Very old drivers: findings from a population cohort of people aged 84 and over

Prevalence, dimensions, and correlates of excessive daytime sleepiness in community-dwelling older adults: the Yilan study, Taiwan

BACKGROUND

Daytime sleepiness is an important health problem. However, the dimensionality of the Epworth Sleepiness Scale (ESS) in older adults remains unclear. This study aimed to determine the prevalence of ESS-defined excessive daytime sleepiness in older adults. Furthermore, the dimensionality of ESS and its respective correlates were also compared.

MATERIALS AND METHODS

This is a community-based survey in which community-dwelling older adults aged ≥ 65 years participated. Excessive daytime sleepiness was assessed using the ESS and was defined as an ESS score of > 10. Exploratory factor analysis was performed to identify the ESS factors. Multiple logistic regression analysis was used to examine the independent correlates of the ESS-defined and factor-specific correlates of excessive daytime sleepiness.

RESULTS

In total, 3978 older adults participated in this study. The mean age was 76.6 ± 6.7 years, with 53.8% ≥ 75 years, and 57.1% were female. The prevalence of ESS-defined excessive daytime sleepiness was 16.0%. An exploratory factor analysis revealed two factors in the ESS, which were designated as 'passive' and 'active' according to the soporific levels of ESS items loaded in each factor. Multiple logistic regression showed that male, illiteracy, depression, disability, short sleep duration and no exposure to hypnotics were risk indicators for ESS-defined excessive daytime sleepiness. However, the correlates for passive and active factor-defined excessive daytime sleepiness differ in pattern, especially in variables related to education, exercise, mental health, and sleep.

CONCLUSIONS

The prevalence of ESS-defined excessive daytime sleepiness is high, and its correlates vary among older adults. This study also suggests a dual ESS structure in community-dwelling older adults.

Toward Safe and Confident Silver Drivers: Interview Study Investigating Older Adults' Driving Practices

BACKGROUND

As the aging population in the United States continues to increase rapidly, preserving the mobility and independence of older adults becomes increasingly critical for enabling aging in place successfully. While personal vehicular transport remains a popular choice among this demographic due to its provision of independence and control over their lives, age-related changes may heighten the risk of common driving errors and diminish driving abilities.

OBJECTIVE

This study aims to investigate the driving practices of older adults and their efforts to maintain safe and confident driving habits. Specifically, we sought to identify the factors that positively and negatively influence older adults' driving performance and confidence, as well as the existing efforts put into sustaining their driving abilities.

METHODS

We recruited 20 adults aged ≥65 years who remained active drivers during the recruitment from the greater New York area. Then, we conducted semistructured interviews with them to examine their perceptions, needs, and challenges regarding safe and confident driving.

RESULTS

Our findings uncovered a notable disparity between older adults' self-perceived driving skills and the challenges they face, particularly caused by age-related limitations and health conditions such as vision and memory declines and medication routines. Drawing on these findings, we proposed strategies to bridge this gap and empower older adults to drive safely and confidently, including fostering a realistic understanding of their capabilities, encouraging open dialogue regarding their driving, encouraging regular assessments, and increasing awareness of available resources.

CONCLUSIONS

This study uncovered a noticeable disparity between the perceived driving competence of older adults and the actual challenges they confront while driving. This divergence underscores a significant need for better support beyond the existing aid available to preserve older adults' driving skills. We hope that our recommendations will offer valuable insights for practitioners and scholars committed to enhancing the overall well-being and quality of life for older adults as they age in their homes.

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Driving-Related Cognitive Abilities: Evaluating Change over Time in a Sample of Older Adults Undergoing an Assessment Regarding Fitness to Drive

Advancing age can bring a decline in many driving-related cognitive abilities. For this reason, public safety concern has raised about older adults' driving performance, and many countries have adopted screening polices to assess older drivers' fitness to drive. As a result of such assessments, authorities may impose behavioral restrictions to driving. The present study examines whether driving-related cognitive abilities change over time and compares drivers either restricted or not by licensing authorities after the first assessment. The data were derived from a database provided by a service of psychodiagnostic assessment of fitness to drive. This database contained data of people referred for cognitive assessment in order to renew their driving license over the period of 2016 to 2022. The sample included 58 cognitively healthy old drivers (mean age = 82.79, SD = 6.13; 97% men) with a follow-up examination (T2) after a period ranging from one to four years (M = 1.59, SD = 0.72) since the first assessment. Cognitive assessments were conducted using the standard test battery from the Vienna Test System (VTS8; ©Schuhfried GmbH, Mödling, Austria). Decision time variability, motor time, reaction time under stress, and obtaining an overview did not show significant changes between T1 and T2, whereas selective attention and inductive reasoning significantly decreased over time in both groups. Improvements in processing speed consistent with practice effects emerged at T2. Restricted drivers (n = 41) maintained significantly worse performances than unrestricted drivers (n = 17) in the follow-up assessment. Chronological age was associated with higher reaction time under stress, while education showed a buffering role against a decrease in perceptual speed. Overall, although older drivers' driving-related cognitive abilities remain relatively stable over the short-term, the decline in some cognitive functions deserves reevaluation and monitoring.

