To reduce or to cease: A systematic review and meta-analysis of quantitative studies on self-regulation of driving

Social and Environmental Characteristics Associated With Older Drivers' Use of Non-driving Transportation Modes

Objective: We examined associations between older drivers' social and environmental characteristics and odds of using non-driving transportation modes. Methods: Using 2015 National Health and Aging Trends Study data for community-dwelling drivers (n = 5102), we estimated logistic regression models of associations between social characteristics, environmental characteristics, and odds of using non-driving transportation modes three years later. Results: Drivers had 20% increase in odds of getting rides three years later for each additional confidante (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI]: 1.11-1.30). Drivers living in more walkable neighborhoods were more likely to walk to get places (National Walkability Index [NWI] score of 18 vs. 2 aOR = 1.71, 95% CI: 1.02-2.90) and take public transit three years later (NWI 18 vs. 2 aOR = 7.47, 95% CI: 1.69-33.0). Discussion: Identifying modifiable social and environmental characteristics can inform future interventions supporting older adults' health during the transition to non-driving.

Exploring the associations of demographics and scale measures with cognitive driving behavior among older drivers in China

Age-related changes and frailty are reasons for the high proportion of older drivers in certain types of crashes, such as giving right of way at intersections and turning left. The identified crash causes include the driver's demographics, driving style, cognitive function, and mental workload. This study aimed to explore the associations of demographics and scale measures with cognitive driving behavior. Thirty-nine drivers, consisting of twenty younger drivers (18-60 years old) and nineteen older drivers (above 60 years old), participated in driving simulation experiments after completing scale tests. The selected scale measures included the demographic questionnaire, Multidimensional Driving Style Inventory (MDSI-C), Mini-Mental State Examination (MMSE), Trail Making Test Part A (TMT-A) and Part B (TMT-B), and the National Aeronautics and Space Administration Task Load Index (NASA-TLX) for obtaining subjective information from drivers. Driving scenarios were developed based on the driving characteristics of older adults to investigate age-related driving ability. The driving behavior parameters included reaction time, lateral stability, and driving speed, corresponding to reaction, perception, and execution. Three stepwise regression models showed that NASA-TLX, the interaction between age and driving experience, and the interaction between age and TMT-A significantly explained 53.3 % of reaction time variance; TMT-A, risk driving style, anxiety driving style, and gender significantly explained 53.5 % of lateral stability variance; TMT-A, NASA-TLX, and MMSE significantly explained 60.6 % of driving speed variance. Subsequently, the impact of four age-related predictor variables on driving behavior was further discussed. It is worth noting that a rich driving experience may compensate for driving performance. However cognitive impairment impairs this compensation. Driving behavior is influenced by a combination of various factors. Age, as a physiological indicator, is not sufficient to be a strong predictive factor for lateral stability and driving speed. The results provide a reference for traffic safety management departments to streamline driving suitability test procedures and propose targeted training methods for older drivers.

Transportation Justice and Health

Policy Points The health care sector is increasingly investing in social conditions, including availability of safe, reliable, and adequate transportation, that contribute to improving health. In this paper, we suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation. Incorporating a transportation justice framework offers an opportunity to address transportation and mobility needs more comprehensively and equitably within health care research, delivery, and policy.

Driving Cessation and Late-Life Depressive and Anxiety Symptoms: Findings from the National Health and Aging Trends Study

OBJECTIVES

To describe the association between driving cessation and depressive and anxiety symptoms over time by assessing depression and anxiety at 1- and 4-years follow-up.

METHODS

The study examined community-dwelling adults aged 65 years and older from the National Health and Aging Trends Study who were driving at the 2015 interview and completed 1-year (N = 4,182) and 4-year (N = 3,102) follow-up interviews. Outcomes were positive screens for depressive and anxiety symptoms in 2016 or 2019, and the primary independent variable was driving cessation within one year of the baseline interview.

