UNASSIGNED: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation.
UNASSIGNED: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies.
UNASSIGNED: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented.
UNASSIGNED: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable \"ownership\" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Many diseases are accompanied by symptoms that can impair the ability to perform complex everyday tasks, such as active participation in road traffic. If a cure is not possible, the aim of drug therapy is to alleviate the symptoms to such an extent that the patient no longer has any restrictions in everyday life. However, around 20% of the approximately 100,000 medicines licensed in Germany have traffic-relevant side effects that can also lead to driving impairment.It is assumed that the effect of a drug is at least partially responsible for one in four traffic accidents and that one in ten victims of fatal road accidents has taken psychotropic drugs before driving. In addition to alcohol and drugs, medications from the benzodiazepine, opioid, and antidepressant groups are suspected of impairing driving safety in particular. The effects of these substances on young people have been described many times, but this review deals specifically with the traffic-relevant (side) effects of various classes of drugs on elderly people (aged 65 and over).Older people in particular often have to take different medications, which are metabolized differently compared to younger people due to underlying diseases and can also interact with each other. It was found that (1) older people often react more sensitively to substances, (2) not all representatives of a drug class have the same effect on driving safety, and (3) a general assessment of a drug\'s safety is not possible, since the effects also depend on other factors such as underlying diseases, treatment regimen, and the time of day the medication is taken.
UNASSIGNED: Viele Grunderkrankungen gehen mit Symptomen einher, die die Fähigkeit, komplexe Aufgaben des Alltags zu lösen, beeinträchtigen können. Hierzu gehört auch die aktive Teilnahme am Straßenverkehr. Das Ziel von Arzneimitteltherapien ist es, sofern keine Heilung möglich ist, die Symptome soweit zu lindern, dass der Patient im Alltag so wenig Einschränkungen wie möglich erfährt. Jedoch haben etwa 20 % der ca. 100.000 in Deutschland zugelassenen Arzneimittel verkehrsrelevante Nebenwirkungen, die die Fahrsicherheit ihrerseits ebenfalls beeinträchtigen können.So wird davon ausgegangen, dass an jedem 4. Verkehrsunfall die Wirkung eines Arzneimittels zumindest mitursächlich ist und jeder 10. Verkehrstote Psychopharmaka vor Fahrtantritt eingenommen hat. Neben Alkohol und Drogen stehen insbesondere Medikamente aus der Gruppe der Benzodiazepine, Opioide und Antidepressiva im Verdacht, die Fahrsicherheit zu beeinträchtigen. Die Effekte dieser Substanzen auf junge Menschen sind vielfach beschrieben. In dieser Übersichtsarbeit sollen speziell die verkehrsrelevanten (Neben‑)Wirkungen verschiedener Wirkstoffklassen auf betagte Personen ab 65 Jahren dargestellt werden.Insbesondere Ältere müssen häufig verschiedene Medikamente einnehmen, die aufgrund von Grunderkrankungen anders metabolisiert werden als bei Jüngeren und darüber hinaus interagieren können. Es kann festgestellt werden, dass (1) ältere Personen häufig sensibler auf Substanzen reagieren, (2) nicht alle Vertreter einer Wirkstoffklasse den gleichen Effekt auf die Fahrsicherheit haben und (3) eine pauschale Beurteilung nicht möglich ist, sondern die Wirkungen von weiteren Faktoren, wie zum Beispiel Grunderkrankungen, Therapieregime und Einnahmezeit der Medikation, abhängen.