Modeling of older adults' driving exposure and avoidance using objective driving data in a naturalistic driving study

Older adults in the United States rely heavily on driving their own vehicles to commute to work, shop for groceries, and access public services. To effectively help older adults maintain mobility and independence,we need to better understand how thecognitive, visual functioning, and health declines influence their tendency to self-restrict their driving. The objective of this study is to develop a causal model to examine the effects of age, gender, household status (specifically living alone), physical, cognitive, visual abilities, and health status on older adults' driving mobility in terms of driving exposure and avoidance. Driving exposure was measured by actual driving data, whereas driving avoidance was assessed by both self-report data and actual driving exposure to challenging situations. Structural equation modeling was used to analyze data collectedin the Second Strategic Highway Research Program Naturalistic Driving Study for establishing relationships between the selected factors and mobility. The structural equation model included a total of794 participants aged 65 and over (367 or 46.22%femalesand 427 or 53.78% males). Results indicate that poorer health is associated with less driving exposure; deteriorating cognitive and physical capabilities are associated with more self-reported driving avoidance and less actual driving in challenging situations; visual function is associated with self-reported avoidance; living alone is associated with higher driving exposure in general as well as in challenging situations; self-reported driving avoidance of challenging situations has a negative association with actual driving in those same situations. The final model could be applied to predict older adults' mobility changes according to their age, gender, household status, as well as their visual, physical, cognitive and health status.

Understanding the relationship between eye disease and driving in very old Australian women: a longitudinal thematic evaluation

Background

Over recent decades an increasing number of adults will retain their driver’s licenses well into their later years. The aim of this study was to understand and explore the experience of driving and driving cessation in very old Australian women with self-reported eye disease.

Methods

An interpretative qualitative study. Participants were from the Australian Longitudinal Study on Women’s Health (cohort born in 1921–26), a sample broadly representative of similarly aged Australian women. Responses to open-ended questions were analysed using an inductive thematic approach, employing a process of constant comparison.

Results

Qualitative data were from 216 older women with eye disease who made 2199 comments about driving, aged between 70 and 90 years depending on the timing of their comments. Themes included: (1) Access to treatment for eye disease promotes driving independence and quality of life; (2) Driving with restrictions for eye disease enables community engagement and (3) Driving cessation due to poor vision leads to significant lifestyle changes.

Conclusions

Key findings highlighted driving cessation, or reduction, is often attributed to deterioration in vision. The consequence is dependence on others for transport, typically children and friends. Access to successful treatment for eye disease allowed older women to continue driving. We posit that occupational therapists can play an essential role in promote driving confidence and ability as women age.

Trial registration: Not applicable.

Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN)

Background

Motor vehicle collisions (MVCs), particularly those associated with entrapment, are a common cause of major trauma. Current extrication methods are focused on spinal movement minimisation and mitigation, but for many patients self-extrication may be an appropriate alternative. Older drivers and passengers are increasingly injured in MVCs and may be at an increased risk of entrapment and its deleterious effects. The aim of this study is to describe the injuries, trapped status, outcomes, and potential for self-extrication for patients following an MVC across a range of age groups.

Methods

This is a retrospective study using the Trauma Audit and Research Network (TARN) database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2019. Patients were excluded when their outcomes were not known or if they were secondary transfers. Simple descriptive analysis was used across the age groups: 16–59, 60–69, 70–79 and 80+  years. Logistic regression was performed to develop a model with known confounders, considering the odds of death by age group, and examining any interaction between age and trapped status with mortality.

Results

70,027 patients met the inclusion criteria. Older patients were more likely to be trapped and to die following an MVC (p < 0.0001). Head, abdominal and limb injuries were more common in the young with thoracic and spinal injuries being more common in older patients (all p < 0.0001). No statistical difference was found between the age groups in relation to ability to self-extricate. After adjustment for confounders, the 80 + age group were more likely to die if they were trapped; adjusted OR trapped 30.2 (19.8–46), not trapped 24.2 (20.1–29.2).

Conclusions

Patients over the age of 80 are more likely to die when trapped following an MVC. Self-extrication should be considered the primary route of egress for patients of all ages unless it is clearly impracticable or unachievable. For those patients who cannot self-extricate, a minimally invasive extrication approach should be employed to minimise entrapment time.

Psychological Resources and Driving Status: A Study of Current and Former Drivers 55 Years of Age and Older

Psychological resources can help individuals adjust to changes associated with aging. In this study, we examined the effect of demographic, health, and psychological resource variables in explaining driving status among adults 55 years and older. A convenience sample of 222 adults between the ages of 55 and 91 years (mean = 72.20 years) completed questionnaires that included measures of driving status, self-rated health, and psychological resources (e.g., life control, life purpose, and locus of control). Multiple logistic regression models that controlled for confounders were constructed with driver status (i.e., current driver or former driver) as the outcome. Former drivers were older, reported being in poorer health, and reported more depression symptoms. After controlling for age and health, current drivers reported higher levels of life control and life purpose and a more internal locus of control. Results highlight the importance of considering psychological resources when examining driving cessation.

Cognitive Reserve and Driving-Related Cognitive Abilities in a Sample of Oldest Old Drivers Undergoing Assessment of Fitness to Drive

This study examines the relationship between age, cognitive reserve (CR), and driving-related cognitive abilities in a sample of oldest old drivers undergoing evaluation of fitness to drive. Structural equation modeling was used to investigate the associations between age, CR, and performances to a standardized set of cognitive tests assessing fitness to drive. Education and work complexity were used as proxy measures of CR. The results showed both measures of CR, but not age, were significantly associated with higher general intelligence. Education also predicted higher decision speed, and decision speed partly mediated the effect of education on general intelligence. These findings suggest that over age of 80 years old, CR was a better predictor of driving-related cognitive abilities than age. Education was associated with better performance across different cognitive domains including processing speed.

Prevalence and determinants of driving habits in the oldest old: Results of the multicenter prospective AgeCoDe-AgeQualiDe study

AIM

To present data on the prevalence of driving habits and to identify the determinants of driving habits among the oldest old in Germany.

