The driving habits of adults aged 60 years and older

Correlation between cognitive impairment and dependence in hypoxemic COPD

We studied 149 patients with stable chronic obstructive pulmonary disease (COPD). Three clusters were generated (high, mid, and low level of cognitive function) based on 11 neuropsychologic scores; personal independence in basic/instrumental activities of daily living (BADL/IADL) of clusters was compared by discriminant analysis. Pattern of BADL/IADL was cluster-specific in 79.2% of high and 54.9% of low clusters, but only 20.8% of mid cluster. Self-administering drugs, continence, managing money, and dressing items had the greatest discriminatory capacity. Clusters had comparable respiratory function. In older COPD patients, dependence parallels cognitive impairment only to some extent. Indices of COPD severity are poor correlates of dependence.

Visual and cognitive deficits predict stopping or restricting driving: the Salisbury Eye Evaluation Driving Study (SEEDS)

PURPOSE

To determine the visual and other factors that predict stopping or restricting driving in older drivers.

METHODS

A group of 1425 licensed drivers aged 67 to 87 years, who were residents of greater Salisbury, participated. At 1 year after enrollment, this group was categorized into those who had stopped driving, drove only within their neighborhood, or continued to drive beyond their neighborhood. At baseline, a battery of structured questionnaires, vision, and cognitive tests were administered. Multivariate analysis determined the factors predictive of stopping or restricting driving 12 months later.

RESULTS

Of the 1425 enrolled, 1237 (87%) were followed up at 1 year. Excluding those who were already limiting their driving at baseline (n = 35), 1.5% (18/1202) had stopped and 3.4% (41/1202) had restricted their driving. The women (odds ratio [OR], 4.01; 95% confidence interval [CI], 2.05-8.20) and those who prefer to be driven (OR, 3.91; 95% CI, 1.91-8.00) were more likely to stop or restrict driving. Depressive symptoms increased likelihood of restricting or stopping driving (OR, 1.08; 95% CI, 1.009-1.16 per point Geriatric Depression Scale). Slow visual scanning and psychomotor speed (Trail Making Test, Part A: OR, 1.02; 95% CI, 1.01-1.03), poor visuoconstructional skills (Beery-Buktenica Test of Visual Motor Integration: OR, 1.14; 95% CI, 1.05-1.25), and reduced contrast sensitivity (OR, 1.15; 95% CI, 1.03-1.28) predicted stopping or reducing driving. Visual field loss and visual attention were not associated. The effect of vision on changing driving behavior was partially mediated by cognition, depression, and baseline driving preferences.

CONCLUSIONS

In this cohort, contrast sensitivity and cognitive function were independently associated with incident cessation or restriction of driving space. These data suggest drivers with functional deficits make difficult decisions to restrict or stop driving.

Social integration and social support among older adults following driving cessation

OBJECTIVES

The objective of this study was to evaluate the impact of driving cessation on social integration and perceived support from relatives and friends among older adults.

METHODS

Data came from the population-based Baltimore Epidemiologic Catchment Area Study. We restricted analyses to participants aged 60+ with a history of driving (n=398). Social integration (number and frequency of contact) and perceived social support from relatives/friends, driving status (continuing or ceased), and demographic and health characteristics were assessed at interviews 13 years apart. The potential mediating role of ability to use public transit was also investigated. We used repeated measures random-intercept models to evaluate the effect of driving cessation on social network characteristics over time.

RESULTS

Former drivers were older, were more likely to be female and non-White, had lower education, had poorer self-rated health, and had lower Mini-Mental State Examination scores relative to continuing drivers. Over the follow-up period, cessation was associated with reduced network of friends (odds ratio=0.49, p<.05). This association was not mediated by ability to use public transportation. Cessation had no impact on support from friends or relatives.

DISCUSSION

Social integration is negatively affected by driving cessation even among elders who feel competent in using alternative forms of transportation, at least concerning networks of friends.

