Article

Older Drivers and Cataract: Driving Habits and Crash Risk

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Abstract

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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... They were more sensitive to glare from headlights, streetlights, or the sun, causing them to have difficulty in seeing signages and other vehicles. This was supported by Owsley et al. , 11 who found that older drivers with cataract had significant driving difficulty during rain, rush hours, heavy traffic and night time. It was also reported that older adults with cataract had two times the risk of crashing compared to the older adults without cataract. ...
... It was also reported that older adults with cataract had two times the risk of crashing compared to the older adults without cataract. 11 Driving is a challenging task that requires good vision, psychomotor, and cognitive abilities. 8 Previous study showed that good visual attention and motor function were the two crucial components in driving safety 24 and driving performance. ...
... 15 Driving difficulty status was identified using the Driving Difficulty Questionnaire which is a subset of Driving Habits Questionnaire. 11 Participants were asked to rate the degree of visual difficulty that they experienced from 0 to 5-point scale. A composite score of driving difficulty was computed based on the responses to all 8 items and scaled on a 100point scale. ...
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Purpose The presence of cataract causes reduction in visual acuity (VA) and contrast sensitivity (CS) and thus can affect individual's daily activities. The aim of this study was to investigate self-reported driving difficulty in patients with bilateral cataract. Methods A total of 99 participants aged 50 and above, with bilateral cataract, who possessed a valid driving license and drove regularly were chosen for this cross-sectional study that looked into their visual functions (VA and CS) and driving difficulty using the self-reported Driving Difficulty Questionnaire. Results The mean age of the participants was 65.04±7.22 years old. Results showed that the mean composite driving difficulty score was 83.18±11.74 and most of the participants were having difficulty for driving in the rain (73.7%) and at night (85.9%). Furthermore, the study found that there was a significant correlation between driving difficulty score and CS (rs = 0.40, p = 0.03). However, there was no significant correlation between driving difficulty score and VA (rs = -0.14, p = 0.17). A linear regression was calculated to predict driving difficulty score based on binocular CS and a significant regression equation was found (F (1,28) = 8.115, p = 0.008) with R² of 0.225. Drivers with bilateral cataract will most likely experience some forms of difficulty, especially when driving under low contrast conditions. Conclusion The findings of this study demand that a comprehensive eye examination should be made compulsory for older adult drivers when issuing or renewing their driving license for the safety of all road users.
... They were more sensitive to glare from headlights, streetlights, or the sun, causing them to have difficulty in seeing signages and other vehicles. This was supported by Owsley et al. , 11 who found that older drivers with cataract had significant driving difficulty during rain, rush hours, heavy traffic and night time. It was also reported that older adults with cataract had two times the risk of crashing compared to the older adults without cataract. ...
... It was also reported that older adults with cataract had two times the risk of crashing compared to the older adults without cataract. 11 Driving is a challenging task that requires good vision, psychomotor, and cognitive abilities. 8 Previous study showed that good visual attention and motor function were the two crucial components in driving safety 24 and driving performance. ...
... 15 Driving difficulty status was identified using the Driving Difficulty Questionnaire which is a subset of Driving Habits Questionnaire. 11 Participants were asked to rate the degree of visual difficulty that they experienced from 0 to 5-point scale. A composite score of driving difficulty was computed based on the responses to all 8 items and scaled on a 100point scale. ...
... Dal punto di vista epidemiologico, la relazione tra condizioni di salute specifiche e l'aumentata probabilità di incidenti in auto è piuttosto limitata. Secondo Charlton e Colleghi [49], vi sono un certo numero di malattie associate a un modesto incremento negli incidenti d'auto (rischio relativo >2) tra [38,44,50]. Le opacità del cristallino, tuttavia, presentano un ampio range di gravità e nelle sue fasi iniziali non compromettono la capacità visiva. ...
... Dalla nostra revisione della letteratura sono emerse una serie di patologie oculari o neurologiche che possono determinare una compromissione della funzionalità visiva con potenziali conseguenze negative sulla sicurezza e/o sulla performance alla guida. Secondo le linee guida australiane per l'idoneità alla guida[50], vi sono alcune condizioni oculo-visive che devono essere attentamente considerate, in quanto possono rappresentare una causa di non idoneità alla guida. Queste sono la diplopia, le malattie progressive degli occhi, il nistagmo congenito e acquisito. ...
Article
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Introduzione: In Italia non esistono allo stato attuale linee guida emanate a livello governativo né protocolli o indicazioni da parte del Legislatore sulle patologie oculo-visive progressive che possono rappresentare una causa permanente di non idoneità alla guida o che richiedano particolari limitazioni. Tale criticità comporta un’inevitabile ed eccessiva discrezionalità nelle procedure adottate e nelle risultanti valutazioni medico-legali, che spesso risultano prive di evidenza scientifica, vanificando così lo scopo principale delle visite mediche, quale misura di prevenzione sanitaria degli incidenti stradali. L’obiettivo di questo lavoro è quello di proporre sulla base della normativa vigente in Italia e della letteratura scientifica di riferimento, un protocollo sanitario finalizzato alla formulazione, da parte dell’autorità sanitaria competente, del giudizio di idoneità alla guida, sulla base delle condizioni oculo-visive del richiedente. Metodi: È stata effettuata una revisione della letteratura scientifica attraverso la ricerca nei database “Pubmed/Medline” e “Google Scholar”. Sono state revisionate le normative specifiche sull’idoneità alla guida pubblicate in Italia e nell’Unione Europea e le linee guida internazionali riguardanti gli aspetti relativi ai requisiti visivi per l’idoneità alla guida. Sono stati inoltre intervistati medici specialisti in medicina legale e oftalmologia, seguendo la metodologia di Delphi. Infine, è stato proposto un protocollo operativo pensato sulla base della normativa vigente in Italia e delle linee guida scientifiche e di indirizzo normativo pubblicate in Italia dalla Regione Lombardia e negli altri Paesi. Risultati: Sulla base dei risultati ottenuti abbiamo predisposto un protocollo sanitario per la valutazione preliminare in sede “monocratica” e uno per la valutazione approfondita presso la Commissione Medica Locale (CML) Patenti di Guida istituita presso la Azienda Sanitaria Locale in caso di alterazione dei test di funzionalità visiva o di patologie oculo-visive progressive. Discussione: Il protocollo sanitario proposto in questo lavoro evidenzia come il medico monocratico possa applicare i codici di “guida con lenti e/o lenti a contatto”, ma non dovrebbe applicare altri codici “unionali” ovvero quelli con limitazioni o altri tipi di prescrizione che, invece, dovrebbero essere di competenza della CML.
... To date, research on the impact of ageing on driving performance has largely focused on physical and sensory function (Owsley et al., 1999). By contrast, cognitive changes, which are known to be critical for driving performance, have been much less explored in healthy ageing populations (Fraade-Blanar et al., 2018;Karthaus & Falkenstein, 2016). ...
... To assess how cognition relates to driving behaviour, seven measures for driving behaviour were selected from the Driving Habits Questionnaire (Owsley et al., 1999) and a custom driving history questionnaire and were filtered into 3 main factors: frequency, space, and difficulty (O'Connor et al., 2012) Driving space also consisted of two variables. One was developed from a driving space measure assessing how often participants drove within their immediate neighbourhood (lowest), to A c c e p t e d M a n u s c r i p t 7 outside their region (highest). ...
Article
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Objectives Global cognitive changes in older age impact driving behaviour and road safety, but how spatial orientation differences impact driving behaviours is unknown on a population level, despite clear implications for driving policy and evaluation during ageing. The present study aimed to establish how spatial navigation changes impact driving behaviour and road safety within a large cohort of older adults. Methods 804 participants (mean age: 71.05) were recruited for a prospective cohort study. Participants self-reported driving behaviour followed by spatial orientation (allocentric & egocentric) testing and a broader online cognitive battery (visuomotor speed, processing speed, executive functioning, spatial working memory, episodic memory, visuospatial functioning). Results Spatial orientation performance significantly predicted driving difficulty and frequency. Experiencing more driving difficulty was associated with worse allocentric spatial orientation, processing speed, and source memory performance. Similarly, avoiding challenging driving situations was associated with worse spatial orientation and episodic memory. Allocentric spatial orientation was the only cognitive domain consistently affecting driving behaviour in under 70 and over 70 age groups, a common age threshold for driving evaluation in older age. Discussion We established for the first time that worse spatial orientation performance predicted increased driving difficulty and avoidance of challenging situations within an older adult cohort. Deficits in spatial orientation emerge as a robust indicator of driving performance in older age, which should be considered in future ageing driving assessments, as it is has clear relevance for road safety within the ageing population.