RESULTS

Adjusting for socio-demographic and clinical characteristics, driving cessation was associated with depressive symptoms at 1 year (OR = 2.25, 95% CI: 1.33-3.82) and 4-year follow-up (OR = 3.55, 95% CI: 1.72-7.29). Driving cessation was also associated with anxiety symptoms at 1 year (OR = 1.71, 95% CI: 1.05-2.79) and 4 year follow up (OR = 3.22, 95% CI: 1.04-9.99).

CONCLUSIONS

Driving cessation was associated with an increased risk of developing depressive and anxiety symptoms in later life. However, reasons for this association remain unclear.

CLINICAL IMPLICATIONS

Although the mechanism linking driving cessation with worse mental health symptoms is uncertain, driving facilitates many important activities. Clinicians should monitor the well-being of patients who stop or intend to stop driving.

15-year incidence of driving cessation and associated risk factors: The Blue Mountains Eye Study

OBJECTIVES

To report the 15-year incidence of driving cessation and its associated vision-related risk factors in an older Australian population-based cohort.

STUDY DESIGN

15-year data from a sample of 2379 participants who indicated that they were driving at baseline from The Blue Mountains Eye Study was analysed. Questions about driving cessation was asked at all four visits and was recorded as a binary response (Yes/No). Clinical vision examinations were performed at each visit to determine presenting and best-corrected visual acuity and any incident eye diseases (Yes/No).

MAIN OUTCOME MEASURES

The cumulative 15-year incidence of driving cessation was calculated using interval-censored data progression-free survival analyses. Age- and sex-adjusted and multivariable-adjusted interval-censored Cox proportional hazard models were used to report the hazard ratios (HRs) for associations of baseline and incident vision status with driving cessation.

RESULTS

The 15-year cumulative incidence of driving cessation amongst the 2379 participants was 20.7 %, with women more likely to cease driving than men (p = 0.0005). Cataract (HR 1.98 (95 % confidence interval(Cl) 1.45-2.71)) and age-related macular degeneration (HR 1.85 (95%Cl 1.37-2.50)) were associated with increased risk of driving cessation whilst presenting and best-corrected visual acuity in the better eye were protective against cessation (presenting: HR 0.96 (95%Cl 0.95-0.98); best-corrected: HR 0.93 (95%Cl 0.91-0.95)) in age- and sex-adjusted models, with these factors remaining independently associated in the multivariable-adjusted models.

CONCLUSION

Cumulative incidence of driving cessation increased with older age and was higher in females. Cataract and age-related macular degeneration were independently associated with cessation, whilst better visual acuity at baseline helped prolong driving.

Drivers' self-regulatory behaviors in active and responsive scenarios

OBJECTIVE

Drivers usually appear to self-regulate their driving behaviors in situations considered to be challenging, such as mobile phone-distracted driving. It is important to clarify how drivers self-regulate their actual behaviors. In addition, few studies investigated driver distraction in active and responsive scenarios. Therefore, the present study aimed to gain a better understanding of drivers' actual self-regulation of driving behaviors and phone use behaviors while mobile phone-distracted driving in active and responsive scenarios. The contribution of compensatory beliefs to self-regulation was also explored.

METHODS

This study was conducted using a 2 (mobile phone use behaviors: phone calling vs. WeChat messaging) × 2 (scenarios: active vs. responsive) within-group design. A total of 34 participants completed a driving simulation experiment. The dependent variables of drivers' driving behaviors, phone use behaviors, and physiological data were collected. Participants' compensatory belief was also measured.

RESULTS

The results showed that the speed reduction in the stages with WeChat messaging was significantly greater than that in the stages with phone calls, and the speed reduction in the responsive scenario was significantly greater than that in the active scenario. Participants would adopt relatively equal phone-use-related self-regulatory behaviors in active and responsive scenarios. Participants with higher compensatory beliefs had relatively greater speed reduction in most scenarios, but fewer phone-use-related self-regulatory behaviors. In addition, the respiratory rate could contribute to evaluating the changes in drivers' physiological status during phone calling-distracted driving.

CONCLUSIONS

Participants would self-regulate driving behaviors and phone use behaviors according to different distracted driving tasks and scenarios. The driving-related self-regulation in WeChat messaging scenarios and responsive scenarios was greater. There was a trend in the effect of compensatory beliefs on actual self-regulatory behaviors, which needs to be further verified in the future. This study contributes to the verification of the different actual driving-related and phone-use-related self-regulatory behavior of drivers in active and responsive mobile phone distracted driving scenarios.