Self-regulatory driving practices among older adults: health, age and sex effects

The purpose of this study was to better understand how older adults self-regulate driving, and to identify differences by age, sex, and health-related functioning. Michigan drivers over age 64 were surveyed by telephone (n=961, age [mu=74.2, sigma=5.8], 56% female) about their driving-related behaviors, physical functioning, and health. Respondents were presented with scenarios involving driving to an important appointment under adverse conditions (rainy stormy weather, on alternate route in heavy freeway traffic, 200-mile trip on unfamiliar roads). Generalized logit models examined outcomes for each scenario: driving as usual, driving with modifications, and not driving. Results indicate that the effect of sex on self-regulation was significant and greater than that of age and physical functioning. Women were more likely to self-regulate by not driving. Odds ratios and 95% confidence limits for each scenario for women vs. men are 6.8 (3.8-2.0), 6.5 (3.6-12.0), and 17.7 (11.0-28.6). The effect of sex on self-regulation by modifying driving was smaller and significant only in scenarios 2 and 3. Women were more likely then men to modify driving for scenario 2 (odds ratio, 3.0 (2.0-4.5)) and scenario 3 (odds ratio 4.4 (3.1-0.1)). Overall, the study finds the relative effect of sex on self-regulation greater than that of age and physical functioning for conditions examined.

Transportation and aging: a research agenda for advancing safe mobility

PURPOSE

We review what we currently know about older driver safety and mobility, and we highlight important research needs in a number of key areas that hold promise for achieving the safety and mobility goals for the aging baby boomers and future generations of older drivers.

DESIGN AND METHODS

Through the use of a framework for transportation and safe mobility, we describe key areas of screening and assessment, remediation and rehabilitation, vehicle design and modification, technological advancements, roadway design, transitioning to nondriving, and alternative transportation to meet the goals of crash prevention and mobility maintenance for older adults.

RESULTS

Four cross-cutting themes emerged from this review: safe transportation for older adults is important; older adults have a variety of needs, abilities, and resources; research to help meet the transportation needs of older adults may be of benefit to persons with disabilities; and transportation issues concerning older adults are multifaceted.

IMPLICATIONS

Safe mobility is essential to continued engagement in civic, social, and community life, and to the human interactions necessary for health, well-being, and quality of life. When safe driving is no longer possible for older adults, safe and practicable alternative transportation must be available. Furthermore, older adults are individuals; they have specific needs, abilities, and resources. Not all older adults will have difficulty meeting their transportation needs and no single transportation solution will work for all people. Research and countermeasures intended to help meet the transportation needs of older adults will likely also benefit younger users of the transportation system, particularly those with disabilities. The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if we are to make significant progress in the next decade as the baby boomers begin to reach age 70.

Do older drivers pose a risk to other road users?

OBJECTIVE

To investigate the extent to which older drivers pose a risk to other road users, relative to drivers of other ages, using Australian fatal crash data.

METHOD

The principal data source was the Australian Transport Safety Bureau's National Fatalities Database, which has provided fatality numbers for the most recent available 10-year period (1988, 1990, 1992, 1994, and 1996-2001). For each driver age group ("target drivers"), fatality rates were calculated for the following categories of road users: target driver deaths, their passenger deaths, road users external to the target vehicle but killed in the crash involving the target driver, all road users killed other than target drivers, and all road users killed (including target drivers). Fatality rates were calculated on three bases: per population numbers in each age category, per licensed driver numbers in each age category, and per distance driven for each age category. The different road user fatality rates associated with drivers aged 80 years and older were compared to the rates associated with drivers from younger age categories.

RESULTS

On a per population basis, older drivers had a significantly lower "all road users" fatality rate than all age groups bar one (RR for other age groups: 1.2-3.1) and these differences strengthened once target drivers were excluded (RR: 1.4-5.1), all differences significant. On a per licence basis, older drivers had significantly higher "all road users" fatality rate when compared to the rates for drivers aged 30-39 years through to 70-79 years (RR for these age groups: 0.5-0.7) but once the target drivers were excluded, older drivers' "all other road users & fatality rates for were significantly lower than for drivers aged 17-24 years to 30-39 (RR: 1.3-2.6) years. On a per-distance basis, older drivers had significantly higher all road users fatality rate when compared to the rates for all drivers aged 25-29 years through to 70-79 years (RR for these age groups: 0.1-0.4). Once the target drivers were excluded, older drivers' all other road users fatality rates remained significantly higher than for these other age groups (RR: 0.3-0.7) years.

CONCLUSIONS

Based on two of the three bases (per population and per licence), it has been strongly asserted that overall, the older the driver, the less the threat to other road users--and particularly, the less the threat to road users external to the driver's vehicle. Drivers aged 80 years and older appeared to be the greatest threat to other road users only when per distance fatality rates were compared.

