Driving Performance of Experienced Young Adult Drivers with and without Autism Spectrum Disorder While Listening to Music on Two Scenarios: Hazards versus Wayfinding

This study explored the effect of music on the driving performance of experienced young adult drivers with and without autism spectrum disorder (ASD) using an interactive driving simulator with two types of scenarios. A 2 (Group: autism/neurotypical) × 2 (Music: music/no music) × 2 (Scenario: hazards/wayfinding) factorial design was used with the order of scenarios and music conditions counterbalanced. Participants were 34 neurotypical drivers and 5 drivers with ASD, all with at least 3 years of driving experience. Paired sample t-tests demonstrated no effect of music for any condition. Overall, the drivers with ASD had higher performance means than the neurotypical group with significant differences in the wayfinding scenario and the category for following regulations. Neurotypical drivers had better performance on the wayfinding scenario than the hazard scenario in maneuvers and being attentive to the environment. Although this study had a low number of drivers with ASD, it suggests drivers with ASD can perform better than neurotypical drivers, possibly because they follow road rule guidelines more consistently than neurotypical peers. In addition, this is the first study to examine wayfinding skills in teens/young adults with and without ASD.

Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study

Introduction

There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activities; (iii) what wound care and rehabilitation advice should be provided after CTR.

Methods

We developed consensus recommendations from an expert panel of hand surgeons, primary care surgeons and hand therapists using an electronic Delphi process. Participants were recruited from clinical organisations using pre-defined criteria. Delphi questionnaires included open text and tick-box responses. Consensus was defined as ≥75% agreement and summary feedback was provided after each round.

Results

There were 33 panellists (21 surgeons and 12 hand therapists), of which 27 (82%) completed all rounds. Expected return to driving was agreed as 5-14 days. Expected timescales were also agreed for return to seven selected occupational activities. Post-operative advice focused on using and moving the hand, rather than specific rehabilitation. While consensus was reached for most items, there were important areas of disagreement, including divergent views on driving with sutures in situ and the need to inform car insurers.

Conclusion

Recommendations from this study expand on existing advice by including functional descriptors for occupational activities and guidance timescales generated through a formal consensus process. Areas where consensus was not reached warrant further exploration to assess whether different practices impact clinical and functional outcomes for patients.

A Deep Learning Approach to Classify Sitting and Sleep History from Raw Accelerometry Data during Simulated Driving

Prolonged sitting and inadequate sleep can impact driving performance. Therefore, objective knowledge of a driver's recent sitting and sleep history could help reduce safety risks. This study aimed to apply deep learning to raw accelerometry data collected during a simulated driving task to classify recent sitting and sleep history. Participants (n = 84, Mean ± SD age = 23.5 ± 4.8, 49% Female) completed a seven-day laboratory study. Raw accelerometry data were collected from a thigh-worn accelerometer during a 20-min simulated drive (8:10 h and 17:30 h each day). Two convolutional neural networks (CNNs; ResNet-18 and DixonNet) were trained to classify accelerometry data into four classes (sitting or breaking up sitting and 9-h or 5-h sleep). Accuracy was determined using five-fold cross-validation. ResNet-18 produced higher accuracy scores: 88.6 ± 1.3% for activity (compared to 77.2 ± 2.6% from DixonNet) and 88.6 ± 1.1% for sleep history (compared to 75.2 ± 2.6% from DixonNet). Class activation mapping revealed distinct patterns of movement and postural changes between classes. Findings demonstrate the suitability of CNNs in classifying sitting and sleep history using thigh-worn accelerometer data collected during a simulated drive. This approach has implications for the identification of drivers at risk of fatigue-related impairment.

Driving Simulator Brake Reaction Parameters After Total Hip Arthroplasty According to Different Surgical Approaches

BACKGROUND

The aim of this study is to validate the point of normalization of braking following total hip arthroplasty (THA) and to determine the relevance of the surgical approach.

