Fitness-to-Drive in Older Adults with Stroke

David B Carr, M.D.


Project Overview:
Stroke is the third leading cause of death in the United States, and a major cause of serious long-term disability.  Each year, there are about 500,000 first time new strokes, and three-quarters of all strokes occur in people over the age of 65.  In adults, stroke can impair vision, cognition, motor skills, and speech.  The result can be a loss of functional independence.  With medical advances and proper rehabilitation, many stroke survivors are able to regain function.  Often, the activity of driving is not resumed after stroke. The ability to operate a motor vehicle is strongly related to independence in the home and a return to a more productive lifestyle.  Without the ability to drive safely and independently, stroke survivors may become a burden to their families, are at increased risk of depression, and may require a move to assisted living or a nursing home setting. In order to return the patient to active driving, many physicians utilize rehabilitation driving assessments, typically performed by occupational therapists. These evaluations usually include performance-based road tests in actual traffic, which have inherent safety risks, are time consuming, and expensive. Thus, there is a need to identify stroke survivors that are able to resume driving to assist with their independence.

The primary objective of this study is to determine whether stroke patients that return to active driving maintain their current level of care (e.g. independent living) when compared to patients that are not able to resume driving privileges. We believe that patients that are unable to return to driving will have a higher rate of transfer to a more structured environment (e.g. assisted living and/or nursing home) and/or have an increase in depressive features. The secondary objective of this proposal is to determine whether tests of clinical skills (vision, motor, cognition) in stroke patients are predictive of safe driving.  We hypothesize that a combination of specific tests will predict who will pass a standardized road exam and/or have a motor vehicle crash. We anticipate completing driving evaluations on our first 50 participants with stroke by the end of the first year of funding. In order to fully test these hypotheses, we plan to study an additional 50 stroke patients during the second year. We also will follow-up the participants who were evaluated in year one of the study, to determine whether they have maintained their independence by assessing their current level of care, the presence of any depressive features, and by determining crash risk. Information from this pilot study should assist with determining which patients with stroke are able to return to driving and prospectively maintain independence at home. The data generated from this pilot study will ultimately assist toward establishing appropriate evaluation guidelines for physicians, occupational therapists, and state licensing departments that are faced with making a decision regarding safe driving. If health care professionals are able to make decisions regarding an individual’s ability to resume driving without the need to perform an evaluation in a real traffic setting, this will reduce expense and allow for an increase in availability of testing for all stroke patients.  Assisting stroke patients with their ability to drive should maintain their independence, reduce family burden, decrease the incidence of depression, and delay a move to a more expensive setting such as assisted living and/or the nursing home.


Final Report Applicant’s Summary:
Stroke is the third-leading cause of death in the United States, and a major cause of serious long-term disability. Each year, there are about 500,000 first-time new strokes, and three-quarters of all strokes occur in people over the age of 65. In adults, stroke can impair vision, cognition, motor skills, and speech. The result can be a loss of functional independence. With medical advances and proper rehabilitation, many stroke survivors are able to regain function. Often, the activity of driving is not resumed after stroke. Without the ability to drive safely and independently, stroke survivors may become a burden to their families, are at increase risk of depression, and may require a move to assisted living or a nursing home setting. Read the full Final Report.