A randomized trial to evaluate the effectiveness of an individual, education-based safe transport program for drivers aged 75 years and older

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

CLINICAL RELEVANCE

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sex differences evident in self-reported but not objective measures of driving

It has been consistently reported that women self-regulate their driving more than men. Volunteer drivers aged 75 years and older from the suburban outskirts of Sydney, Australia joined a longitudinal study in 2012-2014. GPS in-vehicle monitoring was used to objectively measure driving and surveys of driving patterns. The study included 343 drivers (203/343, 59% men) with an average age of 80 years. Our results revealed that men were 3.85 times more likely to report driving beyond their local shire during the past year (95% CI 2.03-5.72) and 1.81 times more likely to report that they do not avoid night driving (95% CI 1.21-3.22). In contrast sex was not predictive of any objective measure of driving during a one-week period of monitoring. These findings suggest that men and women report different self-regulation practices but that actual driving exposure is quite similar. These findings can inform strategies to promote safe mobility.

Predictors of older drivers' involvement in high-range speeding behavior

OBJECTIVE

Even small increases in vehicle speed raise crash risk and resulting injury severity. Older drivers are at increased risk of involvement in casualty crashes and injury compared to younger drivers. However, there is little objective evidence about older drivers' speeding. This study investigates the nature and predictors of high-range speeding among drivers aged 75-94 years.

METHODS

Speed per second was estimated using Global Positioning System devices installed in participants' vehicles. High-range speeding events were defined as traveling an average 10+km/h above the speed limit over 30 seconds. Descriptive analysis examined speeding events by participant characteristics and mileage driven. Regression analyses were used to examine the association between involvement in high-range speeding events and possible predictive factors.

RESULTS

Most (96%, 182/190) participants agreed to have their vehicle instrumented, and speeding events were accurately recorded for 97% (177/182) of participants. While 77% (136/177) of participants were involved in one or more high-range events, 42% (75/177) were involved in greater than five events during 12-months of data collection. Participants involved in high-range events drove approximately twice as many kilometres as those not involved. High-range events tended to be infrequent (median = 6 per 10,000 km; IQR = 2-18). The rate of high-range speeding was associated with better cognitive function and attention to the driving environment.

CONCLUSION

This suggests those older drivers with poorer cognition and visual attention may drive more cautiously, thereby reducing their high-range speeding behavior.

Predictors of older drivers' involvement in rapid deceleration events

Rapid deceleration occurs when substantial force slows the speed of a vehicle. Rapid deceleration events (RDEs) have been proposed as a surrogate safety measure. As there is concern about crash involvement of older drivers and the effect of age-related declining visual and cognitive function on driving performance, we examined the relationship between RDEs and older driver's vision, cognitive function and driving confidence, using naturalistic driving measures. Participants aged 75 to 94 years had their vehicle instrumented for 12 months. To minimise the chance of identifying false positives, accelerometer data was processed to identify RDEs with a substantial deceleration of >750 milli-g (7.35m/s²). We examined the incidence of RDEs amongst older drivers, and how this behaviour is affected by differences in age; sex; visual function, cognitive function; driving confidence; and declines over the 12 months. Almost two-thirds (64%) of participants were involved in at least one RDE, and 22% of these participants experienced a meaningful decline in contrast sensitivity during the 12 months. We conducted regression modelling to examine associations between RDEs and predictive measures adjusted for (i) duration of monitoring and (ii) distance driven. We found the rate of RDEs per distance increased with age; although, this did not remain in the multivariate model. In the multivariate model, we found older drivers who experienced a decline in contrast sensitivity over the 12 months and those with lower baseline driving confidence were at increased risk of involvement in RDEs adjusted for distance driven. In other studies, contrast sensitivity has been associated with increased crash involvement for older drivers. These findings lend support for the use of RDEs as a surrogate safety measure, and demonstrate an association between a surrogate safety measure and a decline in contrast sensitivity of older drivers.

