On-road driving test performance in veterans: Effects of age,clinical diagnosis and cognitive measures

Introduction: Veterans are at heightened risk of being in a motor-vehicle crash and many fail on-road driving evaluations, particularly as they age. This may be due in part to the high prevalence of age-associated conditions impacting cognition in this population, including neurodegenerative diseases (e.g., Alzheimer’s Disease) and acquired neurological conditions (e.g., cerebrovascular accident). However, understanding of the impact of referral diagnosis, age and cognition on Veterans’ on-road driving performance is limited. Methods: 109 Veterans were referred for a driving evaluation (mean age = 72.0, SD = 11.5) at a driving assessment clinic at the Minneapolis Veterans Affairs Healthcare System. Of the 109 Veterans enrolled, 44 were referred due to a neurodegenerative disease, 37 due to an acquired neurological condition, and 28 due to a non-neurological condition (e.g., vision loss). Veterans completed collection of health history information and administration of cognitive tests assessing visual attention, processing speed, and executive functioning, as well as a standardized, on-road driving evaluation. Results: A total of 17.9% of Veterans failed the on-road evaluation. Clinical diagnostic group was not associated with failure rate. Age was not associated with failure rates in the full sample or within diagnostic groups. After controlling for age, poorer processing speed and selective/divided attention were associated with higher failure rates in the full sample. No cognitive tests were associated with failure rates within diagnostic groups. Conclusion: Referral diagnosis and age alone are not reliable predictors of Veterans’ driving performance. Cognitive performance, specifically speed of processing and attention, may be helpful in screening Veterans’ driving safety. Practical Applications: Clinicians tasked with assessing Veterans’ driving safety should take into account cognitive performance, particularly processing speed and attention, when making decisions regarding driving safety. Age and referral diagnosis, while helpful information, are insufficient to predict outcomes on driving evaluations.     

Assessing fitness to drive—A validation study on patients with mild cognitive impairment

Objectives: There is no consensus yet on how to determine which patients with cognitive impairment are able to drive a car safely and which are not. Recently, a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment. A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia. The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid) for a closely related group of patients; that is, patients with mild cognitive impairment (MCI).

Methods: Eighteen patients with mild cognitive impairment completed the proposed approach to the measurement of fitness to drive, including clinical interviews, a neuropsychological assessment, and driving simulator rides. The criterion fitness to drive was again assessed by means of an on-road driving evaluation. The predictive validity of the fitness to drive assessment strategy was evaluated by receiver operating characteristic (ROC) analyses.

Results: Twelve patients with MCI (66.7%) passed and 6 patients (33.3%) failed the on-road driving assessment. The previously proposed approach to the measurement of fitness to drive achieved an overall predictive accuracy of 94.4% in these patients. The application of an optimal cutoff resulted in a diagnostic accuracy of 100% sensitivity toward unfit to drive and 83.3% specificity toward fit to drive. Further analyses revealed that the neuropsychological assessment and the driving simulator rides produced rather stable prediction rates, whereas clinical interviews were not significantly predictive for practical fitness to drive in the MCI patient sample.

Conclusions: The selected measures of the previously proposed approach revealed adequate accuracy in identifying fitness to drive in patients with MCI. Furthermore, a combination of neuropsychological test performance and simulated driving behavior proved to be the most valid predictor of practical fitness to drive.     

Predictability of clinical assessments for driving performance

PROBLEM: As the number of older drivers grows, it is increasingly important to accurately identify at-risk drivers. This study tested clinical assessments predictive of real-time driving performance. METHOD: Selected assessment tools considered important in the identification of at-risk older drivers represented the domains of vision, cognition, motor performance, and driving knowledge. Participants were administered the battery of assessments followed by an on-road test. A univariate analysis was conducted to identify significant factors (<.05) to be included in a multivariate regression model. RESULTS: Assessments identified as independently associated with driving performance in the regression model included: FACTTM Contrast sensitivity slide-B, Rapid Pace Walk, UFOV rating, and MMSE total score. DISCUSSION: The domains of vision, cognitive, and motor performance were represented in the predictive model. SUMMARY: Due to the dynamic nature of the driving task, it is not likely that a single assessment tool will identify at risk drivers. IMPACT ON INDUSTRY: By standardizing the selection of clinical assessments used in driving evaluations, practitioners should be able to provide services more efficiently, more objectively, and more accurately to identify at-risk drivers.     

