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.     

Factorial structure of recklessness: to what extent are older drivers different?

PROBLEM: This study tests whether the original factorial structure of a recklessness questionnaire can be maintained for the current Spanish population of older drivers. JUSTIFICATION: Our recent interest in dedicating special attention to senior citizen mobility (Monterde, 2001), is due to the impending increase of the aging population in Western countries; this has led us to reinitiate the psychometric study of the construct validity, revising and including older drivers in the psychometric aspects of those evaluation instruments that will then be used in the Spanish psycho-medical check of drivers and in research. METHODS: Factorial analysis was used to determine validity. RESULTS: There was an appearance of a different psychological pattern in elderly drivers, specifically, a psychological anxiety trait related to the task of driving. Furthermore, interesting data were found about the attitude of this sector toward the "traffic society" and toward some of the measures included in Spanish legislation that affect especially older drivers (such as the psycho-medical check). IMPACT ON INDUSTRY, RESEARCH AND PRACTICE: These results suggest the possible existence of some kind of "compensation phenomenon," which could have influence over the scores obtained and their interpretation. Consequently, the evaluation instruments should be tested and, if necessary, adapted or specifically created for use with this age group.     

COMPARING THE IMPAIRMENT PROFILES OF OLDER DRIVERS AND NON-DRIVERS: TOWARD THE DEVELOPMENT OF A FITNESS-TO-DRIVE MODEL

The purpose of this research effort was to compare older driver and non-driver functional impairment profiles across some 60 assessment metrics in an initial effort to contribute to the development of fitness-to-drive assessment models. Of the metrics evaluated, 21 showed statistically significant differences, almost all favoring the drivers. Also, it was shown that a logistic regression model comprised of five of the assessment scores could completely and accurately separate the two groups. The results of this study imply that older drivers are far less functionally impaired than non-drivers of similar ages, and that a parsimonious model can accurately assign individuals to either group. With such models, any driver classified or diagnosed as a non-driver would be a strong candidate for further investigation and intervention.     

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.     

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.     

The overall program effects of California's 3-Tier Assessment System pilot on crashes and mobility among senior drivers

IntroductionIn 2007, the California Department of Motor Vehicles (DMV) undertook a pilot study of the 3-Tier Assessment System, the purpose of which was to examine, in a large-scale real-time public agency setting, the effectiveness of this method for both reducing the crash risk of individual drivers and for extending the safe driving years of Californian drivers of all ages.MethodThe 3-Tier Assessment System consisted of tiered series of screening tools incorporated into the in-office driver's license renewal process. These screening tools identified drivers with various kinds of functional limitations (physical, visual, and cognitive/perceptual), that might impact safe driving. Paired with the screening tools were educational materials designed to improve drivers' knowledge of their own limitations, including compensating techniques. The present study is a population-based evaluation of the effects of the pilot on subsequent crash risk and mobility outcomes (including delicensure) of participating drivers age 70 and older. Pilot participants were compared with two control groups processed according to standard California DMV license renewal procedures. Because the 3-Tier Assessment System was designed to identify limitations normally associated with aging, the present analyses focus on drivers age 70 and older. However, it should be emphasized that during the 3-Tier pilot the screening tools were applied to drivers of all ages.ResultsThere were two main findings. First, there were no consistent, statistically significant differences between the pilot and control groups in crash risk in the two years following screening. Second, pilot participants experienced statistically significant effects on mobility. These effects included delays in time to complete their license renewal, an increase in the number of assigned license restrictions, and an increase in the number of customers failing to renew their driving privilege.ConclusionsBased on these findings, suggestions for further research are made.Impact on industryNone.     

An Australasian model license reassessment procedure for identifying potentially unsafe drivers

Most licensing jurisdictions in Australia currently employ age-based assessment programs as a means to manage older driver safety, yet available evidence suggests that these programs have no safety benefits. This paper describes a community referral-based model license re assessment procedure for identifying and assessing potentially unsafe drivers. While the model was primarily developed for assessing older driver fitness to drive, it could be applicable to other forms of driver impairment associated with increased crash risk. It includes a three-tier process of assessment, involving the use of validated and relevant assessment instruments. A case is argued that this process is a more systematic, transparent and effective process for managing older driver safety and thus more likely to be widely acceptable to the target community and licensing authorities than age-based practices.     

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.     

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.     

