Exploratory multinomial logit model–based driver injury severity analyses for teenage and adult drivers in intersection-related crashes

Objective: Teenage drivers are more likely to be involved in severely incapacitating and fatal crashes compared to adult drivers. Moreover, because two thirds of urban vehicle miles traveled are on signal-controlled roadways, significant research efforts are needed to investigate intersection-related teenage driver injury severities and their contributing factors in terms of driver behavior, vehicle–infrastructure interactions, environmental characteristics, roadway geometric features, and traffic compositions. Therefore, this study aims to explore the characteristic differences between teenage and adult drivers in intersection-related crashes, identify the significant contributing attributes, and analyze their impacts on driver injury severities.

Methods: Using crash data collected in New Mexico from 2010 to 2011, 2 multinomial logit regression models were developed to analyze injury severities for teenage and adult drivers, respectively. Elasticity analyses and transferability tests were conducted to better understand the quantitative impacts of these factors and the teenage driver injury severity model's generality.

Results: The results showed that although many of the same contributing factors were found to be significant in the both teenage and adult driver models, certain different attributes must be distinguished to specifically develop effective safety solutions for the 2 driver groups.

Conclusions: The research findings are helpful to better understand teenage crash uniqueness and develop cost-effective solutions to reduce intersection-related teenage injury severities and facilitate driver injury mitigation research.     

Prevalence of alcohol impairment and odds of a driver injury or fatality in on-road farm equipment crashes

Objective: The objective of this article was to estimate the prevalence of alcohol impairment in crashes involving farm equipment on public roadways and the effect of alcohol impairment on the odds of crash injury or fatality.

Methods: On-road farm equipment crashes were collected from 4 Great Plains state departments of transportation during 2005–2010. Alcohol impairment was defined as an involved driver having blood alcohol content of ≥0.08 g/100 ml or a finding of alcohol impairment as a driver contributing circumstance recorded on the police crash report. Injury or fatality was categorized as (a) no injury (no and possible injury combined), (b) injury (nonincapacitating or incapacitating injury), and (c) fatality. Hierarchical multivariable logistic regression modeling, clustered on crash, was used to estimate the odds of an injury/fatality in crashes involving an alcohol-impaired driver.

Results: During the 5 years under study, 3.1% (61 of 1971) of on-road farm equipment crashes involved an alcohol-impaired driver. One in 20 (5.6%) injury crashes and 1 in 6 (17.8%) fatality crashes involved an alcohol-impaired driver. The non-farm equipment driver was significantly more likely to be alcohol impaired than the farm equipment driver (2.4% versus 1.1% respectively, P = .0012). After controlling for covariates, crashes involving an alcohol-impaired driver had 4.10 (95% confidence interval [CI], 2.30–7.28) times the odds of an injury or fatality. In addition, the non-farm vehicle driver was at 2.28 (95% CI, 1.92–2.71) times higher odds of an injury or fatality than the farm vehicle driver. No differences in rurality of the crash site were found in the multivariable model.

Conclusion: On-road farm equipment crashes involving alcohol result in greater odds of an injury or fatality. The risk of injury or fatality is higher among the non-farm equipment vehicle drivers who are also more likely to be alcohol impaired. Further studies are needed to measure the impact of alcohol impairment in on-road farm equipment crashes.     

Analysis of risk factors affecting driver injury and crash injury with drivers under the influence of alcohol (DUI) and non-DUI

Objective: The objective of this research was to study risk factors that significantly influence the severity of crashes for drivers both under and not under the influence of alcohol.

Methods: Ordinal logistic regression was applied to analyze a crash data set involving drivers under and not under the influence of alcohol in China from January 2011 to December 2014.

Results: Four risk factors were found to be significantly associated with the severity of driver injury, including crash partner and intersection type. Age group was found to be significantly associated with the severity of crashes involving drivers under the influence of alcohol. Crash partner, intersection type, lighting conditions, gender, and time of day were found to be significantly associated with severe driver injuries, the last of which was also significantly associated with severe crashes involving drivers not under the influence of alcohol.

