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Understanding the views of older adults and people living with Mild Cognitive Impairment on driving and fitness to drive

Lead Research Organisation: University of Sheffield
Department Name: Neurosciences

Abstract

Unfitness to drive is a major contributing factor of road crashes and age-related neurodegenerative conditions are a growing area of concern for road safety. With life expectancy constantly increasing, the number of elderly drivers will increase proportionally (people aged over 70 represents 6% of all UK driving licences). At the same time, driving is a key part of maintaining independence especially in rural areas where public transport is less able to match the flexibility of driving one's car. The Department for Transport (DfT) and DVLA places no restrictions on elderly drivers and there is no evidence that older drivers are at increased risk of traffic accidents. However, age is associated with other medical conditions where the DVLA guidance is determined by symptoms or medical reports. For example, people with certain types of heart failure may drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving and need not notify the DVLA.
A very common condition associated with ageing is Mild Cognitive Impairment (MCI), a state in between normal ageing and brain function and that of abnormal ageing and dementia. In response to the National Dementia Strategy in 2008 and the Prime Minister's Challenge there has been an increase in people referred to memory clinics from 202 per clinic to 1579 per clinic between 2008/9 and 2014 (a 682% increase). The 2019 national memory clinic audit found that 17% of people attending memory clinics are diagnosed with MCI. Therefore approximately 270 new cases of MCI are diagnosed in each memory clinic.
Currently driving risk is assessed by self reports or by medical reports, that take into account factors such as whether the person presents poor short-term memory, disorientation, lack of judgment, attention disorders. , that do not accurately reflect safety to drive. For those with affected by cognitive impairments, detailed, time-consuming and expensive neuropsychological testing are undertaken in a minority and the usefulness of these in terms of predicting driving ability is unknown. On referral from a specialist or GP, specialist driving assessment tests can be carried out. In the UK specialist driving assessment centres carry out detailed driving assessments for people with a medical condition which can affect their driving. The DVLA guidance divides MCI into those with, "No likely driving impairment' and those with, 'Possible driving impairment'.
Elderly drivers or people with MCI are not at an increased risk of accident, however they might struggle in certain circumstances such as high speed junctions, high-speed roundabouts and slip roads onto motorways, where drivers are required to look around and make quick decisions. Therefore it is important to investigate new means to understand individual driving risks. In car monitoring technology to measure real-world driving may be a cheaper and more accurate measure of on the road driving behaviour and may better compare with cognitive function. Furthermore, it can detect particular areas of concern such as high-speed junctions, motorways etc so that advice and potentially driving awareness education sessions could be delivered to reduce risk of accidents. In this project we will collect real world driving behaviour data from patients with MCI and healthy elderly to understand any links between their diagnosis, standardised cognitive function tests and driving behaviour.
This could help detect those at most risk and develop interventions to introduce graduate driving licenses that better support an evolving condition. We will take into account the views of different stakeholders by arranging a series of workshops with a group of healthy elderly and a group of people with MCI, plus opinions and views and we disseminate other stakeholders such as DfT, DVLA, insurance companies, Age UK and dementia charities such as Alzheimer research UK and Alzheimer Society and Sheffield Dementia advisory group.

Publications

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Lise Sproson (2022) Keeping patient and public partnership at the heart of medical technology development during Covid-19: examples of adaptive practice in Journal of Medical Engineering & Technology

 
Description There are preliminary data to show changes in driving behaviour form people with MCI. There is also a fear from many healthy older drivers and people with MCI about remote monitoring of driving. This has resulted in collaboration with Prof Hornberger in University of East Anglia and other colleagues to see if we can combine real world monitoring and simulator data.
Exploitation Route We are exploring collaborations with other researchers to expand data collection and different models of monitoring driver
Sectors Healthcare

Transport
 
Description Piloting new technology and processes to optimise fitness to drive assessments and improve safety
Amount £189,919 (GBP)
Organisation Road Safety Trust 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2022 
End 09/2023
 