... The most common 'handicap' is eye damage. It has been shown that people with vision loss are particularly careful when driving because they are aware of their own limitations [16,17]. ...
... Examining the first column of Table 5 (and the Results section), it can be seen that this is only partially true. They are more thoughtful (e.g., planning habits), drive less and pay more attention to safety (e.g., they don't use the built-in GPS while driving), which supports what was found by others [15][16][17]. Surprisingly, they know and use the device anyway. Based on these results, it seems that their GPS usage habits are the same as those of younger people. ...
Article
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We encounter prejudices and stereotypes in all areas of life, including human navigation. This study seeks to answer whether there is a basis for navigation stereotypes such as: does our age, gender, place of residence or country affect our car navigation habits? An online questionnaire was distributed in three Central European countries (Hungary, Romania and Austria) and 1556 respondents were reached. In addition to habitancy (settlement type), it was noted that half of the examined concerns are influenced by stereotypes. A significant difference can be shown in questions that are directly or indirectly related to the financial situation of the driver (e.g., the existence and quality of the built-in GPS depends on whether someone has enough money to buy it). However, it seems that other stereotypes we have about driving and navigation are mostly false. The results suggest that it may be possible to personalize built-in navigation systems. By incorporating various “extra” services (e.g., personalized interface, placement), driving and navigation can be made safer and more comfortable for particular segments of society—the driver does not need to use other devices.
... If participants felt comfortable with the virtual driving task, they then performed four trials (intersections) of the real task, where they experienced traffic and the pedestrian running across the road. After this practice, participants completed the Driving Habit Questionnaire (assesses driving habits and experience within the last year; Owsley et al., 1999), the Useful Field of View test (measures divided attention, selective attention and visual processing; Ball et al., 1988), and the Choice Reaction Time test (measures visual processing speed). ...
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Introduction: Intersections are particularly complex traffic situations and are often the scene of accidents. Driver behaviour and decision-making might be affected by specific factors such as the right of way, traffic volume, and the occurrence of a critical event directly before the intersection. Methods: We developed a new driving scenario in virtual reality (VR) to test the impact of these factors using a fully immersive head-mounted display. Participants had to navigate through a series of intersections to reach their target destination. We recorded their driving behaviour as well as their brain activity using electroencephalography (EEG). Results: Our results showed that participants engaged cognitive control processes when approaching an intersection with high traffic volume and when reacting to a critical event, as indexed by driving behaviour and proactively by increased theta power. We did not find differences for right of way in the EEG data, but driving behaviour was as expected, revealing a driving speed reduction when participants had to yield to traffic. Discussion: We discuss advantages and potential challenges of an immersive VR-based approach to driving simulations and the challenges encountered when recording and analysing EEG data. We conclude that despite movement and electronic artefacts, EEG data in the theta and alpha bands can be analysed robustly and allow for novel insights into control processes in realistic VR scenarios.
... 34,35 In addition, this test may aid in understanding the visual challenges of individuals with eye disease who report most difficulty with night driving compared with age-matched controls, including those with AMD, 36,37 glaucoma, [38][39][40] and cataracts. [41][42][43] An advantage of the approach taken in this study is that the only factor that varied between tests in both experiments was the visual status of the participants, that was manipulated through viewing with refractive blur in experiment 1 and cataract blur in experiment 2. It was also possible to minimize the effects of practice on the tests by randomizing the order in which the blurring lenses were worn and using two different sets of videos for each of the vision conditions. ...
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Purpose Night-time driving is dangerous, with increased crash rates, particularly involving vulnerable road users. A Night-Time Hazard Visibility Test (NHVT) was developed and validated by exploring the effects of refractive and cataract blur on performance. Methods The NHVT comprised video clips of night-time roads from the driver's perspective, including different hazards (pedestrians, cyclists, and vehicles). Participants responded when they first recognized hazards requiring them to take evasive action to avoid a collision. In experiment 1, there were 16 young visually normal drivers (mean age = 22.3, standard deviation [SD] = 2.2 years) who completed 2 NHVT sets, viewed separately through best-correction and refractive blur (+1.00 diopter sphere [DS]). In experiment 2, a refined version of the NHVT was administered to an additional 16 young visually normal drivers (mean age = 21.1, SD = 1.2 years) with best-correction and cataract blur. The order of visual conditions and NHVT sets were counterbalanced. Results In experiment 1, refractive blur significantly reduced photopic visual acuity (VA) compared to best-corrected vision (+0.09 vs. −0.21 logMAR, P < 0.001) and delayed response times by 0.69 seconds (3.10 vs. 2.41 seconds, P < 0.001) compared to best-corrected vision. In experiment 2, cataract blur reduced VA compared to best-corrected vision (+0.03 vs. −0.17 logMAR, P < 0.001) and delayed response times by 0.63 seconds (2.92 vs. 2.29 seconds, P < 0.001). Conclusions The NHVT was sensitive to refractive and cataract blur, providing preliminary support of its validity as a measure of night-time hazard visibility performance. Translational Relevance The NHVT has potential as an off-road assessment of visibility for night driving and application for assessment of drivers with different refractive corrections and ocular diseases.
... and the Driving Habits Questionnaire(Owsly, Stalvey, Wells, & Sloane, 1999), as well as the newly developed ones. Although the initial version of the E-DMQ-A had 21 items rated on a 5-point Likert type scale (1=Never, 5=Always), the results ofanalyses conducted by Wong and her colleagues (2015) suggested dropping 7 items, ending up with a 14-item scale with 2 dimensions. ...
Thesis
Self-regulatory behaviors in road traffic context involve modifying driving behavior in a way to adapt to changes in capacity and occurs in the form of reduction or cessation of driving in the face of challenging situations. One individual difference variable that may potentially be a precursor of self-regulatory behaviors in driving is causal attribution, which means the set of evaluations about the perceived causes of success and failure. Previous studies investigated different precursors of driving self-regulation. However, this study is the first to examine the precursors of driving self-regulation within the causal attributional framework. Unlike previous studies that either have participants of old age or make age-based comparisons, this study aims to understand the aforementioned mechanism independent from age. The current study aims to investigate the relationship between causal attributions (about the best and the worst performed aspects of driving), affective outcomes of these attributions (i.e. Positive Affect and Negative Affect), and behavioral outcomes associated with them (i.e. driving self-regulation measured by the level of avoidance). A sample of 400 drivers filled out the demographic information form, the Causal Dimension Scale-II, the International Positive and Negative Affect Schedule Short Form, and the Extended Driving Mobility Questionnaire-Avoidance. Results show that attributional model is more useful for explaining driving avoidance in the context of the worst performance as compared to the best performance. Increased External Control leads to increased Negative Affect, which then leads to increased avoidance behavior. This study shows that causal evaluations about performance can influence self-regulatory driving behaviors.
... Each participant self-reported the total number of years they had been driving, and bioptic drivers also reported their years of bioptic driving experience in cases where they were licensed without a bioptic telescope initially and later needed to enter the bioptic driving program to maintain licensure. All participants verbally completed the Driving Habits Questionnaire 35 with a trained member of the research team. Average weekly mileage was calculated based on responses to the survey. ...