Conclusions: This study found that pedestrian involvement decreases the odds of severe driver injury when a driver is under the influence of alcohol, with a relative risk of 0.05 compared to the vehicle-to-vehicle group. The odds of severe driver injury at T-intersections were higher than those for traveling along straight roads. Age was shown to be an important factor, with drivers 50–60 years of age having higher odds of being involved in severe crashes compared to 20- to 30-year-olds when the driver was under the influence of alcohol.

When the driver was not under the influence of alcohol, drivers suffered more severe injuries between midnight and early morning compared to early nighttime. The vehicle-to-motorcycle and vehicle-to-pedestrian groups experienced less severe driver injuries, and vehicle collisions with fixed objects exhibited higher odds of severe driver injury than did vehicle-to-vehicle impacts. The odds of severe driver injury at cross intersections were 0.29 compared to travel along straight roads. The odds of severe driver injury when street lighting was not available at night were 3.20 compared to daylight. The study indicated that female drivers are more likely to experience severe injury than male drivers when not under the influence of alcohol. Crashes between midnight and early morning exhibited higher odds of severe injury compared to those occurring at other times of day.

The identification of risk factors and a discussion on the odds ratio between levels of the impact of the driver injury and crash severity may benefit road safety stakeholders when developing initiatives to reduce the severity of crashes.     

Investigating factors influencing pedestrian injury severity at intersections

Objective: Vehicle crashes that involve pedestrians at intersections have been reported occasionally. Pedestrian injury severity in these crashes is significantly related to driver and pedestrian attributes, vehicle characteristics, and the geometry of intersections. Identifying factors associated with pedestrian injury severity (PIS) is critical for reducing crashes and improving safety. For developing the proposed probit models, drivers involved in crashes are classified into 3 groups: young drivers (16 ≤ age ≤ 24), middle-aged drivers (25 ≤ age ≤ 64), and older drivers (age ≥ 65). This study determines that PIS is significantly but differently affected by these grouped drivers with different sets of explanatory variables.

Methods: A total of 2,614 crash records (2011–2012) at intersections in Cook County, Illinois, were collected. An ordered probit modeling approach was employed to develop the proposed model and examine factors influencing PIS. The likelihood ratio test was used to assess model performance. Elasticity analysis was conducted to interpret the marginal effect of contributing factors on PIS associated with different driver groups by age.

Results: The results show that 4 independent variables, including pedestrian age, vehicle type, point of first contact, and weather condition, significantly affect PIS at intersections for all drivers. Two additional independent variables (i.e., number of vehicles and traffic type) affect PIS for young and middle-aged drivers, and 2 other variables (i.e., divided type and hit-and-run related) are significant to PIS for both young and older drivers.

Conclusions: The independent variables significant to PIS at intersections for young, middle-aged, and older driver groups were identified and the marginal effect of each variable to the likelihood of PIS were assessed.     

Ankle fracture patterns in drivers are associated with femoral fracture,higher BMI,and advanced age

Objective: Despite advances in vehicle safety systems, motor vehicle crashes continue to cause ankle fractures. This study attempts to provide insight into the mechanisms of injury and to identify the at-risk population groups.

Methods: A study was made of ankle fractures patients treated at an urban level 1 trauma center following motor vehicle crashes, with a concurrent analysis of a nationally representative crash data set. The national data set focused on ankle fractures in drivers involved in frontal crashes. Statistical analysis was applied to the national data set to identify factors associated with fracture risk.

Results: Malleolar fractures occurred most frequently in the driver's right foot due to pedal interaction. The majority of complex/open fractures occurred in the left foot due to interaction with the vehicle floor. These fractures occurred in association with a femoral fracture, but their broad injury pattern suggests a range of fracture causation mechanisms. The statistical analysis indicated that the risk of fracture increased with increasing driver body mass index (BMI) and age.

Conclusions: Efforts to reduce the risk of driver ankle injury should focus on right foot and pedal interaction. The range of injury patterns identified here suggest that efforts to minimize driver ankle fracture risk will likely need to consider injury tolerances for flexion, pronation/supination, and axial loading in order to capture the full range of injury mechanisms. In the clinical environment, physicians examining drivers after a frontal crash should consider those who are older or obese or who have severe femoral injury without concurrent head injury as highly suspicious for an ankle injury.     

