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Older Drivers and Cataract: Driving Habits and Crash Risk
Abstract and Figures
Cataract is a leading cause of vision impairment in older adults, affecting almost half of those over age 75 years. Driving is a highly visual task and, as with other age groups, older adults rely on the personal automobile for travel. The purpose of this study was to examine the role of cataract in driving.
Older adults (aged 55-85 years) with cataract (n = 279) and those without cataract (n = 105) who were legally licensed to drive were recruited from eye clinics to participate in a driving habits interview to assess driving status, exposure, difficulty, and "space" (the distance of driving excursions from home base). Crash data over the prior 5 years were procured from state records. Visual functional tests documented the severity of vision impairment.
Compared to those without cataract, older drivers with cataract were approximately two times more likely to report reductions in days driven and number of destinations per week, driving slower than the general traffic flow, and preferring someone else to drive. Those with cataract were five times more likely to have received advice about limiting their driving. Those with cataract were four times more likely to report difficulty with challenging driving situations, and those reporting driving difficulty were two times more likely to reduce their driving exposure. Drivers with cataract were 2.5 times more likely to have a history of at-fault crash involvement in the prior 5 years (adjusted for miles driven/week and days driven/week). These associations remained even after adjustments for the confounding effects of advanced age, impaired general health, mental status deficit, or depression.
Older drivers with cataract experience a restriction in their driving mobility and a decrease in their safety on the road. These findings serve as a baseline for our ongoing study evaluating whether improvements in vision following cataract surgery expand driving mobility and improve driver safety.
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... Participants provided written informed consent and were screened to ensure that they were eligible to participate in the study. Before riding in the AS, participants completed the Demographic Questionnaire, Driving Habits Questionnaire (DHQ; Owsley et al., 1999), and the Autonomous Vehicle User Perception Survey (AVUPS; Mason et al., 2021). After completing the questionnaires, participants rode the AS route. ...
Individuals with a spinal cord injury (SCI) have challenges using transportation. Autonomous shuttles (ASs), if accessible, may support their transportation needs. This study quantified the perceptions of AS for adults with and without SCI, before and after riding in the AS. We hypothesized that the perceptions of AS for individuals with SCI would improve, by the greatest magnitude, after riding in the AS. This mixed-method quasi-experimental design included 16 adults with SCI and 16 age-matched controls. While there were no differences between the groups, both groups reported having fewer perceived barriers to using AS after riding in the AS (p = .025). After riding in the AS, both groups stated that the AS must be available, accessible, and affordable if they are to use AS. In conclusion, adults with SCI should experience AS if they are to accept and adopt this mode of transportation.
... The Driving Habits Questionnaire (DHQ) provides information on past and present driving history and habits [36]. The DHQ consists of 34 items obtaining driving information from six domains during the past year. ...
The deployment of autonomous shuttles (ASs) holds health and safety benefits for people with and without disabilities. Transportation is critical in helping people with disabilities (PWDs) access health care, services, and jobs, but the current transportation system has not afforded them ubiquitous access. To understand the acceptance of ASs, we (1) quantified PWDs’ (N = 42) perceptions before and after riding in an AS (Level 4) and (2) developed a model of facilitators and barriers from 143 participants. For Objective 1, after riding in the AS, PWDs (n = 42) expressed increased Intention to Use (p < 0.001) and Acceptance (p < 0.001), and decreased Perceived Barriers (p < 0.001), compared with baseline. For Objective 2, four multiple linear regression models were conducted to predict the outcomes for Intention to Use, Perceived Barriers, Well-being, and Acceptance among all participants (N = 143). The results indicated that optimism and ease of use negatively predicted Perceived Barriers and positively predicted Intention to Use, Well-being, and Acceptance. Driving status (i.e., active driver) negatively predicted Intention to Use, Well-being, and Acceptance. Predictors of user Acceptance included optimism, perceived ease of use, driver status, and race/ethnicity—with 30.7% of the variance in Acceptance explained. We also recommended deployment strategies to project stakeholders.
... The collection of driving-related data included information about driving history, experience and practice. Therefore, several questionnaires were utilized such as the Driving Habits Questionnaire (DHQ; Owsley et al. 1999) and the German version of the Driver Behavior Questionnaire (DBQ; Parker et al. 1995, Glaser andWaschulewski 2005) as well as questionnaires addressing compensation behavior (FKA; Wagner et al. 2017) and the comprehension of drivingrelated technical and behavioral aspects (VVT; Müller 1991). ...
Objectives: Older drivers often show less precise self-ratings with a tendency to overestimate themselves. It is
unclear, however, how overestimators differ from underestimators or drivers with adequate self-ratings.