Description Stakeholder consultation Understanding Driver Behaviour project 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact This Interim Stakeholder Consultation Report outlines initial themes drawn from user experience consultation activity from January to March 2021, undertaken as part of the Understanding Older Adults' Driving Behaviour Project. Further, more detailed qualitative analysis will be undertaken as the project progresses and this will be submitted for publication in a peer reviewed journal.
This is a UKRI Digital Health Catalyst Award project, funded from November 2020 - October 2021 by the Economic Social Research Council. The Chief Investigator is Dr Dan Blackburn, Co-Investigators are Dr Vita Lanfranchi and Dr Sam Chapman, supported by Lise Sproson and Ursula Ankeny.
Summary of the consultation process
Stakeholder engagement and consultation objectives for the first quarter of this project were to:
? Explore perspectives and experiences of each group on the current methods of driver safety assessment methods
? Discuss the perceived benefits & concerns about driver safety evaluation methods
? Gather views on acceptable terminology for potential participants, for example "older adult,
senior drivers, mature drivers" to determine whether there is consensus on a preferred
acceptable term
? Present and explain the technology for use within this project and the rationale for the trial
? Introduce the trial study design plan and seek feedback on recruitment approaches, study
information materials, preferred formats for sharing study findings
? Discuss perceived benefits and any concerns about the project
? Seek feedback on iterative design suggestions for the device and on adoption and roll out
To date, five focus group meetings have been undertaken, involving 30 participants in total, from 4 main stakeholder groups:
? Group 1a: 7 Representatives from Professional and Regulatory bodies
? Group 1b: 9 Representatives from Professional and Regulatory bodies
? Group 2: 8 Healthy Older Adults/family members
? Group 3: 8 People with a diagnosis of Mild Cognitive Impairment/Dementia and family
members
? Group 4: 6 People with a diagnosis of Stroke and family members*
*The Stroke Stakeholder group took place on June 14th 2021 and transcription and theming have therefore not yet been completed for this group at the time of this report.


As this is an interim report, themes are presented here purely as descriptive summaries. Further, more detailed qualitative analysis is planned once all data collection and transcription is completed. Themes from each Stakeholder Group
Group 1a and 1b: Professional and Regulatory Stakeholders
The group included representatives from a wide range of professional and regulatory bodies:
? Driver and Vehicle Licensing Agency (DVLA)
? Driver assessment Centres
? Driving Mobility
? Insurance companies
? NHS Medical Consultants
? Older Drivers Task Force
? The Parliamentary Advisory Council for Transport Safety (PACTS)
? RAC Foundation
? Road Safety Foundation
Current Driver Safety Assessment processes
The group were consulted on their opinions and experience of current driver safety assessment processes.
The consensus was that currently there is no legal obligation for assessment at or beyond the age of 70, drivers can self-certify that they are fit to drive. Further assessment is only required where there may have been driving incidents and/or a doctor makes a diagnosis of a notifiable condition. Legally it is still the driver's responsibility to notify the DVLA and some drivers may choose to avoid this.
Medical practitioner participants explained that GPs receive guidance (updated every 6 months) from the DVLA to help guide assessment of safety to drive against medical safety standards. These guidelines are based around conditions and not around age.
Positive aspects of current methods
? "(On road) driving assessment currently the best that we have"
? "The current process isn't too stressful for older adults"
? "(It does) support mobility in older age"
Problems with current methods
i) Failure to disclose notifiable conditions:
? Because it is still currently the driver's responsibility to notify the DVLA, if they are resistant to this it can cause disputes among family members and sometimes GPs are faced with the task of explaining to their patient that they feel they must make a report"