Development and pilot testing of an assessment battery for older drivers

INTRODUCTION

The purpose of the study reported here was to develop and pilot test a comprehensive battery of assessment instruments for older drivers that would be inexpensive and easy to administer so that it could be used in longitudinal studies.

METHOD

The resulting battery was developed by selecting a set of validated assessment instruments and combining them into a package, with a total acquisition cost of less than $900. As part of this battery, three questionnaires were developed utilizing items from established questionnaires with minor modifications. The battery was pilot tested with a convenience sample of 38 drivers aged 65 years or older.

RESULTS

Results showed that the entire battery required less than one hour to complete. Data from the assessment outcomes fell within normative ranges. Feedback from subjects indicated that the battery was acceptable, free of problems, presented tasks in a good order, and was not too long.

CONCLUSIONS

Based on study findings, the assessment battery appeared to be low-cost, transportable, easy to administer, easy for subjects to complete, provides a comprehensive assessment of a person's physical health, mental health, and driving behaviors, and would serve as a valuable data collection tool for a longitudinal study of older drivers. Such a longitudinal study is needed in order to answer some of the most important questions about older driver safety and mobility.

Self-reported health and driving cessation in community-dwelling older drivers

BACKGROUND

Stopping driving has significant negative consequences for older adults, but there is no simple, reliable screening tool to predict driving cessation. We sought to determine if self-rated health (SRH) was an independent predictor of driving cessation among older adults.

METHODS

Data on SRH (poor, fair, good, very good, or excellent), medical diagnoses, physical performance, visual acuity, driving status, and other relevant covariates were collected from 649 community-dwelling older Alabama drivers during in-home interviews. Using multivariable logistic regression analyses, we estimated the association of SRH with driving cessation 2 years later.

RESULTS

Participants had a mean age of 74 years; 43% were women, 41% African American, and 48% rural. Overall, 36% reported poor to fair SRH at baseline, and 11% had stopped driving after 2 years. Compared to 8% of drivers with good to excellent SRH, 17% with poor to fair health stopped driving (adjusted odds ratio [OR], 1.93; 95% confidence interval [CI], 1.09-3.41; p=.025). Lower Short Physical Performance Battery (SPPB) scores (adjusted OR, 0.86; 95% CI, 0.78-0.95; p=.001) and older age (adjusted OR, 1.06 per year; 95% CI, 1.01-1.11; p=.010) were also associated with driving cessation. Receiver operating characteristics curves documented similar predictive discrimination (c statistics) for SRH (0.72), the SPPB (0.70), and a count of comorbidities based on the Charlson Comorbidity Index (0.73).

CONCLUSIONS

Poor to fair SRH predicted incident driving cessation after 2 years in a cohort of older adults. SRH can be easily obtained during clinic visits to identify at-risk drivers.

Evaluation of Two Assessment Tools in Predicting Driving Ability of Senior Drivers

OBJECTIVE

To evaluate Motor Free Visual Perceptual Test (MVPT) and Clock Drawing Task (clock test) as quick assessment tools in predicting driving capability of senior drivers for an on-road driving test.

DESIGN

Senior drivers (> or = 55 yrs) referred for evaluation and recommendation for license renewal were given the MVPT, clock test, and an on-road driving test. Receiving operating characteristic (ROC) analysis and stepwise multivariate logistic regression (SMLR) were used to develop a probability model to differentiate between capable and incapable senior drivers.

RESULTS

Data for 232 seniors who had completed all written tests and the on-road driving test were analyzed. Of the 232 seniors, 131 (56%) were classified as capable and 101 (44%) as incapable drivers on the road test. Mean scores for capable and incapable drivers were MVPT 32.0 +/- 4.0 vs. 28.4 +/- 4.6 and mean clock test score 3.5 +/- 0.8 vs. 2.7 +/- 1.2, and mean processing time was 7.1 + 6.5 vs. 10.6 + 5.5. The means of the three measurements were significantly different between the two groups (P value <0.001). ROC curve analysis revealed an optimal cut point of > or = 32 for MVPT score with 60% sensitivity and 83% specificity. The optimal cut point for clock test scores is > or = 3 with 70% sensitivity and 65% specificity. The optimal cut point for processing times is < or = 6.27 secs with 60% sensitivity and 80% specificity. SMLR showed that the most significant predictor of seniors' driving capabilities are the MVPT test scores and clock test scores.

