中高齡認知障礙汽車駕駛者的適性駕駛評估

Fitness-to-Drive Assessment for Older Drivers with Cognitive Impairments

張玲慧(Ling-Hui Chang) ； 陳郁婷(Yu-Ting Chen) ； 王劼(Jye Wang)

《臺灣職能治療研究與實務雜誌》 12卷2期 (2016/12) Pp. 115-135

https://doi.org/10.6534/jtotrp.2016.12(2).115

摘要

台灣逐漸步向高齡社會，越來越多的高齡汽車駕駛者會受到認知功能障礙或失智症的影響，導致駕駛能力退化並有較高的車禍事故風險，交通管理當局對如何篩選、評估和規範較高風險高齡駕駛者已訂定初步規範，因為職能治療師在國外的適能駕駛評估佔有重要角色，但國內職能治療文獻尚未有中文文獻回顧，且駕駛評估很少在大學養成教育或繼續教育提及，為提升國內職能治療師對此議題的了解，本文將以國外的實證研究與臨床篩選、評估模式經驗，提供台灣職能治療界在汽車駕駛復健與評估領域發展的參考。本文主要有三個主題。首先釐清年齡、認知能力與車禍事故發生率的關係。目前的科學證據認為年齡或輕度認知障礙的診斷，都無法正確預測汽車駕駛的事故風險，因此不適宜作為吊銷汽車駕照的單一標準。第二部份強調駕駛是重要的社區移行(community mobility)技巧與職能，可維持高齡駕駛者的獨立性與社會參與程度；因此對於此族群的照護目標應為早期發現認知障礙與介入，以適當方式延長其安全駕駛年限，同時盡快協助汽車駕駛者做好停止開車的準備與尋找社區移行的替代方案，以期兼顧駕駛者本身的安全性與獨立功能與大眾交通安全。第三部份簡介美國、加拿大、澳洲等國家有關高齡認知障礙汽車駕駛的篩選與評估流程，並統整評估工具的相關實證研究的結果。希望藉由本篇文章的論述提升台灣職能治療對失智駕駛評估相關議題發展的興趣，並積極反思職能治療在駕駛評估領域的角色、意義與未來發展，並期待未來有更多職能治療師投入台灣本土的駕駛者習慣與駕駛環境的研究與臨床實務的開發與實踐。

關鍵字

老化 ； 駕駛評估 ； 輕度認知障礙 ； 失智

並列摘要

Taiwan is a society with a growing number of older drivers. This demographic is susceptible to age-related medical conditions, such as mild cognitive impairment (MCI) or dementia, which may affect their driving capacity and lead to higher crash risk. Screening and regulating these at-risk drivers have been heavily debated in Taiwanese society, but no clear consensus has been reached. To fill this gap based on scientific evidence and sophisticated experiences, this review article will summarize current literature about screening and evaluation concerns among drivers with cognitive impairments and introduce driver rehabilitation practices from several Western countries to a Taiwanese audience. There are three parts in this article. The first part clarifies the relationship between age, cognitive function and crash risks among older drivers with cognitive impairments. Current evidence suggests that neither age nor the diagnosis of MCI should be the single criterion to revoke one's driver's licence. The second part addresses the importance of driving in older adults and the means to prolong safe driving performance in persons who are still capable of driving. Through proper interventions and acts, driving can enhance older adults' outdoor mobility and social participation without compromising traffic safety. The third part introduces the screening and evaluation procedure of at-risk drivers in the United States, Canada, and Australia. This section also presents several evidence-based in-office assessment tools and on-road driving evaluations that are commonly administered by trained occupational therapists. This article provides an overview of research and clinical practices related to at-risk drivers in several countries. In Taiwan, involvement in the regulation of at-risk drivers should also be one of the responsibilities of occupational therapists, because these professionals have the expertise to analyze drivers' occupational profile and occupational performance. It is expected that more Taiwanese occupational therapists will engage in advanced, specified training in driver rehabilitation, and that more localized studies will focus on Taiwanese drivers' habits and environment.

並列關鍵字

Aging ； Driving evaluation ； Mild cognitive impairment ； Dementia ； Review