On-road driving evaluations: a potential tool for helping older adults drive safely longer

PROBLEM: This paper explores the potential use of on-road driving evaluations as a tool for helping older adults extend their safe driving years. METHOD: Three separate research activities were carried out. The first was a national telephone survey of current and former older drivers. The results of this survey provide information relevant to the potential market for on-road driving evaluations. The second was a series of focus groups with potential stakeholders in the process: driver educators, occupational therapists, and physicians. These groups explored the feasibility and requirements of offering on-road driving evaluations to the wider public. Supplemental data were also collected from a mail survey of driving schools nationwide. RESULTS: Based on the results of these efforts, a number of recommendations are presented for expanding the availability of on-road driving evaluations, specifically to help older adults make more responsible decisions about continuing or stopping driving, and more generally to help them drive safely longer.     

In-vehicle workload assessment: effects of traffic situations and cellular telephone use

PROBLEM: Assessment of drivers' on-road workload is an important traffic safety consideration. This study was conducted to examine the effects of cellular phone communication on driving performance, with particular emphasis on variations in task demand in different traffic situations. METHOD: Twelve participants were asked to drive on urban roads and motorways with or without concomitant mathematical-addition tests relayed via cellular phone. Measurements included task and driving performance, physiological responses, and compensatory behavior. RESULTS: Analysis of task performance revealed that mean response time was markedly increased (11.9%) for driving on urban roads compared to motorways. The mean driving speed only decreased 5.8% in the presence of phone tasks in comparison to normal driving without distractions. In addition, overall physiological workload increased through compensatory behavior in response to the phone tasks. CONCLUSIONS: Driving with phone use in different traffic environments induced measurable variations in driver workload. IMPACT ON INDUSTRY: When faced with heavy traffic, a greater safety margin is typically adopted, with more lowered driving speed and restricted phone use, and it can be assumed that there is a general trade-off between tasks to preserve driving safety.     

安全控制技术──用“控制论”研究重大工业危险源

首次将“控制论”中过程控制的理论与方法应用于重大工业危险源的安全控制，提出了“安全通道”和“事故临界状态”的概念，它不停留于对危险源的认识上（安全评价），而是针对危险源可能发生的灾难性事故采取切实有效的解决办法，是防止事故的最具成效的研究方法。本方法主要适用于大型、连续化生产的工业对身，用以防止重大事故。     

Are older drivers’ driving patterns during an on-road driving task representative of their real-world driving patterns?

Abstract

Objective: The current study investigated whether older drivers’ driving patterns during a customized on-road driving task were representative of their real-world driving patterns.

Methods: Two hundred and eight participants (male: 68.80%; mean age?=?81.52 years, SD?=?3.37 years, range?=?76.00–96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants’ real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant’s vehicle.

Results: During the 4-month period prior to completing the on-road driving task, participants’ median real-world driving trip distance was 2.66?km (interquartile range [IQR]?=?1.14–5.79?km) and their median on-road driving task trip distance was 4.41?km (IQR?=?2.83–6.35?km). Most participants’ on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n?=?198).

Conclusions: These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants’ real-world driving patterns.     