METHODS

Cross-sectional data were used from the "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe), including primary care patients aged 85 years and above (n = 549 at FU 9, mean age was 90.3 years; 86-101 years). Driving habits were measured (driving a car; frequency of driving a car and driving duration). Correlates were quantified using widely established scales (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale). Multiple regression models were used to identify the determinants of driving habits.

RESULTS

Sixteen percent (87 out of 549) drove a car. Among the car-drivers, about 80% drove at least several times a week and about two-thirds drove longer distances (>15 min). Multiple logistic regressions showed that among the oldest old being a male was more likely to be a current driver compared to being a female. Other significant factors were subjective memory impairment, severe visual impairment, functional and cognitive impairment. Correlates of frequency of driving a car and driving duration were further identified.

CONCLUSION

About one in six very old Germans is still a regular car driver. Several determinants of driving habits among the oldest old were identified. Future longitudinal studies are required to clarify the factors leading to changes in driving habits.

EEG-Based Neurocognitive Metrics May Predict Simulated and On-Road Driving Performance in Older Drivers

The number of older drivers is steadily increasing, and advancing age is associated with a high rate of automobile crashes and fatalities. This can be attributed to a combination of factors including decline in sensory, motor, and cognitive functions due to natural aging or neurodegenerative diseases such as HIV-Associated Neurocognitive Disorder (HAND). Current clinical assessment methods only modestly predict impaired driving. Thus, there is a need for inexpensive and scalable tools to predict on-road driving performance. In this study EEG was acquired from 39 HIV+ patients and 63 healthy participants (HP) during: 3-Choice-Vigilance Task (3CVT), a 30-min driving simulator session, and a 12-mile on-road driving evaluation. Based on driving performance, a designation of Good/Poor (simulator) and Safe/Unsafe (on-road drive) was assigned to each participant. Event-related potentials (ERPs) obtained during 3CVT showed increased amplitude of the P200 component was associated with bad driving performance both during the on-road and simulated drive. This P200 effect was consistent across the HP and HIV+ groups, particularly over the left frontal-central region. Decreased amplitude of the late positive potential (LPP) during 3CVT, particularly over the left frontal regions, was associated with bad driving performance in the simulator. These EEG ERP metrics were shown to be associated with driving performance across participants independent of HIV status. During the on-road evaluation, Unsafe drivers exhibited higher EEG alpha power compared to Safe drivers. The results of this study are 2-fold. First, they demonstrate that high-quality EEG can be inexpensively and easily acquired during simulated and on-road driving assessments. Secondly, EEG metrics acquired during a sustained attention task (3CVT) are associated with driving performance, and these metrics could potentially be used to assess whether an individual has the cognitive skills necessary for safe driving.

Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

BACKGROUND

Driving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility.

METHODS

Patients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated.

RESULTS

Respectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use.

CONCLUSIONS

Adherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.

The effects of age on crash risk associated with driver distraction

Background

Driver distraction is a major contributing factor to crashes, which are the leading cause of death for the US population under 35 years of age. The prevalence of secondary-task engagement and its impacts on distraction and crashes may vary substantially by driver age.

Methods

Driving performance and behaviour data were collected continuously using multiple cameras and sensors in situ for 3542 participant drivers recruited for up to 3 years for the Second Strategic Highway Research Program Naturalistic Driving Study. Secondary-task engagement at the onset of crashes and during normal driving segments was identified from videos. A case-cohort approach was used to estimate the crash odds ratios associated with, and the prevalence of, secondary tasks for four age groups: 16-20, 21-29, 30-64 and 65-98 years of age. Only severe crashes (property damage and higher severity) were included in the analysis.

Results

Secondary-task-induced distraction posed a consistently higher threat for drivers younger than 30 and above 65 when compared with middle-aged drivers, although senior drivers engaged in secondary tasks much less frequently than their younger counterparts. Secondary tasks with high visual-manual demand (e.g. visual-manual tasks performed on cell phones) affected drivers of all ages. Certain secondary tasks, such as operation of in-vehicle devices and talking/singing, increased the risk for only certain age groups.

Conclusions

Teenaged, young adult drivers and senior drivers are more adversely impacted by secondary-task engagement than middle-aged drivers. Visual-manual distractions impact drivers of all ages, whereas cognitive distraction may have a larger impact on young drivers.

Challenges for Older Drivers in Urban, Suburban, and Rural Settings

Along with age-related factors, geographical settings—urban, suburban, and rural areas—also contribute to the differences in fatal crashes among older drivers. These differences in crash outcomes might be attributed to the various driving challenges faced by older drivers residing in different locations. To understand these challenges from the perspective of the older driver, a focus group study was conducted with drivers 65 and older from urban, suburban, and rural settings. Guided-group interviews were used to assess driving challenges, mobility options, opportunities for driver support systems (DSS), and alternate transportation needs. Content analysis of the interview responses resulted in four categories representing common challenges faced by older drivers across the settings: behavior of other drivers on the road, placement of road signs, reduced visibility of road signs due to age-related decline, and difficulties using in-vehicle technologies. Six categories involved location-specific challenges such as heavy traffic situations for urban and suburban drivers, and multi-destination trips for rural drivers. Countermeasures implemented by older drivers to address these challenges primarily involved route selection and avoidance. Technological advances of DSS systems provide a unique opportunity to support the information needs for route selection and avoidance preferences of drivers. Using the content analysis results, a framework was built to determine additional and modified DSS features to meet the specific challenges of older drivers in urban, suburban, and rural settings. These findings suggest that there is heterogeneity in the driving challenges and preferences of older drivers based on their location. Consequently, DSS technologies and vehicle automation need to be tailored to not only meet the driving safety and mobility needs of older drivers as a population, but also to their driving environment.