Article
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Purpose Bioptic telescopic spectacles can allow individuals with central vision impairment to obtain or maintain driving privileges. The purpose of this study was to (1) compare hazard perception ability among bioptic drivers and traditionally licensed controls, (2) assess the impact of bioptic telescopic spectacles on hazard perception in drivers with vision impairment, and (3) analyze the relationships among vision and hazard detection in bioptic drivers Methods Visual acuity, contrast sensitivity, and visual field were measured for each participant. All drivers completed the Driving Habits Questionnaire. Hazard perception testing was conducted using commercially available first-person video driving clips. Subjects signaled when they could first identify a traffic hazard requiring a change of speed or direction. Bioptic drivers were tested with and without their bioptic telescopes in alternating blocks. Hazard detection times for each clip were converted to z-scores, converted back to seconds using the average response time across all videos, and then compared among conditions. Results Twenty-one bioptic drivers and 21 normally sighted controls participated in the study. The hazard response time of bioptic drivers was improved when able to use the telescope (5.4 ± 1.4 seconds vs 6.3 ± 1.8 seconds without telescope); however, it remained significantly longer than for controls (4.0 ± 1.4 seconds). Poorer visual acuity, contrast sensitivity, and superior visual field sensitivity loss were related to longer hazard response times. Conclusions Drivers with central vision loss had improved hazard response times with the use of bioptic telescopic spectacles, although their responses were still slower than normally sighted control drivers. Translational Relevance The use of a bioptic telescope by licensed, visually impaired drivers improves their hazard detection speed on a video-based task, lending support to their use on the road.
... Both parent and teen driving habits/crash and violation histories include a history of distracted driving, seatbelt use, and crash-related events, including violations and crashes (either as a driver or passenger). Additional data collected from teens include vehicle make, model, and VIN #; age at first driving experience; age at licensure; any participation in a teen driving safety program(s); hours driven per week; and items from the Driving Habits Questionnaire concerning difficulties/ avoidance in specific driving situations (e.g., driving at night, inclement weather) (Owsley et al. 1999). ...
Article
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Background Teen drivers with a traffic violation are at increased risk for crashes and crash-related injuries; however, most parent-focused interventions target teen drivers with supervised learner’s permits. Very few interventions are implemented at the probationary driver's license stage or target high-risk teen drivers, such as those with traffic violations. This paper describes the protocol of ProjectDRIVE, A Randomized Controlled Trial to Improve Driving Practices of High-Risk Teen Drivers with a Traffic Violation, which targets improving parent-teen communication about safe driving practices to reduce unsafe driving behaviors and traffic violation recidivism of teen drivers cited for traffic violation. Methods Teen drivers (ages 16 or 17) cited for a moving violation and the parent/legal guardian most involved with the teen’s driving are recruited from juvenile traffic courts following their required court hearing. After completing informed consent/assent, enrolled dyads are randomized into one of three groups using stratified block randomization: control, device feedback only, or device feedback plus parent communication training. Participating dyads are followed for 6 months with 3 months of active intervention. Using in-vehicle device and smartphone application technology, the study provides real-time and cumulative driving feedback to intervention teens and collects continually recorded, objectively measured driving outcome data throughout the teen’s study participation. Primary outcomes include rates of risky driving events and unsafe driving behaviors per 1000 miles driven. Secondary outcomes include traffic violation recidivism up to 12 months following study completion and frequency and quality of parent-teen communication about safe driving practices. Discussion Through partnership with the local juvenile traffic courts, this study integrates recruitment and randomization into existing court practices. Successfully completing this study will significantly impact juvenile traffic court’s practices and policies by informing judges’ decisions regarding the driving safety programs they refer to teens to prevent motor vehicle crashes and crash-related injuries and deaths. Trial registration The study was registered on ClinicalTrials.gov Registry (NCT04317664) on March 19, 2020, https://clinicaltrials.gov/study/NCT04317664 and updated on April 27, 2021. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist.
... We assessed participants' experiences with five specifically developed pilot questions about kratom use and driving, and one open-ended text response. We then administered the Driving Habits Questionnaire (DHQ) (Owsley et al. 1999), which assesses driving behaviors (e.g., driving 10 mph or more over the speed limit) and driving history and habits (e.g., "how long have you been driving?", "how often do you drive?"), including items related to driving under the influence of substances (e.g., alcohol, cannabis). ...
Article
Objectives: Despite widespread kratom use, there is a lack of knowledge regarding its effects on driving. We evaluated the self-reported driving behaviors of kratom consumers and assessed their simulated-driving performance after self-administering kratom products. Methods: We present results from: 1) a remote, national study of US adults who regularly use kratom, and 2) an in-person substudy from which we re-recruited participants. In the national study (N = 357), participants completed a detailed survey and a 15-day ecological momentary assessment (EMA) that monitored naturalistic kratom use. For the remote study, outcomes were self-reported general and risky driving behaviors, perceived impairment, and driving confidence following kratom administration. For the in-person substudy, 10 adults consumed their typical kratom products and their driving performance on a high-fidelity driving simulator pre- and post-kratom administration was evaluated. Results: Over 90% of participants surveyed self-reported driving under the influence of kratom. Most reported low rates of risky driving behavior and expressed high confidence in their driving ability after taking kratom. This was consistent with EMA findings: participants reported feeling confident in their driving ability and perceived little impairment within 15-180 min after using kratom. In the in-person substudy, there were no significant changes in simulated driving performance after taking kratom. Conclusions: Using kratom before driving appears routine, however, self-reported and simulated driving findings suggest kratom effects at self-selected doses among regular kratom consumers do not produce significant changes in subjective and objective measures of driving impairment. Research is needed to objectively characterize kratom's impact on driving in regular and infrequent consumers.
... These variables were selected based on published literature, pilot study results, and their potential association with mTBI-related neurocognitive deficits (Evans 1991;Shechtman et al. 2007). Self-reported driving behaviors are measured at weekly assessments using the driving space and crashes/citations domains of the Driving Habits Questionnaire (Owsley et al. 1999). Participants report their driving history and driving avoidance in 9 scenarios (e.g., at night, bad weather, high traffic roads). ...
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Background Mild traumatic brain injury (mTBI) and traffic-related injuries are two major public health problems disproportionately affecting young people. Young drivers, whose driving skills are still developing, are particularly vulnerable to impaired driving due to brain injuries. Despite this, there is a paucity of research on how mTBI impacts driving and when it is safe to return to drive after an mTBI. This paper describes the protocol of the study, R2DRV, Longitudinal Assessment of Driving After Mild TBI in Young Drivers, which examines the trajectory of simulated driving performance and self-reported driving behaviors from acutely post-injury to symptom resolution among young drivers with mTBI compared to matched healthy drivers. Additionally, this study investigates the associations of acute post-injury neurocognitive function and cognitive load with driving among young drivers with and without mTBI. Methods A total of 200 young drivers (ages 16 to 24) are enrolled from two study sites, including 100 (50 per site) with a physician-confirmed isolated mTBI, along with 100 (50 per site) healthy drivers without a history of TBI matched 1:1 for age, sex, driving experience, and athlete status. The study assesses primary driving outcomes using two approaches: (1) high-fidelity driving simulators to evaluate driving performance across four experimental study conditions at multiple time points (within 96 h of injury and weekly until symptom resolution or 8 weeks post-injury); (2) daily self-report surveys on real-world driving behaviors completed by all participants. Discussion This study will fill critical knowledge gaps by longitudinally assessing driving performance and behaviors in young drivers with mTBI, as compared to matched healthy drivers, from acutely post-injury to symptom resolution. The research strategy enables evaluating how increased cognitive load may exacerbate the effects of mTBI on driving, and how post-mTBI neurocognitive deficits may impact the driving ability of young drivers. Findings will be shared through scientific conferences, peer-reviewed journals, and media outreach to care providers and the public.
... These factors were categorized based on the existing literature adopting quantitative research and examined using a survey. Driving performance factors were identified from the literature [52,53]. These items reflect attention, reaction time, and driver's vigilance. ...
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The increasing use of road traffic for land transportation has resulted in numerous road accidents and casualties, including those involving oil and gas tanker vehicles. Despite this, little empirical research has been conducted on the factors influencing tanker drivers' performance. This study aims to address this knowledge gap, particularly in the energy transportation industry, by examining the driving performance factors that affect tanker drivers and incorporating risk assessment measures. The model variables were identified from the literature and used to develop a survey questionnaire for the study. A total of 307 surveys were collected from Malaysian oil and gas tanker drivers, and the driving performance factors were contextually adjusted using the Exploratory Factor Analysis (EFA) approach. The driving performance model was developed using partial least squares structural equation modeling (PLS-SEM). The EFA results categorized driving performance into two constructs: 1) drivers' reaction time with β = 0.320 and 2) attention and vigilance with β value = 0.749. The proposed model provided full insight into how drivers’ reaction time, attention, and vigilance impact drivers' performance in this sector, which can help identify potential risks and prevent accidents. The findings are significant in understanding the factors that affect oil and gas drivers' performance and can aid in enhancing oil and gas transportation management by including effective risk assessment measures to prevent fatal crashes.