? "It relies on drivers' honesty to admit to medical issues and, as we said, that can be very difficult because people can feel defensive or humiliated"
? "There are occasions where patients have changed specialists, changed GPs, etc"
? "(It's) easy to fly under the radar"
ii) Medics may struggle with various aspects of completing medical reporting::
? "Often I'm unable to give more information to the form to say whether they're safe or not cos I haven't seen them",
? "I'm not always a hundred percent certain about what detail to put in there"
? "They might just say, I don't know, I haven't seen them for ages, or I really, I really don't know if
they're safe to drive"
? "Our biggest challenge as far as timescales are concerned are getting reports back from clinicians,
who are obviously busy and this is not their top priority"
? "In the drivers' medical group we've got about six hundred and fifty caseworkers making decisions,
only forty of those are doctors, so most of the decisions are made from algorithms"
iii) It takes a long time, which leads to delays
? "It's all paper forms at the moment that I fill in and my secretary turns back"
iv) Medical reporting of safety to drive often has a largely subjective element:
? "She says she's safe to drive; I, I've no idea whether she is or not, you know, cos I can't tell"
v) Current on road assessment may not be reliable/truly representative of ability
? "Patients are often variable from day-to-day; so that could be a negative of the current process if people are required to make just a, a decision based on a snapshot"
? "The other thing obviously as well with older people is the comorbidity issue and that is one of our significant challenges, cos you, you might have somebody who just about meets a medical standard for condition A, just about meets the standard for condition B, but you put them together and how do they affect each other?"
? "Not infrequently that we'll find somebody who has an absolutely bad MoCA (Montreal Cognitive Assessment - a pen and paper assessment) score of thirteen out of forty, for example, and we'll put them in a car and they'll drive absolutely fine, and we'll get the converse"
? So we couldn't do it (revoke a licence) just if they had a bad drive because they're an appalling driver; that, that would be a criminal issue for the Courts to deal with, we can only, sort of have an input into that licensing decision if it's actually a result of the medical condition"
? "one of the primary reasons we have the hazard perception test as part of the driving test now, because if you take somebody out on an on-road test the likelihood of encountering one of those serious hazards that might lead to a collision is relatively low and inconsistent"
? "I think that is always a problem that you might have a drive where the issues don't come up and you therefore don't identify the problem"

? "It all comes down to having sufficient insight into your problem so that you can moderate your driving"
? "Lack of a consistent process"
vi) Absence of support as people transition to non-driving
? "A lack of support for those that give up driving, especially if they're distanced from family"
? "Poor retirement planning in a post-car world,...have we got the public transport infrastructure to
sufficiently support older adults when they're transitioning to not being able to drive anymore?"
? "I agree we do not prepare drivers for driving cessation"
vii) Problems with the desk top/pen and paper assessments
? "Most tests are strongly biased in language aren't they?"
? "There's a learned effect with lots of these tests; so if we gave them out to people to use they may
just get better at them" Uncertainties around current methods
? "Are the right people referred at the right point?"
? "My first question is, I guess, what do you mean by older driver? "When we talk of older drivers
now are we talking seventy and above?
? "I think that one of the problems we're talking about, operating within the law as it is, or are we
going to change the law for our ideal options? "
? (As medicine advances and we can determine risk of developing conditions) "based on genetics or
in a pre-clinical stage based on biomarker or genetics or an assessment that say they've got an increased risk of having something, you know, increased risk of having epilepsy or Alzheimer's disease or Parkinson's disease, should they be treated differently and when should they be assessed?"
? "As medical science moves on there is gonna be so many more people who are identified as having various genes, are at risk of conditions, etc, etc, then I think it's gonna intrude upon us in a fairly big way in the future"
Suggestions for an improved assessment approach
? "I'm very much a proponent of sort of lifelong assessment regardless of a fitness issue"
Feedback of the approach under evaluation in this study i) Concerns/queries about the research design
? "I guess my only concern would be the length of the study" (no gathering of longitudinal data) long enough to facilitate"
? "I think data security would be an important issue, just about where that data lies, who has access to the data, and what the future legacy of that data will be? I think people will be really quite keen to understand just what will happen to their data in the short to middle to long-term"


