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Older driver involvements in police reported crashes and fatal crashes: trends and projections

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Abstract

Objectives: Older drivers have become a larger part of the driving population and will continue to do so as the baby boomers reach retirement age. The purpose of this study was to identify the potential effects of this population increase on highway safety. Methods: Driver involvement rates for all police reported crashes were calculated per capita, per licensed driver, and per vehicle-mile of travel for 1990 and 1995. Also, driver involvement rates for fatal crashes were calculated for 1983, 1990, and 1995. Based on current crash rates per licensed driver and estimates of the future number of licensed drivers, projections of crashes involving drivers aged 65 and older were made for years 2010, 2020, and 2030. Results: Driver crash involvement rates per capita decreased with age, but fatal involvement rates per capita increased starting at age 70. The same pattern existed for involvement rates per licensed driver. For both all crashes and fatal crashes, involvement rates per mile driven increased appreciably at age 70. Using projections of population growth, it was estimated that for all ages there will be a 34% increase in the number of drivers involved in police reported crashes and a 39% increase in the number involved in fatal crashes between 1999 and 2030. In contrast, among older drivers, police reported crash involvements are expected to increase by 178% and fatal involvements may increase by 155% by 2030. Drivers aged 65 and older will account for more than half of the total increase in fatal crashes and about 40% of the expected increase in all crash involvements; they are expected to account for as much as 25% of total driver fatalities in 2030, compared with 14% presently. Conclusions: By most measures, older drivers are at less risk of being involved in police reported crashes but at higher risk of being in fatal crashes. Although any projections of future crash counts have inherent uncertainty, there is strong evidence that older drivers will make up a substantially larger proportion of drivers involved in fatal crashes by 2030 because of future increases in the proportion of the population aged 65 and older, and trends toward increased licensure rates and higher annual mileage among older persons. Countermeasures to reduce the anticipated death toll among older drivers should address the increased susceptibility to injury of older vehicle occupants in crashes.

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... driver falling asleep at the wheel are more common among young individuals [10,[14][15][16][17]. Nevertheless, almost 7000 older adults were involved in motor vehicle accidents in the USA, considering that it has been estimated that more than 40 million elderly drivers have a driving license [18]. Although the absolute number of crashes involving older drivers is currently low, we have to note that the percentage of older people with a driving license has grown by 34% in the last decade [18], and crash frequency per mile driven begins to increase at around 65 years of age [19]. Despite accounting for only 8% of miles driven per year, older drivers appear to be involved in 14% of crash fatalities [19]. ...
... Although the absolute number of crashes involving older drivers is currently low, we have to note that the percentage of older people with a driving license has grown by 34% in the last decade [18], and crash frequency per mile driven begins to increase at around 65 years of age [19]. Despite accounting for only 8% of miles driven per year, older drivers appear to be involved in 14% of crash fatalities [19]. In particular, Italian data [20] showed that the drivers more frequently involved in road accidents were those aged 20-29 years (18.3%) and 40-54 years (29.2%), with a growing percentage (9.2%) of elders (≥70 years). ...
... Prior studies ascribed reductions in geriatric driving skills to cognitive, visual, and/or physical impairments [2,19,[22][23][24][25]. However, sleepiness and sleep-related complaintswhich strongly affect the other functions-have been rarely investigated. ...
Article
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Background: Several studies highlighted that sleepiness affects driving abilities. In particular, road traffic injuries due to excessive daytime sleepiness are about 10-20%. Considering that aging is related to substantial sleep changes and the number of older adults with driving license is increasing, the current review aims to summarize recent studies on this issue. Further, we intend to provide insights for future research. Methods: From the 717 records screened, ten articles were selected and systematically reviewed. Results: Among the selected articles, (a) five studies investigated sleepiness only by self-reported standardized measures; (b) two studies assessed sleepiness also using a behavioral task; (c) three studies obtained objective measures by electroencephalographic recordings. Conclusions: The available literature on the topic reports several limitations. Overall, many findings converge in evidencing that older drivers are less vulnerable to sleep loss and sleepiness-related driving impairments than young adults. These discrepancies in sleepiness vulnerability between age groups may be ascribed to differences in subjects' lifestyles. Moreover, it has been hypothesized that older adults self-regulate their driving and avoid specific dangerous situations. We believe that an easy protocol to objectively evaluate the vigilance level in elderly and young adults is required, and further studies are needed.