Naturalistic rapid deceleration data: Drivers aged 75 years and older

The data presented in this article are related to the research manuscript “Predictors of older drivers’ involvement in rapid deceleration events”, which investigates potential predictors of older drivers’ involvement in rapid deceleration events including measures of vision, cognitive function and driving confidence (A. Chevalier et al., 2016) [1]. In naturalistic driving studies such as this, when sample size is not large enough to allow crashes to be used to investigate driver safety, rapid deceleration events may be used as a surrogate safety measure. Naturalistic driving data were collected for up to 52 weeks from 182 volunteer drivers aged 75–94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Accelerometer data were recorded 32 times per second and Global Positioning System (GPS) data each second. To measure rapid deceleration behavior, rapid deceleration events (RDEs) were defined as having at least one data point at or above the deceleration threshold of 750 milli-g (7.35 m/s²). All events were constrained to a maximum 5 s duration. The dataset provided with this article contains 473 events, with a row per RDE. This article also contains information about data processing, treatment and quality control. The methods and data presented here may assist with planning and analysis of future studies into rapid deceleration behaviour using in-vehicle monitoring.

A longitudinal investigation of the predictors of older drivers' speeding behaviour

There is little objective evidence about the extent older drivers' are involved in speeding or factors that may influence this behaviour. Particular concern exists for the increasing number of older drivers with poor or declining cognitive and visual function. This study investigates whether a reduction in speeding forms part of the self-restrictive driving behaviour evident when older drivers experience poor cognitive and visual function. Driving data over 12 months were collected from 182 volunteers aged 75-94years. Driving speed was estimated using Global Positioning System location, and speed limit data was based on a service-provider database. Speed events were defined as driving 1km/h or more, with 3% tolerance, above a single speed limit, averaged over 30s. Almost all participants (99%) were involved in speed events. While, 16-31% of participants experienced a meaningful decline in cognitive or visual function during the 12-months, these declines were not predictive of a change in speed events. Our results indicate speeding behaviour in this age group was highly prevalent, but less so for the oldest drivers whereby the rate of speed events was 7% lower per year older (IRR=0.93, 95%CI=0.89-0.96). Older drivers with worse function were less involved in speed events (unadjusted for distance driven) during 12 months of observation. Weekly distance driven decreased over the year by approximately 0.45km with every week of monitoring for these older drivers. When distance driven was taken into account, decreased function was not predictive of involvement in speed events, indicating the reduction in speed events may be achieved by older drivers with lower function reducing distance driven. These results are important for developing policy to address speeding behaviour of the growing population of older drivers to reduce the incidence of crashes and resulting casualties.

Seat belt repositioning and use of vehicle seat cushions is increased among older drivers aged 75 years and older with morbidities

OBJECTIVE

Good seat belt fit and positioning is important for crash protection. Older drivers experience problems in achieving good seat belt fit and often reposition seat belts and/or use seat cushions. Comfort influences these behaviours. This work examines the impact of functional morbidities on belt positioning and accessory use and whether comfort mediates this relationship METHODS: Mediation analysis was used to examine the relationship between morbidities affecting physical function, comfort, belt repositions and seat cushion use among 380 drivers aged 75 years and older.

RESULTS

Musculoskeletal morbidities increase the likelihood of seat belt repositioning (OR 1.37, 95% CI 1.12-1.67) and comfort partially mediates this relationship (P = 0.03). Morbidities of any type also increase the likelihood of seat cushion use (OR 1.15 95% CI 1.04-1.27), but comfort plays no role in this relationship (P = 0.87).

CONCLUSION

Greater awareness among older drivers is needed, to ensure behavioural modifications do not impair their crash protection.

Naturalistic speeding data: Drivers aged 75 years and older

The data presented in this article are related to the research article entitled "A longitudinal investigation of the predictors of older drivers׳ speeding behavior" (Chevalier et al., 2016) [1], wherein these speed events were used to investigate older drivers speeding behavior and the influence of cognition, vision, functional decline, and self-reported citations and crashes on speeding behavior over a year of driving. Naturalistic speeding behavior data were collected for up to 52 weeks from volunteer drivers aged 75-94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Global Positioning System (GPS) data were recorded at each second and determined driving speed through triangulation of satellite collected location data. Driving speed data were linked with mapped speed zone data based on a service-provider database. To measure speeding behavior, speed events were defined as driving 1 km/h or more, with a 3% tolerance, above a single speed limit, averaged over 30 s. The data contains a row per 124,374 speed events. This article contains information about data processing and quality control.

Behind the wheel: community consultation informs adaptation of safe-transport program for older drivers

BACKGROUND

Safe-transport is important to well-being in later life but balancing safety and independence for older drivers can be challenging. While self-regulation is a promising tool to promote road safety, more research is required to optimise programs.