... I druga su istraživanja to potvrdila čiji rezultati pokazuju da komponente ponašanja poput stava prema prometnim pravilima (Ulleberg i Rundmo, 2003.) i samoregulacija u vožnji (Owsley et al., 1999.) imaju važnu ulogu u predviđanju prometnih nesreća. ...
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Sigurnost u prometu na cestama predstavlja važno istraživačko područje jer su posljedice prometne nesigurnosti značajan sigurnosni i javno zdravstveni problem. O čovjekovoj aktivnoj ulozi sudionika u prometu na cestama, njegovom ponašanju i radnjama koje čini ili propušta najviše ovisi prometna sigurnost. U skladu s tim glavni cilj ovog istraživanja bio je utvrditi učestalost kršenja prometnih propisa koji se odnose na vozače te istražiti povezanost između određenih sociodemografskih karakteristika vozača, kao i vozačkog iskustva s njihovim kažnjivim ponašanjem, odnosno kršenjem pojedinih prometnih pravila. Na temelju podataka dobivenih u anketi na nacionalnom uzorku od 2072 ispitanika, obrađenih deskriptivnim statističkim analizama, korelacijskom te kanoničkom korelacijskom analizom utvrđeno je kako određene prometne propise vozači učestalije krše, prije svega prekoračenje brzine, neodržavanje sigurnosnog razmaka te nedopušteno korištenje mobitela za vrijeme vožnje, kao i da su dob, spol, zaposlenost, razina mjesečnih primanja, obrazovanje i vozačko iskustvo značajni za predviđanje kršenja prometnih propisa od strane vozača. Ovo istraživanje značajno je za razumijevanja razlika između pojedinih kategorija (skupina) vozača kada je u pitanju učestalost kršenja prometnih propisa. Međutim, da bi se stekao bolji uvid u čimbenike koji pridonose razlikama među vozačima, uz sociodemografske varijable i vozačko iskustvo, u obrade bi trebalo uvrstiti i varijable koje definiraju druga svojstva vozača, prije svega, osobine ličnosti, stavove o prometnoj sigurnosti te percepciju rizika u prometu.
... Self-reported crashes were collected annually using the "crashes and citations" domain from the Driving Habits Questionnaire (DHQ), 14 which asks "How many accidents have you been involved in over the past year when you were the driver?" and a follow-up question asking the number where police were called to the scene. For the prevalent migraine analysis, total number of past-year accidents reported at Y1 and Y2 visits were combined and categorized as any MVC during 2-year follow-up versus none. ...
Article
Background Migraine headache is common in older adults, often causing symptoms that may affect driving safety. This study examined associations of migraine with motor vehicle crashes (MVCs) and driving habits in older drivers and assessed modification of associations by medication use. Methods In a multi‐site, prospective cohort study of active drivers aged 65–79 (53% female), we assessed prevalent migraine (i.e., ever had migraine, reported at enrollment), incident migraine (diagnosis first reported at a follow‐up visit), and medications typically used for migraine prophylaxis and treatment. During 2‐year follow‐up, we recorded self‐reported MVCs and measured driving habits using in‐vehicle GPS devices. Associations of prevalent migraine with driving outcomes were estimated in multivariable mixed models. Using a matched design, associations of incident migraine with MVCs in the subsequent year were estimated with conditional logistic regression. Interactions between migraine and medications were tested in all models. Results Of 2589 drivers, 324 (12.5%) reported prevalent migraine and 34 (1.3%) incident migraine. Interactions between migraine and medications were not statistically significant in any models. Prevalent migraine was not associated with MVCs in the subsequent 2 years (adjusted OR [aOR] = 0.98; 95% CI: 0.72, 1.35), whereas incident migraine significantly increased the odds of having an MVC within 1 year (aOR = 3.27; 1.21, 8.82). Prevalent migraine was associated with small reductions in driving days and trips per month and increases in hard braking events in adjusted models. Conclusion Our results suggest substantially increased likelihood of MVCs in the year after newly diagnosed migraine, indicating a potential need for driving safety interventions in these patients. We found little evidence for MVC risk or substantial changes in driving habits associated with prevalent migraine. Future research should examine timing, frequency, and severity of migraine diagnosis and symptoms, and use of medications specifically prescribed for migraine, in relation to driving outcomes.
... night driving, peak-hour traffic, long distance driving, and bad weather) than non-CVL participants. 35,[43][44][45] They also reported significantly more difficulty in common driving situations in both good and reduced visibility conditions, and their higher perceived driving difficulty was correlated with more driving avoidance and less driving frequency. These self-restrictions could be an adaptive strategy employed by drivers with CVL to cope with their visual limitations. ...
Article
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Purpose: The purpose of this study was to investigate driving difficulties and Advanced Driver Assistance Systems (ADAS) use and preferences of drivers with and without central vision loss (CVL). Methods: Fifty-eight drivers with CVL (71 ± 13 years) and 68 without (72 ± 8 years) completed a telephone questionnaire. They rated their perceived driving difficulty and usefulness of technology support in 15 driving situations under good (daytime) and reduced visibility conditions, and reported their use experience and preferences for 12 available ADAS technologies. Results: Drivers with CVL reported more difficulty (P = 0.002) and greater usefulness of technology support (P = 0.003) than non-CVL drivers, especially in reduced visibility conditions. Increased driving difficulty was associated with higher perceived technology usefulness (r = 0.34, P < 0.001). Dealing with blind spot road users, glare, unexpected pedestrians, and unfamiliar areas were perceived as the most difficult tasks that would benefit from technology support. Drivers with CVL used more advanced ADAS features than non-CVL drivers (P = 0.02), preferred to own the blind spot warning, pedestrian warning, and forward collision avoidance systems, and favored ADAS support that provided both information and active intervention. The perceived benefits of and willingness to own ADAS technologies were high for both groups. Conclusions: Drivers with CVL used more advanced ADAS and perceived greater usefulness of driver assistance technology in supporting difficult driving situations, with a strong preference for collision prevention support. Translational Relevance: This study highlights the specific technology needs and preferences of older drivers with CVL, which can inform future ADAS development, evaluation, and training tailored to this group.
... 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. ...
Article
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. ...
Article
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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.
... Life Space. Life space was measured using the Life Space Questionnaire (LSQ; Owsley et al., 1999;Stalvey et al., 1999). The LSQ asked people to respond to nine items which asked participants whether they had moved within a sequence of successively further zones in the last 2 months. ...
Article
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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.
... 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). ...
Article
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. ...
Article
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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?" ...
Article
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.
... In one of the first studies in this area, an increased number of errors in on-road tests were observed among cognitively normal older adults with higher ratios of CSF tau/Aβ42 and ptau181/ Aβ42, as well as mean cortical binding potential (MCBP) for Pittsburgh Compound B (PIB), consistent with the presence of underlying AD pathology [19]. Other studies based on self-reported driving habits questionnaire also indicate that persons with preclinical AD show patterns of risky driving (e.g. higher frequency of traffic violations and accidents) similar to, albeit to a lesser degree, those with very early Alzheimer's dementia [20,21]. Furthermore, persons with preclinical AD also have a more rapid time to fail a road test in the future compared to those without the disease [22,23]. ...
Article
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Background Changes in driving behaviour may start at the preclinical stage of Alzheimer’s disease (AD), where the underlying AD biological process has begun in the presence of cognitive normality. Here, we summarize the emerging evidence suggesting that preclinical AD may impact everyday driving behaviour. Main Increasing evidence links driving performance and behaviour with AD biomarkers in cognitively intact older adults. These studies have found subtle yet detectable differences in driving associated with AD biomarker status among cognitively intact older adults. Conclusion Recent studies suggest that changes in driving, a highly complex activity, are linked to, and can indicate the presence of, neuropathological AD. Future research must now examine the internal and external validity of driving for widespread use in identifying biological AD.
... A survey questionnaire was developed based on the literature analysis to study the moderating influence of safety culture on the relationship that exists between oil tanker drivers' work schedules and their driving performance in Malaysia. The current study used a five-point Likert scale ranging from 1 ¼ (Never) to 5 ¼ (Always) with 41 items on the questionnaire [51,52,53,54,55,56]. The Likert scale is widely used since it is one of the most trustworthy methods of measuring views, perceptions, and behaviours [57]. ...