Higher cue utilization in driving supports improved driving performance and more effective visual search behaviors

IntroductionOnce qualified, drivers rarely receive objective feedback concerning their performance. This is especially the case in the context of cognitive skills such as situation assessment. The aim of this study was to test the construct validity of an online assessment of motor-vehicle driver cue utilization that forms the foundation for situation assessment. Method: Seventy-one undergraduate Psychology students with broadly comparable driving experience completed a motor-vehicle driving version of EXPERTise 2.0, an online tool that enables inferences concerning the utilization of cues based on responses to task-related stimuli. They also completed a simulated driving task while fitted with an eye tracking device, during which a range of hazards were presented with participants’ responses recorded. Results: The results indicated that higher cue utilization was associated with fewer driving errors and collisions, fewer visual fixations, and fewer saccades in comparison to participants with lower cue utilization. Conclusion: The results provide support for the construct validity of EXPERTise 2.0 as an effective measure of cue utilization in the context of driving.Practical applicationsProviding comparative feedback to drivers concerning their development of situation assessment skills may provide opportunities for further training and development, thereby reducing the likelihood of motor-vehicle accidents.     

Relationships between frequency of driving under the influence of cannabis,self-reported reckless driving and risk-taking behavior observed in a driving simulator

IntroductionThe role of cannabis consumption in traffic crashes is unclear and the causal link between cannabis and collisions is still to be demonstrated. While cannabis use is very likely to impair driving ability, there is as yet no overwhelming evidence that cannabis use in isolation contributes more to collisions than other characteristics inherent to cannabis users. As noted in a growing body of literature, individuals driving under the influence of cannabis (DUIC) seem to exhibit a general reckless driving style putting them at higher risk to be involved in traffic crashes.MethodThis study aims at investigating the relationship between self-reported DUIC and reckless driving by means of self-reported measures and direct observations made in a driving simulator. Participants (n = 72) were required to be between 18 and 25 years of age, to hold a valid driver's license, and to drive at least twice a week. They completed standard driving simulation tasks recreating everyday on-road trivial conditions.ResultsResults show that people admitting that they commit more real-life dangerous driving behaviors reached higher maximum speed and demonstrated more reckless driving behaviors on the driving simulation tasks. Self-reported DUIC is associated with a risky driving style including a broad range of reckless on-road behaviors and support the problem driving behavior theory. Moreover, beyond confounding factors, both self-report DUIC and observed dangerous behaviors are associated with real-life traffic violations.Practical applicationsSince DUIC appears to be related to an overall reckless style of driving, it is proposed that public safety policies should be more holistic, simultaneously targeting multiple on-road dangerous behaviors for intervention.     

Association between older driver characteristics, on-road driving test performance, and crash liability

From May 1999, a new system for licensing older drivers was introduced in New Zealand. It included a practical on-road driving test with expanded scope, to be completed every two years from the time the driver turns 80. The relationship between crashes and test performance needed to be studied to inform the debate regarding the testing system. The population studied was all drivers who entered this licensing system during its first three years of operation. They were defined as crash involved if they were involved in an injury crash during the two years following their first licensure under the new system. Logistic regression was used to describe the risk of crash involvement in terms of driving test performance and other driver characteristics. Each driving test failure was associated with a 33% increase in the odds of crash involvement (95% CI 14% to 55%), controlling for age, gender, minor traffic violations, and whether the older driver lived with another licensed driver or not. Minor traffic violations in the two years following the driving test were associated with twice the odds of crash involvement. These results suggest that the new on-road driving test does identify older driver behaviors or limitations that are related to crash liability. It is anticipated that the results presented here will provide essential information for discussing older driver licensing systems, whose impact will grow in importance as the population of drivers ages.     

Effectiveness of mandatory license testing for older drivers in reducing crash risk among urban older Australian drivers

