Older driver retraining: An updated systematic review of evidence of effectiveness

Problem and Objective

The number of older drivers who might benefit from driver retraining is growing. A previous review on the effectiveness of older driver retraining included intervention studies up to 2004. The objective was to perform an updated systematic review of the effectiveness of older driver retraining for improving driving-related skills and reducing crash rates.

Method

Articles published from 2004-2008 were grouped according to the intervention provided and outcome studied. Randomized clinical trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale and scored for quality according to their internal validity. Each intervention's effectiveness was then rated and assigned a level of evidence by combining pre- and post- 2004 findings.

Results

Three RCTs and one matched-pairs cohort design met the inclusion criteria. There is strong evidence (Level 1a) that education combined with on-road training improves driving performance and moderate evidence (Level 1b) that it improves knowledge. There is moderate evidence (Level 1b) that physical retraining improves driving performance. There is moderate evidence (Level 1b) that an educational intervention curriculum alone is not effective in reducing crashes.

Summary

The updated evidence on the effectiveness of retraining aimed at older drivers is sufficiently encouraging to merit assertive health promotion actions regarding intervention and program planning.

Impact on Industry

These positive findings warrant a comprehensive plan that has both behavioral and monetary incentives encouraging older driver participation in programs aimed at driver safety.     

Deconstructing a gender difference: driving cessation and personal driving history of older women

PROBLEM: The purpose of this study is to understand the reasons behind older women's driving cessation by comparing the driving histories of Finnish women who either gave up or renewed their drivers license at the age of 70. METHOD: A mail survey was sent to all Finnish women born in 1927 who gave up their license in 1997 (N=1,476) and to a corresponding random sample of women who renewed their license (N=1,494). The total response rate was 42.1%. RESULTS: The length and level of activity of personal driving history were strongly associated with driving cessation and continuation. Ex-drivers tended to have an inactive driving career behind them, whereas drivers had a more active personal driving history. In addition, those women with an active, "male-like" driving history who had decided to stop driving gave reasons for driving cessation that were similar to what is known about older men's reasons to give up driving. The results suggest that the decision to stop driving is related to driving habits rather than gender.     

Health, safety, self-regulation and the older driver: It's not just a matter of age

Problem

The purpose of this research was to examine the impact of age and health on patterns of driving and self-regulation among older adults who still drive.

Method

This analysis presents the results of a nationwide survey of drivers who are 50 + (N = 3,824, 53.11% response rate), focusing on questions about the impact of their self-reported health on attitudes toward and self-regulation of driving.

Results

The data indicate that as age increases, so too does reported self-regulation of driving, increasing sharply among those ages 70 and older. The data also indicate that respondent's reported confidence in driving and their enjoyment of driving decline as they age. Health status bears a significant relationship with all three of these variables, positively related to confidence in driving skills and to enjoyment in driving, but negatively related to self-regulation reports. As self-reported health declines, respondent's report engages in greater voluntary restrictions of their driving.

Discussion

All too often, the driving decision is linked primarily to chronological age. Analysis done here indicates that age alone is not the best indicator of self-regulation and how older adults change their driving behaviors.

Summary

This research presents the results of a nationwide survey of 50+ drivers and their self-reported driving, self-regulation behaviors, and health status. Strong support was found for the argument that chronological age is not an adequate measure of self-regulating behaviors and driver safety among those 50+. In particular, it was found that a person's health status and the interaction between age and health are essential considerations in the decisions around self-regulation and driving. People tend to self-regulate more with age, but the effect becomes much more pronounced as health status declines.

Impact on industry

In the coming years, if older adults can't get to where they want to go and continue to be viable consumers in our national fabric, all industries will eventually suffer. Transportation is a key component to the nation's social contract with older individuals and their families.     

Driving and alternatives: older drivers in Michigan

Method: A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive. Results: Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years. Impact on industry: Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.     

Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes

PROBLEM: To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator, and to determine which measures were associated with the occurrence of motor-vehicle crash. METHOD: One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study. Using the driving simulator, appropriate driving tasks were devised to test the older drivers, whose performances were assessed by 10 reliable assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome. RESULTS: As expected, driving skill of older drivers was found to decline with age. Over 60% of the sample participants reported having at least one motor-vehicle crash during the past year. Adjusting for age in a logistic regression analysis, the cognitive abilities associated with the crash occurrence were working memory, decision making under pressure of time, and confidence in driving at high speed. SUMMARY: The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator. Prospective studies need to be undertaken to determine whether the driving simulator can predict future crash events. IMPACT ON INDUSTRY: This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered.     