Article
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The adverse effects of work schedule on driving performance are relatively common. Therefore, it is necessary to fully understand an organisation’s safety culture to improve driver performance in order to avoid road crashes. This study aims to investigate the moderating role of safety culture in the relationship between driver work schedules and driving performance. The study developed a conceptual framework based on the literature review of existing studies, which is supported by situation awareness theory that explains the model’s relationships and supports the study’s hypotheses. Three hundred four questionnaires were collected from oil and gas truck drivers then Structural equation modelling (SEM) was applied to test the study hypotheses. Derived from the findings, the outer loading for all items was above the threshold of 0.70 unless two items were deleted. The latent exogenous variables of safety culture and work schedule explained 59.1% of driving performance. Besides, work schedule and safety culture significantly impact driving performance. In addition, the results show that safety culture moderates the unfavourable work schedule impact on driving performance with an effect size of 23%. Therefore, this study showed strong evidence that safety culture acts as a critical moderator in reducing the negative impact of work schedule on driving performance in the energy transportation sector. Drivers with high safety culture can manage and reduce the effect of work schedule disorder on driving performance through their safety attitude and patterns compared to those drivers with low safety culture. Consequently, the improvement in driving performance will be noticed among drivers with a high awareness of safety culture.
... Prospective participants will also undergo a physical exam by a physician or nurse practitioner and routine blood tests will be conducted including clinical chemistry, hematology, serology, and serum pregnancy (for females). Other screening assessments include: the MINI for DSM-5 (Sheehan et al., 2010), the Alcohol Use Disorders Identification Test (AUDIT), the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) (Sullivan et al., 1989;Bush et al., 1998), the brief sensation seeking questionnaire (Stephenson et al., 2003), the Eysenck Impulsivity Questionnaire (Eysenck et al., 1985), and the driving history questionnaire (Kidd and Huddleston, 1994;Owsley et al., 1999). Individuals who are eligible will be scheduled to undergo training on the various performance measures (e.g., DRUID, driving, field sobriety tests, etc.) in order to minimize the potential for practice effects during sessions. ...
Article
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The legalization of cannabis for medicinal and non-medicinal purposes, and the corresponding increase in diversity of cannabis products, has resulted an urgent need for cannabis regulatory science. Among the most pressing needs is research related to impairment due to cannabis exposure, especially on driving performance. The present project was designed to evaluate the impact of oral and vaporized cannabis, when administered alone or in combination with alcohol, on simulated driving performance (STISIM driving simulator), cognitive/psychomotor ability, and field sobriety performance. Healthy adults will complete two, double-blind, double-dummy, placebo-controlled, randomized crossover clinical laboratory studies, one with oral cannabis (16 men/16 women) and the second with vaporized cannabis (16 men/16 women). In each study, participants will complete seven experimental sessions during which acute doses of placebo or high Δ9-THC cannabis containing 0, 10, or 25 mg Δ9-THC will be administered both alone and in combination with placebo or alcohol-containing beverages (target breath alcohol concentrations, BAC, of 0.0% or 0.05%). A positive control session (i.e., alcohol at target BAC of 0.08% with placebo cannabis) will also be completed. Simulated driving performance tests (available for download; see Methods), field sobriety assessments, subjective drug effect questionnaires, a mobile device impairment test (DRUID app), and collection of whole blood specimens will be completed repeatedly during each session. Linear mixed models will be used to test for differences across experimental conditions and a priori planned comparisons will be used to determine differences between conditions of interest (e.g., cannabis alone vs cannabis with alcohol). This research is designed to extend prior studies of cannabis and alcohol on driving performance by using oral and vaporized routes of cannabis administration. By increasing understanding of impairment associated with co-use of alcohol and these novel forms of cannabis, this research could inform impairment detection standards for cannabis and alcohol and have important implications for law enforcement, public policy decisions regarding accessibility of these substances, and education of the general population who may use cannabis and/or alcohol. Lastly, this manuscript provides interested researchers with access to the simulated driving scenarios and data extraction tools developed for this study as a means of facilitating future cross-study comparisons, which is important given the heterogeneity in methods used across laboratories in prior research.
... Driving measures are defined in Table 1. Driving habit measures were based on previous work (Molnar et al., 2013a), conceptualized based on three components of the Driving Habits Questionnaire (DHQ) (Owsley et al., 1999): driving space, driving exposure, and driving avoidance. Two driving measures -rapid deceleration (''hard braking") events and speeding events (Table 1) -served as proxies for unsafe driving (Chevalier et al., 2017;Eby et al., 2019;Williams et al., 2006). ...
Article
Objective: Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits. Methods: This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices. Results: Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics. Discussion: Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.
Technical Report
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This report, prepared by Washington State University’s (WSU) Division of Governmental Studies and Services (DGSS), was produced at the request of the Washington State Department of Licensing (DOL) to assist in addressing specific legislative requirements contained in Engrossed Substitute House Bill (ESHB) 1125 Section 208 3a, which called for the DOL “to develop a comprehensive plan aimed at improving older driver safety.” DGSS was contracted as an independent research unit to produce a plan for addressing the following: • A comprehensive review of DOL policies aimed to address issues related to older drivers as well as medically at-risk drivers • A feasibility analysis for establishing a medical advisory board (MAB) for the purpose of advising on policy surrounding medically at-risk drivers, to include policies for managing driving privileges • A recommended assessment tool that can be used by the DOL to identify a driver’s level of risk to themselves or others • Guidance on how each component of the comprehensive plan will balance the improvement of driver safety with the preservation of maximal driver independence and privacy To develop a comprehensive plan for improving older driver safety, DGSS consulted with numerous entities as specified by ESHB 1125, including individuals representing the Washington Traffic Safety Commission, the Department of Health, the Elder Law Section of the Washington State Bar Association, organizations serving older drivers (e.g., AAA, AARP, Washington State Senior Citizens’ Lobby, Washington State Council on Aging), and driver rehabilitation specialists. In addition, DGSS conducted a comprehensive review of existing research to provide an assessment of the nature and scope of driver safety as it pertains to age; quantitatively analyzed Washington State crash data; assessed the feasibility of establishing a medical advisory board (MAB) in the state of Washington through evaluation of existing practices in the United States and review of the relevant research MABs; and reviewed existing screening tools and assessments for validity and reliability.
Article
Background Persons with Parkinson's disease (PD) experience progressive motor and non‐motor symptoms which may influence their ability to drive a car. This is experienced as a massive challenge by many affected individuals, for whom being able to drive a car is vital to maintain functional independence. Objectives We assessed how the diagnosis of PD affected the possession of a driving license, how people with PD had adapted their driving style, and to what extent they had communicated about their driving ability with their healthcare professionals. We also evaluated their knowledge on insurance‐ and Driver and Vehicle Licensing Agency (DVLA)‐related implications. Method A cross‐sectional 10‐item survey was completed by 540 participants of a population‐based cohort of persons with PD in the Netherlands (PRIME‐NL study). Results Participants had a mean age of 70 years and disease duration of 7.3 years. 84% possessed a valid driving license. Of those who gave up their license, this was done mostly (78%) on a voluntarily basis. Forty percent of those with a driving license adjusted their driving style. Over 50% of respondents had not discussed the impact of PD on their driving ability with their healthcare professionals. Although not compulsory by Dutch law, 52% of the respondents had informed the DVLA about their diagnosis. Conclusion This study highlights the need for information and support from healthcare professionals to proactively address driving in their clinical practice. This will help persons with PD in their efforts to maintain their driving license for as long as possible.