Most licensing jurisdictions in Australia maintain mandatory assessment programs targeting older drivers, whereby a driver reaching a specified age is required to prove his or her fitness to drive through medical assessment and/or on-road testing. Previous studies both in Australia and elsewhere have consistently failed to demonstrate that age-based mandatory assessment results in reduced crash involvement for older drivers. However studies that have based their results upon either per-population or per-driver crash rates fail to take into account possible differences in driving activity. Because some older people maintain their driving licenses but rarely if ever drive, the proportion of inactive license-holders might be higher in jurisdictions without mandatory assessment relative to jurisdictions with periodic license assessment, where inactive drivers may more readily either surrender or lose their licenses. The failure to control for possible differences in driving activity across jurisdictions may be disguising possible safety benefits associated with mandatory assessment. The current study compared the crash rates of drivers in Melbourne, Australia, where there is no mandatory assessment and Sydney, Australia, where there is regular mandatory assessment from 80 years of age onward. The crash rate comparisons were based on four exposure measures: per population, per licensed driver, per distance driven, and per time spent driving. Poisson regression analysis incorporating an offset to control for inter-jurisdictional road safety differences indicated that there was no difference in crash risk for older drivers based on population. However drivers aged 80 years and older in the Sydney region had statistically higher rates of casualty crash involvement than their Melbourne counterparts on a per license issued basis (RR: 1.15, 1.02-1.29, p=0.02) and time spent driving basis (RR: 1.19, 1.06-1.34, p=0.03). A similar trend was apparent based on distance travelled but was of borderline statistical significance (RR: 1.11, 0.99-1.25, p=0.07). Collectively, it can be inferred from these findings that mandatory license re-testing schemes of the type evaluated have no demonstrable road safety benefits overall. Further research to resolve this on-going policy debate is discussed and recommended.     

On-road and simulated driving: concurrent and discriminant validation

Introduction

A converging pair of studies investigated the validity of a simulator for measuring driving performance/skill.

Study 1

A concurrent validity study compared novice driver performance during an on-road driving test with their performance on a comparable simulated driving test.

Results

Results showed a reasonable degree of concordance in terms of the distribution of driving errors on-road and errors on the simulator. Moreover, there was a significant relationship between the two when driver performance was rank ordered according to errors, further establishing the relative validity of the simulator. However, specific driving errors on the two tasks were not closely related suggesting that absolute validity could not be established and that overall performance is needed to establish the level of skill.

Study 2

A discriminant validity study compared driving performance on the simulator across three groups of drivers who differ in their level of experience - a group of true beginners who had no driving experience, a group of novice drivers who had completed driver education and had a learner's permit, and a group of fully licensed, experienced drivers.

Results

The findings showed significant differences among the groups in the expected direction -- the various measures of driving errors showed that beginners performed worse than novice drivers and that experienced drivers had the fewest errors. Collectively, the results of the concurrent and discriminant validity studies support the use of the simulator as a valid measure of driving performance for research purposes.

Impact on industry

These findings support the use of a driving simulator as a valid measure of driving performance for research purposes. Future research should continue to examine validity between on-road driving performance and performance on a driving simulator and the use of simulated driving tests in the evaluation of driver education/training programs.     

Older driver fitness-to-drive evaluation using naturalistic driving data

ProblemAs our driving population continues to age, it is becoming increasingly important to find a small set of easily administered fitness metrics that can meaningfully and reliably identify at-risk seniors requiring more in-depth evaluation of their driving skills and weaknesses.MethodSixty driver assessment metrics related to fitness-to-drive were examined for 20 seniors who were followed for a year using the naturalistic driving paradigm. Principal component analysis and negative binomial regression modeling approaches were used to develop parsimonious models relating the most highly predictive of the driver assessment metrics to the safety-related outcomes observed in the naturalistic driving data.ResultsThis study provides important confirmation using naturalistic driving methods of the relationship between contrast sensitivity and crash-related events.Practical applicationsThe results of this study provide crucial information on the continuing journey to identify metrics and protocols that could be applied to determine seniors' fitness to drive.     

