Self-reported driving, cognitive status, and physician awareness of cognitive impairment

OBJECTIVES: To assess self-reported driving rates in older people and correlate these data with cognitive status and physician recognition of cognitive impairment. DESIGN: Cross-sectional study. SETTING: A multiphysician private practice clinic in a primarily Asian-American community of Honolulu, Hawaii. PARTICIPANTS: Two hundred ninety-seven ambulatory patients aged 65 and older. MEASUREMENTS: Cognitive function was assessed by physician interview using the Cognitive Abilities Screening Instrument (CASI) and proxy informant data. Subjects' self-reported driving status. Outpatient medical records were reviewed. RESULTS: Sixty percent of the studied population reported that they currently drove. This rate decreased from 73.3% (148/202) for subjects with good CASI performance (CASI greater than or equal to82) to 37.5% (21/56) for subjects with intermediate CASI performance (CASI 74-81.9) and further to 23.7% (9/38) for subjects with poor CASI performance (CASI <74). Further analysis of drivers with intermediate and poor CASI performance scores revealed that almost none of their physicians recognized that these drivers had cognitive problems (4.8% (1/21) of drivers with intermediate CASI performance and 11.1% (1/9) of drivers with poor CASI performance). CONCLUSION: In this convenience sample of older drivers, driving rates dropped precipitously with poorer performance on cognitive tests, yet a significant percentage of individuals with intermediate or poor cognitive test performance reported that they currently drove. This poor performance was often unrecognized by their physicians. Low recognition rates could affect physicians' interventions to curb unsafe driving.