Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness to Drive Among Older Adults

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Title: Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness to Drive Among Older Adults
Authors: Ranger, Valerie
Date: 2019-04-30
Abstract: For older adults, driving contributes to independence, autonomy, and wellbeing. For some older adults there comes a time when their ability to drive safely may be questioned due to illness or cognitive impairment. Decisions related to driving safety and when to cease driving are complex and often left to the clinical judgement of the primary care physician. There is an interest in developing a method that could help assist physicians in making that determination. To date, there is no well-defined cut-off point on neuropsychological tests that produces an acceptable level of sensitivity and specificity allowing for the determination of an individual’s fitness to drive. Serial trichotomization involves classifying drivers as either pass, fail or indeterminate based on cut-points that lead to 100% sensitivity and specificity. The purpose of this study was to examine the serial trichotomization method using four common neuropsychological tests (i.e., 3MS, Trails A & B, clock drawing). Sensitivity and specificity for each test were established using a medical expert’s clinical judgement. Charts of 105 patients at a tertiary memory disorders clinic were reviewed and data related to neuropsychological test scores and clinical judgement around fitness to drive were abstracted. After applying the serial trichotomization model, 38.1% of the sample were classified as unfit to drive, 36.1% were classified as indeterminate, and 25.8% were classified as fit to drive. This model could offer physicians a better preliminary method in assessing fitness to drive using common paper-pencil cognitive tests. With easy administration, a simple scoring system, and no equipment requirement, serial trichotomization allows primary care physicians to make specific and sensitive decisions around fitness to drive, in a timely fashion. This study adds to the growing body of literature supporting the use of serial trichotomization in making decisions about fitness to drive.
URL: http://hdl.handle.net/10393/39122
http://dx.doi.org/10.20381/ruor-23370
CollectionThèses Saint-Paul // Saint Paul Theses
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