Article
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Purpose To describe progression of best-corrected visual acuity (BCVA), full-field stimulus thresholds (FST), and electroretinography (ERG) over 4 years in the USH2A-related Retinal Degeneration study and to assess their suitability as clinical trial endpoints. Design Prospective natural history study. Participants Participants (n = 105) with biallelic disease-causing sequence variants in USH2A and BCVA letter scores of ≥54 were included. Methods BCVA, FST, fundus-guided microperimetry, static perimetry, and spectral domain OCT were performed annually and ERG at baseline and 4 years only. Mixed effects models were used to estimate annual rates of change with 95% confidence intervals. Associations of change from baseline to 4 years between BCVA, FST, ERG, and other metrics were assessed with Spearman correlation coefficients (rs). Main Outcome Measures Best-corrected visual acuity, FST, and ERG. Results The annual rate of decline in BCVA was 0.83 (95% confidence interval: 0.65−1.02) letters/year. For FST, the change was 0.09 (0.07−0.11) log cd.s/m²/year for white threshold, 0.10 (0.08−0.12) log cd.s/m²/year for blue threshold, and 0.05 (0.04−0.06) log cd.s/m²/year for red threshold. Changes were 22.6 (17.4−28.2)%/year for white threshold, 26.0 (20.3−32.1)%/year for blue threshold, and 12.3 (8.7−16.0)%/year for red threshold. The high percentage of eyes with undetectable ERGs at baseline limited assessment of change. Conclusions Best-corrected visual acuity was not a sensitive measure of progression over 4 years. Full-field stimulus threshold was a more sensitive measure; however, additional information on the clinical relevance of changes in FST is needed before this test can be adopted as an endpoint for clinical trials. Financial Disclosure(s) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Article
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Nowadays, due to the increase in traffic accidents, research has emphasized the importance of vision in driving. This research aims to study the relationships between publications and their corresponding authors and identify the different research areas on vision and safe driving that have awakened interest in researchers. Web of Science was the database utilized for searching publications from the first paper published (1957) to December 2021, selecting the keywords: driv*, safety, and vision. The publications’ analysis was made using the CitNetExplorer, VOSviewer, and CiteSpace software. A total of 3,777 publications and 3,887 citation networks were found. In 2019, there was a total of 391 publications and 15 citation networks. The most cited publication was “Older Drivers and Cataract: Driving Habits and Crash Risk” published by Owsley et al. in 1999, with 76 as citation index. By the clustering function, five groups were found that cover the main research areas in this field: ocular movements, detection systems, road safety, and age. The citation network offers both, a quantitative and qualitative analysis of the main articles. Being a multidisciplinary field of study, current research emphasizes the importance of eye movements while driving, the visual impairment in elderly drivers, and the new video-based detection systems.
Article
Objective: To examine longitudinal patterns of return to driving (RTD), driving habits, and crash rates associated with moderate-to-severe traumatic brain injury (TBI). Setting: Eight TBI Model System sites. Participants: Adults (N = 334) with TBI that required inpatient acute rehabilitation with follow-up of 197 and 218 at 1 and 2 years post-injury, respectively. Data collection at 2 years occurred almost exclusively during the pandemic, which may have affected results. Design: Longitudinal and observational. Main measures: Driving survey completed during rehabilitation and at phone follow-up 1 and 2 years after injury. Results: The rate of RTD was 65% at 1-year follow-up and 70% at 2-year follow-up. RTD at both follow-up time points was positively associated with family income. The frequency of driving and distance driven were diminished compared to before injury. Limitation of challenging driving situations (heavy traffic, bad weather, and at night) was reported at higher rates post-injury than before injury. Crash rates were 14.9% in the year prior to injury (excluding crashes that resulted in TBI), 9.9% in the first year post-injury, and 6% during the second year. Conclusion: RTD is common after TBI, although driving may be limited in terms of frequency, distance driven, and avoiding challenging situations compared to before injury. Incidence of crashes is higher than population-based statistics; however, those who sustain TBI may be at higher risk even prior to injury. Future work is needed to better identify characteristics that influence the likelihood of crashes post-TBI.
Article
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O aumento da proporção de condutores idosos na população mundial despertou um interesse significativo na investigação para compreender os desafios e as implicações associadas a este grupo demográfico. Este estudo apresenta uma revisão bibliométrica e uma análise VOS Viewer da literatura centrada nos condutores idosos, utilizando dados recolhidos na base de dados Scopus. O objetivo desta revisão é explorar os principais temas e tendências na literatura, oferecendo assim uma perspetiva do panorama do conhecimento existente neste domínio. A revisão bibliométrica abrange uma coleção abrangente de artigos académicos publicados até ao ano de 2023, utilizando critérios de pesquisa específicos com a palavras-chave “older drivers”. A pesquisa restringiu-se a artigos de revistas e conferências, com revisão por pares publicados até 16 de junho de 2023, em língua inglesa. Um total de 2.037 estudos foram identificados e analisados para compreender o panorama da investigação. Vários indicadores bibliométricos, como tendências de publicação, padrões de autoria, distribuição de periódicos e padrões de citação, foram examinados para avaliar o crescimento e o desenvolvimento geral do campo. Além disso, utilizando o software VOS Viewer, foi efetuada uma análise da rede de coocorrência para identificar grupos temáticos e as suas inter-relações na literatura. Esta análise facilitou a visualização de temas de investigação, permitindo uma exploração dos tópicos mais prevalecentes, colaborações de investigação e áreas de interesse emergentes. As principais áreas temáticas, como o declínio cognitivo e o desempenho da condução, as intervenções de segurança rodoviária, as considerações políticas e os avanços tecnológicos, foram identificadas e analisadas em pormenor. Os resultados desta revisão bibliométrica lançam luz sobre o estado da arte da investigação sobre condutores idosos, destacando a evolução do campo ao longo do tempo e identificando lacunas para investigação futura. A análise também fornece uma visão geral dos principais contribuintes e das suas colaborações, indicando potenciais caminhos para a investigação interdisciplinar. Além disso, a identificação de tópicos emergentes e o mapeamento de grupos de investigação apresentam informações valiosas para investigadores, decisores políticos e partes interessadas que pretendem desenvolver intervenções e políticas específicas no domínio da segurança e mobilidade dos condutores idosos. Ao sintetizar a literatura existente e analisar as tendências de investigação, esta revisão bibliométrica e a análise do VOS Viewer contribuem para a compreensão da investigação sobre condutores idosos. Os resultados fornecem uma base para futuros esforços de investigação, desenvolvimento de políticas e intervenções destinadas a melhorar a segurança e o bem-estar dos condutores idosos.
Article
''Using eye-tracking technology, this study examined hazard detection at night. Using a 2 (younger versus older) x 2 (simulator versus on road) repeated-measures mixed design, 16 older adults and 17 younger adults drove their own vehicle and on a driving simulator under nighttime conditions wearing eye tracking technology. Both driving conditions had three roadway hazards of pedestrians looking at their cell phone while posed to cross the roadway. Pupil glances were recorded using outcome measures of total fixation duration, number of fixations, and time to first fixation. Results showed older adults detected hazards similarly to younger adults, especially during on-road performance. Night hazard detection was similar across driving conditions except for time to first fixation, which was faster on-road for both age groups. Results support potential use of driving simulators as a proxy for on-road with night driving needed for research and practice.
Article
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Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study (n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility.
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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.
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Background: Driving may be adversely affected by any movement disorder, but has been mostly studied in Parkinson's disease (PD). Few studies have addressed driving impairment in patients with Huntington's disease (HD); driving in other movement disorders such as dystonia, blepharospasm and Tourette syndrome (TS) has not been adequately evaluated. Objectives: The aim of this review is to summarize the findings of driving impairment in movement disorders and evaluate the usefulness of clinical tools in guiding clinicians whether to refer patients for driving assessment. Methods: A review of literature was performed on PubMed and articles on driving and movement disorders were identified using a Boolean phrase. Results: We were able to identify 66 articles that fulfilled the target subject: impairment of driving in PD, cervical dystonia, blepharospasm, HD and TS. We also included articles discussing the role of driving rehabilitation in patients with movement disorders. Conclusions: Driving is often impaired in patients with PD and other movement disorders not only due to motor symptoms but also because of cognitive and behavioral co-morbidities. Certain screening tools may be helpful in guiding the clinician in referring the patients for driving assessment.