CONCLUSION

MVPT and clock test tools are significant predictors of driving capability on an on-road driving test.

Predictors of driving assessment outcome in Parkinson's disease

This study evaluated selected clinical and functional tests as predictors of driving safety outcomes in Parkinson's disease (PD) patients. A total of 25 PD patients and 21 age-matched controls, all regular drivers, underwent neurological evaluation and assessment of cognitive, visual, and motor function and a standardized, on-road driving assessment. The capacity of the tests to predict pass/fail driving outcomes was determined by selecting a subset with the highest predictive value from each domain and then subjecting these subsets to discriminant function analysis. Accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Three relatively simple tests from the larger battery predicted passes with relatively high sensitivity (PD, 72.7%; controls, 93.8%; both combined, 85.2%); and moderate specificity (PD, 64.3%; controls, 60.0%; both combined. 63.2%). These tests assessed motor performance (Purdue Pegboard test), contrast sensitivity (Pelli-Robson test), and cognitive function (verbal version of Symbol Digit Modalities test). Adding time since diagnosis for the PD group increased sensitivity to 90.9% and specificity to 71.4%. These simple tests confer more objectivity and predictive power to clinical recommendations for driving, they reflect distinct functions that are necessary for safe driving, and they may be especially useful when on-road assessments are not feasible.

Limb deficiency and prosthetic management. 4. Comorbidities associated with limb loss

This self-directed learning module highlights common comorbidities found in people with amputations and their impact on functional outcome. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on prosthetic considerations, functional outcome, and potential complications for a woman with the comorbidities of stroke and diabetes who experiences a dysvascular amputation. Formulation of the differential diagnosis, management of limb pain, and evaluation of the potential psychosocial issues arising after amputation are also discussed.

OVERALL ARTICLE OBJECTIVE

To analyze common comorbidities of people with amputations and to delineate their impact on functional outcome.

Measures of visual function and time to driving cessation in older adults

PURPOSE

Older adults may place restrictions on their driving once their visual function has become compromised, presumably in an effort to ensure their safety. It is important to identify the types of visual function loss that lead to driving cessation to better understand the relationship between vision and driving.

METHODS

Data were used from the Salisbury Eye Evaluation project, a cohort study of 2520 older adults followed for 8 years with four rounds of data collection. Multiple measures of visual function were objectively assessed and driving information was collected through self-report from subjects or proxies. Cox regression was used to examine whether those with worse baseline and 2-year change scores in acuity, contrast sensitivity, visual fields, and glare sensitivity were more likely to stop driving after baseline after adjusting for demographic and health variables.

RESULTS

Those with worse baseline scores in acuity, contrast sensitivity, central or lower peripheral visual fields were more likely to stop driving (trend p values < 0.05). Also, those who experienced 2-year losses in acuity, contrast sensitivity, or lower peripheral visual fields were more likely to stop driving (trend p values < 0.05). With the vision variables entered into the same model, baseline acuity and 2-year acuity loss were no longer statistically significant. Those with worse baseline scores in contrast sensitivity, central and lower peripheral visual fields were more likely to stop driving (trend p values < 0.05), and those who had 2-year losses in contrast sensitivity and lower peripheral visual fields were more likely to stop driving (trend p values < 0.05). Interactions with gender, other drivers in the house, or cognitive impairment were not detected.

CONCLUSIONS

We present prospective data that indicate that older adults with worse scores in multiple measures of vision are more likely to stop driving and that contrast sensitivity and visual fields are most associated with driving cessation.

Night Driving Self-Restriction: Vision Function and Gender Differences

PURPOSE

The purpose of this study was to evaluate gender differences in the relationship between night driving self-restriction and vision function in an older population.

METHODS

Night driving self-restriction patterns (assessed by questionnaire) were examined cross-sectionally in relation to age, gender, health and cognitive status, depression, and vision function in a sample of 900 elders (mean age, 76 years) living in Marin County, California.

