the results of applying the algorithm to two drivers in a simulator who were instructed to drive normally and risky, respectively. RESULTS: The evaluation of normal driving statistics provided suitable ranges for safety parameters like vehicle distances, time headways, and time to collision based on real traffic data. The sensitivity test provided preliminary evidence that the scoring method can discriminate between safe and risky drivers based on their driving style. In contrast to previous approaches, collision situations are not needed for this assessment. CONCLUSIONS: The developed safety score shows potential for assessing the level of safety of automated vehicle (AV) behavior in traffic, including AV ability to avoid exposure to collision-prone situations. Occasional bad scores may occur even for good drivers or autonomously driving vehicles. However, if the safety index becomes low during a significant part of a driving session, due to frequent or harsh safety margin violations, the corresponding driving style should not be accepted for driving in real traffic.

Life is a highway: Driver's license acquisition and social determinants for youth in foster care and their non-foster care peers.

BACKGROUND: Data regarding the connection between driver licensure and social determinants for youth could provide insight into the impact of driver license acquisition. These relationships are important for youth overall and particularly for foster youth given that adolescents in foster care obtain driver's licenses less often than their non-foster care peers. This integrative review explores the association between driver licensure and social determinants. METHODS: Whittemore and Knafl guidelines were used to conduct the integrative review. The articles were identified in collaboration with an expert in library science and public health. Results were organized by the Healthy People 2030 (HP 2030) Social Determinants of Health (SDOH) model. RESULTS: Six studies were included. Social and community context included social support structures helping youth get driver's licenses. Economics, including income and education, influenced license acquisition. Driver license acquisition was associated with improved well-being, security, and mental health. CONCLUSION: While fewer of those living in urban, walkable neighborhoods with access to public transportation were licensed, results from other studies suggest that car access is associated with psychological well-being. Further, licensure is disproportionately lower for populations historically marginalized from equal housing, education, and employment opportunities. Licensure plays a role in well-being.

A decision tree to determine fitness to drive in epilepsy: Results of a pilot in two Australian states.

OBJECTIVE: Certification by treating physicians of fitness to drive in people with epilepsy creates a conflict of interest that may result in unsafe decisions, damage the doctor-patient relationship, expose the physician to legal liability and prevent optimal treatment. Ideally, the treating physician should provide objective clinical information to the driver licensing authority (DLA), which then determines fitness or otherwise. However, DLAs in Australia do not employ medical staff and the national standards are complex. Fitness is determined by the treating physician, according to published national standards. The purpose of this study was to determine the feasibility of using a decision tree to determine fitness, according to the Australian standards. METHODS: A decision tree was constructed to use clinical data to determine whether a patient met the national standard to drive a private motorcar, failed to meet it or required further assessment. A form was designed to collect the necessary clinical data from the treating physician. A computerized version of the decision tree was then used in a pilot in two Australian states in parallel with the existing certification system. Four hundred thirty-nine drivers with declared epilepsy and their treating physicians were invited to participate when their annual driver licence review was due. RESULTS: Two hundred fifty-three (58%) forms were returned. All patients were considered fit to drive by their physician. Seventy-six percent had not had a seizure for over two years. In 88.1%, there was agreement between the decision tree and treating physician, with 3.6% identified by the decision tree as requiring review. Although considered fit by their physician, 6.3% did not meet the national standard to drive. SIGNIFICANCE: The decision tree model is a practical alternative to fitness certification by treating physicians. This Australian pilot can serve as a model for applying objective standards to driving assessments in other jurisdictions, using local driving standards. It has the potential to improve road safety by avoiding the negative effects of certification by treating physicians and can cope with complex standards. It is now in use in two states of Australia.

Utility of a novel simulator paradigm in the assessment of driving ability in individuals with and without attention-deficit hyperactivity disorder.

This study aimed to evaluate the utility of a novel, more cost-effective driving simulator, Assetto Corsa (AC), in detecting differences in driving performance between individuals with and without ADHD. Driving simulators are a useful means of assessing driving performance in those with attention-deficit hyperactivity disorder (ADHD); however, they are frequently expensive and thus unavailable to many researchers. A total of 87 participants (16 with ADHD, 71 without) completed an AC driving simulator task. They also completed computerized measures of attention and executive functioning and a questionnaire assessing self-reported driving behaviors and anger, ADHD and related symptoms, and mind wandering. Relative to those without ADHD, participants with ADHD reached higher average ground speeds and more greatly utilized the throttle. They also applied higher maximum pressure to the throttle and brake pedals. Within the full sample, greater mind wandering was associated with average and maximum throttle pressure and maximum ground speed. Findings confirm prior works indicative of a deleterious effect of ADHD diagnosis on simulator performance and may be attributed to a combination of impulsivity and mind wandering.