METHODS

Brake reaction parameters (BRPs), including brake reaction time, total brake time, and brake pedal depression force were measured in 90 patients who underwent primary arthroplasty of the right hip (42 with direct anterior approach and 48 with posterolateral approach) using a modern driving simulator. The driving parameters were measured preoperatively and every 2 weeks postoperatively until the eighth week. BRPs were measured in 40 subjects without hip problems, and the results were used as a control. Statistical assessment was performed to analyze when the patients' reaction to braking recovered to that of the control group with respect to different surgical approaches and also according to the pain.

RESULTS

Preoperative BRPs of the patients undergoing THA were prolonged compared to the control group and were normalized at the sixth week following the operation. Although BRPs of the direct anterior approach group showed significantly better improvement compared to the posterolateral approach group (total brake time at week 2, brake reaction time and brake pedal depression at week 4), both groups reached baseline value at week 6. In addition, we found no correlation between the pain score and BRPs.

CONCLUSION

The results of the current study indicate that the response to braking events normalizes at 6 weeks following THA in young active patients and is irrelevant to the surgical approach.

Three-dimensional multiple object tracking improves young adult cognitive abilities associated with driving: evidence for transfer to the useful field of view

OBJECTIVES

3-dimensional multiple object tracking (3D-MOT) and the useful field of view (UFOV) both claim to measure and train cognitive abilities, such as selective and divided attention implicated in driving safety. 3D-MOT is claimed to improve even young adult cognitive ability. If true, one would expect to observe the transfer of 3D-MOT training to UFOV performance mediated by way of shared underlying cognitive mechanisms.

METHODS

We test this notion by assessing whether ten 30-min sessions of 3D-MOT training spread across 5 weeks improves UFOV performance relative to an active control group trained on a visual task and a challenging puzzle game (participants aged between 23 and 33 years old).

RESULTS

The 3D-MOT training group exhibited significantly improved UFOV performance whereas the active control group exhibited only a small, statistically nonsignificant improvement in the task.

CONCLUSIONS

This suggests that 3D-MOT and UFOV performance are likely dependent on overlapping cognitive abilities and helps support the assertion that these abilities can be trained and measured even in young adults. Such training could have implications for improving driver safety in both young and older adults.

Effect of variable priority training on police officer driving performance and workload

Motor vehicle crashes are a leading cause of police injuries and deaths in line of duty. These crashes have been mainly attributed to the use of in-vehicle technologies while driving. Police officers receive extensive training on driving skills; however, limited training is provided on the use of in-vehicle technologies. Variable priority training (VPT) is a computer-based training that has shown promising results in improving multi-tasking performance. Eighteen police officers participated in a driving simulation study to assess the effect of VPT on officers' performance and workload. Findings suggested that although VPT was effective in improving officers' performance in dual and multi-task simulations across the training sessions, this effect was not generally transferred to driving. However, the VPT might be effective for training of high-demand situations involving pursuit driving and multiple secondary tasks. The findings can be beneficial for police agencies to improve training protocols. Practitioner summary: A driving simulation study was conducted to assess the effect of a computer-based training approach on police officers' driving performance and cognitive workload. The findings suggested that the proposed training approach might be effective for training of high-demand situations involving pursuit driving and multi-tasking.

Having the conversation about vision for safe driving with older adults: an exploratory study of eyecare professional experiences in England and Australia

CLINICAL RELEVANCE

Eyecare professionals assess older adults against the vision requirements for driving and discuss this with them on a regular basis. Improved access to resources/training would be beneficial and help eyecare professionals navigate more difficult conversations about driving, e.g., following acute vision changes.

BACKGROUND

The numbers of drivers aged >65 years is increasing in many countries, in line with ageing populations. In most countries the onus is on the driver to self-monitor their vision for driving, by engaging in regular eye tests. Eyecare professionals therefore could play an important role in older driver decision-making about their fitness to drive. There is limited guidance for eyecare professionals regarding how to approach conversations with older drivers about their vision, and when these conversations should be had.

METHODS

Semi-structured interviews were undertaken with eyecare professionals involved in vision assessments and decision-making about medical fitness to drive for older adults (optometrists, orthoptists, ophthalmologists). Framework analysis identified challenges and facilitators to conversations with older drivers about vision.