RESULTS

Of the total sample, 91% of men and 77% of women were current drivers. The mean age of the drivers was 73.3 years (range, 58-96 years). Among current drivers, women had slightly better vision function than men on most measures (low-contrast acuity, contrast sensitivity, low-contrast acuity in glare, low-contrast, low-luminance acuity, and glare recovery) but were twice as likely as men to restrict their driving to daytime. Men showed significant associations with avoidance of night driving on four spatial vision measures (high- and low-contrast acuity, low-contrast, low-luminance acuity, and contrast sensitivity). For women, in addition to these measures, a significant association was seen for low-contrast acuity in glare. Neither men nor women showed significant associations between driving restriction and performance on the other vision measures examined (glare recovery time, attentional field integrity, or stereopsis). The vision measures most predictive of self-restriction were contrast sensitivity for men and low-contrast acuity in glare for women.

CONCLUSIONS

Including both cessation and self-restriction, men over age 85 years are 6.6 times more likely than women to be driving at night. For both genders, vision plays a significant role in the self-restriction decision. A higher percentage of men than women continue to drive at night with poor vision. Men's night-driving cessation was associated with contrast sensitivity and depression, whereas women's night-driving cessation was associated with low-contrast acuity in glare as well as age.

Driving habits and patterns in older men with glaucoma

Glaucoma, an eye disorder that gradually decreases peripheral vision, affects millions of older adults. Consequences of glaucoma can mean changes in the ability to perform familiar tasks, including driving an automobile. We surveyed older drivers with glaucoma and a control comparison group in order to learn more about their driving habits and expectations about driving cessation. Findings indicate that compared to the control group, drivers with glaucoma are significantly more likely to change their driving habits with regard to driving at night (p=0.003), on freeways (p=0.05), and in unfamiliar areas (p=0.01). Drivers with glaucoma were also significantly more likely to report family concern about their driving (p=0.01). However, the drivers with glaucoma did not anticipate that their disease would force them to discontinue driving. Social workers play a pivotal role in coordinating the complex care needs of visually impaired elders. When driving skills are affected, social workers must address transportation, housing as well as quality of life concerns.

Problems with vision associated with limitations or avoidance of driving in older populations

OBJECTIVES

This report examines the role of (a) disease processes affecting vision, (b) reported troubles with vision, (c) physical symptoms affecting the eyes, and (d) objective measures in reported driving limitation due to problems with eyesight among older drivers.

METHODS

Data for this study (N = 1,840) were obtained from participants in a community-based study of aging and physical performance in people age 55 or older in the city of Sonoma, California. Each of 16 visual conditions was assessed for impact on reported driving limitation due to eyesight by calculating a "risk" ratio. Then, prevalence of the condition was combined with the ratio to generate an attributable risk for that condition for vision-related limitations in driving.

RESULTS

Each condition was significantly associated with reported limitations in driving due to eyesight. "Avoiding physical activity due to vision" (ratio = 3.4) and "trouble seeing steps up/down stairs" (ratio = 2.9) had the strongest association. However, "glasses/contacts required for driving" and "trouble with glare from sun/lights" had the highest attributable risks (35.8 and 29.4).

DISCUSSION

The risk ratio is relevant for evaluating individuals; the attributable risk is relevant to planning countermeasures in populations. Addressing specific problems related to vision should substantially reduce driving limitations due to eyesight.

Reasons Given by Older People for Limitation or Avoidance of Driving

PURPOSE

To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance.

DESIGN AND METHODS

Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one medical and nonmedical reasons for limiting or avoiding driving were examined by age and gender.

RESULTS

Most older people continue to drive; however, many, especially older women, report one or more reasons to limit or avoid driving. Among medical reasons, problems with eyesight are by far the most often cited; no other health problem was identified as a major reason for limitation. Among nonmedical reasons, being concerned about an accident, being concerned about crime, and having no reason to drive were often cited. Important predictors of reported driving limitations were low income, limited functional status, and self-report of poor vision.

IMPLICATIONS

Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.

The role of physicians in assessing older drivers: barriers, opportunities, and strategies

BACKGROUND

Evaluation of the older driver is a difficult task for primary care physicians. We investigated the physician-perceived barriers to assessing older drivers in primary care practice.

METHODS

Twenty family physicians whose patients had completed a clinical questionnaire and neuropsychological tests participated in one of 2 focus groups. Physicians were asked about barriers to assessing older drivers in primary care and the usefulness of neuropsychological tests for assessing driving ability.

RESULTS

A number of themes emerged related to barriers in the assessment of the older driver. Major themes included concerns about being liable for the results of driving related screening and about patients reacting unfavorably to a driving assessment including cognitive tests. Physicians uniformly agreed that a protocol to guide driving assessment would be useful.