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Objectives: The aim of this study was to determine the differences in the risk factors for dangerous driving between older adults with normal cognition and those with cognitive impairment. Design: The driving risk questionnaire (DRQ) that was applied to a community-dwelling older adult cohort and 2 years of accident/violation records from the National Police Agency were analyzed. We conducted regression analyses with the presence or absence of risky driving based on records (accidents + violations) 2 years before and after evaluation as a dependent variable and dichotomized scores of each risky driving factor as independent variables. Results: According to four identified factors-crash history, safety concern, reduced mileage, and aggressive driving-significant associations were found between risky driving over the past 2 years and crash history and for aggressive driving in the normal cognition group. In the cognitive impairment group, only crash history was significantly associated, although safety concerns showed a trend toward significance. Conclusions: In this study, it was suggested that the factors of DRQ have a significant association with actual risky driving. Our results are expected to contribute to establishing the evidence for evaluating and predicting risky driving and advising whether to continue driving in clinics.
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This study explored the effect of music on the driving performance of experienced young adult drivers with and without autism spectrum disorder (ASD) using an interactive driving simulator with two types of scenarios. A 2 (Group: autism/neurotypical) × 2 (Music: music/no music) × 2 (Scenario: hazards/wayfinding) factorial design was used with the order of scenarios and music conditions counterbalanced. Participants were 34 neurotypical drivers and 5 drivers with ASD, all with at least 3 years of driving experience. Paired sample t-tests demonstrated no effect of music for any condition. Overall, the drivers with ASD had higher performance means than the neurotypical group with significant differences in the wayfinding scenario and the category for following regulations. Neurotypical drivers had better performance on the wayfinding scenario than the hazard scenario in maneuvers and being attentive to the environment. Although this study had a low number of drivers with ASD, it suggests drivers with ASD can perform better than neurotypical drivers, possibly because they follow road rule guidelines more consistently than neurotypical peers. In addition, this is the first study to examine wayfinding skills in teens/young adults with and without ASD.
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Good vision is important for safe driving. The impact of vision impairment associated with common eye diseases on driving performance, and the association between vision measures and driving performance, are discussed. Studies include those where participants drove a real vehicle on a closed road or on public roads. Closed-road studies include evaluation of both simulated and true vision impairment and day- and night-time driving. Collectively, the findings provide important insights into the impact of refractive conditions, cataracts, glaucoma, age-related macular degeneration, and hemianopic field loss on driving; however, study results show varying impacts on driving performance and are often limited by small sample sizes. Vision measures including motion sensitivity, contrast sensitivity, and useful field of view have stronger associations with driving performance than do visual acuity or visual fields, with studies suggesting that some drivers with field loss can compensate for their field defects through increased eye and head movements.
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Background Based on data regarding the prevalence of Parkinson’s disease (PD), the prevalence of impulsive control disorders (ICD) in PD, and the percentage of PD patients driving a car, it has to be assumed that at least 50,000 PD patients with ICD in Germany actively drive a car. However, these patients might be at risk for unsafe driving due to ICD-related dysfunctions such as failure to resist an impulse or temptation, to control an act or other altered neurobehavioral processes. Objective This study determines the influence of ICD on driving ability in PD. Methods We prospectively compared driving simulator performance of 23 PD patients with and 23 matched patients without ICD. ICD had to be socially compensated and presence was defined clinically for primary and questionnaire-based (QUIP-RS) for post-hoc analyses. Furthermore, between-group comparisons of driving-relevant neuropsychological tests were executed. Results Except from a lower blinking frequency when changing lanes, overall driving safety of patients with ICD did not differ significantly from those without—regardless of the clinical or QUIP-RS-based ICD definition. ICD severity did not correlate with driving performance, but the latter correlated significantly with mean reaction times and certain neuropsychiatric tests (MoCA, TMT-A, TAP-M “flexibility” and DBQ “error”). Conclusion Clinically compensated ICD does not seem to impair driving safety in PD patients. Rather, cognitive and attentional deficits appear to be clinical markers for driving uncertainty.
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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.
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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.
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To identify visual factors that are significantly associated with increased vehicle crashes in older drivers. Several aspects of vision and visual information processing were assessed in 294 drivers aged 55 to 90 years. The sample was stratified with respect to age and crash frequency during the 5-year period before the test date. Variables assessed included eye health status, visual sensory function, the size of the useful field of view, and cognitive status. Crash data were obtained from state records. The size of the useful field of view, a test of visual attention, had high sensitivity (89%) and specificity (81%) in predicting which older drivers had a history of crash problems. This level of predictability is unprecedented in research on crash risk in older drivers. Older adults with substantial shrinkage in the useful field of view were six times more likely to have incurred one or more crashes in the previous 5-year period. Eye health status, visual sensory function, cognitive status, and chronological age were significantly correlated with crashes, but were relatively poor at discriminating between crash-involved versus crash-free drivers. This study suggests that policies that restrict driving privileges based solely on age or on common stereotypes of age-related declines in vision and cognition are scientifically unfounded. With the identification of a visual attention measure highly predictive of crash problems in the elderly, this study points to a way in which the suitability of licensure in the older adult population could be based on objective, performance-based criteria.
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To investigate the outcome of cataract surgery on the patients' self estimation of visual function while driving. Furthermore, the benefit of surgery to the car driving population was determined. A total of 208 consecutive patients (211 cases) with driving licences, who underwent cataract surgery with intraocular lenses, were studied prospectively using self administered questionnaires. Their self estimated degree of visual functional problems while driving were analysed before and after surgery. Visual problems while driving declined from 82% preoperatively to 5% after surgery. Remaining visual problems with the operated eye were present in only seven patients. Problems in estimating distance while driving decreased from 37% before surgery to 6% after surgery. Twenty three per cent of the patients drove with a visual acuity below the requirements for driving in Sweden before surgery and only 4% after surgery. There was no correlation between the degree of visual problems while driving and visual acuity before surgery. The car driving population greatly benefited from cataract surgery in terms of subjectively improved visual function and distance estimation while driving. Functional visual problems while driving should be considered as an indication for cataract surgery. These findings also indicated that the second eye should be operated on, if necessary, to achieve optimal ability to estimate distance and give best possible road safety.
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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)
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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.
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Clinical studies of intraocular lenses (IOLs) as investigational devices have been regulated in the United States by the Food and Drug Administration (FDA) since February 9, 1978. As of August 1982, data have been collected on more than one million IOLs implanted. During the last 12 months of the study, 409,000 IOLs were implanted. Visual acuity of 20/40 or better at one year after surgery was present in 85% of over 45,000 cases reviewed. Increasing patient age, surgical problems, postoperative complications, and adverse reactions were factors that reduced the visual acuity. The current trend in the USA is for implantation of the posterior chamber and anterior chamber IOLs.
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Three new visual acuity charts facilitate quantitative use of visual acuity test results. The charts have high-contrast lettering on washable white polystyrene. Each line has five Sloan letters; the lines are of equal difficulty and there is a geometric progression in letter size from line to line. This provides a similar task for each line on the chart with the letter size being the only variable. Charts with different letter sequences are used for testing right and left eyes.
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To examine the association of distant vision and physical function in the population of older adults. Cross-sectional and cohort study. 5143 older residents of three communities (Established Populations for the Epidemiologic Studies of the Elderly) who were interviewed in 1988-89, including residents of two communities who were re-interviewed 15 months later (n = 3133, 97% of those eligible). Visual acuity screening, self-reported activities of daily living and mobility, and objective physical performance measures of balance, walking, and rising from a chair. Limitations in mobility, activities of daily living, and physical performance were associated with worse visual function. In prospective analyses controlling for potential confounders, participants with severe visual impairment had 3-fold higher odds of incident mobility and activity of daily living limitations than those with acuity of 20/40 or better (P < 0.001). In prospective analyses investigating the relationship of vision with improvement in function, those with poor vision were about half as likely to improve as those with better acuity, but this relationship was only statistically significant for improvement in mobility limitations. Distant visual function appears to play an important role in physical function, particularly for mobility. An intervention to improve vision in at-risk elders might preserve function and prevent disability; this warrants further investigation.