... Higher crash risk and the projected increase in the older population due to the aging baby-boom cohort led to concern in the past that an increase in fatal crashes among older adults would follow (Lyman et al., 2002), yet previous research showed a decline from the mid-1990s through 2012 (Cicchino & McCartt, 2014). With the continued increase in older adult population size and longevity, profound implications remain for the safe and independent mobility of older adults. ...
... Data on vehicle miles traveled were obtained from the National Household Travel Surveys (NHTSs) conducted by FHWA. The current study used data from the Nationwide Personal Transportation Survey (NPTS) conducted during 1995-1996and the NHTSs administered during 2001-2002-2009-2017. These surveys will be referred to as the 1995, 2001, 2009, and 2017 surveys from this point on. ...
... In addition to trends of crash involvement per licensed driver, this study explored fatal crash involvements per 100 million vehicle miles traveled (VMT) using data from the 1995 NPTS and the 2001, 2009, and 2017 NHTSs. Crash data from April-March of 1995-1996, 2001-2002-2009-2017 to approximately align with the data collection periods of the NHTSs. Fatally injured driver counts were derived for the same periods from FARS. ...
Article
Introduction: With the growing older adult population due to the aging baby-boom cohort, there was concern that increases in fatal motor-vehicle crashes would follow. Yet, previous analyses showed this to be untrue. The purpose of this study was to examine current trends to determine if previous declines have persisted or risen with the recent increase in fatalities nationwide. Methods: Trends among drivers ages 70 and older were compared with drivers 35-54 for U.S. passenger vehicle fatal crash involvements per 100,000 licensed drivers from 1997 to 2018, fatal and all police-reported crash involvements per vehicle miles traveled using the 1995, 2001, 2009, and 2017 National Household Travel Surveys, and driver deaths per 1,000 crashes. Results: Since the mid-1990s, fatal crashes per licensed driver trended downward, with greater declines for drivers ages 70 and older than for middle-aged drivers (43% vs. 21%). Fatal crash rates per 100,000 licensed drivers and police-reported crash rates per mile traveled for drivers ages 70-79 are now less than those for drivers ages 35-54, but their fatal crash rates per mile traveled and risk of dying in a crash remain higher as they drive fewer miles. As the economy improved over the past decade, fatal crash rates increased substantially for middle-aged drivers but decreased or remained stable among older driver age groups. Conclusions: Fatal crash involvements for adults ages 70 and older has recently increased, but they remain down from their 1997 peak, even as the number of licensed older drivers and the miles they drive have increased. Health improvements likely contributed to long-term reductions in fatal crash rates. As older drivers adopt vehicles with improved crashworthiness and safety features, crash survivability will improve. Practical Application: Older adults should feel confident that their independent mobility needs pose less risk than previously expected.
... In brief, data recorded in this database were collected from an instrumented car to study driving behaviors and performances of vulnerable car drivers. Vulnerable car drivers are defined here as drivers liable to have more difficulties than the others when driving their car, due to the potential negative effects of their old age [12][13][14][15][16], or due to their lack of driving experience (i.e., novice drivers [17][18][19][20]. Motivations for using such a pre-existing database collected among vulnerable car drivers in this study was justified In case of automated driving (from SAE Level 3 to 5) as initial state (i.e., corresponding to the blue section in Figure 1), monitoring functions have to assess automated system limits and/or driving tasks requiring a transfer of the vehicle control from the automation to the human driver, and then to adequately support this transition. ...
... In brief, data recorded in this database were collected from an instrumented car to study driving behaviors and performances of vulnerable car drivers. Vulnerable car drivers are defined here as drivers liable to have more difficulties than the others when driving their car, due to the potential negative effects of their old age [12][13][14][15][16], or due to their lack of driving experience (i.e., novice drivers [17][18][19][20]. Motivations for using such a pre-existing database collected among vulnerable car drivers in this study was justified by the objective to design ADAS able to assist users who have the highest needs in assistance and who are liable to gain the most benefits from future driving aids. ...