Analyzing pedestrian crash injury severity under different weather conditions

Objective: Pedestrians are the most vulnerable road users due to the lack of mass, speed, and protection compared to other types of road users. Adverse weather conditions may reduce road friction and visibility and thus increase crash risk. There is limited evidence and considerable discrepancy with regard to impacts of weather conditions on injury severity in the literature. This article investigated factors affecting pedestrian injury severity level under different weather conditions based on a publicly available accident database in Great Britain.

Method: Accident data from Great Britain that are publicly available through the STATS19 database were analyzed. Factors associated with pedestrian, driver, and environment were investigated using a novel approach that combines a classification and regression tree with random forest approach.

Results: Significant severity predictors under fine weather conditions from the models included speed limits, pedestrian age, light conditions, and vehicle maneuver. Under adverse weather conditions, the significant predictors were pedestrian age, vehicle maneuver, and speed limit.

Conclusions: Elderly pedestrians are associated with higher pedestrian injury severities. Higher speed limits increase pedestrian injury severity. Based on the research findings, recommendations are provided to improve pedestrian safety.     

IIHS head restraint ratings and insurance injury claim rates

Objectives: The Insurance Institute for Highway Safety (IIHS) rates front seat/head restraint designs using a combination of static and dynamic measurements following RCAR-IIWPG procedures. The purpose of this study was to determine whether vehicles with better IIHS-rated seats/head restraints had lower injury risk in rear-end collisions and how the effect of better rated seats interacted with driver gender and age.

Methods: The presence of an associated insurance injury claim was determined for rear-impact crashes using 2001–2014 model year cars and SUVs. Logistic regression was used to compare injury risk for vehicles with good, acceptable, and marginal IIHS-rated seats/head restraints with poor-rated seats/head restraints. Analyses were run by gender and driver age and also by the rate of more severe injury claims.

Results: Injury rates were 11.2% lower for vehicles with seats/head restraints rated good compared to vehicles with seats/head restraints rated poor. The percentage reduction for good- versus poor-rated seats was greater for females (12.7%) than males (8.9%). Comparing good- with poor-rated seats, driver ages 15–24 had the largest reduction at 19.8%, followed by 10.7% for driver ages 45–64 and 10.4% for driver ages 25–44.

Conclusions: Seats/head restraints with better IIHS ratings are associated with lower injury rates in rear-impact collisions than seats rated poor. The reductions in injury rates were strongest for females and for young-to–middle-age drivers. The strong reductions in injury rates for these groups are encouraging given their high initial injury rates.     

Evaluation of the effectiveness of toe board energy-absorbing material for foot,ankle, and lower leg injury reduction

Objective: Since 2000, numerous improvements have been made to the National Association for Stock Car Auto Racing, Incorporated (NASCAR®) driver restraint system, resulting in improved crash protection for motorsports drivers. Advancements have included seats, head and neck restraints (HNRs), seat belt restraint systems, driver helmets, and others. These enhancements have increased protection for drivers from severe crash loading. Extending protection to the driver's extremities remains challenging. Though the drivers’ legs are well contained for lateral and vertical crashes, they remain largely unrestrained in frontal and frontal oblique crashes.

Method: Sled testing was conducted for the evaluation of an energy-absorbing (EA) toe board material to be used as a countermeasure for leg and foot injuries. Testing included baseline rigid toe boards, tests with EA material–covered toe boards, and pretest positioning of the 50th percentile male frontal Hybrid III anthropomorphic test device (ATD) lower extremities. ATD leg and foot instrumentation included foot acceleration and tibia forces and moments.

Results: The sled test data were evaluated using established injury criteria for tibial plateau fractures, leg shaft fractures, and calcaneus, talus, ankle, and midfoot fractures.

Conclusion: A polyurethane EA foam was found to be effective in limiting axial tibia force and foot accelerations when subjected to frontal impacts using the NASCAR motorsport restraint system.     

A new approach to managing work-related road traffic injury: The development of a health investment framework

Objective: Statistics indicate that employees commuting or traveling as part of their work are overrepresented in workplace injury and death. Despite this, many organizations are unaware of the factors within their organizations that are likely to influence potential reductions in work-related road traffic injury.

Methods: This article presents a multilevel conceptual framework that identifies health investment as the central feature in reducing work-related road traffic injury. Within this framework, we explore factors operating at the individual driver, workgroup supervisor, and organizational senior management levels that create a mutually reinforcing system of safety.