Driving simulator scenarios and measures to faithfully evaluate risky driving behavior: A comparative study of different driver age groups

To investigate the links between mental workload, age and risky driving, a cross-sectional study was conducted on a driving simulator using several established and some novel measures of driving ability and scenarios of varying complexity. A sample of 115 drivers was divided into three age and experience groups: young inexperienced (18-21 years old), adult experienced (25-55 years old) and older adult (70-86 years old). Participants were tested on three different scenarios varying in mental workload from low to high. Additionally, to gain a better understanding of individuals' ability to capture and integrate relevant information in a highly complex visual environment, the participants' perceptual-cognitive capacity was evaluated using 3-dimensional multiple object tracking (3D-MOT). Results indicate moderate scenario complexity as the best suited to highlight well-documented differences in driving ability between age groups and to elicit naturalistic driving behavior. Furthermore, several of the novel driving measures were shown to provide useful, non-redundant information about driving behavior, complementing more established measures. Finally, 3D-MOT was demonstrated to be an effective predictor of elevated crash risk as well as decreased naturally-adopted mean driving speed, particularly among older adults. In sum, the present experiment demonstrates that in cases of either extreme high or low task demands, drivers can become overloaded or under aroused and thus task measures may lose sensitivity. Moreover, insights from the present study should inform methodological considerations for future driving simulator research. Importantly, future research should continue to investigate the predictive utility of perceptual-cognitive tests in the domain of driving risk assessment.

Predictors of driving outcomes including both crash involvement and driving cessation in a prospective study of Japanese older drivers

The first aim of this study was to investigate predictors of future traffic crash involvement, taking into account bias in the handling of data for former drivers. The second aim was to compare characteristics of former drivers and crash-involved drivers in order to gain an understanding of appropriate driving cessation among older drivers. In all, 154 drivers aged 70 years or older participated in the baseline interview and the follow-up survey conducted two years later. In the baseline interview, participants were asked to respond to a questionnaire, take the Useful Field of View test^® (UFOV), and complete the Mini-Mental State Examination. In the follow-up survey, participants were asked by mail or telephone whether they had stopped driving. Participants reporting that they still drove were invited to participate in a subsequent interview. Based on the information obtained in the follow-up survey, participants were classified as follows: driving cessation group (n=26); crash-involved group (n=18); and crash-free group (n=110). A multinomial logistic regression was then used to analyse the data. Contrary to the results of previous studies, we found older age to be associated with crash involvement but not with driving cessation. The cessation group had more decreased cognitive processing speed than the crash-involved and crash-free groups. Crash history was also predictive of crash involvement. Participants who were subject to license renewal between baseline and follow-up had a greater tendency to continue driving. Results suggested that age and crash history could potentially identify high-risk older drivers. The predictive power of cognitive processing speed is reduced under certain conditions. License-renewal procedures may induce Japanese older adults to continue driving. Future studies should use a large national sample to confirm the results of the present study.

Association of visual sensory function and higher-order visual processing skills with incident driving cessation

BACKGROUND

Many studies on vision and driving cessation have relied on measures of sensory function, which are insensitive to the higher-order cognitive aspects of visual processing. The purpose of this study was to examine the association between traditional measures of visual sensory function and higher-order visual processing skills with incident driving cessation in a population-based sample of older drivers.

METHODS

Two thousand licensed drivers aged 70 years or older were enrolled and followed for three years. Tests for central vision and visual processing were administered at baseline and included visual acuity, contrast sensitivity, sensitivity in the driving visual field, visual processing speed (useful field of view [UFOV] Subtest 2 and Trails B) and spatial ability measured by the Visual Closure Subtest of the Motor-free Visual Perception Test. Participants self-reported the month and year of driving cessation and provided a reason for cessation. Cox proportional hazards models were used to generate crude and adjusted hazard ratios with 95% confidence intervals between visual functioning characteristics and risk of driving cessation over a three-year period.

RESULTS

During the study period, 164 participants stopped driving, which corresponds to a cumulative incidence of 8.5 per cent. Impaired contrast sensitivity, visual fields, visual processing speed (UFOV and Trails B) and spatial ability were significant risk factors for subsequent driving cessation after adjusting for age, gender, marital status, number of medical conditions and miles driven. Visual acuity impairment was not associated with driving cessation. Medical problems (63 per cent), specifically musculoskeletal and neurological problems, as well as visual problems (17 per cent) were cited most frequently as the reason for driving cessation.

CONCLUSION

Assessment of cognitive and visual functioning can provide useful information about subsequent risk of driving cessation among older drivers. In addition, a variety of factors, not just vision, influenced the decision to stop driving and may be amenable to intervention.

Automobile driving in older adults: factors affecting driving restriction in men and women

OBJECTIVES

To identify factors associated with driving restriction in elderly men and women.

DESIGN

Prospective cohort study of French drivers from 2003 to 2009.

SETTING

The Three-City Cohort of Bordeaux, a prospective study of 2,104 people aged 65 and older.

PARTICIPANTS

Five hundred twenty-three drivers with a mean age of 76 (273 male, 250 female).

MEASUREMENTS

Sociodemographic characteristics, driving habits, health variables, cognitive evaluation and dementia diagnosis. Predementia was defined as no dementia at one follow-up and dementia at the next follow-up.