Article
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This article is about the Human-Centered Design (HCD), development and evaluation of an Artificial Intelligence (AI) algorithm aiming to support an adaptive management of Human-Machine Transition (HMT) between car drivers and vehicle automation. The general principle of this algorithm is to monitor (1) the drivers’ behaviors and (2) the situational criticality to manage in real time the Human-Machine Interactions (HMI). This Human-Centered AI (HCAI) approach was designed from real drivers’ needs, difficulties and errors observed at the wheel of an instrumented car. Then, the HCAI algorithm was integrated into demonstrators of Advanced Driving Aid Systems (ADAS) implemented on a driving simulator (dedicated to highway driving or to urban intersection crossing). Finally, user tests were carried out to support their evaluation from the end-users point of view. Thirty participants were invited to practically experience these ADAS supported by the HCAI algorithm. To increase the scope of this evaluation, driving simulator experiments were implemented among three groups of 10 participants, corresponding to three highly contrasted profiles of end-users, having respectively a positive, neutral or reluctant attitude towards vehicle automation. After having introduced the research context and presented the HCAI algorithm designed to contextually manage HMT with vehicle automation, the main results collected among these three profiles of future potential end users are presented. In brief, main findings confirm the efficiency and the effectiveness of the HCAI algorithm, its benefits regarding drivers’ satisfaction, and the high levels of acceptance, perceived utility, usability and attractiveness of this new type of “adaptive vehicle automation”.
... Previous studies have been done in identifying the older population involvement in certain crash types and concluded with significant evidence that people aged 65 or older have higher crash rates of fault in traffic crashes (Alam & Spainhour, 2009). In addition, most of the recent surveys and older population crash safety articles have taken the people aged 65 or older as the representative groups in determining the difficult older driver issues related to crash injuries (Cerrelli, 1989;Chandraratna, Mitchell, & Stamatiadis, 2002;Lyman, Ferguson, Braver, & Williams, 2002;Pymont, Anstey J, & Sargent-Cox, 2012). Despite using the sequential or functional age groups for labeling 'older drivers' in analysis, it should be important to remember that the older people are not one homogeneous group, rather it is likely to find individual differences within groups (Cerrelli, 1989). ...
Thesis
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Older people form a vulnerable age group who are susceptible to road traffic injuries and in recent years, the fatality rates among the older drivers, pedestrians and pedacyclists have increased in an alarming rate. Due to the statewide increase in motor vehicle crashes involving older population, the Illinois Department of Transportation (IDOT) has identified older drivers as an emphasis area in the Illinois Strategic Highway Plan. This study is aimed to determine the major causes behind older population crashes by analyzing the crash data and county-level socioeconomic data. First, preliminary analysis on the IDOT 2011-2016 crash data was conducted and several crash injury characteristics for older people (age 65 or more) were identified and compared with the remaining age groups. Then, Hierarchical Linear Models has been used to identify the association between senior people crashes and crash characteristics along with county-level demographic features. From the analysis, it has been found that, the factors including percentage of older people and primary care physicians along with road surface condition, light, weather, alignment conditions, vehicle types, vehicle defects, time of crash, gender, BAC (Blood Alcohol Content), TCD (Traffic Control Devices)etc. are significant predictors which result in older people injury over different counties In Illinois.
... Epidemiological studies have projected a large increase in the percentage of drivers aged 60 and older, a cohort at risk of road crashes [1][2][3]. Older drivers have one of the highest vehicle crash rates in comparison with other population groups, largely due to the functional effects of the accumulation, and progression of age-related declines in visual, cognitive and motor conditions that impact on fitness to drive [4]. Knowledge of the cognitive characteristics associated with particular driving behaviour of older people has important implications for the improvement of safety on our roadways and the mobility of older adults. ...