New Zealand drivers study: developing a methodology for conducting a follow-up study of newly licensed drivers

PROBLEM: In recent years, there has been a significant reduction in traffic crash injury among young people, but they continue to be overrepresented in the traffic crash statistics. To improve this situation, sound scientific evidence is needed to develop effective policies and programs. METHOD: The aim of the proposed study is to provide this evidence by examining early driving and driving-related experiences of newly licensed drivers as they progress through the learner-, restricted-, and full-license stages of the graduated licensing system and to determine the impact of these experiences on subsequent negative traffic-related outcomes (risky driving behavior, injury traffic crashes, noninjury traffic crashes, infringements, convictions). Given the size and complexity of the proposed study, a comprehensive pilot study was undertaken to determine the feasibility of conducting a New Zealand-wide cohort study of newly licensed drivers. RESULTS: This article describes the pilot study process and the methodology that has been developed for the New Zealand-wide study.     

Measurement of driving patterns of older adults using data logging devices with and without global positioning system capability

BACKGROUND: Methods to study driving patterns and exposure of older drivers have typically relied on surveys or driving diaries. Electronic data logging devices may offer a reliable, alternative method of measuring driving exposure, and global positioning system (GPS) technology may be able to provide further information about driving patterns. OBJECTIVES: The aim of this study was to compare a driving diary with two electronic data logging devices, one of which had GPS capability, in order to identify which method best assesses the driving exposure and habits of older drivers as well as the method most acceptable to study participants. METHOD: In this prospective cohort study we recruited 20 participants aged 70 years or more (mean 78; range 70-85) (15 men and 5 women). The participants' driving patterns were recorded for one week with an electronic data logging device with GPS (FleetPulse), followed by recording for a further week with an electronic data logging device without GPS (CarChip). During both time periods the subjects also completed a standard driving diary. RESULTS: More comprehensive information, including braking and acceleration patterns, duration of driving time, time of day, and maximum speeds, was collected with the electronic devices than with the driving diary. There was excellent correlation between the driving diary data and those obtained with the CarChip (r = 0.9; p < 0.01). The correlation between the driving diary data and the FleetPulse data was moderate (r = 0.56; p = 0.02). The subjects clearly preferred the electronic monitoring devices over the driving diary. GPS data were able to demonstrate driving routes. CONCLUSIONS: Electronic data logging devices are a valid method for recording the driving patterns of older adults. These devices also reduce burden and improve the completeness of data.     

Real-world effects of using a phone while driving on lateral and longitudinal control of vehicles

IntroductionTechnologies able to augment human communication, such as smartphones, are increasingly present during all daily activities. Their use while driving, in particular, is of great potential concern, because of the high risk that distraction poses during this activity. Current countermeasures to distraction from phone use are considerably different across countries and not always widely accepted/adopted by the drivers.MethodsThis study utilized naturalistic driving data collected from 108 drivers in the Integrated Vehicle-Based Safety Systems (IVBSS) program in 2009 and 2010 to assess the extent to which using a phone changes lateral or longitudinal control of a vehicle. The IVBSS study included drivers from three age groups: 20–30 (younger), 40–50 (middle-aged), and 60–70 (older).ResultsResults from this study show that younger drivers are more likely to use a phone while driving than older and middle-aged drivers. Furthermore, younger drivers exhibited smaller safety margins while using a phone. Nevertheless, younger drivers did not experience more severe lateral/longitudinal threats than older and middle-aged drivers, probably because of faster reaction times. While manipulating the phone (i.e., dialing, texting), drivers exhibited larger lateral safety margins and experienced less severe lateral threats than while conversing on the phone. Finally, longitudinal threats were more critical soon after phone interaction, suggesting that drivers terminate phone interactions when driving becomes more demanding.ConclusionsThese findings suggest that drivers are aware of the potential negative effect of phone use on their safety. This awareness guides their decision to engage/disengage in phone use and to increase safety margins (self-regulation). This compensatory behavior may be a natural countermeasure to distraction that is hard to measure in controlled studies.Practical ApplicationsIntelligent systems able to amplify this natural compensatory behavior may become a widely accepted/adopted countermeasure to the potential distraction from phone operation while driving.     

Automated vehicles and older drivers in Canada

Introduction: As seniors represent a growing proportion of the driving population, research about how automated vehicles can help improve older driver safety and mobility is highly relevant. This paper examines the knowledge, attitudes and perceptions of older drivers towards limited self-driving vehicles (LSDVs), and how these variables can influence the likelihood that they will rely on this technology. Method: The study includes data from a previous national survey (N = 2662) about automated vehicle technology, with new analyses to test hypothetical models using structural equation modeling. Results of the first model were confirmed and built upon with a second more complex model that incorporated the construct “behavioral adaptation.” Focus groups with older drivers were also conducted (N = 38) to help reveal nuances in older drivers' knowledge, attitudes, perceptions, and behaviors regarding this technology. Results: Survey results demonstrated that feelings of safety and knowledge about LSDVs are positively related to perceived ease of use and adoption of the technology. The positive association between safety and perceived ease of use was further highlighted when comparing responses of older drivers to those of younger age groups, as older drivers were significantly less likely to agree that LSDVs were easy to use and were significantly less agreeable about feeling safe using them. Focus groups results confirmed that safety and knowledge of LSDVs are essential to the likelihood of adopting this technology, and revealed a high receptivity among older drivers to educational strategies and tools to increase their knowledge of LSDVs. Implications for educational strategies and safety benefits for older drivers are discussed. Practical applications: Results provide insight into strategies to encourage the early adoption of automated vehicles by older drivers and facilitate a safer transition towards automated vehicles that is lead by a cohort of safety-conscious drivers.     