RESULTS

Over the 6-year period, 54% of men and 63% of women stopped driving or reduced the distance they drove. Predementia, Parkinson's disease, older age, and a high number of kilometers previously driven were common restriction factors in both sexes. Prevalent dementia, depressive symptomatology, a decline in one or more instrumental activities of daily living, and poor visual working memory were specific factors in men. In women, low income, fear of falling, slow processing speed, and severe decline in global cognitive performance all affected driving restriction.

CONCLUSION

Older women restricted their driving activity more than older men, regardless of the number of kilometers previously driven, physical health, and cognitive status. Factors affecting driving restriction differed according to sex, and women were more likely to stop driving than men in the period preceding a dementia diagnosis.

Stages of driving behavior change within the Transtheoretical Model (TM)

INTRODUCTION

Many older adults voluntarily restrict their driving or stop driving of their own accord. Driving behavior change may occur in stages, as predicted by the Transtheoretical Model of Behavior Change (TM).

METHOD

This study explored the process of older driver behavior change within the TM framework using interviews/focus groups with drivers and former drivers aged 71-94 years. Within those groups of drivers, driving behavior was divided into two classes: those who changed their driving with age and those who did not. Those who changed their driving as they aged included people gradually imposing restrictions ("gradual restrictors") and those making plans in anticipation of stopping driving ("preparers"). Participants who did not change their driving included those who employed lifelong driving restrictions ("consistent") and those who made no changes ("non-changers").

RESULTS

Preliminary support for TM within the driving context was found; however, further exploration of driving behavior change within this framework is warranted.

PRACTICAL APPLICATIONS

It is important to continue to investigate the factors that might influence driving behavior in older adults. By promoting self-regulation in individuals, it may be possible to help older adults continue to drive, thereby improving older adult's mobility and quality of life.

The Impact of Health Problems on Driving Status among Older Adults

OBJECTIVE

This study assesses the impact of health problems on driving status (current driver vs. ex-driver) among older adults to identify which of those health problems have the greatest individual and population impact on driving cessation.

METHODS

Data were from baseline and 5 year follow-up waves of a longitudinal survey of adults age 55 years and older (N=1,279). The impact of several health problems on driving status was assessed using a relative risk ratio and a population attributable risk percent. Analyses controlled for age, gender, and the presence of additional baseline health problems.

RESULTS

Many health conditions were not associated with driving cessation. Functional limitations, cognitive function, and measures of vision were significant predictors of driving cessation. Self-care functional limitations were associated with the highest risk for driving cessation, while visual function was associated with the highest attributable risks.

DISCUSSION

In order to effectively address healthy aging and mobility transitions, it is important to consider the implications of targeting individuals or populations who are most at risk for driving cessation. The risk ratio is relevant for evaluating individuals; the attributable risk is relevant for developing interventions in populations.

Driving Cessation Anno 2010

This study focuses on the decision to either stop or continue driving among a cohort of Danish seniors whose driving licenses expire, for the first time, at the age of 70. Based on 1,537 standardized telephone interviews with licensed drivers, we compared persons who intended to renew or not to renew their licenses. The results partly recapture the findings of earlier studies. However, in contrast to former cohorts, a much higher percentage of older drivers intended to keep their licenses. The strongest factors predicting the intention to renew were active car use, feeling safe as a driver, and not having illnesses that impaired driving ability. Three of these factors were strongly correlated with gender, indicating that efforts to prevent premature driving cessation should especially focus on increasing women’s confidence and experience in driving.

Biopsychosocial Risk Factors for Driving Cessation

Objective: This study aims to identify social, psychological, and biomedical risk factors for current and future driving cessation in older adults. Method: Data from six waves (1998-2008) of the Health and Retirement Study (HRS) were pooled. Participants aged 65 and above were included in the study ( N = 17,349). Results: Multivariate logistic regression models to identify risk factors for current and future driving cessation were consistent (age, gender, education, race, marital status, income, cognitive function, limits in activities of daily living and instrumental activities of daily living, vision, health, diabetes, stroke, arthritis, and hip fracture). Only one variable, falls, was associated with future driving cessation (odds ratio [OR] = 0.92; confidence interval [CI] = [0.85, 1.0]), but not current driving cessation. Discussion: Older age, female gender, and minority race were risk factors for current and future cessation. Adults with arthritis were more likely to keep driving compared with those without arthritis.

Antecedents of self-regulation in driving among older drivers

Maintaining quality of life and wellbeing into advanced age is a major challenge to societies. Driving is one factor contributing to an ageing individual's independence. Understanding antecedents of driving-related self-regulation is important for designing interventions to preserve safe driving in old age. This paper reports on a study that investigated factors associated with two forms of self-regulation in driving (SRD) – avoidance of difficult driving conditions and voluntary cessation of driving – in a sample of 860 Israeli drivers aged 70 and over. We examined roles of health, vision, driving experience, driving-related self-efficacy (DRSE) and global self-esteem in SRD. Health and DRSE had direct effects on SRD, and effects of vision and driving experience were mediated by DRSE. Participants who had ceased driving were older, with poorer vision and health, and less driving confidence and experience than active drivers. Statistical analyses demonstrated that SRD is affected by a reduced sense of confidence due to an initial lower level of driving experience, compounded by deteriorating vision, and that older drivers are sensitive to factors affecting their ability to drive safely. Our results demonstrate that older drivers tend to self-regulate their driving. Programmes for older adults can be introduced for diagnosing driving capabilities, improving skills and confidence, and/or helping to develop self-regulation habits of avoiding driving in difficult conditions, and assisting drivers who must adjust to driving cessation.