Article
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Abstract Introduction Safe driving constantly challenges the driver’s ability to respond to the dynamic traffic scene under space and time constraints. It is of particular importance for older drivers to perform sufficient visual and motor actions with effective coordination due to the fact of age-related cognitive decline. However, few studies have been able to integrate drivers’ visual-motor behaviours with environmental information in a spatial-temporal context and link to the cognitive conditions of individual drivers. Little is known about the mechanisms that underpin the deterioration in visual-motor coordination of older drivers. Development Based on a review of driving-related cognitive decline in older adults and the context of driver-vehicle-environment interactions, this paper established a conceptual framework to identify the parameters of driver’s visual and motor behaviour, and reveal the cognitive process from visual search to vehicle control in driving. The framework led to a psycho-geoinformatics approach to measure older drivers’ driving behaviours and investigate the underlying cognitive mechanisms. The proposed data collection protocol and the analysis and assessments depicted the psycho-geoinformatics approach on obtaining quantified variables and the key means of analysis, as well as outcome measures. Conclusions Recordings of the driver and their interactions with the vehicle and environment at a detailed scale give a closer assessment of the driver’s behaviours. Using geoinformatics tools in driving behaviours assessment opens a new era of research with many possible analytical options, which do not have to rely on human observations. Instead, it receives clear indicators of the individual drivers’ interactions with the vehicle and the traffic environment. This approach should make it possible to identify lower-performing older drivers and problematic visual and motor behaviours, and the cognitive predictors of risky driving behaviours. A better targeted regulation and tailored intervention programs for older can be developed by further research.
... years for women, which does not initially align with the scientific literature analysed. The literature indicates that older drivers and younger drivers are at greater risk of being involved in traffic crashes (Augenstein, Perdeck, Stratton, Digges, & Bahouth, 2003;Kim, Ulfarsson, Kim, & Shankar, 2013;Li, Braver, & Chen, 2003;Lyman, Ferguson, Braver, & Williams, 2002;Newgard, 2008;Ridella, Rupp, & Poland, 2012). In the specific case of motorcycle drivers, several authors also point to youth as a risk factor (Haworth & Smith, 1998;Mullin et al., 2000;Rutter & Quine, 1996;Ulleberg, 2003;Yeh & Chang, 2009). ...
Article
This study analysed motorcycle crashes in Spain. Ninety-nine thousand three hundred and four motorcycle crash reports filed in the years 2006–2011 were extracted from the Directorate General of Traffic database of crashes with victims. These data were analysed in terms of gender, age groups, trip purpose, type of crash, speed violation, day of the week, harm caused, use of helmet and psychophysical conditions of the driver to study the characteristics of motorcycle crashes in Spain and to assess the differences between male and female motorcycle drivers in these crashes. Significant differences were found in all the variables considered in the study, which implies gender differences in the profile of the injured motorcycle driver. The severity of motorcycle crashes suffered by male drivers is higher than that of women. These results corroborate the need to develop measures differentiated by gender, based on their profile.
... For the elderly, the effects of aging include increased mechanical fragility of biological components and physiological changes such as visual, morphological, and musculoskeletal decline (Yoganandan et al. 2007). Other studies show that around 40% of crashes involve drivers over the age of 65 (Lyman et al. 2002). As life expectancies increase and the quality of older age continues to improve, it is feasible to assume that there will be more elderly drivers on the road in the coming years compares to past decades. ...
Thesis
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Loading conditions resulting from the detonation of improvised explosive devices (IEDs) have posed a serious risk to the warfighter in modern military conflicts. Vehicle bourn IEDs result in high-rate lateral loading to the vehicle structure that can cause side panel intrusion into occupant compartment, and potentially into the body of a mounted warfighter inside. These impacts can cause severe injury throughout the body, including the pelvis. Combat-related pelvis fractures are linked to increased mortality rates and amputation risk. Biomechanical research is needed to improve the design of vehicles and protective equipment to mitigate injuries to the pelvis. Finite element (FE) models are useful tools in evaluating the biomechanics of impact and injury. FE models can provide quick analyses over a range of loading scenarios, and can be used directly in the countermeasure design process. With this in mind, an injury-predictive FE model of the human pelvis was developed using modeling methods appropriate for evaluating the high-rate injurious loading characteristics found in military combat. The response and injury predictions of this pelvis model were assessed against experimental lateral impact testing performed on human cadaveric pelvises. Signal correlation analysis was applied to objectively rate the validity the FE pelvis force responses. Injuries predicted by the pelvis model, when using maximum principal strain failure criteria, were consistent with those occurring in the experiments. The pelvis model was then used to perform an injury threshold analysis where impactor mass and velocity was varied. This study identified the anterior pelvis as being more vulnerable to lateral impact. Recent research has highlighted a lack of consensus on a consistent injury predictive metric for the pelvis in lateral impact. Injury risk functions were constructed based on anterior and posterior pelvis force, and the posterior force of the pelvis was identified as a more consistent injury predictive metric than anterior force. This finding has potential implications for dummy design. Finally, the model developed in this study was part of a larger development project to create a whole human body FE model for analyses of human body exposure to military-relevant impact events. The addition of the developed and validated pelvis model will aid future vehicle development for improved safety features. Side panel safety design efforts should focus on mitigating acetabular loading in the event of a lateral impact scenario, and dummy instrumentation should include load cells located in the posterior pelvis for measuring pelvis injury risk.