The prevalence of cardiovascular diseases increases with age. Common symptoms such as dyspnea, chest pain, dizziness, or syncope can impact driving fitness. Due to a growing number of private drivers aged 65 and older and an increasing prevalence of cardiovascular diseases, questions regarding driving fitness restrictions for cardiological patients are gaining prominence in clinical settings. This article aims to summarize current recommendations for driving fitness in the context of cardiovascular diseases. The basis for the guidelines includes the Driving License Ordinance, the expert assessment guidelines of the Federal Highway Research Institute, and the guidelines of the German Society of Cardiology on driving fitness. Original literature on this topic is limited.Emphasizing an individualized assessment, clear guidelines for driving fitness in cardiac diseases or their symptoms and treatments are formulated. Regardless of the cardiac condition, the symptoms and likelihood of sudden loss of consciousness play a leading role in driving fitness assessment. Resulting impairments can range from a few weeks to a complete revocation of driving fitness. Regular examinations and differentiated assessments by medical professionals are prerequisites for maintaining driving fitness.The driving fitness of older private drivers is a significant and practical topic in cardiology. Current guidelines support the treating physicians in providing appropriate recommendations.
UNASSIGNED: Die Prävalenz von Herz-Kreislauf-Erkrankungen steigt mit zunehmenden Alter an. Häufige Symptome sind Atemnot, Brustschmerzen, Schwindel oder Synkopen, welche die Fahreignung beeinflussen können. Aufgrund einer zunehmenden Anzahl an Privatfahrer:innen über 65 Jahren und einer steigenden Prävalenz kardiovaskulärer Erkrankungen rücken Fragestellungen zur Einschränkung der Fahreignung von kardiologischen Patient:innen zunehmend in den klinischen Vordergrund. Dieser Artikel soll aktuelle Empfehlungen zur Fahreignung im Kontext kardiovaskulärer Erkrankungen zusammenfassen. Die Grundlage der Vorgaben stellen die Anlage 4 der Fahrerlaubnisverordnung, die Begutachtungsleitlinie der Bundesanstalt für Straßenwesen sowie die Leitlinien der Deutschen Gesellschaft für Kardiologie zur Fahreignung dar. Originalliteratur zu diesem Thema ist nur begrenzt vorhanden.Mit Betonung auf eine individualisierte Bewertung werden klare Vorgaben für die Fahreignung bei kardialen Erkrankungen bzw. deren Symptomen oder Behandlungen formuliert. Die resultierenden Beeinträchtigungen können von wenigen Wochen bis hin zur generellen Aufhebung einer Fahreignung ausfallen. Führenden Einfluss auf die Bewertung der Fahreignung nehmen unabhängig von der kardialen Erkrankung die Symptomatik und die Wahrscheinlichkeit für einen plötzlichen Bewusstseinsverlust ein. Regelmäßige Untersuchungen sowie differenzierte Beurteilungen durch medizinisches Fachpersonal sind Voraussetzung für den Erhalt der Fahreignung.Die Fahreignung älterer Privatfahrer:innen stellt ein bedeutendes und praxisrelevantes Thema in der Kardiologie dar. Aktuelle Richtlinien unterstützen die behandelnden Ärzt:innen entsprechende Empfehlungen auszusprechen.

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.

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Background: The multicenter, randomized, double-blind, parallel-group, phase IIIb CANNA-TICS (CANNAbinoids in the treatment of TICS) trial showed clear trends for improvement of tics, depression, and quality of life with nabiximols versus placebo in adult patients with Gilles de la Tourette syndrome and other chronic tic disorders. Although in general nabiximols was well tolerated, it is unclear whether treatment using this cannabis extract influences driving skills in patients with chronic tic disorders. Methods: Here we report results of the \"Fitness to Drive\" substudy of the CANNA-TICS trial. The key endpoint was fitness to drive as a binary criterion with a computerized assessment at baseline and after 9 weeks of stable treatment (week 13) with nabiximols or placebo. A patient was considered unfit to drive according to the German Federal Highway Research Institute guidelines. Results: In the substudy, a total of 64 patients (76.6% men, mean±standard deviation of age: 36.8±13.9) were recruited at two study sites. The number of patients who were fit to drive increased from 24 (55.8%) at baseline to 28 (71.8%) at week 13 among 43 patients treated with nabiximols, and decreased from 14 (66.7%) to 10 (52.6%) among 21 patients who received placebo. The risk difference (nabiximols - placebo) was 0.17 (95% confidence interval=-0.08 to 0.43) in favor of nabiximols. Specifically, only 2 of 24 (8.3%) patients in the nabiximols, but 4 of 14 (28.6%) patients in the placebo group changed for the worse from fit (at baseline) to unfit (at week 13) to drive, whereas 8 of 19 (42.1%) patients in the nabiximols, and only 2 of 7 (28.6%) patients in the placebo group improved from unfit to fit. Conclusion: Treatment with nabiximols does not impair skills relevant to driving in those patients with tic disorders who were fit to drive at baseline and even improved fitness to drive in a subset of patients who were unfit to drive before start of treatment. EudraCT number: 2016-000564-42.

UNASSIGNED: Driving requires a series of cognitive abilities, many of which are affected by age and medical conditions. The psychosocial importance of continued driving ushers the need for valid measurements in fitness-to-drive assessments. A driving simulator test could prove useful in these assessments, having greater face validity than other off-road tests and being more cost-effective and safer than ordinary on-road testing. The aim of this study was to validate a driving simulator test for assessment of cognitive ability in fitness-to-drive assessments.
UNASSIGNED: The study included 67 healthy participants. Internal consistency of the simulator subtests was estimated. A correlation analysis between results on the simulator and the cognitive tests Trail Making Test (TMT) A and B and the Useful field of View test (UFOV) and multiple regression analysis were conducted. Finally, a comparison of results between age groups (>65 years) and (<65 years) was done.
UNASSIGNED: Results showed good internal consistency. Significant and moderate correlations were found for all reaction time in the simulator\'s subtests and UFOV 3, and all but two with TMT A. Lane positioning in the simulator showed significant and low to moderate correlations with UFOV 3 in all subtests. Reaction time and Double reaction time on subtest 3 were significantly correlated with UFOV 2 and UFOV 3 and TMT A, respectively. Test on Centerline (position) in subtest 3 as dependent variable was significantly correlated with UFOV 3. Significant means differences and large effect sizes between the age groups were found for all reaction time and lane positioning tests.
UNASSIGNED: The findings of concurrent validity, especially with TMT A and UFOV 3 and its sensitivity for age-related differences, indicate potential for the simulator to be used as a complement in fitness-to-drive assessments. However, a clinical study is necessary to further examine its usefulness for patients with cognitive deficits.