Effect of Navigation Problems, Assessment Location, and a Practice Test on Driving Assessment Performance for People with Alzheimer's Disease.

BACKGROUND: People with Alzheimer's disease may be required to undertake clinical and on-road assessments to determine fitness to drive. The manner in which on-road assessments are conducted with drivers who do and do not have navigational problems may affect the outcome. OBJECTIVES: Investigate the effect of 1) navigational difficulties, 2) location of assessment (un/familiar area) and assessment order, and 3) undertaking a second assessment (practice), on passing an on-road driving assessment. METHODS: Forty-three drivers undertook an Occupational Therapy-Driver Assessment Off Road Assessment (OT-DORA) Battery which included the Drive Home Maze Test (DHMT). Participants with/without a history of navigational problems were randomly allocated into three groups: 1) Unfamiliar/then familiar area assessment; 2) Unfamiliar/unfamiliar; 3) familiar/unfamiliar. An on-road assessment protocol was used including over 100 expected behaviors at nominated points along the directed route. For familiar area assessments, the driver self-navigated from their home to shops and services. A pass/fail decision was made for each assessment. RESULTS: A generalized linear mixed effects model showed neither location, nor practice affected passing the on-road assessment. Participants with navigational problems were six times less likely to pass regardless of route familiarity and direction method, and the DHMT was a significant negative predictor of passing. CONCLUSION: Drivers with Alzheimer's disease who have navigational problems and are slow to complete the DHMT are unlikely to pass an on-road assessment. However, navigation and maze completion skills may be a proxy for an underlying cognitive skill underpinning driving performance.

Predicting fitness-to-drive following stroke using the Occupational Therapy - Driver Off Road Assessment Battery.

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.

Characterizing on-road driving performance in individuals with traumatic brain injury who pass or fail an on-road driving assessment.

OBJECTIVE: To characterise on-road driving performance in individuals with traumatic brain injury who fail on-road driving assessment, compared with both those who pass assessment and healthy controls, and the injury and cognitive factors associated with driving performance. STUDY DESIGN: Cross-sectional. METHODS: Forty eight participants with traumatic brain injury (Age M = 40.50 SD = 14.62, 77% male, post-traumatic amnesia days M = 28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures. RESULTS: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills. CONCLUSIONS: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs. Implications for rehabilitation Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries. Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres. Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury. Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.

Safe return to driving following severe acquired brain injury: role of a short neuropsychological assessment.

BACKGROUND: Driving is a complex ability requiring a broad range of motor, cognitive-behavioral and visual skills that may be impaired after severe acquired brain injury (sABI). Resumption of driving is perceived as a major need by patients, being closely linked to personal autonomy, work and social activities. AIM: The objective of this study was to identify a short battery of neuropsychological tests with predictive value with regard to safe return to driving after sABI. DESIGN: Observational study. SETTING: Outpatient of a rehabilitation center for sABI. POPULATION: A continuous series of 127 patients with stable sABI, well-reintegrated at a family and social level, dismissed since at least one year from the end of their intensive rehabilitation, enrolled between 2006 and 2014. METHODS: Patients underwent an extensive battery of neuropsychological tests (pencil and paper and specific PC programs), aimed at assessing cognitive functions, in performance and verbal tasks. The results were analyzed in relation to their on-road performance during the driving test conducted by the office of the Italian Government Authority (success or failure of the test). RESULTS: No correlations were found between demographic data, etiology, driving experience, verbal competence and the decision of the competent authority. Significant correlation was found between attention, executive functions, overall visual-spatial exploration and driving performance. CONCLUSIONS: Both "pencil and paper" and computerized tests in the cognitive domains of attentive functions, and those involving performance with visual-spatial material, are significantly correlated with the driving test outcome, even if there is not enough evidence of the relative value of off-road compared to direct on-road tests. CLINICAL REHABILITATION IMPACT: We propose a small neuropsychological battery of tests with normative data for Italian population, predictive with respect to the ability to drive safely. We recommend to use it as first screening before submitting patients to more demanding and risky on-road driving tests.

On-road assessment of fitness-to-drive in persons with MS with cognitive impairment: A prospective study.