RESULTS

Twenty-six eyecare professionals from Australia (n = 17) and England (n = 9) participated from urban and regional/rural areas. Themes were divided into facilitators (clear standards and comprehensive testing; positive approach; preparation and patient self-awareness; relationships and trust; importance of multiple options in guiding a transition to driving retirement) and challenges (acute loss of visual function; limited self-awareness of the impact of visual problems on driving; and perceived lack of resources and need for training).

CONCLUSIONS

Eyecare professionals prefer to have early and regular conversations with older adults about their vision for driving. Acute visual field/acuity loss or onset of double vision, necessitating rapid changes to driving behaviour, were both identified as major challenges for eyecare professionals. Improved access to resources and training would be beneficial, to help eyecare professionals navigate these especially difficult conversations and signpost older drivers to appropriate support.

The association between whole body vibration exposure and spine degeneration on imaging: A systematic review

BACKGROUND

Low frequency vibrations from motorized vehicles and heavy equipment have been associated with musculoskeletal disorders. Spine degeneration on diagnostic imaging provides direct and objective measures of the possible effects of such exposures on the spine.

OBJECTIVE

The objective of this systematic review was to evaluate the association of exposure to whole-body vibration (WBV) with spine degeneration on imaging.

METHODS

We conducted electronic searches in MEDLINE, CINAHL, EMBASE, and Web of Science to July 2021. Two reviewers independently screened search results, assessed quality, and extracted data. Studies evaluating the exposure to WBV and lumbar spine degeneration on imaging were included.

RESULTS

Fifteen studies (16 manuscripts) were included. Seven studies including a meta-demonstrated moderate quality evidence of no association between WBV and disc degeneration. There was also moderate quality evidence of no association between WBV and disc height narrowing and osteophytes. Overall, there was low level evidence of no association between WBV and other degenerations findings.

CONCLUSIONS

There was moderate to low quality evidence suggesting no association between WBV exposures with spine degeneration on imaging. The results of this study currently do not support assertion that motorized vehicle and WBV exposure accelerates degeneration and causes structural damage to the spine.

[Driving improvement in spinal cord injury patients using virtual reality. Systematic review]

INTRODUCTION

Spinal cord injury is a pathology which causes motor and sensory impairment under the region damaged by the lesion. This results in limitations in daily activities such as driving. In recent years, improvement in this task has been achieved by means of virtual reality treatment in the rehabilitation of patients with spinal cord injury. The aim of the present study was to analyze, through a systematic review, the effectiveness of using virtual reality on driving skills in patients with spinal cord injury.

MATERIALS AND METHODS

The literature search was carried out using the following databases: PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, Medline, Scopus and CINAHL, including articles published from January 2000 to May 2021.

RESULTS

After the research process, out of a total of 51 articles, 7 were included: 2 applied immersive VR and 5 semi-immersive VR. Road driving simulation was addressed by 4 of them: 1 on sailing, 1 on motorbike and 1 on bicycle.

CONCLUSIONS

The use of virtual reality in driving skills training has led to improvements in quality of life, driving skills and reduction of fear of driving. Despite these findings, more research, patients, sessions and improvements are needed for a clearer understanding of this topic and its usefulness.

Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach

Obstructive sleep apnea syndrome (OSAS) is an under-recognized clinical condition and is correlated with sleepiness and impaired cognitive function. Objectives: The primary aim of this systematic review, developed within the Sleep@OSA project, was to determine the correlations of obstructive sleep apnea syndrome, daytime sleepiness and sleep-disordered breathing with the risk of car accidents in adult working populations; a secondary aim was to analyze the epidemiologic data with a gender-based approach to identify differences between women and men in the data and in associated risk factors. Methods: Clinical trials and studies reporting data on the frequency of car accidents involving adult working population with daytime sleepiness and/or OSAS compared with a control group of participants were included. Literature searches of free text and MeSH terms were performed using PubMed, Google Scholar, the Cochrane Library and Scopus from 1952 to 3 May 2021. Results and Conclusions: The search strategy identified 2138 potential articles. Of these, 49 papers were included in the qualitative synthesis, and 30 were included in the meta-analysis. Compared with controls, the odds of car accidents were found to be more than double in subjects with OSAS (OR = 2.36; 95% CI 1.92−2.91; p < 0.001), with a similar risk between commercial motor vehicle drivers (OR = 2.80; 95% CI 1.82−4.31) and noncommercial motor vehicle drivers (OR = 2.32; 95% CI 1.84−2.34). No significant correlation was found between sleepiness and car crashes, but subjects with sleep-disordered breathing were at increased risk of car accidents (OR = 1.81; 95% CI 1.42−2.31; p < 0.001). To our surprise, although epidemiological studies on the risk of road accidents in the adult population with OSAS and daytime sleepiness are currently very abundant, specific data on the female population are not available.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