CONCLUSIONS

Physicians encounter a number of barriers to assessing older drivers but recognize the importance of driving within the context of geriatric functional assessment.

The Influence of Age and Gender on the Driving Patterns of Older Adults

The purpose of this study was to investigate the influences of age and gender on the driving patterns of 300 older adults. Odds of driving less than every day increased significantly with age and female gender. However, no differences were found in the reduction of overall driving. Females were more likely than men to have stopped or reduced driving under certain adverse conditions and for elective purposes. The driving patterns of today's cohort of older females suggest that the gender gap may be narrowing. Social and cultural issues such as security, safety, and identity with driving may explain existing gender differences.

Older drivers and road safety: the acceptability of a range of intervention measures

A survey questionnaire was used to ascertain the views of 1932 UK drivers aged between 50 and 90 on a range of measures designed to promote safer driving among the elderly. Factor analysis of the items produced six factors, relating to statistically distinct types of measure. Differences in acceptability on the basis of age and sex were explored. Ratings of the effectiveness of each measure revealed little consensus about which measures would be most effective. Compulsory re-testing after a driving ban, a police power to require an assessment of the driving of anyone observed driving in a risky manner, and a requirement for opticians to report to the licensing authority any driver with sight problems likely to affect driving emerged as the individual measures offering the best combination of acceptability and perceived effectiveness.

Diabetes and driving mishaps: frequency and correlations from a multinational survey

OBJECTIVE

The intensive treatment of diabetes to achieve strict glycemic control is a common clinical goal, but it is associated with an increased incidence of hypoglycemia. Becoming hypoglycemic while driving is a hazardous condition and may lead to a greater incidence of driving mishaps. This study investigated whether diabetes is associated with increased risk of driving mishaps and correlates of such a relationship.

RESEARCH DESIGN AND METHODS

During routine visits to diabetes specialty clinics in seven U.S. and four European cities, consecutive adults with type 1 diabetes, type 2 diabetes, and nondiabetic spouse control subjects (n = 341, 332, and 363, respectively) completed an anonymous questionnaire concerning diabetes and driving.

RESULTS

Type 1 diabetic drivers reported significantly more crashes, moving violations, episodes of hypoglycemic stupor, required assistance, and mild hypoglycemia while driving as compared with type 2 diabetic drivers or spouse control subjects (P < 0.01-0.001). Type 2 diabetic drivers had driving mishap rates similar to nondiabetic spouses, and the use of insulin or oral agents for treatment had no effect on the occurrence of driving mishaps. Crashes among type 1 diabetic drivers were associated with more frequent episodes of hypoglycemic stupor while driving, less frequent blood glucose monitoring before driving, and the use of insulin injection therapy as compared with pump therapy. One-half of the type 1 diabetic drivers and three-quarters of the type 2 diabetic drivers had never discussed hypoglycemia and driving with their physicians.

CONCLUSIONS

Type 1 diabetic drivers are at increased risk for driving mishaps, but type 2 diabetic drivers, even on insulin, appear not to be at a higher risk than nondiabetic individuals. Clinical and treatment factors appear to increase risk, e.g., more frequent hypoglycemia while driving, method of insulin delivery, and infrequent self-testing before driving. Physicians are encouraged to talk to their type 1 diabetic patients about hypoglycemia and driving.

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.

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.

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.

Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities

PURPOSE

This study explored the impact of cognition and the availability of other drivers on driving restriction and cessation among older adults.

DESIGN AND METHODS

Survey data from the first wave of the Asset and Health Dynamics Among the Oldest Old data were analyzed, using multinomial logistic regressions.

RESULTS

Cognitive impairment is associated with driving restriction and cessation, although a noteworthy minority of mildly and severely cognitively impaired individuals continue to drive. Partner's driving and involvement and presence of other drivers in the household moderated the effect of cognition on driving restriction and cessation.

IMPLICATIONS

The decision processes surrounding an individual's restricting or stopping driving are complex and may include consideration not only of competence, but also of sense of self-worth and relationship with a partner.

Risk factors for motor vehicle crashes in older women

BACKGROUND

Motor vehicle crash and fatality rates are higher per mile driven for elderly drivers, with an exponential increase above age 75. Identifying elderly drivers who are at risk for automobile crashes may help direct interventions to reduce their high rate of injuries and deaths.