Methods: 59 healthy older drivers participated in this on-road study. Besides standardized on-road driving
assessment, the study protocol included the collection of neuropsychological and driving-related data as well as
different self-ratings. Statistical analyses involved correlations between different subjective and objective ratings
as well as statistical comparisons between drivers who overestimated and drivers who adequately rated their onroad
driving performance (no drivers underestimated their performance).
Results: Despite positive correlations between different self- and expert ratings, our results revealed that 25 % of
the participants overestimated their on-road driving skills. Among other things, overestimators showed poorer
on-road driving performances, more prospective near and minor at-fault accidents, poorer cognitive performances
in specific driving-related domains and reduced annual mileage.
Discussion: Our results suggest that older drivers who overestimate their driving skills show poorer performances
within a broad range of skills that directly reflect or are closely related to driving safety. Against the background
that an adequate self-assessment is required by German traffic regulations, our findings suggest that overestimators
represent a risk group among the population of older drivers.
... In addition to the DRIVES, participants completed the Driving Habits Questionnaire (DHQ) [23] annually, which queries self-reported driving behavior over the previous year, yielding scores that reflect specific outcomes. To examine if there were group differences at baseline, we analyzed the following variables: the total number of trips taken, driving space (how far they travel from home), dependency on other drivers, number of unique destinations, and reported difficulty driving. ...
Background:
Cerebral small vessel disease (CSVD) as measured by cortical atrophy and white matter hyperintensities [leukoaraiosis], captured via magnetic resonance imaging (MRI) are increasing in prevalence due to the growth of the aging population and an increase in cardiovascular risk factors in the population. CSVD impacts cognitive function and mobility, but it is unclear if it affects complex, functional activities like driving.
Methods:
In a cohort of 163 cognitively normal, community-dwelling older adults (age ≥ 65), we compared naturalistic driving behavior with mild/moderate leukoaraiosis, cortical atrophy, or their combined rating in a clinical composite termed, aging-related changes to those without any, over a two-and-a-half-year period.
Results:
Older drivers with mild or moderate cortical atrophy and aging-related changes (composite) experienced a greater decrease in the number of monthly trips which was due to a decrease in the number of trips made within a one-to-five-mile diameter from their residence. Older drivers with CSVD experience a larger reduction in daily driving behaviors than drivers without CSVD, which may serve as an early neurobehavioral marker for functional decline.
Conclusions:
As CSVD markers, leukoaraiosis and cortical atrophy are standard MRI metrics that are widely available and can be used for screening individuals at higher risk for driving safety risk and decline in community mobility.
... Outcomes of interest included self-reported MVC and traffic stops, using questions from the "crashes and citations" domain of the Driving Habits Questionnaire (DHQ) (Owsley et al. 1999). Participants were asked "How many accidents have you been involved in over the past year when you were the driver?" ...
Background:
Acute cannabis use is associated with a higher risk of motor vehicle crashes (MVC). This study aimed to determine if self-reported past-year cannabis use is associated with MVC or traffic stops among older drivers.
Methods:
This cross-sectional analysis used data from a multi-center study enrolling active drivers aged 65-79 years. Data regarding cannabis use, MVC, and traffic stops (i.e., being pulled over by police, whether ticketed or not) within the previous 12 months were collected through participant interviews. Log-binomial regression models examined associations of past-year cannabis use with MVC and traffic stops, adjusting for site and sociodemographic and mental health characteristics.
Results:
Of 2,095 participating older drivers, 186 (8.88%) used cannabis in the past year but only 10 (<0.5%) within an hour before driving in the last 30 days; 11.41% reported an MVC and 9.45% reported a traffic stop. Past-year cannabis users had a higher prevalence of MVC (adjusted prevalence ratio [aPR] = 1.38; 95%CI: 0.96, 2.00; p = 0.086) and traffic stops (aPR = 1.58; 1.06, 2.35; p = 0.024).
Conclusions:
Past-year cannabis use was associated with increased traffic stops, which are correlated modestly with increased MVC in past studies and may indicate impaired driving performance. We did not find a statistically significant association of past-year cannabis use with MVC, which may indicate limited sustained effects on driving performance from periodic use among older adults, who report rarely driving immediately after use.
Objectives
To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs.
Design
Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis.
Participants
Drivers of four-wheeled vehicles of all ages with no cognitive declines.
Primary and secondary outcomes
MVC involvement (primary) and driving cessation (secondary).
Results
101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I ² =46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I ² =0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I ² =28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I ² =93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I ² =3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I ² =22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I ² =75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I ² =63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I ² =97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD.
Conclusion
Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety.
PROSPERO registration number
CRD42020172153.