A Systematic Review of the Effects of Second-Eye Cataract Surgery on Motor Function

Cataract removal surgery is one of the most commonly performed surgical procedure in developed countries. The financial and staff resource cost that first-eye cataract surgery incurs, leads to restricted access to second-eye cataract surgery (SES) in some areas, including the United Kingdom. These restrictions have been imposed despite a lack of knowledge about the impact of not performing SES on visuo-motor function. To this end, a systematic literature review was carried out, with the aim of synthesising our present understanding of the effects of SES on motor function. Key terms were searched across four databases, PsycINFO, Medline, Web of Science, and CINAHL. Of the screened studies (K = 499) 13 met the eligibility criteria. The homogeneity between participants, study-design and outcome measures across these studies was not sufficient for meta-analyses and a narrative synthesis was carried out. The evidence from objective sources indicates a positive effect of SES on both mobility and fall rates, however, when considering self-report measures, the reduction in falls associated with SES becomes negligible. The evidence for any positive effect of SES on driving is also mixed, whereby SES was associated with improvements in simulated driving performance but was not associated with changes in driving behaviours measured through in vehicle monitoring. Self-report measures of driving performance also returned inconsistent results. Whilst SES appears to be associated with a general trend towards improved motor function, more evidence is needed to reach any firm conclusions and to best advise policy regarding access to SES in an ageing population. Systematic Review Registration: https://osf.io/7hne6/, identifier INPLASY2020100042.

Adverse driving behaviors are associated with sleep apnea severity and age in cognitively normal older adults at risk for Alzheimer's disease

Alzheimer's disease (AD) pathology accumulates for decades before the onset of cognitive decline. Cognitively normal individuals with biomarker evidence of AD brain pathology (i.e. biomarker + or preclinical AD) can be differentiated from individuals without AD brain pathology based on naturalistic driving data, such as hard acceleration or braking and speeding, measured using in-vehicle dataloggers. Older adults are at increased risk of injury and death from motor vehicle crashes and driving cessation is also linked to negative health outcomes. Identifying potentially modifiable risk factors that increase driving risk may prolong safe driving in old age. Sleep apnea is associated with adverse driving behaviors across the age span. In this study, we hypothesized that high-risk driving behaviors would be associated with increased sleep apnea severity and AD pathology. We found that higher sleep apnea severity measured by a home sleep apnea test was associated with a higher incidence of adverse driving behaviors even after controlling for multiple confounders (β = 0.24 ± 0.09, p < 0.01). This association was independent of AD biomarker positivity (i.e. increased t-tau/Aβ 42 ratio). Increasing age was associated with a higher likelihood of high-risk driving behaviors in individuals with AD brain pathology (β = 0.12 ± 0.04, p < 0.01), but a lower likelihood in individuals without AD brain pathology (β = -0.06 ± 0.03, p < 0.05). These findings suggest that adverse driving behaviors linked to a higher rate of traffic crashes in older adults are associated with sleep apnea severity and AD pathology even in cognitively unimpaired individuals. Further studies are needed to determine if treatment of sleep apnea decreases high-risk driving behaviors and therefore motor vehicle crashes.

Opportunities and Limitations of a Gaze-Contingent Display to Simulate Visual Field Loss in Driving Simulator Studies

Background

Research on task performance under visual field loss is often limited due to small and heterogenous samples. Simulations of visual impairments hold the potential to account for many of those challenges. Digitally altered pictures, glasses, and contact lenses with partial occlusions have been used in the past. One of the most promising methods is the use of a gaze-contingent display that occludes parts of the visual field according to the current gaze position. In this study, the gaze-contingent paradigm was implemented in a static driving simulator to simulate visual field loss and to evaluate parallels in the resulting driving and gaze behavior in comparison to patients.