Learning to Drive: Learners’ Self-Reported Cognitive Failure Level Predicts Driving Instructor’s Observation Rating of Driving Performance

Objectives. Evidence increases that cognitive failure may be used to screen for drivers at risk. Until now, most studies have relied on driving learners. This exploratory pilot study examines self-report of cognitive failure in driving beginners and error during real driving as observed by driving instructors. Methods. Forty-two driving learners of 14 driving instructors filled out a work-related cognitive failure questionnaire. Driving instructors observed driving errors during the next driving lesson. In multiple linear regression analysis, driving errors were regressed on cognitive failure with the number of driving lessons as an estimator of driving experience controlled. Results. Higher cognitive failure predicted more driving errors(p < .01) when age, gender and driving experience were controlled in analysis. Conclusions. Cognitive failure was significantly associated with observed driving errors. Systematic research on cognitive failure in driving beginners is recommended.     

Improving older driver knowledge and self-awareness through self-assessment: the driving decisions workbook

PURPOSE: This study aims to assess whether the Driving Decisions Workbook, a self-assessment instrument for older drivers, increased self-awareness and general knowledge. This study also assessed perceptions regarding its usefulness, particularly as a tool for facilitating discussions within families of older drivers. A secondary purpose of the study was to determine if problems identified by drivers in the workbook related to problems they had with actual driving. DESIGN AND METHODS: The Driving Decisions Workbook was administered along with a questionnaire and a road test. A convenience sample of 99 licensed drivers aged 65 and above was used. RESULTS: After completing the workbook, about three fourths of the participants reported being more aware of changes that could affect driving. Fourteen percent reported that they had discovered a change in themselves of which they had not been previously aware. All respondents found the workbook to be at least a little useful and thought the workbook could help facilitate family discussions. Workbook responses were positively correlated with overall road test scores. Significant correlations were also noted between the road test and a majority of workbook subsection responses. IMPLICATIONS: This study indicates that the workbook may be a useful first-tier assessment instrument and educational tool for the older driver. It may encourage an older driver to drive more safely and/or to seek clinical assessment, and help in facilitating discussions about driving within their families.     

The combined effects of on-road and simulator training with feedback on older drivers' on-road performance: Evidence from a randomized controlled trial

Objective: A number of training programs that seek to improve driving performance among older drivers are available accompanied by a growing interest in their effectiveness. The purpose of the present investigation was to examine the combined effect of (1) basic in-class training (BT); (2) on-road training with individualized feedback (OR); and (3) training on a driving simulator (S).

Methods: Using a randomized controlled trial study design, 78 older drivers were randomly assigned to one of 3 groups (BT, BT + OR, or BT + OR + S). All participants completed a pre- and postintervention on-road driving evaluation on a standardized route. The driving evaluations were recorded using video and Global Positioning System (GPS) equipment and were scored by a blind assessor.

Results: The results indicated a significant reduction of approximately 30% in overall number of driving errors/omissions among participants in the BT + OR and the BT + OR + S groups in comparison to participants in the BT group.

Conclusions: This study adds to the mounting evidence demonstrating the effectiveness of individualized driver training in improving safe driving among older adults.     

纺织企业噪声职业危害风险评价及降噪措施

噪声是纺织业的主要职业危害之一。纺织企业生产车间的噪声不仅会影响到纺织生产的效率、工人的工作能力及安全,还会对纺织工人的健康造成危害,甚至导致职业病。以南方某纺织企业为研究对象,对其生产车间的噪声进行了调查测量,并采用职业病作业危害、职业接触风险评估二种评价方法,对该企业各生产工序的噪声职业危害进行风险评价,得出评价结论,从声源、声传播途径、个体防护及管理制度四个方面提出了降噪措施,以便更好地加强防治,预防减少噪声职业危害。     