... There is also an increased risk of thoracic injuries for obese individuals (Boulanger et al., 1992;Cormier, 2008). Risks of incurring a serious or fatal injury are also higher in older individuals (Lyman et al., 2002); after 65 years old the fatality risk increases by ∼3% per year (Frampton et al., 2012). ...
Article
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ging and obesity are two key areas of research as risk factors leading to motor vehicle collisions (MVCs). However, only a few studies identified obese older drivers as an at-risk population of MVC (i.e., older than 65 years old with Body Mass Index greater than 30 kg/m2). This paper aims to review the literature related to aging, obesity, and MVCs. Extensive literature searches were conducted, and the results are presented in a narrative review of the literature, in order to discuss the risk for involvement in MVC as well as the solutions for this population. Extrinsic factors are components of the “built environment” that decrease road safety for this population and poor fit of the vehicle through their inappropriate design for this population. The intrinsic factors are the autonomy and the health status of the driver. Health status are challenges associated with obesity and aging that increase the prevalence of being part in a MVC and that increase risk of morbidity and mortality during or following a collision. Finally, some prevention strategies are presented for consideration. There is a need to inform public policy makers on the additional risk factors associated with aging and obesity for MVCs.
... Previous studies have been conducted to identify the older population's involvement in certain crash types and concluded that people aged 65 or older have higher fault rates in traffic crashes (Alam & Spainhour, 2009). Most recent surveys and older population crash-safety articles use people aged 65 or older as a representative group to determine issues related to older driver's crash injuries (Cerrelli, 1989;Chandraratna et al., 2002;Lyman et al., 2002;Pymont et al., 2012). Despite using chronological or functional age groups for labeling "older drivers" in this analysis, note that older people are not comprised of one homogeneous group. ...
Technical Report
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The objectives of this project were to examine fatality and severe injury risks of motor vehicle crash among older people, identify specific areas where crash risks may be mitigated, and make recommendations for improved safety while promoting mobility and independence among older people.
... This study aims to predict the vehicle crash severity (i.e., injury level) caused by senior drivers. Previously, a few scholars have investigated the senior involved traffic accidents [3,6,8,[11][12][13]. Most studies addressed that older drivers are more susceptible to being injured and killed by accidents. ...
Article
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Along with the rapid demographic change, there has been increased attention to the risk of vehicle crashes relative to older drivers. Due to senior involvement and their physical vulnerability, it is crucial to develop models that accurately predict the severity of senior-involved crashes. However, the challenge is how to cope with an imbalanced severity class distribution and the ordered nature of crash severities, as these can complicate the classification of the severity of crashes. In that regard, this study investigates the influence of implementing ordinal nature and handling imbalanced class distribution on the prediction performance. Using vehicle crash data in Ohio, U.S., as an example, the eight machine learning classifiers (logistic and ordered logistic regressions and random forest and ordered random forest with or without handling imbalanced classes) are suggested and then compared with their respective performances. The analysis outcomes show that balancing strategy enhances performance in predicting severe crashes. In contrast, the effects of implementing ordinal nature vary across models. Specifically, the ordered random forest classifier without balancing appears to be superior in terms of overall prediction accuracy, and the ordered random forest with balancing outperforms others in predicting severer crashes.
... Older adult transportation safety is a public health concern. Due to age-related physical and cognitive decline and increased frailty and fragility, older drivers are more likely to be involved in crashes and to be severely injured than their younger counterparts (Anstey et al., 2005;Braver & Trempel, 2004;Lyman et al., 2002;Shen & Neyens, 2015). To mitigate the high crash risk associated with older drivers, many U.S. states have enacted licensing laws specifically pertaining to older adults. ...