? "(I am wondering) to what extent you're gonna try and sample for gender and probably distance travelled so that you can start to understand a little bit more about how these indicators might vary...and also how much experience somebody has as a driver?"
ii) Perceived potential benefits of this research
? "We know we need to do things differently and we know we need to look at things, how we can do things differently, because we can't continue the way we're going with, as we've talked about, an aging population, more people have got more conditions...there's more comorbidities.... we need to look at things doing differently to make sure that people are safe on road"
? "We've only got a handful of these assessment centres around the country that we use, people are waiting longer"
? "It all sounds potentially very promising. I think one of my first thoughts from it is that what would be particularly helpful from it is those situations whereby you get a very, a favourable report to say, yeah, this, this chap is driving smoothly, driving fine. I think that will be probably more useful than an unfavourable report"
? "We, (DVLA) we would have a very limited role as far as that data is concerned, whereas I can see the, you know, the benefits in, in wider society, totally"
? (Mobility Centres) "there's no doubt in our minds,...that telematics is a really interesting technology somewhere in this mix, without any doubt at all"
? "(Could be helpful in reducing) "DVLA's workload, so we've got over fifty million licence holders"
? "I think it's a great opportunity to collect some longitudinal data which gets around the idea of just
basing decisions on one-off drives or contact-free assessment"
? "I think, in terms of when I get asked to fill in a form and I don't know, I (would) feel like I'm acting
as a better advocate for the person to say I can to refer you to some objective evidence"
? (To be able to) "show the trends that this shows predictiveness of they're not having accidents,
people who perform with these, within the bounds of a normal driving pattern, then that could be
really useful and really powerful for people"
? Potential to reduce insurance premiums for older drivers: "the premiums do go up again at the
older age range. So there's potentially more opportunity there"
? Several participants felt the technology may be useful if UK law introduces graduated/restricted
licences.
? "Some (older people) give up driving too soon because they're scared about driving and the risk of,
you know, driving at night and driving in more traffic and things like that. So it's really important that we do have a whole plethora of information to be available to people to confidence-build them, to show them what can help them"
Suggestions for future design improvements and/or further research
? "I think what would be important would be to ensure that there was, assuming that that data came to the individual, ...that they had a means of then using that data with their clinician so that they would know what red flags, for example, to start discussing.... whether these changes meant anything. So that would involve education of clinicians as well as, as the individual"
? "We need to present this to older drivers as a supportive tool for the decision-making process for the driving cessation"
5

? "(It) is about time that licensing authorities should be looking for some new licensing category, so, for example, like pre-driver retirement licence category, so that it could be linked with the new licence category, supported by the evidence through the technology"
? "So it's a multi agency support and we need to take everybody together in this; and I think that can be a very successful thing"
? "If you provide this and offer this as a supportive tool to, to educate and improve their driving, you know, and experience, and also prepare them for, you know, the driving cessation as a supportive tool, I think that might be a better way of, you know, encouraging them to adopt to new technology."
? "Obviously we are dealing with a vulnerable group who may collapse at the wheel; and if it actually had something within it, so you could say this is something as a protection field for you as well. So if a sudden incident happened it would be able to notify someone or you'd be, easily be able to be found from it, because people maybe suffering from Alzheimer's or problems like that, it's a way of tracking them as well to where they may be located and things. So if there was some form of additional benefit in there as well that could be fitted or accessed using the modern technology that is fitted to a lot of cars these days"
Inclusivity Support Measures for Older Adults and People with Mild Cognitive Impairment to support their engagement
To support inclusivity and optimise engagement, lightly simplified, large font participant information sheets were sent to the Healthy Older Adults and an easy-read large font version made for people with a diagnosis of mild cognitive impairment or dementia.
Once people had expressed an interest in joining the online focus groups, pre-meeting booklets were designed, printed and sent by post. These gave reminder information about the project and confidentiality arrangements, an illustrated guide on using Zoom, and a preview of most of the focus group questions. We hoped that this would give participants an idea of what to expect and time to think about their responses and space to jot responses/reminders for those who would find extra thinking time helpful.
We had good representation of male (8/17) and female (9/17) perspectives across stakeholder groups 2 and 3 and some representation (3/17 participants) from South Asian ethnicity.
Group 2: Healthy Older Adults and family members
Perceived value of driving - freedom and independence, self confidence/esteem
? "You're chopping my legs off by not giving me, me the, the opportunity to drive"
? "(Driving) gives the ability to be independent"
? "I've been driving to a very high level for, for thirty years"
? "I look at my car as freedom"