"I don't trust it, so I don't read it": How do older Australians navigate and search for information about their health and driving?

OBJECTIVES

Driving is pivotal to successful aging, yet older people may need to adapt their driving to changes associated with aging or transition to driving retirement at some stage. However, most older people are reluctant to discuss or plan for changes to their future mobility. This study describes formative research to inform a social marketing campaign to promote the "DRIVING AND STAYING INDEPENDENT" resource assisting older drivers to make informed decisions about timely changes to their driving.

METHODS

Semi-structured interviews were conducted with 16 drivers aged between 67 and 84 years living in the state of NSW, Australia. A discussion guide based on social marketing principles was used to explore the perspectives and experiences of older drivers seeking health and driving information. Thematic analysis was conducted on the interview data.

RESULTS

Succinct, clear messages with a clear call to action were identified as essential features of social marketing campaigns targeting older drivers. Realistic portrayals of older people in marketing material are important in engaging the audience. Older drivers preferred positive messages that emphasize the relevance of the product to them. Trusted and reputable sources were of utmost importance when seeking health and driving information. Traditional channels such as TV and radio remain the dominant media consumed by the older participants, however, digital resources are being used increasingly.

CONCLUSIONS

This study provides important insights for an evidence-based social marketing campaign promoting the "DRIVING AND STAYING INDEPENDENT" resource to older drivers. The findings add to the limited literature on campaigns targeting older adults and may prove valuable for promoting other issues relevant to older adults. Campaigns targeting older drivers should consider selecting clear messages, demonstrating relevance to the audience, using trustworthy sources and selecting channels used by older adults.

Age is more than just a number: The relationship among age, non-chronological age factors, self-perceived driving abilities, and autonomous vehicle acceptance

Globally, adults aged 65 and older are a rapidly-growing population. Aging is associated with declines in perceptual, cognitive, and physical abilities, which often creates challenges in completing daily activities, such as driving. Autonomous vehicles (AVs) promise to provide older adults one way to maintain their mobility and independence. However, recent surveys of AV acceptance suggest that older adults have a lower AV acceptance compared to younger generations. One challenge is that most of these assessments have not accounted for the various non-chronological age factors that contribute to how older adults perceive their own driving skills and the utility of AVs. To fill this research gap, this study investigated the effects of non-chronological age factors and rated self-perceived driving abilities on AV acceptance across three age groups. An online survey was conducted using Amazon Mechanical Turk (MTurk), for which 438 valid responses were received. Respondents were categorized into a younger (18-40 years), middle-aged (41-64 years), and older (65-79 years) adult age group. Results showed that drivers of a younger age, with higher educational attainment, who rated themselves to have higher social support, and who have lower rated self-perceived driving abilities, report being more willing to accept AVs. Findings from this work can help to inform models of AV technology acceptance and guide in the development of marketing strategies to promote knowledge of AVs.

Food Accessibility in the Suburbs of the Metropolitan City of Antwerp (Belgium): A Factor of Concern in Local Public Health and Active and Healthy Aging

Population aging and declining birth rates are key demographic trends of the 21st century. While the overall life expectancy and healthy life years increase, the quality of life and functional capacity worsens due to non-communicable diseases strongly related to aging. Therefore, aging citizens are often vulnerable to food insecurity. The aim of this paper is to provide insights into the physical accessibility of fresh food and possible alternatives within the setting of an aging society in Antwerp (Belgium), a metropolitan city at the heart of the EU Reference Site 'Three Rivers Food Delta'. We demonstrate that a large number of the Antwerp suburban areas in which 15 to 25% of current inhabitants are already over 65 years old are confronted with problematic physical accessibility of food due to long walking distances to the nearest food shop. E-commerce has the potential to provide better access to fresh food. This is especially relevant for people with specific needs, such as health-related diets, dysphagia, and/or limited mobility. However, e-commerce introduces new inequalities, as those who would benefit the most from digital accessibility currently use it least. Hence, the organization of fresh food access requires a more thoughtful organization of the 'last mile' and possible alternatives to home delivery. This makes food accessibility an urgent factor of concern in public health and healthy aging in the Antwerp suburban areas.