METHODS

Subjects were 1416 women aged 65 to 84 enrolled in the Portland, Ore. site of the Study of Osteoporotic Fractures. Motor vehicle crash information for the years 1986-1995 for each participant was obtained from the Oregon State Department of Transportation. Items from questionnaires, interviews, and physical examinations were tested prospectively for associations with the occurrence of motor vehicle crashes.

RESULTS

About one third of participants (415 of 1416) had a motor vehicle crash during a mean follow-up time of 5.7 years. After adjustment for age and weekly driving mileage, risk factors significantly associated with motor vehicle crashes were a fall in the previous year [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.26-1.86], a greater orthostatic systolic blood pressure drop (HR 1.11 per 12.5 mm Hg, 95% CI 1.01-1.22), and increased foot reaction time (HR 1.10 per 0.06 second, 95% CI 1.00-1.22). Other neuromuscular tests, functional status, medical diagnoses, vision tests, and cognitive tests did not predict motor vehicle crashes in this study population.

CONCLUSIONS

This prospective study with extended follow-up of a large cohort of elderly women has identified crash risk factors that can be measured in the clinical setting. Further study is needed to determine if interventions aimed at these risk factors can decrease the risk of motor vehicle crashes.

Impaired vision and other factors associated with driving cessation in the elderly: the Blue Mountains Eye Study

The aim of present study was to review vision and other factors associated with the cessation of driving. As part of the Blue Mountains Eye Study, detailed demographic information, driving status and medical history were taken. Visual acuity was measured during a standardized refraction and visual fields documented. Potential risk factors were decided a priori. Among the 3654 Eye Study participants, 2831 (77.5%) had driven a motor vehicle in the past, of whom 2379 (84.0%) were current drivers and 452 (16.0%, 95% CI 14.6-17.4%) said they had stopped driving. Older persons and women were more likely to have stopped driving. After adjusting for age and sex, sensory impairment affecting vision and hearing, plus chronic medical conditions and benzodiazepine use were significantly associated with cessation of driving. The study found that sensory impairment, particularly visual parameters, was associated with the decision to stop driving by older subjects.

Factors related to driving difficulty and habits in older drivers

OBJECTIVES

To evaluate the association between chronic medical conditions, functional, cognitive, and visual impairments and driving difficulty and habits among older drivers.

DESIGN

Cross-sectional study.

SETTING

Mobile County, Alabama.

PARTICIPANTS

A total of 901 residents of Mobile County, Alabama aged 65 or older who possessed a driver's license in 1996.

MEASUREMENTS

Information on demographic characteristics, functional limitations, chronic medical conditions, driving habits, and visual and cognitive function were collected via telephone. The three dependent variables in this study were difficulty with driving, defined as any reported difficulty in > or = 3 driving situations (e.g. at night), low annual estimated mileage, defined as driving less than 3000 miles in 1996, and low number of days ( < or = 3) driven per week.

RESULTS

A history of falls, kidney disease or stroke was associated with difficulty driving. Older drivers with a history of kidney disease were more likely to report a low annual mileage than subjects without kidney disease. Low annual mileage was also associated with cognitive impairment. In general, older drivers with a functional impairment were more likely to drive less than 4 days per week. Older drivers with a history of cataracts or high blood pressure were more likely to report a low number of days driven per week, while subjects with visual impairment were at increased risk of experiencing difficulty driving as well as low number of days driven per week.

CONCLUSIONS

The results underscore the need to further understand the factors negatively affecting driving independence and mobility in older drivers, as well as the importance of improved communication between older adults and health care professionals regarding driving.

Visual risk factors for driving difficulty among older drivers

This study sought to evaluate associations between visual function and self-reported difficulty with driving tasks. Drivers (N = 384) between the ages of 55 and 85 were selected from ophthalmology practices and optometry clinics; three out of four of the sample had cataracts and the remaining were cataract-free. Information on driving exposure and difficulty was obtained via self-report. Visual functional status of all participants was measured with respect to acuity, contrast sensitivity, disability glare and useful field of view. Cognitive impairment was evaluated using the Mattis Organic Mental Syndrome Screening Examination. The results show a pattern of difficulty in high-risk driving situations among those with decreased visual acuity and contrast sensitivity, even after adjustments for age, gender, weekly mileage, and cognitive impairment.