Â鶹¾«Æ·ÊÓƵ

It’s one of the most fraught and dreaded experiences for aging drivers, their families and caregivers: the realization that a loved one’s cognitive decline has left them unsafe behind the wheel of a car.

Even when working through this transition with compassion and concern for the health and safety of the driver and other motorists, these conversations can easily give over to anger and frustration.

"That set of keys is our ticket to being independent adults in so many ways," said Ruth Tappen, Ed.D., RN, FAAN, professor and Christine E. Lynn Eminent Scholar, Florida Atlantic’s Christine E. Lynn College of Nursing.

"It’s life-changing to give up your keys," said Tappen, who has decades of experience studying care of individuals with Alzheimer’s disease and related dementias. "Many families say it’s the hardest thing they had to deal with as things were changing. It was easier to give up work."

An online tool developed by Tappen and her colleagues aims to ease that decision. Called Fit2Drive, it’s a screening test that can help predict an older driver’s ability to pass an on-road driving exam. It’s simple enough to administer in a primary care doctor’s office and is 91.5% accurate in predicting on-road results, according to a recently published article describing the tool in the Journal of the American Medical Directors Association.

The primary care office is one of the places where Fit2Drive may be most helpful, Tappen said. It’s among the first places that patients and caregivers take their concerns about driving, but it’s difficult for providers to make an informed decision on driving ability within the confines of a regular visit.

"It’s really hard to judge when you’re in a clinic or a medical office," Tappen said. "Many cognitive batteries can last an hour or two. In a primary care office, you don’t have time for that." The online Fit2Drive tool requires users to input scores from just two common, relatively brief cognitive assessments that Tappen and her team found to be the best predictors of success in an on-road evaluation: the Mini Mental State Exam and the Trails Making Test. An algorithm converts those scores into a probability that the driver would pass a road test.

"Then we have some objective data to help make the decision, to guide people," Tappen said.

Driving hadn’t been Tappen’s focus when it came to dementia research, but it was an issue the Florida Department of Transportation wanted to understand better. Tappen and her collaborators spoke with Alzheimer’s support groups around the state, gathering stories from people with memory concerns and their caregivers.

"People told us stories that if we had just done a survey or sent out a questionnaire, we would not have heard," she said. "People had some fascinating, some heart-breaking stories. Those are not stories that you forget. And you understand that this is a big issue in people’s lives."

That experience led Tappen to develop a driver evaluation program as part of her work in founding and directing the Louis and Anne Green Memory and Wellness Center. The center is a component of the College of Nursing with a mission to meet the complex needs of patients with memory disorders and their families through care, research and education.

The center’s driver program includes several established assessments of relevant cognitive areas (like concentration, visual-spatial abilities and problem solving) and an on-the-road test with a trained instructor.

Many participating drivers choose to share their results with the center’s researchers, creating a data pool that proved integral to developing and calibrating the Fit2Drive algorithm. The team also recruited drivers without known memory issues to complete the same cognitive assessments and a road test. Adding this data to the calculations significantly improved the algorithm’s predictive accuracy, Tappen said.

The tool is complete and available online at Fit2Drive.org, but the work isn’t done. Tappen received a $350,000 grant from the Florida Department of Health’s Ed and Ethel Moore Alzheimer’s Disease Research Program to develop a tablet app version of the tool that would allow users to complete an assessment and see their probability of passing a road test on a single device.

"The idea is to put a short set of cognitive tests on a tablet that will predict as well as the current Fit2Drive, or hopefully even better," she said.