The driving competence of 90-year-old drivers: from a hospital-based driving clinic

OBJECTIVES

To compare the performance on a standardized driving evaluation of a group of oldest old adults (age 90-97) against younger old adults (age 80-87) and examine whether the same cognitive variables and brake reaction time performance were associated with pass-fail status on a road test in both groups. Secondary objectives focused on an examination of the specific driving errors of both groups.

METHODS

This retrospective cohort study was conducted in the setting of a clinical driving evaluation program at an academic medical center in the United States. In this study we examined the performance of 88 participants (27 age 90-97 and 61 age 80-87) who completed comprehensive driving evaluations between 1997 and 2011. The outcome variable was performance on a standardized road test. Measures included the Trail Making Test (TMT), the Mini Mental State Examination (MMSE), and brake reaction time (BRT). An exploratory analysis of the possible predictive value of specific MMSE subtests was also performed.

RESULTS

Results indicate that the oldest old adults (90-97 years old) were at no greater driving risk than were a younger old (80-87 years old) cohort and made similar types and frequency of driving errors. TMT-B time was associated with pass-fail status in both groups. MMSE attention items discriminated between safe and unsafe younger old drivers, and MMSE orientation items were associated with pass-fail status in the oldest old cohort.

CONCLUSION

Drivers age 90 and above were at no greater driving risk than those one decade younger. MMSE orientation questions may be useful to assist in identifying which oldest old drivers could benefit from a comprehensive driving evaluation including an on-road test.

Examining the aging process through the stress-coping framework: application to driving cessation in later life

The aging process is marked by a series of transitions that influence multiple domains of well-being. One important transition for older adults is the process of driving cessation. Numerous studies have examined risk factors for driving cessation among older adults to identify at-risk older drivers for road safety. Recent research has focused on the consequences of driving cessation in later life for health and well-being. However, these reports have been largely empirical and are not drawn from a defined conceptual framework. Establishing a theoretical model of 'how driving cessation interacts with other processes and domains of aging' will promote synthesis of seemingly disparate findings and also link the empirical research on cessation to the broader field of gerontology. This article describes a conceptual model for articulating and examining the components of the driving cessation process based on the stress-coping paradigm. This model situates driving cessation within the context of exogenous stressors, individual vulnerabilities and coping strategies, and environmental hazards and buffers over the lifespan. This model could assist in guiding intervention strategies aimed at reducing premature driving cessation in older drivers with ameliorable impairments while assisting at-risk older drivers to reduce or stop driving in a less stressful way.

Multiple imputation was an efficient method for harmonizing the Mini-Mental State Examination with missing item-level data

OBJECTIVE

The Mini-Mental State Examination (MMSE) is used to estimate current cognitive status and as a screen for possible dementia. Missing item-level data are commonly reported. Attention to missing data is particularly important. However, there are concerns that common procedures for dealing with missing data, for example, listwise deletion and mean item substitution, are inadequate.

STUDY DESIGN AND SETTING

We used multiple imputation (MI) to estimate missing MMSE data in 17,303 participants who were drawn from the Dynamic Analyses to Optimize Aging project, a harmonization project of nine Australian longitudinal studies of aging.

RESULTS

Our results indicated differences in mean MMSE scores between those participants with and without missing data, a pattern consistent over age and gender levels. MI inflated MMSE scores, but differences between those imputed and those without missing data still existed. A simulation model supported the efficacy of MI to estimate missing item level, although serious decrements in estimation occurred when 50% or more of item-level data were missing, particularly for the oldest participants.

CONCLUSIONS

Our adaptation of MI to obtain a probable estimate for missing MMSE item level data provides a suitable method when the proportion of missing item-level data is not excessive.

Mandatory testing of drivers on the basis of age and degenerative diseases: stakeholder opinions

Concerns about the driving competence of older drivers have led to policy discussions about mandatory aged-based and disorder-based assessments. This study explored the attitudes, beliefs, and preferences of older adults, law enforcement officers, and licensing authorities toward reexamination of driving skills for persons with Alzheimer's disease (AD) and Parkinson's disease (PD) and at varying ages. With few exceptions, participants across all groups supported retesting drivers with AD. Moderate support was given for further evaluation of 90-year-olds and those with PD. Least endorsement was given for reassessment of 70-year-old drivers. Findings have implications for legislative changes to address drivers with AD and PD and at older ages.

Holding On and Letting Go: The Perspectives of Pre-seniors and Seniors on Driving Self-Regulation in Later Life

Although decisions related to driving are vital to well-being in later life, little is known about how aging drivers who do not experience a medical condition that requires driving cessation regulate their driving. This exploratory, qualitative study used focus groups with 79 such community-dwelling individuals to examine driving self-regulation from the perspective of pre-senior (aged 55–64) drivers, senior (aged 65 years or over) drivers, and senior ex-drivers. Themes resulting from inductive analysis addressed the importance of driving, mechanisms of self-monitoring and self-regulation, people who influenced decision making, and opinions regarding licensing regulations. A preliminary model of the process of self-regulation that highlights intrapersonal, interpersonal, and environmental influences on why, how, and when aging drivers adapt or cease driving is presented. The model identifies areas for future research to enhance understanding of this process, including the effectiveness of self-regulation. Findings suggest that increased public awareness of issues related to driving and aging could assist aging drivers, their families, and their family physicians in optimizing driving safety for this population. Since a near accident or accident was seen as the only factor that would lead many informants to stop driving and few informants planned for driving cessation, there is a need for interventions that help aging drivers make the transition to ex-driver in a timely and personally acceptable way.