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.     

Young driver risk in relation to parents' retrospective driving record

PROBLEM: Parents are an important potential influence on the driving safety of their children. This study examined the relationship of parental driving record on male and female offspring's at-fault collision risk. METHOD: Drivers aged 16-21 on the date of full licensure were selected from driver records and a matching process was used to identify putative parents in two-parent households. Poisson regression models were developed to predict at-fault collisions of male and female youth in the three years following full licensure from parents' at-fault collisions, speeding offenses, and other moving offenses in the four years prior to children's licensure. One set of models examined the relative risk associated with increasing numbers of maternal and paternal at-fault collisions and offenses. Other models examined the joint versus separate maternal and parental contributions. RESULTS: Controlling for region of residence, both mothers' and fathers' at-fault collisions were associated with an increased risk in both male and female youth at-fault collisions. Mothers' and fathers' speeding offenses were also associated with increased relative risk of at-fault collisions for both sons and daughters, while fathers' other moving offenses increased collision risk for sons but not daughters. DISCUSSION: Further research is required to identify how parental driving risk is transmitted to children. IMPACT ON INDUSTRY: (a) Parents of young children should be informed of their role in influencing their children's future driving risk; (b) The results identify risk factors that could be of interest to licensing authorities and the insurance industry.     

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.     

Evaluating the impact of passengers on the safety of older drivers

PROBLEM: This study involved a quasi-induced exposure analysis of 4 years of crashes involving older drivers in the state of Kentucky. METHOD: Single- and multivehicle crashes were disaggregated according to the number of passengers: (a) no passenger, (b) one passenger, and (c) two or more passengers. RESULTS: Overall, the presence of two or more passengers was found to negatively impact the probability that drivers 75 years of age or older were at fault in crashes. Several potential factors were studied for interactive effects with passengers: vehicle occupant gender mix, time of the day, road curvature, grade, and number of lanes. The negative impact of passengers increased for some geometric road conditions. However, older drivers were found to be safer at night when carrying two or more passengers. The presence or absence of passengers was not found to affect the 65- to 74-year-old driver group. Groups of male vehicle occupants with a 75+ male driver were found to have high single-vehicle crash rates. IMPACT: These results are among the first to directly consider the effect of passengers on the crash-causing propensity of older drivers and the findings suggest more work is warranted to consider causes for the crash rate differences.     

Assessment of older drivers: relationships among on-road errors, medical conditions and test outcome

PROBLEM: It is essential that driver licensing authorities have a valid and reliable system for evaluating older drivers' continuing competency; road tests are usually required as part of such a system. This study sought to find information about the nature of driving errors made during license review tests, and about relationships between error type and test outcome for older drivers. METHOD: Data from licensing authority files from 533 road tests during a 12-month period were analyzed; medical and other referral information was included. Average driver age was 76 years. Performance scores were generated for intersection negotiation, lane changing, low speed manoeuvres, positioning and speed control, safety margin, and car control. RESULTS: Logistic regression analysis showed that test outcome was well predicted by a subset of driving performance scores; adding driver age to the model explained very little variance. Age alone was strongly associated with outcome. Relationships between referral information and test outcome are also reported. IMPACT: Results highlight several factors relevant to the development of more valid and reliable road tests for older drivers.     

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.     

Enhancing older driver safety: A driving survey and evaluation of the CarFit program

Objective

To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle.

Methods

A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n = 195) were assigned randomly to CarFit intervention (n = 83, M age = 78.1) or Comparison (n = 112, M age = 79.6) groups. After 6 months, participants completed a post-test of driving activity and CarFit recommendations.

Results

Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up.

Conclusion

CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers.

Impact on industry

CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.     