Methods

The sample comprised 15 participants without visual impairment. All the subjects performed three drives: with full vision, simulated left-sided homonymous hemianopia, and simulated right-sided homonymous hemianopia, respectively. During each drive, the participants drove through an urban environment where they had to maneuver through intersections by crossing straight ahead, turning left, and turning right.

Results

The subjects reported reduced safety and increased workload levels during simulated visual field loss, which was reflected in reduced lane position stability and greater absence of large gaze movements. Initial compensatory strategies could be found concerning a dislocated gaze position and a distorted fixation ratio toward the blind side, which was more pronounced for right-sided visual field loss. During left-sided visual field loss, the participants showed a smaller horizontal range of gaze positions, longer fixation durations, and smaller saccadic amplitudes compared to right-sided homonymous hemianopia and, more distinctively, compared to normal vision.

Conclusion

The results largely mirror reports from driving and visual search tasks under simulated and pathological homonymous hemianopia concerning driving and scanning challenges, initially adopted compensatory strategies, and driving safety. This supports the notion that gaze-contingent displays can be a useful addendum to driving simulator research with visual impairments if the results are interpreted considering methodological limitations and inherent differences to the pathological impairment.

Driving and exceptional cases: Supporting relicensing evaluation in patients whose visual fields fail to meet standards

PURPOSE

The UK Driver and Vehicle Licensing Agency's (DVLA) visual field criteria mean that homonymous defects close to fixation are not usually acceptable for driving. Here, we illustrate cases where patients with field defects failing to meet standards had their licences revoked but subsequently were permitted to drive again through exceptional case provisions.

METHODS

Clinical assessment of two patients with homonymous loss: a 62-year-old man (PWT) with a dense left upper homonymous quadrantanopia secondary to a right occipital lobe stroke and a 48-year-old woman (JC), only aware of right upper homonymous quadrantanopia following routine primary care assessment and subsequently attributed to left middle cerebral artery stroke from perinatal intracranial haemorrhage.

RESULTS

PWT's Esterman test showed a significant central defect failing to meet the standard. His subsequent ophthalmic examination was otherwise unremarkable with excellent visual functions. Clinical evidence was provided supporting his relicensing application, and in time, a practical DVLA driving assessment indicated adaptation had been successful, and his licence was restored. JC's defect also failed to meet the standard, and her licence was revoked. Her ophthalmic examination was otherwise unremarkable, and her condition was attributed to a nonprogressive, isolated perinatal event. The DVLA accepted supporting clinical evidence; her subsequent practical driving assessment demonstrated successful adaptation and her licence was also restored.

CONCLUSIONS

Conventional visual field tests are not necessarily predictive of real-world driving performance, with drivers' adaptive strategies not being accommodated. In the UK, individuals with visual field loss failing to meet the standard may be eligible for relicensing as exceptional cases if specific criteria can be met. For exceptional cases potentially licensable under these criteria, the DVLA requires clinician support and a satisfactory practical driving assessment. Similar provisions exist internationally. Clinicians need to be aware of the role they may play in such scenarios.

Factors Associated With Driving Status Among Brazilian Older Adults

This study analyzed the factors associated with driving status among older adults in Brazil. The sample consisted of 15,221 older adults (≥65 years) residing in Brazilian capitals in 2018. The following question established the participants' driving status: "Do you drive a car, motorcycle, and/or another vehicle?" Sociodemographic, health conditions, and health-related behaviors were derived through standard procedures. Poisson regression analysis was performed to estimate prevalence ratios and 95% confidence interval. The prevalence of drivers was 28.83%. We found that being physically active during leisure time and higher daily recreational screen time (>3 h/day) were associated with driving status. Self-perceived negative health and being physically active by commuting showed an inverse association with driving status. The high prevalence of older drivers and the characteristics associated with driving reinforces the importance of public policy strategies for these individuals.