Autonomous vehicles (AVs) have generated excitement for the future of transportation. Public transit agencies and companies (i.e., Uber) have begun developing shared autonomous transportation services. Most AV surveys focus on public opinion of perceived benefits and concerns of AVs but are not directly tied to field implementation of AVs. Experience and exposure to new technology affect adults’ perceptions and level of technology acceptance. As such, the Autonomous RideShare Services Survey (ARSSS) was developed to assess adults’ perceptions of AVs before and after being exposed to AVs. Face validity and content validity were established via focus groups and subject-matter experts (CVI = 0.95). Adults in the U.S. (N = 553) completed the ARSSS, and a subsample (N = 100) completed the survey again after two weeks. An exploratory and confirmatory factor analysis demonstrated that the ARSSS consists of three factors that can be used to reliably quantify users’ perceptions of AVs: (a) Intention to Use, Trust, and Safety (r = 0.85, p < 0.001, ICC = 0.99); (b) Potential Benefits (r = 0.70, p < 0.001, ICC = 0.97); and (c) Accessibility (r = 0.78, p < 0.001, ICC = 0.96) of AVs. These are key factors in predicting intention to use and acceptance of AVs. Results from the ARSSS may inform the acceptance among users of these AV technologies.
Objectives: To investigate the longitudinal association of life space and neighborhood and built environment (NBE) with subjective memory among individuals 65 and older, and the mediating role of depressive symptoms, a major correlate of life space mobility, NBE, and subjective memory. Methods: We examined community-dwelling participants in the Advanced Cognitive Training for Independent and Vital Elderly study ( N = 2,622, Mean age = 73.7 years, 24.9% Black) across annual assessments of up to 3 years. Results: Baseline life space and NBE were positively associated with subjective memory, and these associations were partly mediated by depressive symptoms. Over time, higher baseline life space predicted a better subjective memory as one aged. Life space was concurrently associated with subjective memory across time, mediated by concurrent depressive symptoms. Discussion: Potentially modifiable environmental factors such as life space and NBE appear to influence level and change in subjective memory as we age. Interventions supporting movement in our environments may help offset subjective memory problems, a potential early sign of dementia.
Autonomous vehicles (AVs) may benefit the health and safety of drivers across the driving lifespan, but perceptions of drivers are not known. Lived experiences of drivers exposed to AVs in combination with surveys, can more accurately reveal their perceptions. We quantified facilitators and barriers from data collected in older (N = 104) and younger drivers (N = 106). Perceptions were assessed via Autonomous Vehicle User Perception Survey (AVUPS) subscales (i.e., intention to use, barriers, well-being, and acceptance) pertaining to group exposure (simulator first [SF] or autonomous shuttle first [ASF]). We quantified the effects of group, time, and group × time interaction. Multiple linear regressions identified predictors (e.g., optimism, ease of use, life space, driving exposure, and driving difficulty, age, gender, race) of the AVUPS subscales. The regression analyses indicated that optimism and ease of use positively predicted intention to use, barriers, well-being, and the total acceptance score. Driving difficulty significantly predicted barriers, whereas miles driven negatively predicted well-being. The regression results indicated that predictors of user acceptance of AV technology included age, race, optimism, ease of use, with 33.6% of the variance in acceptance explained. The findings reveal foundational information about driver acceptance, intention to use, barriers, and well-being related to AVs. New knowledge pertains to how demographics, optimism, ease of use, life space, driving exposure, and driving difficulty inform AV acceptance. We provided strategies to inform city planners and other stakeholders on improving upon deployment practices of AVs.
Summary-I. A consideration of methods for assessing contrast sensitivity leads to the conclusion that,
for a clinical test, letters are more suitable than gratings.
2. A letter chart is described in which letters decrease in contrast but not in size. The letters are arranged
in groups of three; successive groups decrease in contrast by a factor of IfJ2 from a very high contrast
down to a contrast below the threshold of normal observers. A subject's threshold is taken to be the lowest
contrast for which at least two letters in a group are correctly reported.
3. A mathematical model of the observer and the chart-testing procedure has been used to predict how
the accuracy and repeatability of the test score depend on the parameters of the chart and observer. This
reveals that even a low probability of misreporting supra threshold letters will seriously bias the test score
if the passing criterion is strict, requiring correct report of all letters in each group, but will have little
effect if the passing criterion is less strict. This effect of the passing criterion may explain Rubin's [Clin.
Vision Sci. 2, No. I (1987)] finding that the new test, which uses a lenient criterion, has excellent test-retest
reliability, much higher than the Ginsburg [Am. J. Optom. Physiol. Opt. 61,403-407 (1984)] chart with
its strict criterion.