METHODS

Qualitative research was used to inform the choice and adaptation of a safe-transport education program for older drivers. Three focus groups were conducted with older drivers living in northwest Sydney to explore four key areas related to driving in later life including aged-based licensing, stopping or limiting driving, barriers to driving cessation and alternative modes of transportation. Data were analysed using content analysis.

RESULTS

Four categories emerged from the data; bad press for older drivers, COMPETENCE not age, call for fairness in licensing regulations, and hanging up the keys: It's complicated! Two key issues being (1) older drivers wanted to drive for as long as possible but (2) were not prepared for driving cessation; guided the choice and adaption of the Knowledge Enhances Your Safety (KEYS) program. This program was adapted for the Australian context and focus group findings raised the need for practical solutions, including transport alternatives, to be added. Targeted messages were developed from the data using the Precaution Adoption Process Model (PAPM), allowing the education to be tailored to the individual's stage of behaviour change.

CONCLUSION

Adapting our program based on insights gained from community consultation should ensure the program is sensitive to the needs, skills and preferences of older drivers.

Seat belt use and fit among drivers aged 75 years and older in their own vehicles

OBJECTIVE

This article aims to describe seat belt wearing patterns and quality of seat belt fit among drivers aged 75 years and older. A secondary aim is to explore associations between body shape, comfort, and seat belt use patterns.

METHODS

This is an observation and survey study of a cohort of 380 drivers aged 75 years and over. During home visits, photographs were taken of the drivers in their vehicles for later analysis of belt fit and a short survey was also administered to collect demographic data and information about seat belt use and comfort. Seat belt fit and use of belt and seat accessories were analyzed from the photographs.

RESULTS

Data from 367 participants with photographs were analyzed. Whereas 97% reported using a seat belt and 90% reported their seat belt to be comfortable, 21% reported repositioning their seat belt to improve comfort. Good sash and lap belt fit were achieved in 53 and 59% of participants, respectively, but only 35% achieved overall good fit. Both poor sash and lap belt fit were observed in 23% of participants. Drivers who were in the obese category had over twice the odds (95% confidence interval [CI], 1.2-4.1) of having a poor lap belt fit than those in the normal body mass index [BMI] range, and drivers who were overweight had 1.8 times the odds (95% CI, 1.1-2.9) of having poor lap belt fit. Older females also had twice the odds (95% CI, 1.3-3.5) of poor lap belt fit compared to older males, regardless of BMI. Sash belt fit did not vary significantly by BMI, stature, or gender. However older drivers who reported that they had not made any adjustments to the D-ring height had 1.7 times the odds of having poor sash belt fit than those who made adjustments (1.2-2.9). Females were 7.3 times more likely to report comfort problems than males (95% CI, 3.2, 16.3) but there was no association between reported comfort and BMI or seat belt fit. Drivers who reported comfort problems had 6 times the odds (3.2-13.6) of also reporting active repositioning of the belt.

CONCLUSIONS

The results suggest that older drivers face challenges in achieving comfortable and correct seat belt fit. This may have a negative impact on crash protection. Belt fit problems appear to be associated with body shape, particularly high BMI and gender. There is a need for further investigation of comfort accessories; in the interim, older drivers and occupants should be encouraged to use features such as D-ring adjusters to improve sash belt fit.

DriveSafe and DriveAware Assessment Tools Are a Measure of Driving-Related Function and Predicts Self-Reported Restriction for Older Drivers

Safety concerns together with aging of the driving population has prompted research into clinic-based driving assessments. This study investigates the relationship between the DriveSafe and DriveAware assessments and restriction of driving. Community-dwelling adults aged more than 75 ( n = 380) were recruited in New South Wales, Australia. Questionnaires were administered to assess driving habits and functional assessments to assess driving-related function. Self-reported restriction was prevalent in this cross-sectional sample (62%) and was related to DriveSafe scores and personal circumstances but not DriveAware scores. DriveSafe scores were correlated with better performance on the Trail-Making Test (TMT; β = −2.94, p < .0001) and better contrast sensitivity (β = 48.70, p < .0001). Awareness was associated with better performance on the TMT (β = 0.08, p < .0001). Our data suggest that DriveSafe and DriveAware are sensitive to deficits in vision and cognition, and drivers with worse DriveSafe scores self-report restricting their driving.