Daily Archives: 9 May 2024

Introducing spatial orientation tests would enhance safety assessments for older drivers

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New findings from the University of East Anglia (UEA) reveal that older drivers with diminished spatial orientation capabilities face more challenges while executing turns across oncoming traffic. Spatial orientation, a crucial skill set for drivers, involves mentally ascertaining one’s or one’s vehicle’s position relative to the surroundings.

Sol Morrissey, a doctoral student at UEA’s Norwich Medical School, underscores the profound implications of ageing on driving safety. As individuals age, a myriad of changes can impact driving behavior, yet the specific role of cerebral alterations in this behavior remains largely uncharted. Morrissey’s study illuminates that older adults with compromised spatial orientation tend to drive less frequently and report more difficulties while driving. A striking discovery is an association between poor spatial orientation and heightened challenges in navigating turns across oncoming traffic, a well-known precursor to serious road accidents. This revelation hints at the potential future integration of spatial orientation tests in driving safety assessments for the elderly, a measure that could significantly enhance road safety.

The study, conducted between February and August 2021, involved 804 participants, averaging 71. Criteria for inclusion were being 65 or older, holding a valid driving license, and driving at least once a week. Participants provided information through online surveys covering demographics, health, driving history and habits, and incidents, in addition to assessments of spatial memory and navigation skills. They also underwent neuropsychological tests to evaluate cognitive performance in various domains.

Results highlighted a direct link between spatial orientation deficits and driving difficulties among the elderly, reinforcing previous studies that identified processing speed as a crucial factor affecting driving in older adults. Spatial orientation emerged as the sole cognitive skill significantly impacting driving behaviour, underscoring its importance in safely navigating turns and judging vehicle positioning.

The overrepresentation of older adults in multi-vehicle intersection crashes points to spatial orientation deficits as a significant individual risk factor. The study’s findings further demonstrate that poor spatial orientation, reduced processing speed, and episodic memory are associated with increased driving difficulty and avoidance of challenging driving scenarios.

Professor Michael Hornberger of Norwich Medical School underscores the robustness of spatial orientation deficits as an indicator of driving performance in the elderly. He advocates for the consideration of these deficits in future driving assessments to bolster road safety among the ageing population. With the projected increase in the number of older drivers, comprehending and addressing the challenges posed by age-related physiological changes and health conditions become pivotal for maintaining both independence and safety. The study’s findings offer a beacon of hope, suggesting that incorporating spatial orientation tests in driving safety assessments can potentially mitigate the risks associated with ageing and driving.

Traditionally, research on the impact of ageing on driving has focused more on physical and sensory functions, with less attention given to cognitive changes despite their known significance. The UEA study contributes valuable normative data on cognitive functioning in healthy older adults, utilizing online cognitive assessments to offer a more convenient and efficient alternative to traditional in-person tests for monitoring changes in driving fitness over time.

The researchers also propose that spatial orientation’s role in driving difficulty could explain the reduced road safety observed in individuals with Mild Cognitive Impairment (MCI) and Alzheimer’s disease. However, they acknowledge limitations such as reliance on self-reported driving behaviours and their study’s lack of environmental context. Future research could include naturalistic driving measures and explore cognitive functioning trajectories to inform the frequency and fitness methods to drive assessments and monitoring.

More information: Sol Morrissey et al, The Impact of Spatial Orientation Changes on Driving Behavior in Healthy Aging, Journal of Gerontology. DOI: 10.1093/geronb/gbad188

Journal information: Journal of Gerontology Provided by University of East Anglia

Research indicates that ChatGPT could be an effective tool for managing medications, potentially enhancing healthcare for older adults

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Polypharmacy, which refers to the simultaneous use of five or more medications, is prevalent among older adults and elevates the risk of adverse drug interactions. Combatting this risk involves deprescribing unnecessary medications, an intricate process that demands considerable time. There is a growing need for robust tools to manage polypharmacy, primarily to assist the often overburdened primary care practitioners.

A recent study by the Mass General Brigham MESH Incubator highlighted the potential of ChatGPT, a generative artificial intelligence (AI) chatbot, as a valuable resource in managing polypharmacy and facilitating deprescription. The results of this pioneering study, disclosed on April 18th in the Journal of Medical Systems, mark a significant development in the use of AI models in medication management, keeping policymakers informed of the latest advancements.

In their assessment, researchers provided ChatGPT with various clinical scenarios, each depicting an elderly patient on multiple medications but differing in their cardiovascular disease history (CVD) and levels of daily living activities impairment (ADL). ChatGPT was then posed with decision-making questions requiring yes or no answers concerning reducing prescribed medications. The AI tended to recommend deprescribing in cases without CVD history but showed more restraint where CVD was a factor, generally advising to maintain the existing medication regimes. Notably, the severity of ADL impairment did not influence the AI’s decisions.

Interestingly, the study observed that ChatGPT often overlooked pain issues, showing a preference for reducing pain medications rather than other types, such as statins or antihypertensives. The researchers also pointed out that the AI’s responses could vary even when presented with identical scenarios in different sessions, which they attributed to potential inconsistencies in the deprescribing trends on which the AI was trained.

With over 40 per cent of older adults falling into the category of polypharmacy and an increasing number of specialists being involved in their care, primary care providers are often left with the critical task of managing medications. The study suggested that deploying an effective AI tool like ChatGPT could significantly support these efforts.

Dr. Marc Succi, MD, Associate Chair of Innovation and Commercialization at Mass General Brigham Radiology and Executive Director of the MESH Incubator, emphasized the study’s importance. He stated, “Our study provides the first use case of ChatGPT as a clinical support tool for medication management. While enhancing the accuracy of such models is important, AI-assisted polypharmacy management could help alleviate the growing pressure on general practitioners. Continued research with specifically trained AI tools could greatly improve the care provided to elderly patients.”

Arya Rao, the lead author, a researcher at MESH, and a medical student at Harvard, remarked, “Our findings suggest that AI-based tools can play a crucial role in ensuring safe medication practices for older adults; it is vital that we keep refining these tools to better handle the complexities involved in medical decision-making.”

More information: Arya Rao et al, Proactive Polypharmacy Management Using Large Language Models: Opportunities to Enhance Geriatric Care, Journal of Medical Systems. DOI: 10.1007/s10916-024-02058-y

Journal information: Journal of Medical Systems Provided by Mass General Brigham