The effect of aging on decision-making while driving: A diffusion model analysis

We present a diffusion model analysis of the effect of aging on decision processes during driving. Our goal was to examine the changes in the underlying components as a function of age and both task and environment difficulty. Younger and older adults performed each of three decision-making tasks while operating a computer-based driving simulator in which the task required a driving action. The first task was a one-choice task in which the response to brake lights turning on was to drive around a lead car. The second and third tasks were two-choice brightness-discrimination tasks in which participants were asked to drive the car to the left/right if there were more black/white pixels in an array of black and white pixels. Results showed that older adults were slower in the one-choice task and made more errors in the two-choice tasks than younger adults. The behavioral data were fitted well by one- and two-choice diffusion models, showing lower evidence accumulation rates (drift rates) in older than younger adults. Moreover, in the two-choice tasks under higher environmental demands, older adults showed a lower decision criterion (boundary separation) to compensate for a slower decision process. Together, the differences we found in the decision components between age groups provided an example of a subtle interaction between speed and accuracy in older versus younger adults, and this demonstrates the utility of this modeling approach in studying age effects in driving. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Toward a Theory of Visual Information Acquisition in Driving

OBJECTIVE

The aim of this study is to describe information acquisition theory, explaining how drivers acquire and represent the information they need.

BACKGROUND

While questions of what drivers are aware of underlie many questions in driver behavior, existing theories do not directly address how drivers in particular and observers in general acquire visual information. Understanding the mechanisms of information acquisition is necessary to build predictive models of drivers' representation of the world and can be applied beyond driving to a wide variety of visual tasks.

METHOD

We describe our theory of information acquisition, looking to questions in driver behavior and results from vision science research that speak to its constituent elements. We focus on the intersection of peripheral vision, visual attention, and eye movement planning and identify how an understanding of these visual mechanisms and processes in the context of information acquisition can inform more complete models of driver knowledge and state.

RESULTS

We set forth our theory of information acquisition, describing the gap in understanding that it fills and how existing questions in this space can be better understood using it.

CONCLUSION

Information acquisition theory provides a new and powerful way to study, model, and predict what drivers know about the world, reflecting our current understanding of visual mechanisms and enabling new theories, models, and applications.

APPLICATION

Using information acquisition theory to understand how drivers acquire, lose, and update their representation of the environment will aid development of driver assistance systems, semiautonomous vehicles, and road safety overall.

With a Little Help From My Friends and Family: Transportation and Caregiving Hours

OBJECTIVES

To better understand the associations between the driving status of the care recipient and caregiver with provided caregiving hours, more research on the relationships between contextual caregiving factors and driving-related behaviors is needed.

METHOD

Using data from Round 7 of the National Health and Aging Trends Study (NHATS) and the linked National Survey of Caregiving (NSOC; n = 1054 dyads), this study explored how caregiver transportation assistance and care recipient driving frequency are associated with caregiving hours.

RESULTS

Caregiving hours were highest among caregivers who provided transportation every day and among care recipients who had not driven in the last month. After controlling for covariates, negative binomial regression results indicated that greater caregiver transportation assistance was related to more caregiving hours, while greater care recipient driving frequency was related to less caregiving hours.

CONCLUSION

Integrated supports and greater accessibility to transportation services may decrease time spent caregiving.

Impact of the COVID-19 Pandemic on Older Adult Driving in the United States

OBJECTIVES

To examine how the COVID-19 pandemic affected driving and health outcomes in older adults.

METHODS

We compared Advancing Understanding of Transportation Options (AUTO) study participants enrolled before (December 2019 to March 2020) versus during the pandemic (May 2020 to June 2021). Participants were English-speaking, licensed drivers (≥70 years) who drove weekly and had a primary care provider at a study site and ≥1 medical condition potentially associated with driving cessation. We used baseline self-reported measures on mobility and health.

RESULTS

Compared to those enrolled pre-COVID-19 (n = 61), more participants enrolled during COVID-19 (n = 240) reported driving reductions (26% vs. 70%, p < .001) and more often for personal preference (vs. medical/emotional reasons). While mean social isolation was higher during than pre-COVID-19, self-reported depression, stress, and overall health PROMIS scores did not differ significantly.

DISCUSSION

Our findings highlight the resiliency of some older adults and have implications for mitigating the negative effects of driving cessation.