Results: The health investment framework identifies key factors at the senior manager, supervisor, and driver levels to cultivating a safe working environment. These factors are high-performance workplace systems, leader–member exchange and autonomy, trust and empowerment, respectively. The framework demonstrates the important interactions between these factors and how they create a self-sustaining organizational safety system.

Conclusions: The framework aims to provide insight into the future development of interventions that are strategically aligned with the organization and target elements that facilitate and enhance driver safety and ultimately reduce work-related road traffic injury and death.     

Understanding the context of alcohol impaired driving for fatal crash–involved drivers: A descriptive case analysis

Objective: The objective of this study was to understand the social context and circumstances surrounding alcohol-impaired driving prior to fatal crash involvement for drivers with an illegal blood alcohol concentration (BAC ≥ 0.05 g/100 ml or 0.00 g/100 ml for restricted license holders).

Methods: Coroners' case reports investigating fatal crashes in South Australia over a 3-year period (2008–2010) were examined. The personal and crash characteristics of drivers with an illegal BAC were compared with those who had a legal BAC. For each driver with an illegal BAC, information was recorded including characteristics of last trip, location and social context of alcohol consumption, quantity and type of alcohol consumed, BAC level, presence of drugs, perceived alcohol intoxication, and alcohol dependence. Official traffic offense records were also obtained.

Results: Of the 284 fatal crashes included in the study, 34% (n = 95) involved a driver or rider with an illegal BAC. Prior to the crash, alcohol was most frequently consumed by drivers in rural areas, within private homes, and was part of normal social activities. Drivers recorded a high level of alcohol impairment, with a mean BAC of 0.173 g/100 ml and a level of alcohol dependence that was above the Australian national average (7.4 vs. 3.9%). In addition, 23% of drivers were known to be experiencing psychological stress at the time of the crash. The results also confirm that drink driving recidivism continues to be a significant problem, with 44% of drivers recording at least one prior alcohol driving offense.

Conclusions: Alcohol-impaired driving continues to be a leading cause of fatal crashes. The popularity of drinking at home, particularly in rural areas, has implications for police enforcement strategies and suggests that drink driving interventions that focus on community values and looking after friends might be beneficial. Importantly, the study highlights the need for a broader holistic approach to reduce the high levels of alcohol consumption and alcohol dependence underlying drink driving behavior.     

Prevalence of alcohol-impaired driving and riding in northern Ghana

Objective: The objective of this study was to determine the roadside prevalence of alcohol-impaired driving among drivers and riders in northern Ghana. The study also verifies motorists' perceptions of their own alcohol use and knowledge of the legal blood alcohol concentration (BAC) limit in Ghana.

Method: With the assistance of police, systematic random sampling was used to collect data at roadblocks using a cross-sectional study design. Breathalyzers were used to screen whether motorists had detectable alcohol in their breath and follow-up breath tests were conducted to measure the actual breath alcohol levels among positive participants.

Results: In all, 9.7% of the 789 participants had detectable alcohol, among whom 6% exceeded the legal BAC limit of 0.08%. The prevalence of alcohol-impaired driving/riding was highest among cyclists (10% of all cyclists breath-tested) followed by truck drivers (9%) and motorcyclists (7% of all motorcyclists breath-tested). The occurrence of a positive BAC among cyclists was about 8 times higher (odds ratio [OR] = 7.73; P < .001) and it was 2 times higher among motorcyclists (OR = 2.30; P = .039) compared to private car drivers. The likelihood for detecting a positive BAC among male motorists/riders was higher than that among females (OR = 1.67; P = .354). The odds for detecting a positive BAC among weekend motorists/riders was significantly higher than on weekdays (OR = 2.62; P = .001).

Conclusion: Alcohol-impaired driving/riding in Ghana is high by international standards. In order to attenuate the harmful effects of alcohol misuse such as alcohol-impaired driving/riding, there is the need to educate road users about how much alcohol they can consume and stay below the legal limit. The police should also initiate random breath testing to instill the deterrence of detection, certainty of apprehension and punishment, and severity and celerity of punishment among drink-driving motorists and riders.     

Injury risks for on-road farm equipment and horse and buggy crashes in Pennsylvania: 2010–2013

Objective: The purpose of this study was to investigate characteristics associated with farm equipment and horse and buggy roadway crashes in relation to person, incident, and injury characteristics to identify appropriate points for injury incident prevention.

