Prevalence, attitudes, and knowledge of in-vehicle technologies and vehicle adaptations among older drivers

Metacognitive Awareness of Older Adult Drivers with Mild Cognitive Impairment: Relationships with Demographics, Subjective Evaluation of Cognition, and Driving Self-Efficacy

(1) Self-regulation of driving is a means of maintaining one's driving identity. The purpose of this study was to investigate the extent to which older drivers with Mild Cognitive Impairment (MCI) are metacognitively aware of the requirements of specific demanding driving conditions and whether this awareness is linked to subjective assessments of cognition. (2) One hundred seventeen (117) older MCI drivers participated in a telephone survey in which they reported their metacognitive experiences in nine driving conditions, listed as an aim of self-regulation. The analyses included the participants' subjective cognitive assessments, both in terms of their cognitive state and their perceived driving self-efficacy. (3) The analyses pointed out a direct and negative effect of age on the formation of the metacognitive feeling of certainty. Furthermore, an indirect effect of sex through driving self-efficacy was established. This effect was negative in the case of the metacognitive feeling of difficulty and the estimation of effort and positive in the case of the metacognitive feeling of certainty. (4) This position points out the need to establish appropriate levels of the perceived self-efficacy of older drivers with MCI, and it raises issues when it moves to fictitious levels.

Driving Difficulties and Preferences of Advanced Driver Assistance Systems by Older Drivers With Central Vision Loss

Purpose

The purpose of this study was to investigate driving difficulties and Advanced Driver Assistance Systems (ADAS) use and preferences of drivers with and without central vision loss (CVL).

Methods

Fifty-eight drivers with CVL (71 ± 13 years) and 68 without (72 ± 8 years) completed a telephone questionnaire. They rated their perceived driving difficulty and usefulness of technology support in 15 driving situations under good (daytime) and reduced visibility conditions, and reported their use experience and preferences for 12 available ADAS technologies.

Results

Drivers with CVL reported more difficulty (P = 0.002) and greater usefulness of technology support (P = 0.003) than non-CVL drivers, especially in reduced visibility conditions. Increased driving difficulty was associated with higher perceived technology usefulness (r = 0.34, P < 0.001). Dealing with blind spot road users, glare, unexpected pedestrians, and unfamiliar areas were perceived as the most difficult tasks that would benefit from technology support. Drivers with CVL used more advanced ADAS features than non-CVL drivers (P = 0.02), preferred to own the blind spot warning, pedestrian warning, and forward collision avoidance systems, and favored ADAS support that provided both information and active intervention. The perceived benefits of and willingness to own ADAS technologies were high for both groups.

Conclusions

Drivers with CVL used more advanced ADAS and perceived greater usefulness of driver assistance technology in supporting difficult driving situations, with a strong preference for collision prevention support.

Translational Relevance

This study highlights the specific technology needs and preferences of older drivers with CVL, which can inform future ADAS development, evaluation, and training tailored to this group.

Preferred Sources of Information, Knowledge, and Acceptance of Automated Vehicle Systems: Effects of Gender and Age

Automobile crashes are a leading cause of death in the United States and worldwide. Driver automation systems and active safety systems have the potential to improve the safety and mobility of all road users and may particularly benefit older adults who have been slow to accept and adopt such systems. Age-related sensory-cognitive changes contribute to higher crash rates and increased physical frailty makes severe injury or death more likely when a crash occurs. Vehicle automation can decrease the sensory-cognitive load of the driving task and many advanced automated safety features can decrease crash severity. Acceptance and adoption of driver automation systems is necessary for their benefit to be realized yet little is known about drivers' preferred sources of information and knowledge about such systems. In a sample of 404 active drivers, we examined the impact of age and gender on understanding and acceptance of vehicle automation, acceptance of new technologies more generally, and preferred sources of information to learn about vehicle automation. Results revealed that older respondents and females felt less technically sophisticated than their younger and male counterparts. Males subjectively reported greater understanding of vehicle automation. However, assessment of objective knowledge of automation operation showed males had no greater knowledge than females. Males also reported a greater willingness to accept higher levels of vehicle automation than females across all age groups. When asked how they would prefer to learn about new vehicle automation, older adults reported wanting information from more objective sources than their younger counterparts and were significantly less likely to rely on friends and family, or social media. The present results provide support for the idea that people are not willing to accept technology that they do not feel they understand well and conversely, if people feel that they understand vehicle automation they will be more likely to adopt it. The results provide insights into assisting drivers to gain more accurate knowledge and hence acceptance of vehicle automation systems.