Perceived challenges of driving in older age
? "For me as I'm getting older it's something that becomes very tiring and, you know, when I think of the traffic today it's so much heavier and faster than it was when I passed my test at twenty-two"
? "I think the important thing to remember is that a car is a weapon at the end of the day and I think if you can think of it in that way, you know, if you're not safe you shouldn't have charge of a weapon"
Experience of and/or perceptions of no longer driving
? "I know what my husband went through when he had his licence taken away"
? "It's better if you stop yourself than somebody else telling you to stop, because they, you know,
they're, they're sort of challenging your intellect, if you like"
? "I look after my mum and she's been driving for a long time and ...her driving has been taken off
her, that is like everybody else says, but I think it affects you mentally. I mean she's suffering from dementia as well, it's like it's, it, she's lost a bit of confidence"
Problems with current assessment methods
i) Stress and worry caused by the current process
? "I have to renew it every year. It's gone now since September and it finishes at the end of this month; I haven't heard anything so I don't know what's going to happen. But my GP is satisfied that I'm OK to drive and the memory clinic, my consultant, they've discharged me from there and they said I'm fit to drive. But what they're looking at, I don't know."
? "I also had a problem with regaining my licence; it was taken away as soon as I was diagnosed and I had to, to fight for it and got it back"
? "I have had my driving licence revoked twice by the DVLA and that was purely and simply because the consultant had ticked the wrong box on the form. But there was a question asking if you take any medication that would affect your ability to drive, and instead of ticking "no" they've ticked "yes" and that happened to me back in 2017 and it's happened again to me now. And all you get is a letter from the DVLA saying your licence has been revoked, no reasoning behind it"..."on both occasions it's taken me about four months to get my driving licence back, through no fault of my own""
? "I reacted so badly when I did have my licence revoked on two occasions. I think if I, if I, if I know myself that my driving is, is failing or, as X said, if we go on an assessment and it's explained to us what areas we're not capable in then we could accept it a bit more"
? "The other thing I'd like to raise ...is I was never under a consultant, I was under a, a Parkinson's nurse for the last four years, and the Parkinson's nurse was the person who always used to fill in the forms for the DVLA and write a report about me and send it to them. And then I'm not, I'm not sure if it was last year or the year before the DVLA would no longer accept reports or forms from specialist nurses, it has to be a consultant; now I'm not under a consultant so this has caused me an awful problem"..My GP refuses to do it because she said, you know, it's, it's not part of her job and, in my opinion, the specialist nurses know far more about you than any consultant ever would because you see them more often, for one, and they do more assessments. So I wasn't sure if you

were aware of this and, you know, if we're not under a consultant how do we overcome this barrier
annually of having to get a report done by a medical consultant?"
? "I'd arranged to, to, to do a driving assessment off my own back cos I thought that might speed the
process up when I had my licence revoked, only to find out that because my driving licence had been revoked I couldn't even do the driving assessment. So there are occasions when you're in a Catch-22 situation, like I was"
ii) Variability in Driving ability - may not be reliable/truly representative of ability
? "They might have good days and bad days"
iii) Failure to disclose notifiable conditions
? "My dad had Alzheimer's disease and it was very difficult getting him to stop driving and, like other people have said, you know, you're trying to hang on to the seat or, or use the brake because you don't feel that his reactions are, are quick enough. And one day he went to pull outside the shop to go and get a newspaper and as he went to park he hit a concrete lamp post which crashed to the floor; and we spoke to him then and said "Look, you know, maybe you shouldn't be driving." But he refused to stop driving. And he got lost going from his house to my house one day, which was two miles away, and he rang me and he said he didn't know where he was. He still wouldn't stop driving
iv) Guilt from family members who feel they have to intervene
? "When my father had, had his licence taken away from him, he was really angry for quite a long time;...And I was getting the blame because I was the eldest child, it was my fault that he had his licence taken away from him, and whether he thought that I'd sort of told the DVLA or something, which I hadn't done, but I don't think he ever forgave me that he lost his licence"
? "So my experience was that I had to be the one, I had to say to my dad that I didn't think that he should get into the car anymore"..."I felt awful that I, that I was having to take that away, but the other side was I'd feel awful if he'd had an accident and he had caused harm to anyone else or to himself and that would have been on my head, I felt, because if I knew that he wasn't safe then I had to take that decision"...he still says he'd like to drive again one day, which is really sad. But I know that I, I did the right thing; as hard as it was, I know I did the right thing at the end of the day."
Suggestions for an improved assessment approach
? "I think everybody should, before they have their licence taken off them, should be given the opportunity to have a driving assessment"
Feedback of the approach under evaluation in this study i) Preferred term of reference
? Either Older Driver or Mature driver