Methods: Information on crashes occurring on public roads during the years 2010–2013 was obtained from the Pennsylvania Department of Transportation (PennDOT) and analyzed.

Results: There were 344 farm equipment and 246 horse and buggy crashes during the 4-year study period. These crashes involved 666 and 504 vehicles and 780 and 838 people, respectively. In incidents with farm equipment, the non-farm equipment drivers had an almost 2 times greater injury risk than farm equipment operators. Horse and buggy crashes were almost 3 times more injurious to the horse and buggy drivers than the drivers of the other vehicles.

Conclusions: The average crash rate for farm equipment was 198.4 crashes per 100,000 farm population and for horse and buggy the crash rate was calculated as 89.4 crashes per 100,000 Amish population per year. This study suggests that road safety and public health programs should focus not only on farm equipment operators and horse and buggy drivers but on other motorists sharing the roadway with them.     

Driver injury severity related to inclement weather at highway–rail grade crossings in the United States

Objective: Previous studies on crash modeling at highway–rail grade crossings were aimed at exploring the factors that are likely to increase the crash frequencies at highway–rail grade crossings. In recent years, modeling driver's injury severity at highway–rail grade crossings has received interest. Because there were substantial differences among different weather conditions for driver's injury severity, this study attempts to explore the impact of weather influence on driver injury at highway–rail grade crossing.

Method: Utilizing the most recent 10 years (2002–2011) of highway–rail grade crossing accident data, this study applied a mixed logit model to explore the determinants of driver injury severity under different weather conditions at highway–rail grade crossing.

Results: Analysis results indicate that drivers' injury severity at highway–rail grade crossings is strongly different for different weather conditions. It was found that the factors significantly impacting driver injury severity at highway–rail grade crossings include motor vehicle speed, train speed, driver's age, gender, area type, lighting condition, highway pavement, traffic volume, and time of day.

Conclusions: The findings of this study indicate that crashes are more prevalent if vehicle drivers are driving at high speed or the oncoming trains are high speed. Hence, a reduction in speed limit during inclement weather conditions could be particularly effective in moderating injury severity, allowing more reaction time for last-minute maneuvering and braking in moments before impacts. In addition, inclement weather-related crashes were more likely to occur in open areas and highway–rail grade crossings without pavement and lighting. Paved highway–rail grade crossings with installation of lights could be particularly effective in moderating injury severity.     

Identifying risky drivers with simulated driving

Objective: The present study aimed to examine whether high-risk drivers differ from low-risk drivers in driving behavior in a simulated environment.

Method: The 2 risk groups including 36 drivers (18 males and 18 females) performed driving tasks in a simulated environment. The simulated driving behaviors are compared between the 2 risk groups.

Results: The high-risk drivers drove much faster and exhibited larger offsets of the steering wheel than did the low-risk drivers in events without incidents. Additionally, the high-risk drivers used turn signals and horns less frequently than the low-risk drivers.

Conclusions: The present study revealed that the high-risk group differed from the low-risk group in driving behavior in a simulated environment. These results also suggest that simulated driving tasks might be useful tools for the evaluation of drivers’ potential risks.     

Driver injury in near- and far-side impacts: Update on the effect of front passenger belt use

Purpose: This is a study that updates earlier research on the influence of a front passenger on the risk for severe driver injury in near-side and far-side impacts. It includes the effects of belt use by the driver and passenger, identifies body regions involved in driver injury, and identifies the sources for severe driver head injury.

Methods: 1997–2015 NASS-CDS data were used to investigate the risk for Maximum Abbreviated Injury Scale (MAIS) 4 + F driver injury in near-side and far-side impacts by front passenger belt use and as a sole occupant in the driver seat. Side impacts were identified with GAD1 = L or R without rollover (rollover ≤ 0). Front-outboard occupants were included without ejection (ejection = 0). Injury severity was defined by MAIS and fatality (F) by TREATMNT = 1 or INJSEV = 4. Weighted data were determined. The risk for MAIS 4 + F was determined using the number of occupants with known injury status MAIS 0 + F. Standard errors were determined.