Comparative optimism among drivers: an intergenerational portrait

We describe a large cross-sectional study examining comparative optimism (CO) regarding the risk of car crash in three age cohorts (17-26, 27-64, 65 and older). The participants completed a questionnaire in which they were asked to indicate their personal risk of being in an at-fault crash over nine driving related events in comparison to young drivers, mid-aged drivers, and older drivers. The results indicated that all three age groups exhibited CO, but that the level varied according to the age group on which they had to base their comparative judgment. Interestingly, greater CO was constantly observed when the three age groups compared themselves to older drivers. Also, young males exhibited greater CO than female of the same age group.

Ten years down the road: predictors of driving cessation

PURPOSE

Recent prospective studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults. However, these studies have been limited to 5 years of follow-up. The current study used data from the Maryland Older Drivers Project to examine predictors of driving cessation in older adults over a 10-year period.

DESIGN AND METHODS

Participants (N = 1,248) completed baseline and 5-year assessments of physical and cognitive abilities. Driving status was ascertained at baseline and annually thereafter.

RESULTS

Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic, physical, and cognitive predictors. The final model indicated three significant predictors of driving cessation, older age at baseline (hazard ratio [HR] = 1.12, p < .001), days driven per week (HR = 0.83, p = .05), and slower speed of processing as measured by the Useful Field of View Test (HR = 1.76, p < .01).

IMPLICATIONS

These results underscore the importance of cognitive speed of processing to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation. Further research is needed to determine the costs and potential benefits of such screening.

The longitudinal impact of cognitive speed of processing training on driving mobility

PURPOSE

To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers.

DESIGN AND METHODS

Older drivers with poor Useful Field of View (UFOV) test performance (indicating greater risk for subsequent at-fault crashes and mobility declines) were randomly assigned to either a speed of processing training or a social and computer contact control group. Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test (reference group) across a 3-year period.

RESULTS

Older drivers with poor UFOV test scores who did not receive training experienced greater mobility declines as evidenced by decreased driving exposure and space and increased driving difficulty at 3 years. Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure, space, and most aspects of driving difficulty.

IMPLICATIONS

Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers. Scientifically proven cognitive training regimens have the potential to enhance the everyday lives of older adults.

Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years

PURPOSE

The purpose of this study was to prospectively examine the role of cognitive and instrumental functional performance in driving cessation while simultaneously accounting for any contributions of demographics, vision, physical performance, and health among a sample of older adults without dementia.

DESIGN AND METHODS

Included in the analyses were 1,838 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were drivers at baseline and completed the third-year assessment. Participants completed baseline assessments of sociodemographic characteristics, health, sensory function, physical function, cognitive abilities, instrumental functional performance, and depressive symptoms. Driving status was again ascertained 3 years later.

RESULTS

We used Cox proportional hazard analyses to examine prospective predictors of driving cessation over a 3-year period. The final model indicated four significant risk factors for driving cessation: older age (hazard ratio [HR] = 1.06, p = .009), poorer balance as measured by the Turn 360 degrees test (HR = 1.17, p = .002), slower cognitive speed of processing as measured by the Useful Field of View test (HR = 1.37, p = .004), and poorer instrumental functional performance as assessed by the Everyday Problems Test (HR = 1.59, p < .001).

IMPLICATIONS

Although vision, health, and physical abilities are commonly considered when determining driving capacity, cognitive speed of processing and instrumental functional performance may be better indicators of subsequent likelihood of driving cessation across 3 years among older adults. Poor health and vision may only impact driving cessation to the extent that cognitive speed of processing and instrumental functioning are affected.

Health conditions, health symptoms and driving difficulties in older adults

OBJECTIVES

Previous research has indicated that age-related medical or health conditions can affect driving performance in older adults but little, if any, research has examined the mechanisms through which health conditions affect driving difficulties in older adults.

DESIGN

Cross-sectional, correlational study.

SETTING

Random sample from the community. We examined the nature of the relations among health conditions, health-related symptoms, physical fitness levels and specific types of self-reported driving difficulties in a random sample of older adults.

PARTICIPANTS

Three hundred eighteen adults 60 years of age or older.

INTERVENTION

None.

MEASUREMENTS

General health, health-related symptoms, driving-related difficulties and physical activity.

RESULTS

Our findings support the position that health-related symptoms are more clearly associated with driving difficulties than are health conditions, and mediate the relations between health conditions and driving difficulties. Health-related symptoms involving the spine and lower body appeared to be particularly relevant to difficulties with driving experienced in those body areas (i.e. spine and lower body).

CONCLUSION

These findings are encouraging, in that the most frequently reported symptoms are in areas highly amenable to modification and, in that most of our respondents indicated a willingness to engage in exercise if an association between fitness and driving was demonstrated.

Predictors of driving exposure and avoidance in a field study of older drivers from the state of Maryland

Using structural equation modeling techniques, this study examines causal models of driving avoidance and exposure among older adults. Prior studies have revealed that past incidence of falls, Useful Field of View (UFOV) test performance, and Trails Making test performance are predictive of subsequent motor vehicle crash involvement [Owsley, C., Ball, K., McGwin Jr., G., Sloane, M.E., Roenker, D.L., White, M.F., Overley, E.T., 1998. Visual processing impairment and risk of motor vehicle crash among older adults. J. Am. Med. Assoc. 279 (14), 1083-1088; Sims, R.V., McGwin, G., Pulley, L., Roseman, J.M., 2001. Mobility impairments in crash-involved older drivers. J. Aging Health 13 (3), 430-438; Stutts, J.C., 1998. Do older drivers with visual nd cognitive impairments drive less? J. Am. Geriatr. Soc. 46, 854-861]. Data analyses used these indices, along with age, health, measures of physical functioning, and additional measures of cognitive functioning, to examine driving exposure and avoidance behaviors. A field sample of 4,234 drivers, 55 years of age and older, were recruited from the Maryland Motor Vehicles Administration after renewing their driver's licenses. A performance-based assessment, which included the Gross Impairment Screening battery and task 2 of the UFOV test, was completed by participants. A sub-sample of participants (n=815) were interviewed by telephone about their health and mobility 3-6 months following the initial assessment at a renewal center. In addition to age and gender, latent variables for health status, physical functioning, cognitive functioning, driving exposure, and driving avoidance were created. Direct and indirect causal paths were specified. Age, gender, health status, and cognitive functioning had direct effects on both driving exposure and driving avoidance; physical functioning did not have a direct effect on driving exposure or avoidance. The implications of these findings are discussed as they relate to designing interventions to promote mobility.