ii) Concerns/queries about the research design
? "I think it would be just making participants really aware of exactly what that the (time) commitment is"
? "If they've just passed an assessment, say, for example, and then they do this with you and fail it, what happens to them?"
iii) Perceived potential benefits of this research
? "If people are wondering am I still OK to drive then the equipment would be able to say, yeah, you appear to be"
? "...Almost as a way to prove that they are still safe to drive"
? "I'm a great supporter in, in the black box technology, which a lot of, a lot of the young drivers now
have in their car because it gives them a substantial reduction on their insurance, because it constantly sends a, a flow of information"
Group 3: People with Lived Experience of Mild Cognitive Impairment/Dementia and family members
Perceived value of driving - freedom and independence, convenience, self confidence/esteem
? "Being able to drive's important because it means it, it can be a convenience at times, for example if you've got to carry things; so going to the supermarket, going to a station, things of, of, of that sort"
? "I was going to say for us, we're, our house is at the bottom of a fairly long steep hill where the bus stop is; so although we would like to use buses it's really not always practical. (X) has back problems and when he was bad in the summer absolutely dependent on the car to, or neighbours who've been very good, to just go to the supermarket, fetch things, whatever. So not being near a bus stop is quite a thing for us"
? "I suspect it would feel a little bit like the (Covid 19) travel lockdown that we're in now"
? "People have said they're happy to take trains and buses but there's a significant cost at times in
having to do this, and in a lot of areas, dependent on where you live, there might not be access to those services. You're continually hearing about remote areas where you're getting two/three buses a day, if you're lucky"
? "Trains, if my wife and myself wanted to go up to see our family in Scotland we're looking at a, almo, you know, several hundred pounds in, in rail fares, even with a rail pass, to try and do it, and also spending a huge, a day or at least the best part of a day just sitting in a very crowded, inconvenient, smelly, hassled thing called a train car"
Perceived challenges of driving in older age
? "It's more trouble than it's worth"
? "So you've got a lot more to think about when you're just going on a journey of one or two miles"
? "The roads out there, which I use on a regular basis are no longer the roads I drove on forty years
ago, they're now packed full of parked cars on both sides of the road, not just cars but vehicles of 9

all shapes and sizes. So the road we've got left to drive on,...is much less.There's a lot of things
you could hit you couldn't hit some years before"
? "It's long-term journeys, the tiredness, the impact on that"
Experience of and/or perceptions of no longer driving
? "Giving up my driving licence was like handing away that last vestige of freedom"
Problems with current assessment methods
i) May not be reliable/truly representative of ability
? "(Taking on-road test in an unfamiliar car). That did shake him because he did expect to do it in his own vehicle, but he was sent from an automatic into a manual which he'd never seen before"
? "Monday, Tuesday, Wednesday, Thursday they might be completely away with the fairies, Friday and Saturday they're fine, and then Sunday they just don't feel up to doing anything"
ii) Failure to disclose notifiable conditions
? "I'd have lied through my back teeth to keep my licence"
Feedback of the approach under evaluation in this study i) Preferred term of reference
? Older Driver
ii) Concerns/queries about the research design
? "If you go in for it and the result is that you're not safe to drive? Would that be passed to the DVLA?"
iii) Perceived potential benefits of this research
? "Anything that makes it safer for you on the road has got to be better for you"
? "I would be very keen as well to find out if my driving was deteriorating at points"
? "There needs to be a way to triage, and this might be a means to do this"
? "If it could be linked to having insurance premiums reduced that might make me even more
interested"
? "If we were in this test you would give us feedback of how well we did"
? "I could be happy with it if someone had lost the right to drive through a legacy system and your
system gave them hope for, hope, if you like, you could overturn it; I could, I could be very much in favour of that. I would also be in favour of a future where something like this was constantly moni, was monitoring everybody's driving and, and, and everybody was measured against the same benchmark"