Understanding Current and Future Transport Needs of Older Australian Drivers to Guide Development of Sustainable and Smart Initiatives to Support Safe Mobility of Older Adults

Access to adequate and appropriate transport options enables older people to continue as thriving community participants, to reach services and to maintain social connections. While transport needs are diverse, and tend to change over time, there is little information on current and future transport patterns, and the awareness, acceptance and adoption of new technologies. A national online survey was administered to current drivers in Australia. A sample of 705 drivers provided information on available travel modes and use of these modes, awareness of in-vehicle technologies and future use of vehicle technologies. The findings revealed high use of private vehicles, walking and taxis but little use of other travel modes (bicycles, motorcycles, rideshare, community services and public transport). Age, gender and residential location influenced the availability and use/potential use of some transport options. Overall awareness of in-vehicle technologies was generally low and particularly so amongst older and female participants. There was some appetite to use emerging technologies in the future. The findings inform the development of effective strategies and initiatives aligned with healthy ageing and wellbeing targets, increased sustainability, resilience and connectedness, creation of healthier travel choices and healthier environments to promote acceptance and use of a range of transport options and uptake of safer vehicles equipped with in-vehicle technologies to ultimately enhance safe and sustainable mobility of older road users.

Associations of Self-Care Health Behaviors With Driving Cessation Among Older Drivers

Older adults are at risk of driving cessation as they age, which can result in negative health outcomes including loss of independence. This study aimed to investigate the associations of self-care health behaviors with the risk of driving cessation. Demographics, health and driving characteristics were captured from healthcare systems in Denver, CO, San Diego, CA, Ann Arbor, MI, Baltimore, MD and Cooperstown, NY for 2,990 adults at baseline then followed from July 2015 to January 2021 via in-person assessments and questionnaires. The follow-up accumulated a total of 7,348 person-years and 46 driving cessations, yielding an incidence rate of 0.63 per 100 person-years. Multivariable Cox proportional hazards regression was used to evaluate the relationship between self-care behaviors and driving cessation, stratified by gender, and accounting for multiple failure events and clustering by study site. Ability to participate in social roles and activities was associated with an 8% reduction in the risk of driving cessation [adjusted hazard ratio (HR): 0.92; 95% CI: 0.89, 0.94]. Increased participation in social activities and relationships is associated with driving longevity in older adults and should be targeted for interventions to maintain driving mobility.

Knowledge of and trust in advanced driver assistance systems

Understanding what drivers know about state-of-the-art advanced driver assistance systems (ADAS), like adaptive cruise control (ACC) and lane keeping assistance (LKA) is important because such knowledge can influence trust in and reliance on the automation. We surveyed ADAS owners (N = 102) and non-owners (N = 262), with the primary objective of assessing knowledge and trust of ACC and LKA, and investigating the relationship between knowledge and trust among drivers who have not received special training. The survey contained demographic questions, ACC and LKA knowledge questionnaires (assessing knowledge of capabilities and limitations commonly found in owner's manuals), and ACC and LKA trust ratings. From the knowledge questionnaires, sensitivity (i.e., knowledge of the true capabilities of ACC and LKA) and response bias were assessed and used to predict trust. Results showed that owners did not have better knowledge of system capabilities/limitations than non-owners, in fact, owners had a stronger bias in favour of system capabilities. For non-owners, better knowledge of system capabilities was associated with lower trust, and those who were more biased towards endorsing system capabilities had higher trust. Neither knowledge nor response bias was associated with trust among owners. Further research is needed to confirm our results with a larger sample of owners, but given that it is also impractical to expect drivers to learn and remember all possible ADAS limitations, it may be beneficial to focus training efforts on improving drivers' overall understanding of the fallibility of ADAS and reinforcing their role when using ADAS to support appropriate trust and reliance.

Age-Related Diseases and Driving Safety

Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.