Predicting driving cessation over 5 years in older adults: psychological well-being and cognitive competence are stronger predictors than physical health

OBJECTIVES

To examine psychological, medical, and sensorimotor risk factors that predict driving cessation in older adults.

DESIGN

Prospective cohort study including five waves of data collected in 1992, 1993, 1994, 1995, and 1997.

SETTING

The Australian Longitudinal Study of Aging.

PARTICIPANTS

One thousand four hundred sixty-six men and women aged 70 and older drawn from the electoral roll and including 753 drivers at baseline.

MEASUREMENTS

Interviews, including assessments of self-rated health (indicating general well-being); medical conditions; driving status; and clinical assessments of vision, hearing, cognitive function, and grip strength, were conducted in 1992 (baseline) and 1994. Information on current driving status was obtained at baseline and four subsequent waves (1993, 1994, 1995, and 1997). Drivers and nondrivers were compared at baseline. Risk factors for driving cessation were identified using logistic regression.

RESULTS

Drivers were younger and more likely to be male and had better self-rated health, vision, hearing, and cognitive performance than nondrivers at baseline. Seventeen percent of drivers in the study had vision of 6/18 or worse, and 7.3% were classified as possibly cognitively impaired. In those identified as drivers at baseline, subsequent cessation was associated with increasing age, low grip strength, poorer cognitive performance, and poorer self-rated health.

CONCLUSION

Self-rated health and cognitive function were more important than medical conditions or sensory function for predicting driving cessation.

Road traffic injuries in the elderly

OBJECTIVE

Elderly victims of motor vehicle collisions are increasing with the aging population. This study aimed to investigate the injury pattern of elderly victims involved in motor vehicle collisions.

METHODS

This was a retrospective study using data from the Victorian State Trauma Outcome Registry and Monitoring Group (VSTORM) from June 2001 to July 2003, Australian Bureau of Statistics year 2001 population estimates, and Victoria Transport Accident Commission year 2001 total road death toll. Elderly victims were defined as age 65 and above. Comparison of fatality rates and general injury patterns for the elderly and young victims was undertaken.

RESULTS

The total fatality rate of the elderly group was almost double that of the younger group. The elderly victims had a higher rate of chest injuries (23.42% v 18.17%; p = 0.003). The three most common chest injuries of the elderly victims were rib fractures (23.58%), flail chest (9.55%), and sternum fractures (5.97%). Elderly chest injured patients also had longer intensive care unit stay compared with the younger group (7.96 days v 5.31 days; p = 0.048).

CONCLUSIONS

Elderly victims of motor vehicle collisions have a higher risk of chest injuries, especially of chest wall injuries. Age specific injury patterns are important in determining primary and secondary prevention strategies.

Coping with daily living: housing, finances, transportation, medical care

Elderly adults with cognitive impairment may face considerable hurdles in navigating through the tasks of daily living. These difficulties may result from such factors as diminished organizational skills, reduced physical mobility, reduced financial resources, perceptual lapses, and reduced attention, among others. The individuals may find it particularly problematic to identify and maintain suitable housing to manage finances, to manage their transportation and/or utilize public transit. Individuals are also vulnerable to various forms of abuse and neglect due to their impairment. We present various cases to illustrate such situations and suggest strategies to ameliorate these difficulties.

La conduite automobile chez les sujets âgés

Impairment of cognitive performance is associated with an excess risk of accidents. Adaptation of driving behavior in subjects with benign cognitive disorders reduces risk of automobile accidents. Cessation of driving or at least not driving alone limits the excess accident risk for drivers with dementia. Alterations in visual field and acuity increase risk of traffic accidents. Drugs affecting vigilance and neurological, cardiovascular and osteoarticular disorders increase accident risk. Screening for these disorders in the elderly is a necessary public safety measure.

Requerimiento auditivo en licencias de conducción de vehículos del Grupo 2. Actualización conforme a la legislación vigente en España

INTRODUCTION

Hearing loss level admitted for acquisition of Group 2 driving licences is actually 35%, but this measurement is not standarized.

METHODS

In 35 drivers with Group 2 licence bearing of hearing loss, it was measured in the usual way -considering threshold as an average-, and also in accordance with valid legislation, which considers deafness when hearing thresholds are under 25 dB in each tone.

RESULTS

Binaural hearing loss average was 41.3+/-6.3% for the first model, and 30.7+/-10.2% for the second. There was a good correlation between the two models by mean of lineal regression (y=1.4785x-30.382; R2=0.8467).

CONCLUSIONS

In Group 2 licences, hearing loss average must be standarized in its quantifyng technique, because there is a wide difference in the results, depending on the model used to measure. In our country there are rules and regulations about quantifying for disable people, valid for establishing deafness measurement patterns in vehicle driving too.

Correctable visual impairment in older people: a major unmet need

This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65-75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is pound 128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in 'developed countries', between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.

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.