BACKGROUND: Cognitive impairment is common in multiple sclerosis (MS). In other populations, cognitive impairment is known to affect fitness-to-drive. Few studies have focused on fitness-to-drive in MS and no studies have solely focused on the influence of cognitive impairment. OBJECTIVE: To assess fitness-to-drive in persons with MS with cognitive impairment and low physical disability. METHODS: Persons with MS, aged 18-59 years with EDSS ⩽ 4.0, impaired processing speed, and impairment on at least one measure of memory or executive function, were recruited. Cognition was assessed using the Minimal Assessment of Cognitive Function battery. A formal on-road driving assessment was conducted. Chi-square analysis examined the association between the fitness-to-drive (pass/fail) and the neuropsychological test results (normal/impaired). Bayesian statistics predicting failure of the on-road assessment were calculated. RESULTS: Of 36 subjects, eight (22.2%) were unfit to drive. Only the BVMTR-IR, measuring visual-spatial memory, predicted on-road driving assessment failure ( X2 ( df = 1, N = 36) = 3.956; p = 0.047) with a sensitivity of 100%, but low specificity (35.7%) due to false positives (18/25). CONCLUSION: In persons with MS and impaired processing speed, impairment on the BVMTR-IR should lead clinicians to address fitness-to-drive.

Driving simulators in the clinical assessment of fitness to drive in sleepy individuals: A systematic review.

Road traffic injuries are projected to be the leading cause of death for those aged between 15 and 29 years by the year 2030, and sleepiness is estimated to be the underlying cause in up to 15-20% of all motor vehicle accidents. Sleepiness at the wheel is most often caused by socially induced sleep deprivation or poor sleep hygiene in otherwise healthy individuals, medical disorders, or the intake of drugs. Validated methods for objectifying sleepiness are urgently sought, particularly in the context of driving. Based on the assumption that the identification and treatment of sleepiness, and its causes, may prevent motor vehicle accidents, driving simulators are a seemingly promising diagnostic tool. Despite the rising use of these in research, the reliability of their conclusions in healthy sleepy individuals and patients is still unclear. This systematic review aims to evaluate the practical value of driving simulators in a clinical environment when judging fitness to drive in sleepy individuals. From the 1674 records screened, 12 studies in sleepy individuals containing both simulated and real driving data were included. In general, simulated driving did not reliably predict real-life motor vehicle accidents, and especially not on an individual level, despite the moderate relationship between simulated and real-road test driving performance. The severity of sleepiness is most likely not the critical factor leading to motor vehicle accidents, but rather the perception of sleepiness. The self-perception of sleepiness related impairment, and risky behaviour while at the wheel should also be considered as key influencing factors.

A novel low-cost solution for driving assessment in individuals with and without disabilities.

Brake reaction time is a key component to studying driving performance and evaluating fitness to drive. Although commercial simulators can measure brake reaction time, their cost remains a major barrier to clinical access. Therefore, we developed open-source software written in C-sharp (C#) for measuring driving related reaction times, which includes a subject-controlled vehicle with straight-line dynamics and several testing scenarios. The software measures both simple and cognitive load based reaction times and can use any human interface device compliant steering wheel and pedals. Measures from the software were validated against a commercial simulator and tested for reproducibility. Further, experiments were performed using hand controls in both able-bodied and spinal cord injured patients to determine clinical feasibility for disabled populations. The software demonstrated high validity when measuring brake reaction times, showed excellent test-retest reliability, and was sensitive enough to determine significant brake reaction time differences between able-bodied and spinal cord injured subjects. These results indicate that the proposed simulator is a simple and feasible low-cost solution to perform brake reaction time tests and evaluate fitness to drive.

[Assessment of ability to drive in patients with MCI and dementia]. / Beurteilung der Fahrtauglichkeit bei Patienten mit MCI und demenziellen Syndromen.

People with mild cognitive impairment and dementia are a frequent and continuously increasing patient group in practically all fields of medicine. The associated challenges involve nearly all areas of life in addition to the direct medical treatment. Assessment of the ability to drive in patients with cognitive deficits is becoming increasingly more important. What are the options available to physicians in order to make a valid assessment? Which legal aspects must be taken into consideration? Which rights and obligations arise from the framework conditions? These questions nowadays give rise to great uncertainty for many medical personnel; however, the increasing importance of these problems necessitates a clear procedure, which allows difficult decisions to be made with utmost sovereignty and legal certainty and to be able to give patients and relatives a plausible explanation. Because age is a substantial risk factor for the development of cognitive disorders, the question of the ability to drive is affected not only by neuropsychiatric diseases, such as mild cognitive disorders or dementia but also the frequently occurring somatic comorbidities. Estimation of the ability to drive is therefore a complex approach, which should be standardized in order to appreciate all relevant aspects. It would be desirable to have a practice-oriented algorithm, the formulation of which is the aim of this article. Additionally, we would like to make a contribution to road safety and make medical personnel fully aware of this topic.