‘…it's hard to prepare yourself, it's like a death’: barriers and facilitators to older people discussing and planning for driving retirement

Driving is the preferred mode of transport for many older drivers, providing mobility to maintain independence and quality of life. The loss of driving privilege has negative psychosocial consequences, including depression. Early discussions and planning for driving retirement are therefore essential. Driving retirement, however, is typically a taboo topic for older drivers and their support networks. To understand why discussions and planning about driving retirement are avoided, 43 semi-structured interviews were conducted with older drivers in New South Wales, Australia. Drawing on Löckenhoff's ageing and decision-making framework, thematic analysis of transcripts offers insights into why discussions and planning for driving retirement are avoided or facilitated. The findings reveal most older drivers had not discussed or planned for driving retirement. Barriers to discussing and planning for driving retirement included: perceptions of loss, change, death and denial. Facilitators to discussing or planning for driving retirement included: declining health and driving confidence, medical advice, age or car accident. Driving retirement in car-dependent societies is a major life event, symbolising an end-of-life stage for many older people. This paper calls for strategies to encourage early and regular discussions about driving retirement with older drivers. To support older drivers’ transition to driving retirement, an understanding of the value and meaning placed on driving in the context of the individuals' identity and lifestyle is recommended.

Development of a Planning for Aging and Frailty Questionnaire

There is a gap in understanding adults' readiness to plan for adaptions across the aging trajectory. The purpose of the current psychometric project was to develop and test the Planning for Aging and Frailty Questionnaire. Clinical experience and extant literature formed the basis for creating items measuring planning for aging. Content validity was established with gerontology and health service research experts. Face validity testing was conducted through two cognitive interviewing and debriefing sessions at a senior center. All survey questions resulted in a content validity index ≥0.80 from experts. Face validity testing involved successful completion of the survey by 12 adults followed by cognitive interviewing/debriefing, resulting in minor changes. The 21-item Planning for Aging and Frailty Questionnaire demonstrates good initial validity and can be used to measure readiness in planning for aging and personal experiences and experiences with others. Further testing with additional usage is warranted. [Research in Gerontological Nursing, 15(5), 239-244.].

Driving, Residential Location, and Employment Outcomes Among Older Adults

The ability to drive is positively associated with workforce participation among older adults. However, residence in neighborhoods where destinations are easy to reach by public transit could potentially narrow the employment gap between older drivers and non-drivers. This study examines the relationship between driving, residential location characteristics, and employment outcomes among older adults. Findings show that both drivers and non-drivers are more likely to be employed if they live in neighborhoods with high levels of access to jobs via public transit. However, the positive relationship between transit access to jobs and employment outcomes is particularly strong among non-drivers. These findings indicate that although older adult drivers are more likely to work than their non-driving counterparts, the gap in employment outcomes is mitigated by living in dense, transit-rich neighborhoods. Results suggest that policies supporting both automobile access and transit-rich residential environments can facilitate labor force participation among older adults.

An innovative therapeutic educational program to support older drivers with cognitive disorders: Description of a randomized controlled trial study protocol