The effects of intranasal esketamine on on-road driving performance in patients with major depressive disorder or persistent depressive disorder

BACKGROUND

Intranasal esketamine demonstrates rapid improvement of depressive symptoms. However, transient adverse effects (dissociation, sedation and dizziness) may occur, which could impact driving performance.

AIMS

To evaluate the effects of 84 mg intranasal esketamine on driving performance in unipolar major depressive disorder (MDD) or persistent depressive disorder (PDD) patients.

METHODS

The study consisted of two parts. Part A was a single-blind, double-dummy, randomized three-period, cross-over study to compare effects of esketamine versus placebo on next morning driving, 18 ± 2 h post-treatment. Alcohol was administered to demonstrate assay sensitivity. In Part B, same-day driving, 6 ± 0.5 hours post-treatment, was assessed during twice weekly esketamine administration for 3 weeks. Twenty-seven patients with mild-to-moderate MDD or PDD without psychotic features completed a 100 km on-the-road driving test on a public highway in normal traffic. The primary outcome was standard deviation of lateral position (SDLP; cm; weaving of car).

RESULTS

In Part A, alcohol impaired driving performance compared to placebo: Least-square means (95% CI), p-value for delta SDLP (cm) compared with placebo: (ΔSDLP = + 1.83 (1.03; 2.62), p < 0.001), whereas esketamine did not: (ΔSDLP = -0.23 (-1.04; 0.58), p = 0.572). In Part B, weekly driving tests showed no differences between placebo baseline SDLP and after esketamine administration over 3 weeks: Day 11: (ΔSDLP = -0.96 (-3.72; 1.81), p = 0.493), Day 18: (ΔSDLP = -0.56 (-3.33; 2.20), p = 0.686) and Day 25: (ΔSDLP = -1.05 (-3.82; 1.71), p = 0.451).

CONCLUSIONS

In this study, esketamine did not impair on-road driving performance the next morning following a single dose, or on same day after repeated administration.

Social Box: Influence of a New Housing System on the Social Interactions of Stallions When Driven in Pairs

In order to improve the housing conditions of stallions in individual boxes, we tested a so-called “social box” allowing increased physical contact between neighbouring horses. This study investigated whether housing stallions in social boxes changes the number of social interactions during carriage driving. We hypothesised that the stay in social boxes would decrease the number of unwanted social interactions between stallions when driven in pairs. Eight Franches-Montagnes breeding stallions were observed when driven in pairs with a “neutral” stallion housed in a so-called “conventional box”, strongly limiting physical contact. They were driven on a standardised route over the course of four days before, during, and after being housed in social boxes. The type and frequency of behaviours of the pairs and the interventions of the groom and the driver during the test drives were assessed live and using video recordings. Results from linear mixed-effect models show that unwanted social interactions decreased during and after the stallions were housed in the social box (p < 0.001). Stallions’ interactions also decreased over the four days (p < 0.01), suggesting a habituation to the test conditions by learning not to interact, or by subtly settling dominance. The social box tended to decrease unwanted social behaviours of stallions driven in pairs and could therefore be used as an environmental enrichment for horses.

"Is it time to stop driving?": A randomized clinical trial of an online decision aid for older drivers

BACKGROUND

Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality.

METHODS

This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores.

RESULTS

Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations.

CONCLUSIONS

The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility.

TRIAL REGISTRATION

ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.

Using Automated Vehicle Technologies With Older Adults: A Mixed-Methods Study

When older adults' driving abilities decline, automated driving technologies may improve community mobility, engagement, and independence. Most previous research has focused on older persons' attitudes rather than their use of automated driving technologies. This study examined older Australians' perceptions and experience of automated vehicle technologies before, during, and after a real-life driving experience, focusing on ease of use, usefulness, safety, acceptance, trust, and confidence. This mixed-methods study included observation of a 6-km test drive using a partially automated vehicle, pre- and post-drive questionnaires, and a post-drive semi-structured interview. Most participants reported positive perceptions and experiences before, during, and after the test drive. Visual analysis of pre/postresponses revealed divergent reactions to the test drive, consistent with the heterogeneity of the older population. Automated driving technologies have potential to contribute to mobility at older ages. Larger-scale studies including actual driving experiences are recommended.