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The decision to stop driving leads to severe contraction of independence, and most localities do not curtail driving privileges in impaired elders. In a population of community-based, ambulatory individuals 70–96 years old, annual medical screening showed that 276 of 1,656 (16.7 ± 1.8%) who reported driving regularly in the past do not currently drive. The cessation of driving behavior was examined in terms of specific medical conditions occurring within the past 5 years. Retired drivers were disproportionately female, and driving cessation risk rose with age. Age-sex-adjusted logistic regression found that six conditions explained about 50 percent of the decisions to stop driving: macular degeneration; retinal hemorrhage; any deficit in Activities of Daily Living; Parkinson's disease; stroke-related residual paralysis or weakness; and syncope. Strikingly, only 1.8 percent of those who stopped driving had ever had a license revoked; 58.7 percent reported voluntarily stopping; 31.9 percent gave health or medical reasons. Clearly, the decision to cede driving privileges is complex and not dependent solely on medical problems
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The factors associated with driving cessation, number of miles driven, and changes in mileage were assessed in a community-living elderly population. A driving survey was administered in 1989 to surviving members of the New Haven EPESE cohort. Of 1,331 respondents, 456 had driven and 139 had stopped driving between 1983 and 1989. Independent predictors of driving cessation from a multiple logistic regression model included higher age, lower income, not working, neurologic disease, cataracts, lower physical activity level, and functional disability. These risk factors were combined to assess their ability to predict driving cessation. If no factors were present, no subjects stopped driving; if one or two factors were present, 17 percent stopped; if three or more factors were present, 49 percent stopped. Along with the expected medical factors, physical activity level and social and economic factors contributed to driving cessation. High mileage drivers tended to be younger, active males who still worked. Increasing age and disability were associated with mileage reduction compared to five years earlier.
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During the period between 1985 and 2000 the number of elderly people (65 years and older) holding a driver's licence will probably double in Germany. Under the broadly accepted assumption that the elderly drive less safely than other age groups, it is suspected that this will negatively affect traffic safety. The central topic of the study concerns the results of driving tests with 80 elderly drivers (60-82 years old), compared with a reference group of 30 middle-aged motorists (40-50 years), and their relation to laboratory performance data. In the laboratory marked differences were found concerning visual acuity by daylight (even when deficiencies were corrected by visual aids) and in the dark, performance in a traffic-related tachistoscopic perception test, and notably in the amount of time needed in tracking and reaction tests. The performance of elderly drivers proved worse in all of these laboratory tasks. On the other hand, in driving tests in the overwhelming number of traffic situations the elderly did not differ unfavorably from the middle-aged drivers. Possible explanations for these findings are considered.
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We assessed vision before and after uncomplicated extracapsular cataract extraction and intraocular lens implantation in 72 symptomatic patients with acuity equal to or better than 20/80 and no other ocular abnormality. Contrast sensitivity was measured with the Pelli-Robson Letter Chart (Metropia Ltd, Cambridge, England) and disability glare was measured under daytime conditions with the Brightness Acuity Tester (Mentor O&O Inc, Norwell, Mass) and under nighttime conditions with a computer-controlled video display. Prior to surgery there was significant disability glare that was not correlated with acuity. There was also a loss in contrast sensitivity that was moderately correlated with acuity (r = -.43; P < .001). Following surgery, most patients' scores returned to normal on all tests. Improvement in disability glare and contrast sensitivity was independent of improvement in acuity. Furthermore, patients with the poorest preoperative vision were as likely to regain normal function after surgery as those with the best preoperative vision.
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To assess the role of demographic factors and chronic conditions in maintaining mobility in older persons, this study utilized longitudinal data collected as part of the Established Populations for Epidemiologic Studies of the Elderly between 1981 and 1987 on 6,981 men and women aged 65 years and older in East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Results are presented for those who at baseline reported intact mobility, defined as the ability to climb stairs and walk a half mile without help, and who were followed annually for up to 4 years for changes in mobility status. Age, income, education, and chronic conditions present at baseline and occurring during follow-up were evaluated for their association with loss of mobility. Over the follow-up period, 55.1% of subjects maintained mobility, 36.2% lost mobility, and 8.7% died without evidence of mobility loss prior to death. In both men and women, increasing age and lower income levels were associated with increased risk of losing mobility, even after controlling for the presence of chronic conditions at baseline. After adjustment for age, income, and chronic conditions, lower education levels were a significant risk factor for mobility loss in men, but not in women. Baseline reports of previous heart attack, stroke, high blood pressure, diabetes, dyspnea, and exertional leg pain were associated with small but significant risks for mobility loss. There was a stepwise increase in the risk of mobility loss according to the number of chronic conditions present at baseline that was very consistent between men and women. The occurrence during the study of a new heart attack, stroke, cancer, or hip fracture was associated with a substantially greater risk of mobility loss than was associated with the presence of these conditions at baseline.
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To identify the content area for a questionnaire designed to measure vision-targeted health-related quality of life and to determine whether problems with vision-related functioning are qualitatively similar across different common eye diseases. Twenty-six condition-specific focus groups were conducted with 246 patients from 5 geographic regions to identify the content area for a questionnaire for use among persons with diabetic retinopathy, glaucoma, macular degeneration, cytomegalovirus retinitis, and cataract. A standard protocol was used to structure each focus group discussion. Sessions were audiotaped, transcribed, and coded in preparation for a content analysis. Five university-based ophthalmology practices and 1 nonprofit eye care foundation. Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. All eligible persons were older than 21 years, spoke English, and had sufficient cognitive function to provide informed consent. Among the 246 participants, 2623 problems with vision-related functioning were mentioned. The mean number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glaucoma. For the sample overall, reading problems were mentioned most frequently, followed by driving, general problems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each problem were difficulty or ease of performance (13%), psychological distress associated with performance of the activity (11%), and complete inability to participate in a visual activity (11%). An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual functioning in every-day life. Although participants mentioned problems that were unique to their disease, across conditions the problems mentioned were similar. These findings provide empirical evidence of content validity for a vision-targeted, health-related quality-of-life survey designed for use across conditions.
Article
The purpose of this study was to examine the association between visual and cognitive impairment in older drivers and their avoidance of potentially challenging, driving situation. A group of 257 older drivers participated in assessments of visual sensory function, eye health and cognitive function including the useful field of view test, and completed a structured questionnaire on driving exposure and how frequently they avoided challenging driving situations. Results replicated earlier studies showing that many older drivers limit their exposure to driving situations which are generally believed to be more difficult (e.g. rain, night, heavy traffic, rush hour). Furthermore, older drivers with objectively determined visual and/or attentional impairments reported more avoidance than those free of impairments; those with the most impairment reported avoiding more types of situations than other less impaired or non-impaired drivers. Older drivers with a history of at-fault crashes in the prior five years reported more avoidance than those who had crash-free records. Future research should evaluate the potentially beneficial role of self-regulation in enhancing older driver safety, particularly in those older drivers with visual and attentional processing impairments who have elevated crash risk.
Article
Older drivers have a high crash rate per vehicle mile of travel. Coupled with the growth of the number of older drivers on the road, this has generated interest in the identification of factors which place older drivers at increased risk. However, much of the existing research on medical and functional risk factors for crash involvement has generally been inconsistent. Methodological differences between studies have been hypothesized as being partly responsible for such inconsistencies. The source of information used to identify crash-involved drivers has been identified as one such difference. This paper reports on the agreement between self-report and state record for identifying crash involved-older drivers. We also sought to determine whether the prevalence of visual and cognitive impairment differs across crash-involved drivers identified by either or both sources. Finally, we assessed whether risk factors for crash involvement differed when crash-involved drivers were identified by either self-report or state records. Results indicated that there was a moderate level of agreement between self-reported and state-recorded crash involvement (kappa = 0.45). However, we did find significant differences between crash-involved drivers identified via state records and/or self-report with respect to demographic (age, race), driving (annual mileage, days per week driven), and vision impairment (acuity, contrast sensitivity, peripheral visual field sensitivity, useful field of view). We also found that the possibility for biased measures of association is real. Useful field of view impairment was associated with both self-reported and state-recorded crash involvement; however, the magnitude of the associations was disparate. Moreover, glaucoma was identified as a significant risk factor when considering state-recorded crashes but not self-reported crashes. While validation of these findings is required, research designed to identify risk factors for crash involvement among older drivers should carefully consider the issue of case definition, particularly if self-report is used to identify crash-involved older drivers.
Use of the Center for Epidemiological Studies-Depression scale with older adults Clinical Gerontology: A Guideto Assessment and Intervention
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Nationwide PersolWl Transponation Survey: Demographic Special Reports. PHWA-PL-94·0I9. Oak Ridge, 1N: Oak Ridge National Laboratories
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Association of visual impairment with mobility and physical function
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