Impact of impulsiveness, venturesomeness, and empathy on driving by older adults

PROBLEM: Although personality characteristics such as impulsiveness have been linked to the driving safety and driving habits of young and middle-aged adults, little research has focused on the role of personality in older driver behavior. METHOD: Using the IVE questionnaire in an exploratory study, three personality dimensions (impulsiveness, venturesomeness, and empathy) were measured in 305 older drivers (ages 57-87 years old). In addition, the Driving Habits Questionnaire was used to estimate driving exposure, and the Driver Behavior Questionnaire (DBQ) was used to estimate driving errors and violations. State-recorded crash data were made available by the state public safety agency. RESULTS: Subjects who reported four or more driving errors had higher impulsivity and empathy scores and lower venturesomeness scores. Subjects reporting driving violations were more likely to have high impulsivity scores. Driving six or more places per week was associated with lower levels of impulsivity. IMPACT: These results suggest that a comprehensive understanding of driving problems among older adults should also include a consideration of personality dimensions. In doing so, the challenges faced in the interpretation of self-report instruments on driving behaviors must be acknowledged, with a move in research toward greater reliance on more objective measures of driving behavior when assessing the impact of personality variables.     

Continued trends in older driver crash involvement rates in the United States: Data through 2017–2018

Introduction: With the growing older adult population due to the aging baby-boom cohort, there was concern that increases in fatal motor-vehicle crashes would follow. Yet, previous analyses showed this to be untrue. The purpose of this study was to examine current trends to determine if previous declines have persisted or risen with the recent increase in fatalities nationwide. Methods: Trends among drivers ages 70 and older were compared with drivers 35–54 for U.S. passenger vehicle fatal crash involvements per 100,000 licensed drivers from 1997 to 2018, fatal and all police-reported crash involvements per vehicle miles traveled using the 1995, 2001, 2009, and 2017 National Household Travel Surveys, and driver deaths per 1,000 crashes. Results: Since the mid-1990s, fatal crashes per licensed driver trended downward, with greater declines for drivers ages 70 and older than for middle-aged drivers (43% vs. 21%). Fatal crash rates per 100,000 licensed drivers and police-reported crash rates per mile traveled for drivers ages 70–79 are now less than those for drivers ages 35–54, but their fatal crash rates per mile traveled and risk of dying in a crash remain higher as they drive fewer miles. As the economy improved over the past decade, fatal crash rates increased substantially for middle-aged drivers but decreased or remained stable among older driver age groups. Conclusions: Fatal crash involvements for adults ages 70 and older has recently increased, but they remain down from their 1997 peak, even as the number of licensed older drivers and the miles they drive have increased. Health improvements likely contributed to long-term reductions in fatal crash rates. As older drivers adopt vehicles with improved crashworthiness and safety features, crash survivability will improve. Practical Application: Older adults should feel confident that their independent mobility needs pose less risk than previously expected.     

Brazilian adaptation of the driving anger expression inventory: testing its psychometrics properties and links between anger behavior,risky behavior,sensation seeking,and hostility in a sample of Brazilian undergraduate students

Introduction: In Brazil, driver aggressiveness in road traffic is a critical issue and could be an important contributing factor to the high number of traffic accidents. Because no instruments are available in Portuguese to register driving aggressiveness or driving anger in Brazil, we adapted English instruments into the Brazilian context. The aims of this study were to provide a Brazilian adaptation of the Driving Anger Expression Inventory (DAX) and to try to validate it by testing its psychometric properties and investigating its relationships with risky driving behaviors (DBQ), road accidents, driving sensation seeking, and hostility. Method: The Brazilian adaptations of the DAX, DBQ, the Driving Sensation Seeking Scale (DSSS) and the hostility Scale were administered to a sample of 512 undergraduate students (with a mean age of 23.7 years, 52.1% men). Results: Confirmatory factor analysis of the Brazilian DAX (DAX-BR) items yielded a four-factor solution with 43 items, which obtained the best goodness-of-fit to the data. Cronbach’s alpha for the DAX-BR factors ranged from 0.69 to 0.88. Other results on validity were a positive correlation (range 0.39–0.59) between the factors of the DAX-BR, DSSS, and DBQ. Conclusion: DAX-BR as the same structure as the original and is a reliable instrument for use with young drivers. Other studies should be conducted to further validate the DAX-BR in different types of populations such as older and more experienced drivers, professional drivers, and traffic regulation offenders whose driver's license has been taken away. Practical applications: This Brazilian version can be recommended for the assessment of driving anger expression in Brazil among young drivers in view of helping them driver more safely, and in particular to reduce traffic violations.     

