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.     

Fit to Drive: A Pilot Study to Improve the Physical Fitness of Older Drivers

This pilot study aimed to explore whether maintaining a driver's license could motivate older adults to participate in a regular fitness program, and determine whether gains in fitness could result in self-perceived improvements in driving. Physical measures and questionnaires were collected from 19 participants and 5 controls. For the intervention group, men showed significant gains in one measure of endurance, while women showed gains in strength, endurance, agility, flexibility, and hand reaction time. Half of the participants felt their driving skills had improved, and 40% reported an increase in driving confidence. Controls showed some improvements in endurance and foot reaction time but no self-reported improvements in driving. This study contributes to the understanding of older adults' motivation for activity participation, and suggests that improvements in physical conditioning may have a positive impact on driver safety.     

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.     

A multidomain approach for predicting older driver safety under in-traffic road conditions

OBJECTIVES: To identify a battery of tests that predicts safe and unsafe performance on an on-road assessment of driving.
DESIGN: Prospective cohort study.
SETTING: University laboratory assessment and an on-road driving test.
PARTICIPANTS: Two hundred seventy community-living adults aged 70 to 88 recruited through the electoral roll.
MEASUREMENTS: Performance on a battery of multidisciplinary tests and on a standardized measure of on-road driving performance.
RESULTS: A combination of three tests from the vision, cognitive, and motor domains, including motion sensitivity, color choice reaction time, postural sway on a compliant foam rubber surface, and a self-reported measure of driving exposure, was able to classify participants into safe and unsafe driver groups with sensitivity of 91% and specificity of 70%.
CONCLUSION: In a sample of licensed older drivers, a short battery of tests and a self-reported measure of driving exposure were able to accurately predict driving safety.