? "Just thinking back to when seat belts were introduced and every, people were saying, oh do we need them, don't we need them, should we have them, shouldn't we have them, and then it was just mandatory that you had to have them and it had been shown that by wearing seatbelts, you know, it saved you getting serious injury, etc; I think if this was introduced as something that was definitely going to make driving safer for everybody and that it would be fitted into all new cars and that it could be fitted into cars up to, I don't know, five years old or something, I think people, you know, would accept it, because anything that makes it safer for you on the road has got to be better"
Suggestions for future design improvements and/or further research
? "Using cameras on dashboard cams to monitor traffic conditions; is there any thoughts about linking the telematics to that, if possible?"
? "Just a, a suggestion, perhaps you could do a little YouTube video or something of somebody going along driving a car and then of the feedback that the system gives them, because I'm trying to envisage what, how it would work"
Summary and conclusions
The Stakeholder consultation to date has given rich and valuable information about the current driver safety assessment processes, and of the experience and perceptions of those involved.
All groups confirmed that there are major challenges in terms of the waiting period for on road assessments, which are very frustrating. Also that as snap shots of driving ability, these and desktop assessments may often not be a reliable/representative measure of true driving ability.
Use of varied assessment tools (medical reporting, desk top tests and on road assessments) can be experienced as unfair, subjective, stressful and confusing for those being assessed.
Medical professionals often feel ill equipped to report accurately and reliably on driver safety.
The current legal requirement is for drivers to disclose notifiable medical conditions. Failure to do so causes stress and conflict among families and guilt for those family members who feel a responsibility to take action when drivers choose not to disclose information to GPs and to the DVLA.
Older adults and people with cognitive challenges felt that it may help the process of safely determining when to stop driving - and to accept this more easily if they had reliable, objective feedback on their day to day driving ability.
All stakeholder groups felt that the data derived from telematics could potentially be used to help drivers moderate their driving behaviour, (possibly via input from clinicians and/or family members) and therefore to enable people to drive more safely, for longer.
The Stakeholder consultation strongly validated the need for, and potential benefits of the research study.


Useful feedback was gained on the research design - some of these points can be incorporated into the current research design, others will be useful guidance for planned follow on studies.
All groups were interested to participate further in the study and to be informed of the findings and follow on research.
Further, more detailed qualitative analysis will be completed and learning incorporated into completion of this study and to help inform planning of ongoing future research. A paper will be prepared and submitted for publication in a peer reviewed journal.
For further information on this report, please contact:
Lise Sproson
PPI Lead, NIHR Devices for Dignity Med Tech Co-operative

Dr Dan Blackburn
Principal Investigator, Senior Lecturer & Honorary Consultant Neurologist, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield
Email: d.blackburn@sheffield.ac.uk
Year(s) Of Engagement Activity 2021
 
Description Workshops 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact The Editorial Board selected our paperhttps://www.tandfonline.com/doi/pdf/10.1080/03091902.2022.2089258?needAccess=true for inclusion as a blog on our website,NIHREvidence. This highlights NIHR-funded research, and aim to reach relevant audiences.

Sylvia Bortoli, has written the proposed blog which has been published on NIHR Evidence: https://evidence.nihr.ac.uk/alert/blog-online-approaches-boosted-public-involvement-in-assistive-technologies-during-the-pandemic/
Year(s) Of Engagement Activity 2023
URL https://evidence.nihr.ac.uk/alert/blog-online-approaches-boosted-public-involvement-in-assistive-tec...