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.     

The older driver with dementia: an updated literature review

INTRODUCTION: At some point during their illness, drivers with dementia pose a public safety risk. METHOD: To address the issue of determining driving competence in drivers with dementia, the authors reviewed 11 studies. RESULTS: When comparing different driving assessments, the authors found that while road tests, simulators, and neuropsychological tests are important, each has limitations. CONCLUSION: Neuropsychological tests that highlighted visual spatial skills, attention, and reaction time provided the most meaningful correlations with driving performance. Furthermore, the authors recommend that patients with MMSE scores of 24 or less have a driving evaluation, and that driving evaluations be repeated at six month intervals or more frequently if a noticeable decline is observed. IMPACT: Because many older adults with dementia continue to drive, competence must be addressed.     

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.     

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.     

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.     

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 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.     

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 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.     

Driving self-regulation and ride service utilization in a multicommunity,multistate sample of U.S. older adults

Objectives: This study examined a multicommunity alternative transportation program available 24 hours a day, 7 days a week, for any purpose, offering door-through-door service in private automobiles to members who either do not drive or are transitioning away from driving. Specific aims were to describe the characteristics of members by driving status and ride service usage of these members.

Methods: Data came from administrative records maintained by a nonprofit ride service program and include 2,661 individuals aged 65+ residing in 14 states who joined the program between April 1, 2010, and November 8, 2013. Latent class analysis was used to group current drivers into 3 classes of driving status of low, medium, and high self-regulation, based on their self-reported avoidance of certain driving situations and weekly driving frequency. Demographics and ride service use rate for rides taken through March 31, 2014, by type of ride (e.g., medical, social, etc.) were calculated for nondrivers and drivers in each driving status class.

Results: The majority of ride service users were female (77%) and aged 65–74 years (82%). The primary method of getting around when enrolling for the transportation service was by riding with a friend or family member (60%). Among the 67,883 rides given, nondrivers took the majority (69%) of rides. Medical rides were the most common, accounting for 40% of all rides.

Conclusions: Reported ride usage suggests that older adults are willing to use such ride services for a variety of trips when these services are not limited to specific types (e.g., medical). Further research can help tailor strategies to encourage both nondrivers and drivers to make better use of alternative transportation that meets the special needs of older people.     

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 anger among motor vehicle drivers in China: A cross-sectional survey

Objective: Driving anger is a common emotion while driving and has been associated with traffic crashes. This study aimed to investigate situations that increase driving anger among Chinese drivers.

Methods: A cross-sectional study was conducted among 3,101 drivers in southern China. The translated version of the 33-item Driving Anger Scale (DAS) was used to measure driving anger. Data were collected by face-to-face interviews between June 2016 and September 2016.

Results: Confirmatory factor analysis showed that the fit of the original 6-factor model (discourtesy, traffic obstacles, hostile gestures, slow driving, illegal driving, and police presence) was satisfactory, after removing 2 items and allowing 5 error pairs to covary. The model showed satisfactory fit: goodness of fit index (GFI) = 0.90, incremental fit index (IFI) = 0.90, root mean square error of approximation (RMSEA) = 0.06, 90% confidence interval (CI) = 0.061–0.064. Driving anger among Chinese drivers was lower than that in some Western countries. Compared to older and experienced drivers, younger and new drivers were more likely to report driving anger. There was no difference in total reported driving anger between males and females. Additionally, the higher the driver’s anger level was, the more likely he or she was to have had a traffic crash.

Conclusion: Driving anger is a common emotion among Chinese drivers and has a strong correlation with aggressive driving behavior and traffic crashes.     

Age of licensure and monitoring teenagers' driving: survey of parents of novice teenage drivers

OBJECTIVE: To assess parental decision making regarding the timing of teenagers initiating driving and monitoring teenagers' driving after licensure. METHODS: About 300 parents were interviewed during spring 2006 in Minnesota, North Carolina, and Rhode Island, states with varying licensing provisions, while teenagers took their first on-road driving tests. RESULTS: States' differences in ages of obtaining learner's permits and licenses reflected different licensing laws, but most teenagers obtained permits and took road tests within the first few months after they became eligible. Common reasons for delaying obtaining permits were fulfilling driver education requirements and lack of readiness/immaturity. Insufficient practice driving most often delayed licensure. Among the parents interviewed, 33-49% believed the minimum licensure age should be 17 or older. Almost all parents planned to supervise teenagers' driving after licensure, and most wanted to know about speeding or distractions. When asked about in-vehicle devices to monitor teenagers' driving, 37-59% of parents had heard of them. Parents were least interested in using video cameras and about equally interested in computer chips and cell-phone-based GPS systems. Disinterest in monitoring devices most often was attributed to trusting teenagers or respecting their privacy. CONCLUSIONS: Licensing laws influence ages of initiating driving. Although many parents support licensing at 17 or older - higher than in all but one state - most teenagers initiate driving soon after reaching the minimum age. Parents plan to supervise teenagers' driving, and many say they are open to using in-vehicle monitoring devices. IMPACT ON INDUSTRY: Many parents support a minimum licensing age of 17 or older and would consider in-vehicle devices to extend their supervision of teenager's driving.     