Excessive daytime sleepiness is the core symptom of central disorders of hypersomnolence (CDH) and can directly impair driving performance. Sleepiness is reflected in relative alterations in distal and proximal skin temperature. Therefore, we examined the predictive value of skin temperature on driving performance. Distal and proximal skin temperature and their gradient (DPG) were continuously measured in 44 participants with narcolepsy type 1, narcolepsy type 2 or idiopathic hypersomnia during a standardised 1-h driving test. Driving performance was defined as the standard deviation of lateral position (SDLP) per 5 km segment (equivalent to 3 min of driving). Distal and proximal skin temperature and DPG measurements were averaged over each segment and changes over segments were calculated. Mixed-effect model analyses showed a strong, quadratic association between proximal skin temperature and SDLP (p < 0.001) and a linear association between DPG and SDLP (p < 0.021). Proximal skin temperature changes over 3 to 15 min were predictive for SDLP. Moreover, SDLP increased over time (0.34 cm/segment, p < 0.001) and was higher in men than in women (3.50 cm, p = 0.012). We conclude that proximal skin temperature is a promising predictor for real-time assessment of driving performance in people with CDH.

Glaucoma is one of the eye diseases that are particularly relevant to driving in old age. The ophthalmologist often has to take on the task of traffic medical consultation or medical appraisal. It is essential to distinguish between fitness to drive and driving ability or driving safety and driving capability. The medical examination of fitness to drive can only be carried out over long intervals and basically requires an ophthalmological examination in compliance with all the requirements of the driving license ordinance. This is not a healthcare task. In the case of clarification of the fitness to drive in people with known glaucoma on behalf of the test persons themselves or a driving license authority, visual field testing must be performed using manual kinetic perimetry according to Goldmann, especially for all borderline case decisions by traffic experts. The ophthalmologist faces the particular difficulty of maintaining a balance between the legal duty of care and patient-centered care in order not to strain the patient-physician relationship.
UNASSIGNED: Das Glaukom gehört zu den besonders fahrrelevanten Augenerkrankungen im Alter. Essenziell wichtig ist im Rahmen der verkehrsmedizinischen Bewertung eine genaue Begriffsabgrenzung zwischen Fahreignung und Fahrtauglichkeit oder Fahrsicherheit und Fahrtüchtigkeit. Die medizinische Überprüfung der Kraftfahreignung kann nur in großen Abständen erfolgen und setzt grundsätzlich eine augenärztliche Untersuchung unter Einhaltung sämtlicher Vorgaben der Fahrerlaubnisverordnung voraus. Dabei handelt es sich um keine Leistung der Krankenversorgung. Die Abklärung der Kraftfahreignung bei bekanntem Glaukom im Auftrag durch den Probanden selbst oder eine Verwaltungsbehörde erfordert bei allen verkehrsgutachtlichen Grenzfallentscheidungen eine Gesichtsfeldprüfung mittels manuell-kinetischer Perimetrie nach Goldmann. In der Krankenversorgung besteht für den Augenarzt die besondere Schwierigkeit, die Balance zwischen gesetzlicher Fürsorgepflicht und patientenorientierter Versorgung zu wahren, um die Patient-Arzt-Beziehung nicht zu belasten.

BACKGROUND: The prevalence and functional burden of the chronic demyelinating disease multiple sclerosis (MS) are well documented; however, little is known about the initial clinical course of alertness, sleep, cognitive, and psychological symptoms.
OBJECTIVE: This exploratory, prospective, longitudinal study multidimensionally investigated the development and progression of alertness, sleep, fitness to drive, and psychological symptoms in the first year after de novo MS diagnosis.
METHODS: Twenty-five people with MS (pwMS) were assessed cognitively, psychologically, and using polysomnography soon after diagnosis and one year later, with outcomes compared to matched healthy controls.
RESULTS: In the early stage of the disease, psychological symptoms of pwMS were comparable with those of controls, and patient conditions did not deteriorate within the first disease year. A small percentage of pwMS experienced increased levels of anxiety and depression after diagnosis. Alertness, sustained attention, and fitness to drive were comparable between both groups, and fatigue levels remained low over the course of the year.
CONCLUSIONS: This study highlights patient experiences within the initial clinical course of MS in a small group of patients. Further research is needed to understand the progression of symptoms and impairments in MS over a longer period and in different stages of the disease.