Article
Objectives: Around the world, aging populations pose significant concerns regarding their community mobility and transportation safety. Most previous studies in the United States have focused on the associations between driver license renewal laws and crash outcomes among older adults (65 years and older). Few studies have evaluated the impact of driver license renewal laws on older adults' community mobility. This study aimed to identify the associations between driver license renewal laws and older males' and females' daily driving likelihood and duration. Methods: The 2003-2017 American Time Use Survey data were merged with driver license renewal legislation using ages 55-64 to control for effects of non-licensure factors (e.g., gasoline price). Weighted Poisson and linear regression models were used to estimate the associations of various driver licensure provisions with older males' and females' daily driving likelihood and duration. Results: A shorter in-person renewal period and the presence of mandatory reporting laws for physicians were associated with a lower daily driving likelihood and shorter driving duration among females aged 75 years or older. The presence of mandatory reporting laws was also associated with reduced daily driving likelihood and duration for males aged 65-74 years. Discussion: Policymakers should be aware that males and females may respond differently to older driver licensure laws, which may require distinct interventions to preserve their mobility. Future studies should consider the gender disparities when examining the association between driver licensure policies and older adults' transportation safety and mobility.
... As the population of older adults grows, it is paramount to address the concerns surrounding older driver safety in a manner that maintains their mobility and independence. In less than 12 years' time, older adults will make up 25% of the licensed driver population in the United States, with an estimated number of 57 million older drivers on the road (Lyman, Ferguson, Braver, & Williams, 2002;U.S. Government Accountability Office, 2007). ...
Article
[Background and Objectives] Mobility is a critical factor that influences older adults’ independence and well-being. Older drivers may experience increased crash risks due to age-related cognitive declines. Ensuring safe driving practices among older drivers is important to maintain their mobility without sacrificing safety. Investigations for an effective assessment technology that can inform older drivers’ risks associated with cognitive declines are warranted. This study aims to identify attentional deteriorations that may underlie crashes in various situations. [Research Design and Methods] This study employed driving simulation to examine associations between attentional functions of older drivers and crash risks in various hazardous situations. Using the Attention Network Test (ANT), a computerized assessment that measures efficiencies of the three distinct attentional functions (i.e., alerting, orienting, and executive), we examined specific attentional functions that underlie older drivers’ crash risks in particular driving situations. [Results] Findings from this study revealed significant associations between executive attentional efficiency and crash risks in situations that demand a driver quickly resolving conflicts among multiple competing tasks or information. These situations include turning while a pedestrian is crossing from an opposite direction, merging, and multitasking while driving. [Discussion and Implications] The present findings expand our understanding of unique involvements of attentional functions in particular driving situations at an old age. Future driver assessment technologies for informing older drivers about their crash risks may aim to address more fundamental cognitive mechanisms that lead to elevated risks in particular driving situations rather than merely focusing on the situations themselves.
... There is also an increased risk of thoracic injuries for obese individuals (Boulanger et al., 1992;Cormier, 2008). Risks of incurring a serious or fatal injury are also higher in older individuals (Lyman et al., 2002); after 65 years old the fatality risk increases by ∼3% per year (Frampton et al., 2012). ...
... In addition, driving seems to be an important component of independence and emotional well-being in older adults [5]. However, the growing proportion of drivers aged ≥ 65 years due to the population aging has been associated with an increased risk of fatal accidents [6,7] and involvement in motor vehicle collisions [8]. Motor vehicle accident data which is adjusted for travel distance showed an exponential increase above the age of 75 [9]. ...
Article
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Research on multitasking driving has suggested age-related deterioration in driving performance. It has been shown that physical and cognitive functioning, which are related to driving performance and decline with aging, are positively associated with physical activity behavior. This study aimed to explore whether driving performance decline becomes severe with advancing age and whether physical activity behavior modifies age-related deterioration in driving performance. A total of one hundred forty-one healthy adults were categorized into three groups based on their age; old-old (74.21 ± 2.33 years), young-old (66.53 ± 1.50 years), and young adults (23.25 ± 2.82 years). Participants completed a realistic multitasking driving task. Physical activity and cardiorespiratory fitness levels were evaluated. Older groups drove more slowly and laterally than young adults, and old-old adults drove slower than young-old ones across the whole driving course. Physical activity level did not interact with the aging effect on driving performance, whereas cardiovascular fitness interacted. Higher-fitness young-old and young adults drove faster than higher-fitness old-old adults. Higher-fitness old adults drove more laterally than higher-fitness young adults. The present study demonstrated a gradual decline in driving performance in old adults, and cardiorespiratory fitness interacted with the aging effect on driving performance. Future research on the interaction of aging and physical activity behavior on driving performance in different age groups is of great value and may help deepen our knowledge.