Use of GPS for Older Adults to Decrease Driving Risk: Perceptions from Users and Non-Users

Community mobility is important for social participation and quality of life. Thus, it is important to sustain older adults in their communities by supporting their ability to drive as long as possible. Use of global positioning system (GPS) technology may provide such support. This descriptive study examined 89 healthy community older adults' perspective on using and programming a GPS after using it for wayfinding to unfamiliar destinations. Participants were equally divided between two age groups (60s, 70s) and familiarity with GPS (familiar, unfamiliar). The results showed age differences in problems following GPS directions and those who were familiar found it significantly easier to use. The majority of the unfamiliar group indicated an increased interest in using GPS and were significantly more interested in training to use a GPS. Preference for learning how to use a GPS included in-person delivery and practice with troubleshooting, using the menus and changing routes as topics critical for training. The implications of these results are discussed.

Population-Level Incidence and Use-Related Factors of Comfort and Orthopedic Accessories Among Older Vehicle Occupants in NSW, Australia

The proportion of people aged 65 years and older regularly traveling in motor vehicles continues to grow worldwide. In a previous convenience sample, we observed many older people using comfort accessories when traveling in vehicles, and these may contribute to the known increased risk of injury in crashes among older people. In this study, we aimed to estimate population-level use of these devices and examine associations between demographic, health, and travel behavior factors and their use. The point estimate of self-reported use of comfort accessories was 25.7% (95% confidence interval [CI] = [19.6%, 31.9%]). Cushions on the vehicle seat were the most common type used (14.3%, 95% CI = [9.7%, 19.0%]), and increasing age, female gender, and frequent vehicle travel were significantly associated with their use. Less frequently used were seat belt padding (10.5%, 95% CI = [6.3%, 14.6%]) and back/neck supports (6.5%, 95% CI = [2.7%, 10.2%]). Back/neck and multiple area pain were significantly associated with the use of the latter.

The Relationship between in-Vehicle Technologies and Self-Regulation among Older Drivers

The study sought to understand the relationship between in-vehicle technologies (IVTs) and self-regulatory behaviors among older drivers. In a large multi-site study of 2990 older drivers, self-reported data on the presence of IVTs and avoidance of various driving behaviors (talking on a mobile phone while driving, driving at night, driving in bad weather, and making left turns when there is no left turn arrow) were recorded. Self-reports were used to identify whether avoidance was due to self-regulation. Hierarchical logistic regressions were used to determine whether the presence of a particular IVT predicted the likelihood of a given self-regulatory behavior after controlling for other factors. Results suggest that the presence of Integrated Bluetooth/Voice Control systems are related to a reduced likelihood of avoiding talking on a mobile phone while driving due to self-regulation (OR= 0.37, 95% CI= 0.29-0.47). The presence of a Navigation Assistance system was related to a reduced likelihood of avoiding talking on a mobile phone while driving (OR= 0.65, 95% CI= 0.50-0.84) and avoiding driving at night due to self-regulation (OR= 0.80, 95% CI = 0.64-1.00). Present findings suggest in-vehicle technologies may differently influence the self-regulatory behaviors of older drivers.

Improving Safe Mobility: An Assessment of Vehicles and Technologies among a Large Cohort of Older Drivers

Evidence suggests that older driver safety may be improved by good vehicle maintenance, in-vehicle advanced technologies, and proper vehicle adaptations. This study explored the prevalence of several measures of vehicle maintenance and damage among older drivers through inspection of their vehicles. We also investigated the prevalence of in-vehicle technologies and aftermarket adaptations. Vehicle inspections were conducted by trained research staff using an objective, standardized procedure. This procedure, developed by a multidisciplinary team of researchers, was based on a review of inspection checklists used by automobile dealerships and the project team's expertise. The study used baseline data from vehicles of 2988 participants in the multi-site Longitudinal Research on Aging Drivers (LongROAD) study. Among this cohort, vehicles were well maintained, had little damage, and contained a range of advanced technologies but few aftermarket adaptations. Implications of study findings for occupational therapy practice are discussed.

Driving Decisions: Distinguishing Evaluations, Providers and Outcomes

Driving is a highly valued instrumental activity of daily living on which many older adults depend for access to their community. The demand to address driving is changing as older adults experience increasing longevity while facing medical conditions that often affect their fitness to drive. As one of the most complex of daily tasks, driving is a multifaceted issue that involves the older driver, family members, state licensing and health care practitioners. This commentary discusses potential options and strategies for making evidence-based fitness to drive decisions by differentiating between driving skills and driving capacities, and how these differences are manifested on the road. Typical service options are described using an algorithm format that suggests decision points with options and referrals for service based on the individual's experiences and/or needs.