Projections of hospitalised fall-related injury in NSW, Australia: impacts on the hospital and aged care sectors

Projections of the number, rate and cost of fall-related hospitalised injuries for individuals aged 65 years and older in New South Wales (NSW), Australia were estimated to 2051 for two scenarios: (1) demographic change only using 2008 admission rates; and (2) modelled change using negative binominal regression taking into account current trends in admission rates. Based on demographic change alone, the number and cost of fall injury hospitalisations among older people is expected to increase almost three-fold by 2051. Transfers to permanent residential aged care will also increase 3.2 fold. However, if the fall-related hospitalisation rate sustains its current trend, these increases are projected to be more than ten-fold by 2051. Even with demographic change alone, there will be a significant impact on the resources required to care for older people suffering a fall injury hospitalisation over the next forty years in NSW. The impact on the hospital and aged care sectors will be considerable unless significant improvements occur in the prevention and treatment of fall-related injury in older people.     

Road safe seniors: Screening for age-related driving disorders in inpatient and outpatient settings

Introduction

Older drivers are increasing in number and they often have health conditions that place them at high risk for motor-vehicle crashes (MVC). Screening is underutilized, and is rarely done in hospital settings.

Methods

A convenience sample of 755 older adults completed age related driving disorders screening at University of California, San Diego inpatient and outpatient health centers. Screening included three strength/frailty tests, two vision tests (acuity and fields), and two cognitive tests, based on AMA recommendations. The average age of participants was 72.5; 55.5% were male and 94% English-speaking; 17.8% of older adults failed at least one aspect of screening.

Results

In multivariate analysis, significant associations of failed status were age, male sex, selfrestrictions of driving, and inpatient screening locations. The screening identified one in six adults to be 'high-risk' for age related driving disorders. Screening was effective and feasible in both inpatient and outpatient settings.

Impact on industry

As the driving population ages, industry, government and health car providers need to plan for the management of driving impairments in older adults.     

Driving anger and its expressions: further evidence of validity and reliability for the Driving Anger Expression Inventory French adaptation

Introduction: The aims of this study were to provide further evidence of validity and reliability for the Driving Anger Expression Inventory (DAX) French adaptation (Villieux & Delhomme, 2008, Le Travail Humain, 71(4), 359-384) and to investigate the relationships between driving anger, how people express their anger while driving, and traffic violations among young drivers in France. Method: The French adaptations of the DAX, of the Driving Anger Scale (DAS), and of the Extended Violations Scale were administered to a sample of 314 drivers. Results: Confirmatory factor analysis of the French DAX items yielded a three factors solution with 11 items, which obtained better goodness-of-fit to the data. Cronbach α reliabilities for DAX factors ranged from .71 to .79. Aggressive forms of anger expression correlated positively with driving anger and traffic violations whereas the 'Adaptive/Constructive Expression' factor correlated negatively with these variables. Discussion: Globally, our results replicated earlier findings and showed that DAX factors are useful predictors of self reported violations and complement established measures like the DAS. Impact on Industry: Implications for driver education and interventions were examined.     

Choice of teenagers' vehicles and views on vehicle safety: survey of parents of novice teenage drivers

Objective

To examine parental decisions about vehicles driven by teenagers and parental knowledge of vehicle safety.

Methods

About 300 parents were interviewed during spring 2006 in Minnesota, North Carolina, and Rhode Island while teenagers took their first on-road driving tests.

Results

Fewer than half of parents surveyed said teenagers would be the primary drivers of the chosen vehicles. Parents most often cited safety, existing family vehicle, and reliability when explaining the choices for their teenagers’ vehicles. About half of the vehicles intended for teenagers were small/mini/sports cars, pickups, or SUVs — vehicles considered less safe for teenagers than midsize/large cars or minivans. A large majority of vehicles were 2001 models or earlier. Vehicles purchased in anticipation of adding a new driver to the family were more likely to be the sizes/types considered less safe than vehicles already owned. Few parents insisted on side airbags or electronic stability control, despite strong evidence of their safety benefits. Even when asked to identify ideal vehicles for their teenagers to drive, about half of parents identified less safe vehicle sizes/types. Most parents knew that midsize/large vehicles are safer than small vehicles, and at least half of parents said SUVs and pickups are not safe for teenage drivers, citing instability.

Conclusions

The majority of parents understood some of the important criteria for choosing safe vehicles for their teenagers. However, parents actually selected many vehicles for teenagers that provide inferior crash protection.

Impact on industry

Vehicle safety varies substantially by vehicle size, type, and safety features. Many teenagers are driving inferior vehicles in terms of crashworthiness and crash avoidance.