Validation of the propensity for angry driving scale

Problem: This study examined the validity of the Propensity for Angry Driving Scale (PADS; DePasquale, J. P., Geller, E. S., Clarke, S. W., and Littleton, L. C. (2001). Measuring road rage: Development of the Propensity for Angry Driving Scale. Journal of Safety Research, 32, 1–16) in predicting aggressive driving. Method: The PADS and the Driving Anger Scale (DAS; Deffenbacher, J. L., Oetting, E. R., and Lynch, R. S. (1994). Development of a driving anger scale. Psychological reports, 74, 83–91.) were administered to 232 college student volunteers with measures of aggressive and risky driving. Results: Convergent and discriminant validity of the PADS were supported through relationships among measures of similar constructs. The PADS significantly (p<.05) predicted moving tickets, minor accidents, aggressive driving, risky driving, and maladaptive driving anger expression, above and beyond gender, miles driven per week, and trait anger. Discussion: Findings suggest that the PADS is a useful predictor of aggressive driving and has some advantages over the DAS. Impact on Industry: The PADS is an effective predictor of aggressive driving that complements established measures like the DAS and provides researchers with another valuable tool for the assessment of aggressive driving.     

Car drivers with dementia: Different complications due to different etiologies?

Objective: Older drivers with dementia are an at-risk group for unsafe driving. However, dementia refers to various etiologies and the question is whether dementias of different etiology have similar effects on driving ability.

Methods: The literature on the effects of dementia of various etiologies on driving ability is reviewed. Studies addressing dementia etiologies and driving were identified through PubMed, PsychINFO, and Google Scholar.

Results and Conclusions: Early symptoms and prognoses differ between dementias of different etiology. Therefore, different etiologies may represent different likelihoods with regard to fitness to drive. Moreover, dementia etiologies could indicate the type of driving problems that can be expected to occur. However, there is a great lack of data and knowledge about the effects of almost all etiologies of dementia on driving. One could hypothesize that patients with Alzheimer's disease may well suffer from strategic difficulties such as finding a route, whereas patients with frontotemporal dementia are more inclined to make tactical-level errors because of impaired hazard perception. Patients with other dementia etiologies involving motor symptoms may suffer from problems on the operational level. Still, the effects of various etiologies of dementias on driving have thus far not been studied thoroughly. For the detection of driving difficulties in patients with dementia, structured interviews with patients but also their family members appear crucial. Neuropsychological assessment could support the identification of cognitive impairments. The impact of such impairments on driving could also be investigated in a driving simulator. In a driving simulator, strengths and weaknesses in driving behavior can be observed. With this knowledge, patients can be advised appropriately about their fitness to drive and options for support in driving (e.g., compensation techniques, car adaptations). However, as long as no valid, reliable, and widely accepted test battery is available for the assessment of fitness to drive, costly on-road test rides are inevitable. The development of a fitness-to-drive test battery for patients with dementia could provide an alternative for these on-road test rides, on condition that differences between dementia etiologies are taken into consideration.     

The on-road experiences and awareness of sleepiness in a sample of Australian highway drivers: A roadside driver sleepiness study

Objective: Driver sleepiness contributes substantially to road crash incidents. Simulator and on-road studies clearly reveal an impairing effect from sleepiness on driving ability. However, the degree to which drivers appreciate the dangerousness of driving while sleepy is somewhat unclear. This study sought to determine drivers' on-road experiences of sleepiness, their prior sleep habits, and personal awareness of the signs of sleepiness.

Methods: Participants were a random selection of 92 drivers traveling on a major highway in the state of Queensland, Australia, who were stopped by police as part of routine drink driving operations. Participants completed a brief questionnaire that included demographic information, sleepy driving experiences (signs of sleepiness and on-road experiences of sleepiness), and prior sleep habits. A modified version of the Karolinska Sleepiness Scale (KSS) was used to assess subjective sleepiness in the 15 min prior to being stopped by police.

Results: Participants' ratings of subjective sleepiness were quite low, with 90% reporting being alert to extremely alert on the KSS. Participants were reasonably aware of the signs of sleepiness, with many signs of sleepiness associated with on-road experiences of sleepiness. Additionally, the number of hours spent driving was positively correlated with the drivers' level of sleep debt.

Conclusions: The results suggest that participants had moderate experiences of driving while sleepy and many were aware of the signs of sleepiness. The relationship between driving long distances and increased sleep debt is a concern for road safety. Increased education regarding the dangers of sleepy driving seems warranted.