Older drivers have more accidents per miles driven than any other age group and tend to have significant impairments in their visual function, which could interfere with driving. Previous research has largely failed to document a link between vision and driving in the elderly. We have taken a comprehensive approach by examining how accident frequency in older drivers relates to the visual/cognitive system at a number of levels: ophthalmological disease, visual function, visual attention, and cognitive function. The best predictor of accident frequency as recorded by the state was a model incorporating measures of early visual attention and mental status, which together accounted for 20% of the variance, a much stronger model than in earlier studies. Those older drivers with a visual attentional disorder or with poor scores on a mental status test had 3-4 times more accidents (of any type) and 15 times more intersection accidents than those without these problems.
We conducted a prospective study of 293 elderly patients undergoing cataract surgery with intraocular lens implantation to determine the impact of the surgery on vision and on subjective and objective measures of patient function. Visual acuity in the surgical eye improved from a mean of 20/100 before surgery to 20/40 four months after surgery; improvement was maintained at one year. Positive changes occurred in some subjective measures of patient function, such as reported activities of daily living and patient report of vision-dependent activities, but these changes were modest. The most marked changes in patient function occurred in objective measures of function. Mental status had improved not quite significantly at four months but significantly at one year. Timed manual performance improved dramatically and significantly at four months and one year. Cataract surgery was associated with improved vision and improved objective function in most patients by four months after surgery, and these improvements were maintained at one year.
(JAMA 1987;257:1064-1066)
The existence of depression in children and adolescents is well established, but debate remains about the phenomenology of the depressive syndrome in the young. In order to discover possible age differences in rates and etiology, the definition and measurement of depression must be comparable across the ages to be studied. A widely used self-report depression symptom scale, the Center for Epidemiologic Studies Depression (CES-D) Scale, was administered to convenient (and not necessarily representative) samples of high school and college students. The scores and patterns of responses to the 20 symptom items of the scale were compared with already existing data from junior high school students, from depressed patients, and from a representative community sample of adults and young adults. The results of the analyses suggest that the CES-D Scale is acceptable and reliable in all the groups studied. The scores of the junior high school group may be inflated by an excess of transient symptoms and should be interpreted with caution, but the scale seems to be very suitable for the high school and older groups.
To develop a method for the evaluation of visual function in subjects with cataracts, the authors identified 20 visual activities and categorized them into five subscales (distance vision, near vision, glare disability, night driving, and daytime driving) that comprised the Activities of Daily Vision Scale (ADVS). Each subscale in the ADVS was scored between 100 (no visual difficulty) and 0 (inability to perform the activity because of visual difficulty). In 334 subjects scheduled for cataract extraction (mean age 75 +/- 9 years, 67% women), ADVS scores (mean +/- standard deviation) for each subscale ranged from 44 +/- 31 for night driving to 72 +/- 24 for near vision activities. When administered by telephone, inter-rater reliability coefficients (r) were 0.82 to 0.97 (P < 0.001) for each of the subscales, and test-retest reliability was 0.87 for the scale overall. Cronbach's coefficient alpha was very high for both the in-person (alpha = 0.94) and telephone (alpha = 0.91) formats. Criterion validity, the correlation between visual loss and ADVS score, was -0.37 (P < 0.001) when the ADVS was administered in person and -0.39 (P < 0.001) when it was administered by telephone. Content validity as assessed with factor analysis showed that 88% of the variance of the principal components weighted on one factor. The authors conclude that substantial visual disability is not captured by routine visual testing and that the ADVS is a reliable and valid measure of patient's perception of visual functional impairment.
Age-related lens opacities are common and are a frequent cause of loss of vision. The Beaver Dam Eye Study was designed to estimate the prevalence and severity of lens opacities in a rural community in the United States. Adults between the ages of 43 and 84 years, identified by private census, were examined and participated in the study (n = 4926). Photographs were taken of the lenses and were graded in masked fashion according to a standardized protocol. For nuclear sclerosis, more severe levels occurred more commonly in older age groups and in women. Overall, 17.3% had nuclear sclerosis more severe than level 3 in a 5-step scale of severity. Cortical opacities increased with increasing age and were more common in women. They were found in 16.3% of the population. Posterior subcapsular opacities occur in 6.0% of the population. There was a significant trend of greater prevalence at older ages, but no sex effect. The frequency of early cataract increased in both sexes through the age group 65 to 74 years, but declined in those 75 years of age and older. The frequency of late cataract increased consistently with age. Women were more severely affected than men. This study confirms that lens opacities are common in adults in the United States. These data are important for providing for social and health care needs. It is important to determine causes of cataracts in order to develop preventive programs.