Self-Regulatory Driving Behaviour, Perceived Abilities and Comfort Level of Older Drivers with ...

237 Pages·2011·2.93 MB·English

Self-Regulatory Driving Behaviour, Perceived Abilities and Comfort Level of
Older Drivers with Parkinson’s disease compared to Age-Matched Controls

by

Alexander Michael Crizzle

A thesis
presented to the University of Waterloo
in fulfillment of the
thesis requirement for the degree of
Doctor of Philosophy
in
Health Studies and Gerontology - Aging, Health and Well-Being

Waterloo, Ontario, Canada, 2011
© Alexander Michael Crizzle 2011
Declaration

I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including
any required final revisions, as accepted by my examiners.

I understand that my thesis may be made electronically available to the public.

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Abstract
Introduction: Multiple studies have shown the symptoms of Parkinson‟s disease (PD) can
impair driving performance. Studies have also found elevated crash rates in drivers with PD,
however, none have controlled for exposure or amount of driving. Although a few studies have
suggested that drivers with PD may self-regulate (e.g., by reducing exposure or avoiding
challenging situations), findings were based on self-report data. Studies with healthy older
drivers have shown that objective driving data is more accurate than self-estimates.
Purposes: The primary objectives of this study were to examine whether drivers with PD
restrict their driving (exposure and patterns) relative to an age-matched control group and
explore possible reasons for such restrictions: trip purposes, perceptions of driving comfort and
abilities, as well as depression, disease severity and symptoms associated with PD.
Methods: A convenience sample of 27 drivers with PD (mean 71.6±6.6, range 57 to 82, 78%
men) and 20 age-matched control drivers from the same region (70.6±7.9, range 57 to 84, 80%
men) were assessed between October 2009 and August 2010. Driving data was collected for two
weeks using two electronic devices (one with GPS) installed in each person‟s vehicle.
Participants completed trip logs, questionnaires on background and usual driving habits, and
measures of cognitive functioning, depression, quality of life, daytime sleepiness, driving
comfort and abilities. Contrast sensitivity and brake response time were also assessed. Severity
of PD was assessed using the Unified Parkinson‟s Disease Rating Scale (UPDRS) motor scores.
An interview was conducted at the end of the second assessment to examine influence of the
devices, driving problems and any departures from usual patterns over the monitoring period.
Results: Of the 128 PD patients screened for possible study participation, 35% had already
stopped driving. Former drivers were older, more likely to be women and had poorer UPDRS
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motor scores. Only 48% of those who were eligible for the study agreed to participate. Compared
to controls, the PD group had significantly slower brake response times, higher depression and
quality of life scores, less comfort driving at night and poorer perceptions of their driving
abilities. The PD group also had significantly lower cognitive functioning scores than controls,
and a significantly greater proportion (74% versus 45%) were classified as having mild cognitive
impairment. Compared to vehicle recordings, both groups mis-estimated the amount they drove
over two weeks (measurement error was 94 km for the PD group and 210 km for the controls).
The PD group drove significantly less overall (days, trips, distance and duration), at night, on
week-ends and in bad weather and for different purposes. Four of the PD drivers had minor
accidents over the two weeks, while one lost his license.
Conclusions: Self-estimates of exposure were inaccurate warranting the continued use of
objective driving data. Overall, the findings suggest that drivers with PD appear to restrict their
driving exposure and patterns relative to controls. The PD group were more likely to combine
several activities into one trip, possibly due to fatigue. Moreover, they were more likely than
controls to drive for medical appointments and less likely to drive for leisure activities and make
out of town trips. The findings need to be replicated with larger samples and longer monitoring
periods to examine changes in self-regulatory practices associated with disease progression and
symptomatology. Other researchers are also likely to have similar difficulty in recruiting drivers
with PD as this group may quit driving at an earlier age and those who are still driving are fearful
of being reported to licensing authorities. Future studies also need to screen for cognitive
impairment which often goes undetected, particularly in otherwise healthy drivers.

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Acknowledgments

I would like to acknowledge several individuals who have provided invaluable support
throughout this project and over the past 5 years at the University of Waterloo. First, I would
like to extend my gratitude to Dr. Anita Myers, my supervisor, for her tireless dedication,
guidance and support throughout the completion of my PhD degree. I am truly appreciative of
her efforts and time in helping me achieve my goals. She truly has a passion for teaching and
mentoring all her students. I believe with her help, I have become a better researcher over my
graduate years at Waterloo.