Evidências de validade de critério para testes de atenção na avaliação psicológica no contexto do trânsito / Evidence for Criterion validity of attention tests for psychological assessment in the traffic context / Evidencias de validez de criterio para pruebas de atención en la evaluación psicológica en el contexto del tránsito

A pesquisa teve como objetivo buscar evidências de validade com base em critério externo para testes que avaliam atenção e que são comumente empregados na avaliação psicológica no contexto do trânsito. Participaram 300 indivíduos do estado do Paraná que responderam aos instrumentos no momento da obtenção da Carteira Nacional de Habilitação (CNH), em 2010. Após quatro anos, em 2014, foi obtido junto ao Departamento de Trânsito do Paraná (DETRAN-PR) o histórico de infrações desses motoristas. Os resultados não mostraram diferenças significativas nas pontuações dos testes entre os grupos de motoristas com e sem registro de infração. Também não foram observadas correlações significativas entre o desempenho nos testes e o número de infrações e pontos na CNH. Discute-se a necessidade de mais pesquisas na área, que considerem outras variáveis relacionadas ao contexto do trânsito, como o envolvimento em acidentes com e sem vítimas fatais, relacionando o resultado das provas teórica e prática com o desempenho na avaliação, entre outros.(AU)

The aim of the research was to obtain validity evidence based on external criteria for tests that evaluate attention and which are commonly used in the assessment of motor vehicle drivers. Participants were 300 individuals from the State of Paraná who answered to the instruments at the time of obtaining their driver's licenses (CNH), in 2010. After four years, in 2014, the history of infractions of these drivers was obtained from the department of traffic of Paraná (DETRAN-PR). The results did not show significant differences in test scores comparing the group of drivers with infraction records and those without infraction records. There were also no significant correlation between the performance in the tests and the number of infractions and points in the CNH. Further studies are necessary in the field, considering other variables involved in the context of traffic, such as involvement in accidents with and without fatalities, relating the results of the theoretical and practical tests with the performance in the evaluation, among others.(AU)

La investigación tuvo como objetivo buscar evidencias de validez con base en criterio externo para pruebas que evalúan la atención y que son bastante utilizadas en la evaluación psicológica en el contexto del tránsito. Participaron 300 individuos del estado de Paraná que respondieron los instrumentos en el momento de la obtención de la cartera nacional de habilitación (CNH), el año 2010. Después de cuatro años, en 2014, se obtuvo el histórico de infracciones de esos conductores junto al Departamento de Tránsito de Paraná (DETRAN-PR). Los resultados no mostraron diferencias significativas en las puntuaciones de las pruebas entre los grupos de conductores con y sin infracciones. Tampoco se observaron correlaciones significativas entre el desempeño en las pruebas y el número de infracciones y de puntos en la CNH. Se discute la necesidad de más investigaciones en el área que tomen en consideración otras variables relacionadas al contexto del tránsito, como saber si la persona se involucró en accidentes con o sin víctimas fatales, relacionando el resultado de las pruebas teórica y práctica con el desempeño en la evaluación, entre otros.(AU)

Comparison of a Virtual Older Driver Assessment with an On-Road Driving Test.

OBJECTIVES: To design a low-cost simulator-based driving assessment for older adults and to compare its validity with that of an on-road driving assessment and other measures of older driver risk. DESIGN: Cross-sectional observational study. SETTING: Canberra, Australia. PARTICIPANTS: Older adult drivers (N = 47; aged 65-88, mean age 75.2). MEASUREMENTS: Error rate on a simulated drive with environment and scoring procedure matched to those of an on-road test. Other measures included participant age, simulator sickness severity, neuropsychological measures, and driver screening measures. Outcome variables included occupational therapist (OT)-rated on-road errors, on-road safety rating, and safety category. RESULTS: Participants' error rate on the simulated drive was significantly correlated with their OT-rated driving safety (correlation coefficient (r) = -0.398, P = .006), even after adjustment for age and simulator sickness (P = .009). The simulator error rate was a significant predictor of categorization as unsafe on the road (P = .02, sensitivity 69.2%, specificity 100%), with 13 (27%) drivers assessed as unsafe. Simulator error was also associated with other older driver safety screening measures such as useful field of view (r = 0.341, P = .02), DriveSafe (r = -0.455, P < .01), and visual motion sensitivity (r = 0.368, P = .01) but was not associated with memory (delayed word recall) or global cognition (Mini-Mental State Examination). Drivers made twice as many errors on the simulated assessment as during the on-road assessment (P < .001), with significant differences in the rate and type of errors between the two mediums. CONCLUSION: A low-cost simulator-based assessment is valid as a screening instrument for identifying at-risk older drivers but not as an alternative to on-road evaluation when accurate data on competence or pattern of impairment is required for licensing decisions and training programs.