Driving Patterns of Older Adults: Results from the Second Injury Control and Risk Survey

OBJECTIVES: To describe older adults' driving patterns, including self‐imposed driving restrictions and motor vehicle crashes (MVCs). DESIGN: The Second Injury Control and Risk Survey (ICARIS‐2) was a national, random‐digit‐dial telephone survey conducted by the Centers for Disease Control and Prevention in 2001 to 2003. ICARIS‐2 sampled 113,476 English‐ and Spanish‐speaking households, using weighting variables to generate national estimates. RESULTS: The response rate was 48% (N=9,684). Six percent (n=728) of respondents were aged 75 and older. Of these, 85.6% (n=613) were aged 75 to 84, and 14.4% (n=115) were aged 85 and older; 59.2% were female. Three‐fourths (74.9%, 95% confidence interval (CI)=70.4–79.4%) of adults aged 75 to 84 and 69.9% (95% CI=48.2–71.6%) aged 85 and older were current drivers. Most (81.9%; 95% CI=77.6–86.2%) older drivers limited their driving, usually in bad weather (59.0%), at night (57.0%), on long trips (49.6%), in traffic (49.0%), or at high speeds (33.6%); only 15.4% limited driving for medical reasons. Women were more likely to self‐limit driving (odds ratio (OR)=1.83, 95% CI=0.99–3.39). Few (4.2%, 95% CI=2.4–6.1%) older adults reported MVC involvement in the past year as a driver or passenger. In multivariate analysis, drivers living alone (OR=3.93, 95% CI=1.55–9.95) and men (OR=2.59, 95% CI=1.18–5.67) were more likely to report a recent crash; drivers who self‐limited were less likely (OR=0.55, 95% CI=0.18–1.60). CONCLUSION: Large majorities of older adults, including those aged 85 and older, are current drivers. Although many limit driving in hazardous conditions, fewer do for medical reasons. Men and older adults who live alone are more likely to report a recent MVC; those who self‐limit their driving are less likely to report crash involvement.     

The 4Cs (Crash History,Family Concerns,Clinical Condition,and Cognitive Functions): A Screening Tool for the Evaluation of the At‐Risk Driver

OBJECTIVES: To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview‐based screening tool for health providers working with older drivers) in identifying at‐risk older drivers. DESIGN: Retrospective cohort study. SETTING: Clinical driving evaluation program at a teaching hospital in the United States. PARTICIPANTS: One hundred sixty patients who completed comprehensive driving evaluations between 2003 and 2009. MEASUREMENTS: Medical record information was used to identify component and total 4Cs scores. Other measurements included the Trail Making Test, the Mini‐Mental State Examination, and brake reaction time. The outcome variable was performance on a 45‐minute road test. RESULTS: Fifty participants passed the road test, 67 failed, and 43 demonstrated marginal driving skills. The relationship between 4Cs scores and road test outcome was statistically significant (P<.001). The domains most strongly associated with road test outcome were cognitive function (P<.001) and family concerns (P=.01). Scores of 9 or greater‐on the 4Cs identified 84% of participants who were at risk for poor road test performance. CONCLUSION: The 4Cs, an interview based screening tool, may be a useful marker to identify at‐risk older drivers.     

Experiencing simulated aging improves knowledge of and attitudes toward aging

Nursing assistants provide 90% of the functional and psychosocial care of older adults in nursing homes. Without knowledge of the normal physical changes of aging, it would be difficult to provide them with appropriate quality care. This quasi-experimental study aimed to test the effects of the Elderly Simulation Program on nursing assistants' knowledge about aging, attitudes toward older adults, and the motivation to care for older adults in nursing homes. The program has two parts: a 1-hour lecture about aging changes and a 1-hour simulation of the roles of an older adult, a caregiver, and a "rusher" (20 minutes for each role). A convenience sample of 83 full-time nursing assistants was recruited from nursing homes in Taiwan. The participants were assigned to an experimental (n = 43) or a control group (n = 40). The experimental group received the Elderly Simulation Program intervention, whereas the control group did not participate in any educational programs. Data were collected before the intervention and 4 wk after the program was completed. Results indicated that 4 wk after the intervention, the experimental group participants' knowledge about aging and attitudes toward older adults had significantly improved (all P < .001). The experimental group participants also had greater knowledge of aging than the control group at posttest (P < .001). It is recommended that the program be incorporated into the regular on-the-job continuing education of nursing assistants in long-term care facilities to enhance their knowledge about aging and their attitudes towards older adults.     

Interventions to reduce the adverse psychosocial impact of driving cessation on older adults

As a result of our aging population, the coming years will see increasing numbers of older adults faced with the prospect of giving up driving due to poor health or functional limitations. Driving cessation has been associated with negative psychosocial outcomes for older adults including restricted mobility and depression. While several studies report evaluations of interventions designed to help older adults to drive safely for longer, there is a paucity of published research concerned with the design or implementation of intervention programs intended to reduce the negative consequences of driving cessation. This paper reviews cognitive and educational interventions designed to promote older driver safety, and discusses possible approaches to the design and implementation of clinical interventions for older adults who have ceased driving. A broad framework for adaptable interventions based on the theoretical tenets of social cognitive theory, with an emphasis on planning for cessation, problem-solving and the involvement of friends and family members is proposed.     

The On-Road Difficulties of Older Drivers and Their Relationship with Self-Reported Motor Vehicle Crashes

OBJECTIVES: To quantify the driving difficulties of older adults using a detailed assessment of driving performance and to link this with self-reported retrospective and prospective crashes.
DESIGN: Prospective cohort study.
SETTING: On-road driving assessment.
PARTICIPANTS: Two hundred sixty-seven community-living adults aged 70 to 88 randomly recruited through the electoral roll.
MEASUREMENTS: Performance on a standardized measure of driving performance.
RESULTS: Lane positioning, approach, and blind spot monitoring were the most common error types, and errors occurred most frequently in situations involving merging and maneuvering. Drivers reporting more retrospective or prospective crashes made significantly more driving errors. Driver instructor interventions during self-navigation (where the instructor had to brake or take control of the steering to avoid an accident) were significantly associated with higher retrospective and prospective crashes; every instructor intervention almost doubled prospective crash risk.
CONCLUSION: These findings suggest that on-road driving assessment provides useful information on older driver difficulties, with the self-directed component providing the most valuable information.