Older drivers face the prospect of having to adjust their driving habits because of health problems, which can include neurocognitive disorders. Self-awareness of driving difficulties and the interaction between individual with neurocognitive disorders and natural caregiver seem to be important levers for the implementation of adaptation strategies and for the subsequent voluntary cessation of driving when the cognitive disorders become too severe. This study aims to evaluate an educational program for patient/natural caregiver dyads who wish to implement self-regulation strategies in driving activity, and to improve self-awareness of driving ability. The ACCOMPAGNE program is based on seven group workshops, which target the dyad. The workshops deal with the impact of cognitive, sensory and iatrogenic disorders on driving. They tackle questions about responsibility, and about autonomy and social life. They also provide alternative solutions aimed at maintaining outward-looking activities even if driving is reduced or stopped. A randomized controlled trial is planned to evaluate the effectiveness of the program 2 months and 6 months after inclusion, and to compare this to the effectiveness of conventional approaches. The main outcome of this trial (i.e., the implementation of self-regulated driving strategies), will be measured based on scores on the “Current Self-Regulatory Practices” subscale of the Driver Perception and Practices Questionnaire. The Driving Habits Questionnaire will be used to measure secondary outcomes (indicators of driving changes; indicators of changes in mood, quality of life and caregiver burden; and self-awareness of driving abilities). Indicators will be collected for both patients and natural caregivers. This cognitive, social and psychological program should allow older individuals with cognitive disorders to drive more safely, and help to maintain the quality of life and mood of both patient and natural caregiver despite driving limitations. The patient's care path would be optimized, as he/she would become an actor in the process of giving up driving, which will, most certainly, be needed at some point in the progress of neurocognitive disorders. This process ranges from becoming aware of driving difficulties, to implementing self-regulation strategies, through to complete cessation of driving when necessary.

Clinical trial registration number

NCT04493957.

Examining Patterns of Driving Avoidance Behaviors Among Older People Using Latent Class Analysis

Objectives: Some older drivers choose to avoid certain situations where they do not feel confident driving. Little is known about the process by which older drivers may use avoidance in transitioning to non-driving. Methods: We analyzed 2015 ConsumerStyles data for 1198 drivers aged 60+. Driving patterns were examined by sociodemographic and driving characteristics. Avoidance classes were characterized by latent class analysis. Results: Among drivers 60+, 79% reported driving 3+ days/week and 84% reported good to excellent health. We identified four driving avoidance classes (low, mild, moderate, and high). High- (versus low-) avoidance drivers were more likely female, 75+, not White/non-Hispanic, and to have income <$25,000/year. Discussion: Avoidance of selected driving behaviors may be one component of a multi-step process supporting the transition to non-driving. Drivers displaying avoidance behaviors may be receptive to resources to prepare for this transition and minimize negative health and quality of life outcomes that accompany driving cessation.

Self-Perception and the Relation to Actual Driving Abilities for Individuals With Visual Field Loss

Background

In Sweden, individuals with visual field loss (VFL) have their driving license withdrawn. The literature clearly indicates that individuals with VFL are unsafe drivers on a group level. However, many drivers with VFL can be safe on an individual level. The literature also suggests that self-perception, beliefs, and insights of one’s own capabilities are related to driving performance. This study had three aims: (1) To investigate self-perceived driving capability ratings for individuals with VFL; (2) to compare these ratings between groups with different medical conditions associated with VFL (stroke, glaucoma, and diabetes); and (3) to relate the self-perception ratings to actual driving performance in an advanced driving simulator.

Methods

Participants comprised 723 individuals whose driver’s license had been withdrawn because of VFL and 92 normally sighted elderly individuals. All participants completed a background survey, rated difficulties with different traffic situations, rated their strengths and weaknesses as drivers, and rated aspects that were important for causing traffic accidents. Of the VFL group participants, 264 also completed a simulator-based driving test that they knew could lead to renewal of their driving license. VFL participants and normally sighted was at the same age when they completed the simulator driving test.

Results

Overall, individuals with VFL rated their capabilities as high on all instruments and scales used, even higher than the elderly normally sighted control group. The only VFL etiology group that rated lower than other groups was the diabetes group. Safety orientation and internal control orientation values were best at discriminating between VFL participants in terms of self-perception of driving performance. Participants categorized as “high” in terms of safety skills and internal control were more modest in their ratings. Finally, participants who passed the simulated driving test did not differ from those who failed, in any of the self-perception measures.

Conclusion

Self-perception ratings among individuals with VFL were higher than those of normally sighted elderly individuals. Self-assessed skills did not predict driving performance. Groups with different VFL etiologies rated similarly. Self-ratings of driving abilities cannot be used to assess actual driving performance. Actual driving tests (on road or in the simulator) are necessary to discriminate between safe and unsafe drivers with VFL.

