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Journal of Rehabilitation, April-June, 1995 by Barbara S. Handler, Jeanne Boland Patterson
Cognitive Loss and Aging
A number of parallels have been noted between individuals with cognitive losses and individuals who are aging (e.g., Stokx & Galliard, 1986; Strano, 1993; Summers, 1986). Aging driver, however, have been defined differently by various researchers. The National Safety Council found that accident rates begin to increase at age 60 and are much higher after age 75 (Summers, 1986), whereas the National Highway Traffic Safety Administration (1994) considers drivers age 70 and older to be aging drivers.
Hypothesizing that "... severe concussions of the brain and normal aging have some underlying processes in common," Stokx and Gaillard (1986, p. 435) found that older individuals were better able to compensate for slowed reaction time in on-the-road testing than were people with TBI. Van Zomeren et al. (1988), however, found that both aged drivers and those with brain damage were able to compensate for their limitations at the operational level by making better decisions at the tactical and strategic levels (e.g., reducing the pressure for fast response by changing the time or route used when driving). Comparing reaction time tasks affected by diffuse and focal brain damage in people with brain damage and older persons whose mean age was 66, Korteling (1990) found that both groups reacted too slowly in laboratory tests, but that patients with brain damage made more errors than older patients. Lambert and Engum (1992), who used the term elders to describe individuals over age 63, documented the negative relationship between age and cognitive function and suggested that some medical personnel make erroneous driving recommendations because they conclude that certain impairments are due to recent brain injury rather than the normal process of aging. They supported the earlier conclusions that some older patients may have skills at the practical and strategic levels that might allow them to compensate for the operational shortcomings measured by the CBDI.
Discussion
Despite numerous studies of the effects of brain injury on driving, there is still little consensus on exactly how medical/rehabilitation teams can make accurate decisions that will allow the individual with brain injury maximum access to the many benefits of driving and still protect the safety of the individual and the general public. There are a number of programs that appear to have good predictive capacity for grossly judging how a survivor of brain injury will perform behind the wheel. No one, of course, can control or control for the behavior of individuals beyond the testing situation in which most people make maximum efforts to give the best possible performance. Areas of general consensus are as follows:
1. Drivers must be evaluated as individuals and no single type of test will provide data with predictive value equal to a battery of tests and screenings. It appears that the most important components of a driving evaluation specifically targeted to people with brain injuries include:
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