A cost-benefit analysis of risk-reduction strategies targeted at older drivers

OBJECTIVE: The risk of motor-vehicle collisions increases as driving-related functional abilities decline. These declines can accompany normal or pathological aging and can be identified through driving-related functional screening exams upon license renewal. The objective of this cost-benefit analysis was to determine the utility of four functional screening procedures used to identify drivers at risk for motor-vehicle collisions, as well as an intervention designed to maintain or improve functional abilities. Additionally, this study sought to determine the expected cost per driver if an intervention was designed to target only those drivers who failed the functional ability-based driving screen, versus the expected cost per driver if the intervention was distributed en masse to all drivers 75 years and older. Improving functional abilities in older adults has potential far-reaching health and financial impacts which are broader than their impact of maintaining mobility. METHODS: A decision tree was constructed to evaluate the expected costs and benefits of (a) screening all drivers and intervening when indicated (several screening batteries of varying length were considered), (b) no screening, but intervening with all drivers of older age, or (c) neither screening nor intervening (i.e., re-licensing per usual). Test characteristics and risk probabilities were based on a cohort of drivers aged 75 and older from a previous study (Ball et al., 2006). Relevant sensitivity analyses were conducted. RESULTS: Providing all drivers with the speed-of-processing intervention is the most cost-beneficial option (expected cost per driver = $493.30), even if the cost of the intervention doubles. Sensitivity analysis indicated the effectiveness of the intervention could drop from 86% to 25% and the preventative approach of intervening with all drivers remains the most cost-beneficial strategy. The least cost-beneficial option is almost always re-licensing per usual (expected cost per driver = $1,562.84). CONCLUSION: Screening drivers upon license renewal is not currently beneficial because the available technology cannot consistently identify drivers at risk for a collision. However, the speed-of-processing intervention has demonstrated efficacy in improving driving competence (Roenker et al., 2003) and is a non-invasive, moderate-cost intervention that has the potential to protect the safety and mobility, as well as the financial interests, of older drivers and the community at large.     

Driving, navigation, and vehicular technology: experiences of older drivers and their co-pilots

OBJECTIVE: The objective of this article is to explore relationship between older drivers and their passengers (co-pilots) and potential implications of in-vehicle navigation technology on their driving safety. METHODS: Semi-structured interviews were conducted with 44 healthy, community-dwelling older adults (aged 60-83) or 22 married couples. Males identified themselves as drivers and females identified themselves as passengers (i.e., co-pilot). RESULTS: Findings indicate that operating a motor vehicle in older adulthood is a shared activity between drivers and passengers. Older drivers and co-pilots reported their level of interaction depended on their familiarity with their route. Navigating unfamiliar areas, particularly large urban centers, was identified as the most challenging driving situation. Participants identified their level of collaboration would increase with the advent of in-vehicle navigation technology. Safety concerns related to the use of this technology, included distraction of both drivers and passengers. Differences amongst couples in their perceptions of using this technology were linked to their level of experience with using other forms of technology. CONCLUSIONS: Older drivers and passengers identified working closely together when operating a motor vehicle. Further investigation into the effects of in-vehicle navigation technology on the driving safety of older drivers and their co-pilots is warranted.     

Individual difference factors in risky driving among older adults

INTRODUCTION: Motor-vehicle crashes kill roughly 4,500 American adults over the age of 75 annually. Among younger adults, one behavioral factor consistently linked to risky driving is personality, but this predictor has been overshadowed by research on cognitive, perceptual, and motor processes among older drivers. METHOD: In this study, a sample of 101 licensed drivers, all age 75 and over, were recruited to complete self-report measures on personality, temperament, and driving history. Participants also completed a virtual environment (VE) course designed to assess risk-taking driving behavior. State records of motor-vehicle crashes were collected. RESULTS: Results suggest both a sensation-seeking personality and an undercontrolled temperament are related to risky driving among older adults. Sensation-seeking was particularly related to history of violations and tickets, while temperamental control was more broadly related to a number of risky driving measures. Methodological and crash prevention issues are discussed.