Why do older drivers self-regulate: Psychological factors influencing self-regulation in a Chinese sample

INTRODUCTION

As China has recently lifted the age limit for getting access to driving licenses, older drivers' safety issues have received wide attention. Driving self-regulation can be regarded as an adjustment strategy for older adults to reduce risks and extend driving lives. Studies abroad mainly stress the three levels and influencing factors of driving self-regulation. China has a long history with a unique cultural background and social reality and relevant research are still in the initial stage.

METHOD

This study applied the extended Theory of Planned Behavior (TPB) to explore the psychological factors that affected self-regulation of older drivers. 317 participants mainly from Beijing urban area completed the questionnaires including demographic information and extend TPB items.

RESULTS

Bivariate correlation analysis showed that self-regulation was negatively correlated with the amount of driving experience (days per week and mileages per month) in a significant way. And so was the number of family-owned motor vehicles. Exploratory factor analysis indicated that the extended TPB questionnaire was reliable and effective for measuring self-regulation. The proposed Structural Equation Model (SEM) explained 73.673% of the variance in self-regulation intention. Attitude (0.50) had the strongest influence among all variables on intention. Subjective norms (0.28), perceived behavior control (0.27), and alternative traffic quality (0.20) significantly influenced intention. Intention (0.34) and physical condition (0.22) imposed significant effect on self-regulation behavior. Practical applications: Feasible suggestions were put forward that contribute to self-regulate reasonably. This study helps to better understand the nature of self-regulation behaviors and provides a theoretical basis for formulating scientific intervention measures. On the transportation side, people from all communities of society should care for and support older drivers.

Active Road Studs as an Alternative to Lighting on Rural Roads: Driver Safety Perception

Drivers, particularly with increasing age, cite driving at night as being problematic and feeling unsafe. Ultimately this may result in self-regulation and avoidance, with potentially negative health effects. The issue is commonly mitigated through provision of street lighting, but with it comes cost, environmental impact, and other negative effects. Research has suggested that provision of LED Active Road Studs may be of assistance to drivers at night. However, it is not known how implementation of this measure affects driver confidence, as research to date has focused on observational study of actual driving behaviour. The present work addresses this gap in knowledge using data from 698 respondents to a questionnaire survey of households around a recently treated route. Overall, 72% reported an increase in confidence driving at night, with key reasons cited as increased preview time and reduced glare. A total of 80% of respondents believed the overall safety of the study route had improved. Underlying confidence was found to be lower in females, with confidence increasing with mileage driven. This study is the first to suggest the use of active road studs may increase driver confidence and provide increased travel opportunities, particularly where street lighting is impractical or undesirable in terms of sustainability.

Barriers and facilitators to social participation after driving cessation among older adults: A cohort study

BACKGROUND

Driving cessation is a challenging transition for older drivers. It is indeed often associated with reduced mobility, loss of autonomy and poor quality of life, as in individuals with acquired disabilities. We examined factors that inhibit or facilitate out-of-home occupations after driving cessation (shopping, visiting/helping friends/family, leisure, and associative activities) in older adults, with particular focus on the role of anticipation.

METHODS

This longitudinal study was conducted with the SAFE MOVE cohort (n=1014 drivers aged≥70 years). Socio-demographic, health, cognitive, mobility and out-of-home occupations data were collected at home at baseline and by a postal questionnaire at 2-year follow-up.

RESULTS

In total, 48 (5%) participants stopped driving between baseline and follow-up, at a mean age of 81.8 years; 71% of drivers who stopped reported that driving cessation affected their out-of-home occupations. Participation in social occupations started to decline before driving cessation. Retired drivers were older, had poorer health, poorer cognitive abilities, drove less at baseline but used more public transportation than active drivers. As compared with participants who did not consider driving cessation at baseline, those who did were more likely to expect a better quality of life in the event of driving cessation and to use public transportation at baseline and follow-up despite their older age and poorer health.

CONCLUSION

Some factors associated with reduced social participation and driving cessation are inevitable, such as health status. However, other factors may facilitate maintenance of social participation, including anticipation of driving cessation and mobility habits. Our findings highlight the need for appropriate interventions that are widely available to older drivers before driving cessation occurs and for public policy actions facilitating alternative transport systems.