I would also like to thank my committee members, Dr. Quincy Almeida, Dr. Brenda Vrkljan
and Dr. Eric Roy for your willingness share your expertise and input which greatly contributed
to the completion of this project. I would also like to acknowledge the external examiner, Dr.
Mary Jenkins, whose advice and interest in the project was invaluable.

I would also like to acknowledge the Canadian Driving Research Initiative for Vehicular Safety
in the Elderly (Candrive) and the Schlegel Research Institute of Aging (RIA) for providing
funding for this project.

Finally, I would like to thank my parents, Renate and William Crizzle, for their support,
encouragement and for all their love. As parents, you have shaped me into who I am and I
thank-you for that. I wouldn‟t be where I am today without you. And lastly, to my fiancée
Joanne Gierlach, you have always been the rock I‟ve leaned on, always providing confidence
and a comforting smile. You truly inspire me to do great things.

Alex Crizzle
University of Waterloo
May, 2011

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Table of Contents

Author’s Declaration .............................................................................................. ii
Abstract ................................................................................................................... iii
Acknowledgements................................................................................................... v
Table of Contents ................................................................................................... vi
List of Figures ......................................................................................................... xi
List of Tables ......................................................................................................... xii
Chapter 1: Introduction .......................................................................................... 1
1.1 Statement of the Problem ...........................................................................................................2
1.2 Parkinson‟s Disease ...................................................................................................................4
1.3 Role of Licensing Authorities and Physicians ...........................................................................6
1.4 Self-Regulation ..........................................................................................................................8
1.5 Summary and Overview ..........................................................................................................11
Chapter 2: Literature Review ............................................................................... 13
2.1 Introduction ............................................................................................................................. 13
2.2 Studies on Older Drivers in General ....................................................................................... 14
2.2.1 Performance ................................................................................................................ 14
2.2.2 Exposure ..................................................................................................................... 15
2.2.3 Patterns ....................................................................................................................... 16
2.2.4 Factors Associated with Self-Regulation ................................................................... 17
2.3 Studies on Drivers with PD..................................................................................................... 19
2.3.1 Crash Rates ................................................................................................................. 19
2.3.2 Driving Errors ............................................................................................................. 20
2.3.3 Factors Associated with Driving Performance ........................................................... 21
2.3.4 Driving Restrictions and Cessation ............................................................................ 23
2.4 Summary and Implications ..................................................................................................... 24
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Chapter 3: Methods ............................................................................................... 26
3.1 Study Rationale, Objectives and Expectations ....................................................................... 26
3.2 Ethics Approval and Consent.................................................................................................. 28
3.3 Sample Recruitment ................................................................................................................ 29
3.3.1 Drivers with Parkinson‟s disease................................................................................ 30
3.3.2 Control Group ............................................................................................................. 31
3.4 Study Protocol ......................................................................................................................... 31
3.4.1 Baseline Assessment .................................................................................................. 32
3.4.2 Second Assessment .................................................................................................... 32
3.5 Instruments .............................................................................................................................. 34
3.5.1 Background and Driving Habits Questionnaires ........................................................ 34
3.5.2 Epworth Sleepiness Scale ........................................................................................... 34
3.5.3 Geriatric Depression Scale-15 .................................................................................... 35
3.5.4 Parkinson‟s disease Questionnaire ............................................................................. 36
3.5.5 Montreal Cognitive Assessment ................................................................................. 36
3.5.6 Contrast Sensitivity .................................................................................................... 38
3.5.7 Driving Comfort Scales .............................................................................................. 39
3.5.8 Perceived Driving Abilities Scales ............................................................................. 40
3.5.9 Brake Test ................................................................................................................... 40
3.5.10 Situational Driving Frequency and Avoidance Scales ............................................. 42
3.5.11 Activities-specific Balance Confidence Scale .......................................................... 43
3.6 Measures of Driving Exposure and Patterns ........................................................................... 44
3.6.1 CarChip Pro ................................................................................................................ 44
3.6.2 Otto Driving Companion ............................................................................................ 45
3.6.3 Trip Logs .................................................................................................................... 45
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3.7 Unified Parkinson‟s disease Rating Scale (UPDRS) .............................................................. 46
3.8 Data Handling and Analysis ................................................................................................... 46
3.8.1 Driving Data ............................................................................................................... 47
3.8.2 Weather Data .............................................................................................................. 48
3.8.3 Descriptive and Comparative Analysis ...................................................................... 49
Chapter 4: Results .................................................................................................. 51