Results: Overall, belted drivers had greater risks for severe injury in near-side than far-side impacts. As a sole driver, the risk was 0.969 ± 0.212% for near-side and 0.313 ± 0.069% for far-side impacts (P < .005). The driver's risk was 0.933 ± 0.430% with an unbelted passenger and 0.596 ± 0.144% with a belted passenger in near-side impacts. The risk was 2.17 times greater with an unbelted passenger (NS). The driver's risk was 0.782 ± 0.431% with an unbelted passenger and 0.361% ± 0.114% with a belted passenger in far-side impacts. The risk was 1.57 times greater with an unbelted passenger (P < .10). Seat belt use was 66 to 95% effective in preventing MAIS 4 + F injury in the driver. For belted drivers, the head and thorax were the leading body regions for Abbreviated Injury Scale (AIS) 4+ injury. For near-side impacts, the leading sources for AIS 4+ head injury were the left B-pillar, roof, and other vehicle. For far-side impacts, the leading sources were the other occupant, right interior, and roof (8.5%).

Conclusions: Seat belt use by a passenger lowered the risk of severe driver injury in side impacts. The reduction was 54% in near-side impacts and 36% in far-side impacts. Belted drivers experienced mostly head and thoracic AIS 4+ injuries. Head injuries in the belted drivers were from contact with the side interior and the other occupant, even with a belted passenger.     

Prevalence and characteristics of road traffic injuries among young drivers in Oman, 2009–2011

Objectives: Studies from different parts of the world have indicated that the impact of road traffic incidents disproportionally affects young adults. Few known studies have been forthcoming from Arabian Gulf countries. Within Oman, a high proportion of the population is under the age of 20. Coupled with the drastic increase in motorization in recent years, there is a need to understand the state of road safety among young people in Oman. The current research aimed to explore the prevalence and characteristics of road traffic injuries among young drivers aged 17–25 years.

Methods: Crash data from 2009 to 2011 were extracted from the Directorate General of Traffic, Royal Oman Police (ROP) database in Oman. The data were analyzed to explore the impact of road crashes on young people (17–25 years), the characteristics of young driver crashes, and how these differ from older drivers and to identify key predictors of fatalities in young driver crashes.

Results: Overall, young people were overrepresented in injuries and fatalities within the sample time period. Though it is true that many young people in crashes were driving at the time, it was also evident that young people were often victims in a crash caused by someone else. Thus, to reduce the impact of road crashes on young people, there is a need to generally address road safety within Oman. When young drivers were involved in crashes they were predominantly male. The types of crashes these drivers have can be broadly attributed to risk taking and inexperience. Speeding and nighttime driving were the key risk factors for fatalities.

Conclusion: The results highlight the need to address young driver safety in Oman. From these findings, the introduction of a graduated driver licensing system with nighttime driving restrictions could significantly improve young driver safety.     

Self-regulation of driving speed among distracted drivers: An application of driver behavioral adaptation theory

Objective: The adaptive behavior of mobile phone–distracted drivers has been a topic of much discussion in the recent literature. Both simulator and naturalistic studies suggest that distracted drivers generally select lower driving speeds; however, speed adaptation is not observed among all drivers, and the mechanisms of speed selection are not well understood. The aim of this research was to apply a driver behavioral adaptation model to investigate the speed adaptation of mobile phone–distracted drivers.

Methods: The speed selection behavior of drivers was observed in 3 phone conditions including baseline (no conversation) and hands-free and handheld phone conversations in a high-fidelity driving simulator. Speed adaptation in each phone condition was modeled as a function of secondary task demand and self-reported personal/psychological characteristics with a system of seemingly unrelated equations (SURE) accounting for potential correlations due to repeated measures experiment design.

Results: Speed adaptation is similar between hands-free and handheld phone conditions, but the predictors of speed adaptation vary across the phone conditions. Though perceived workload of secondary task demand, self-efficacy, attitude toward safety, and driver demographics were significant predictors of speed adaptation in the handheld condition, drivers' familiarity with the hands-free interface, attitude toward safety, and sensation seeking were significant predictors in the hands-free condition. Drivers who reported more positive safety attitudes selected lower driving speeds while using phones.

Conclusion: This research confirmed that behavioral adaptation models are suitable for explaining speed adaptation of mobile phone distracted drivers, and future research could be focused on further theoretical refinement.     

“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.