Distraction in older drivers - A face-to-face interview study

The prevalence of older drivers’ engagement in distracting activities while driving is largely unexplored. Face-to-face interviews were conducted in the city of Braunschweig, Germany, comparing a sample of older drivers (n = 205) to a group of middle-aged drivers (n = 209). The drivers were interviewed on their engagement in distracting activities during the last half an hour of their driving trip, including the frequency and duration of these activities, their perception of the risk associated with these distracting activities and the role of these activities in at-fault crashes. Middle-aged drivers were significantly more likely to engage in certain distracting activities than older drivers. With regard to the duration of interactions with the passengers older drivers were significantly more talkative than middle-aged drivers. Middle-aged drivers rated most of the distracting activities as significantly less dangerous than older drivers. Distraction-related crashes are not a special problem of older drivers but seem to be very comparable to the middle-aged drivers. It is concluded that older drivers’ reluctance to engage in distracting tasks while driving is either a process of self-regulation or their age-related prudence. The study is the first to gather knowledge about distraction in German older drivers. Although older drivers are not currently overrepresented in distraction-related crashes, it is important to note that future cohorts of older drivers might differ in the way they engage with vehicles and technologies, which in turn may influence their driving patterns and willingness to engage in potentially distracting activities.     

Improving graduated driver licensing systems: a conceptual approach and its implications

Graduated driver licensing (GDL) is a concept for how to transform non-drivers into reasonably safe drivers while minimizing the risks as they learn. Several state GDL programs can be improved by moving their structures closer to an adequate implementation of that concept. The learner stage of a GDL system needs to be long enough for beginners to obtain a thorough introduction to the vagaries of driving. The second or intermediate stage needs to effectively limit exposure to known high risk conditions as novices adapt to being fully in charge of the vehicle. The benefits of GDL to date are due almost entirely to the risk-reducing conditions it implements. To improve the functioning of GDL will probably require a better understanding of teen driving than we presently have. The likelihood of further gains will be enhanced by efforts to learn more about the actual causes of teen crashes, the nature and type of teen driver exposures, and what parents do with their teens during the supervised driving stage of GDL. Without a better understanding of these, and other, phenomena it will be difficult to further reduce crashes among young beginning drivers, whether through GDL enhancements or with other approaches.     

Risks older drivers pose to themselves and to other road users

Problem

Studies have shown that older drivers have high death rates and lower rates of involvement in crashes that kill others; but most studies have not considered drivers' responsibility for their crashes, and many have considered only one particular measure of risk.

Method

This study examines risks that drivers of various ages pose to themselves and to others on per-driver, per-trip, and per-mile bases, taking responsibility for crashes into account, using United States fatal crash data from 1999 through 2003 and travel estimates from 2001.

Results

Relative to other age groups, drivers aged 85 and older face the highest risk of their own death, whereas teens pose the greatest risk to passengers, occupants of other vehicles, and non-motorists.

Discussion

The oldest drivers pose more risk to other road users than middle-aged drivers do; the degree of their excess risk depends strongly upon how risk is measured.

Impact on industry

These results demonstrate the importance of keeping clear the meaning and implications of various risk measures.     

The impact of environmental, vehicle and driver characteristics on injury severity in older drivers hospitalized as a result of a traffic crash

INTRODUCTION: Compared to younger age groups, older people are more likely to be seriously injured or to die as a result of a traffic crash. METHOD: The aim of the study is to examine the impact of environmental, vehicle, crash, and driver characteristics on injury severity in older drivers involved in traffic crashes by using recently linked police crash records and hospitalization data from New South Wales, Australia. The severity of injury resulting from traffic crashes was measured using the International Classification of Diseases, 10th revision (ICD-10) Injury Severity Score (ICISS). RESULTS: Multivariate analysis identified rurality, presence of complex intersections, road speed limit, driver error, speeding, and seat belt use as independent predictors of injury severity in older people. The type of intersection configuration explained over half of the observed variations in injury severity. IMPACT ON INDUSTRY: Environmental modification such as intersection treatments might contribute to a decrease in the severity of injury in older people involved in road crashes.     

Increasing self-awareness among older drivers: The role of self-screening

Introduction

Self-screening by older drivers has shown considerable promise for increasing self-awareness about functional abilities associated with safe driving. The purpose of this study was to improve upon existing self-screening instruments by focusing entirely on “health concerns” that affect driving - that is, the symptoms that people experience due to medical conditions and the medications used to treat them - rather than the medical conditions or medications themselves.

Method

A computer-based, easy-to-use self-screening instrument for older drivers was developed to provide individualized feedback intended to increase self-awareness about declines in driving-related abilities, as well as suggestions for behavioral changes or safety tips to maintain safe driving, further evaluation from a physician/health professional, and vehicle modifications to help compensate for driving-related declines.

Results

This paper describes the development of the self-screening instrument and summarizes findings relative to increasing self-awareness among older drivers. This research represents an important first step in improving self-awareness among older drivers through self-screening.