4.1 Screening Results .................................................................................................................... 51
4.1.1 Current versus Former Drivers ................................................................................... 53
4.2 Recruitment Waves ................................................................................................................. 54
4.3 Data Completeness.................................................................................................................. 55
4.4 Sample Characteristics ............................................................................................................ 57
4.4.1 General and Health Characteristics ............................................................................ 57
4.4.2 Driving Experience and Preferences .......................................................................... 60
4.5 Disease Severity and Functional Scores ................................................................................. 61
4.5.1 Disease Severity ......................................................................................................... 62
4.5.2 Sleepiness ................................................................................................................... 63
4.5.3 Depression .................................................................................................................. 63
4.5.4 Perceived Quality of Life ........................................................................................... 63
4.5.5 Cognitive Ability ........................................................................................................ 64
4.5.6 Balance Confidence .................................................................................................... 64
4.6 Performance Scores ................................................................................................................ 65
4.6.1 Contrast Sensitivity .................................................................................................... 65
4.6.2 Brake Reaction, Movement and Response Times ...................................................... 66
4.6.3 Braking and Acceleration Patterns ............................................................................. 66
4.7 Driver Perceptions .................................................................................................................. 67
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4.8 Self-Reported Driving Behaviour ........................................................................................... 71
4.9 Profile of Participant #32 ........................................................................................................ 74
4.10 Actual Driving Behaviour ..................................................................................................... 76
4.10.1 Exposure ................................................................................................................... 76
4.10.2 Patterns ..................................................................................................................... 79
4.10.2.1 When People Drove ..................................................................................... 79
4.10.2.2 Driving Conditions by Wave and Group ..................................................... 81
4.10.2.3 Roadways ..................................................................................................... 82
4.10.2.4 Radius and Trip Purposes ............................................................................ 83
4.11 Participant Experiences ......................................................................................................... 88
4.12 Self-Reported versus Actual Driving Behaviour .................................................................. 89
4.12.1 Exposure ................................................................................................................... 89
4.12.2 Patterns ..................................................................................................................... 92
4.13 Further Associations in PD Group ........................................................................................ 95
4.13.1 Self-Reported Symptoms.......................................................................................... 95
4.13.2 Functional Indicators ................................................................................................ 97
4.13.3 Perceptions ............................................................................................................... 98
4.13.4 Performance Scores .................................................................................................. 99
Chapter 5: Discussion .......................................................................................... 102
5.1 Introduction ........................................................................................................................... 102
5.2 Self-Report and Actual Driving ............................................................................................ 102
5.3 Exposure ............................................................................................................................... 104
5.4 Patterns .................................................................................................................................. 104
5.5 Trip Purposes ........................................................................................................................ 106
5.6 Factors Related to Self-Regulation ....................................................................................... 107
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5.6.1 Symptoms of PD....................................................................................................... 107
5.6.2 Cognitive Impairment ............................................................................................... 108
5.6.3 Driver Perceptions .................................................................................................... 108
5.6.4 Performance Scores .................................................................................................. 109
5.7 Limitations ............................................................................................................................ 110
5.8 Conclusions and Directions for Future Research.................................................................. 112
References ............................................................................................................. 115
Appendix A: Studies Comparing Drivers with PD to Controls .................................................. 129
Appendix B: Recruitment Materials for PD Group .................................................................... 135
Appendix C: Recruitment Materials for Control Group ............................................................. 141
Appendix D: First Visit Materials and Tools .............................................................................. 150
Appendix E: Second Visit Materials and Tools .......................................................................... 171
Appendix F: UPDRS and Hoehn & Yahr Scales ........................................................................ 193
Appendix G: Definition of Time Periods and Roadways .......................................................... 198
Appendix H: Additional Sample Characteristics ........................................................................ 199
Appendix I: Additional Scale Results ......................................................................................... 206
Appendix J: Brake Test Protocol ................................................................................................ 217
Appendix K: Additional Driving Patterns .................................................................................. 219
Appendix L: Associations between Perceptions and Driving Behaviour ................................... 220
Appendix M: Comparison with Prior Samples of Healthy Drivers ............................................ 221
Appendix N: Comparison with Prior Samples of PD Drivers .................................................... 222

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