... Secondly, any increase in driving impairment represents a greater risk for older drivers, particularly those older than 65 years. These drivers are at greater risk of fatal accidents per kilometre driven compared to all other drivers, except for young novice drivers 26 , and are more likely to sustain a fatal injury in a motor vehicle crash due to a pre-existing condition or frailty (playing a role in 50% of fatalities) 27 . As the risk of a sleep-related crashes is lower, yet the consequence is much higher, future work should examine the risk of adverse driving outcomes in these individuals. ...
Article
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Impaired driving performance due to sleep loss is a major contributor to motor-vehicle crashes, fatalities, and serious injuries. As on-road, fully-instrumented studies of drowsy driving have largely focused on young drivers, we examined the impact of sleep loss on driving performance and physiological drowsiness in both younger and older drivers of working age. Sixteen ‘younger’ adults (M = 24.3 ± 3.1 years [21–33 years], 9 males) and seventeen ‘older’ adults (M = 57.3 ± 5.2, [50–65 years], 9 males) undertook two 2 h drives on a closed-loop track in an instrumented vehicle with a qualified instructor following (i) 8 h sleep opportunity the night prior (well-rested), and (ii) after 29-h of total sleep deprivation (TSD). Following TSD, both age groups displayed increased subjective sleepiness and lane departures (p < 0.05), with younger drivers exhibiting 7.37 × more lane departures, and 11 × greater risk of near crash events following sleep loss. While older drivers exhibited a 3.5 × more lane departures following sleep loss (p = 0.008), they did not have a significant increase in near-crash events (3/34 drives). Compared to older adults, younger adults had 3.1 × more lane departures (p = < 0.001), and more near crash events (79% versus 21%, p = 0.007). Ocular measures of drowsiness, including blink duration, number of long eye closures and PERCLOS increased following sleep loss for younger adults only (p < 0.05). These results suggest that for older working-aged adults, driving impairments observed following sleep loss may not be due to falling asleep. Future work should examine whether this is attributed to other consequences of sleep loss, such as inattention or distraction from the road.
... Just under 20% of the group had evidence of self-reported crashes and/or citations-yet this variable did not predict intention to use. Although projections from Lyman et al. indicate that future crash counts are hard to predict, they propose evidence indicating that older drivers will make up a substantially larger proportion of drivers involved in crashes (77), partly due to their increasing age, driving exposure, and need to continue to drive. Of course, a necessary mitigation strategy for avoiding crash risk is to suggest the use of an AS as a safer mode of transportation-but, it is clear that being crash and/or citation involved did not predict intention to use in our study. ...
Article
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Shared autonomous vehicle services (i. e., automated shuttles, AS) are being deployed globally and may improve older adults (>65 years old) mobility, independence, and participation in the community. However, AS must be user friendly and provide safety benefits if older drivers are to accept and adopt this technology. Current potential barriers to their acceptance of AS include a lack of trust in the systems and hesitation to adopt emerging technology. Technology readiness, perceived ease of use, perceived barriers, and intention to use the technology, are particularly important constructs to consider in older adults' acceptance and adoption practices of AS. Likewise, person factors, i.e., age, life space mobility, driving habits, and cognition predict driving safety among older drivers. However, we are not sure if and how these factors may also predict older adults' intention to use the AS. In the current study, we examined responses from 104 older drivers (Mage = 74.3, SDage = 5.9) who completed the Automated Vehicle User Perception Survey (AVUPS) before and after riding in an on-road automated shuttle (EasyMile EZ10). The study participants also provided information through the Technology Readiness Index, Technology Acceptance Measure, Life Space Questionnaire, Driving Habits Questionnaire, Trail-making Test Part A and Part B (TMT A and TMT B). Older drivers' age, cognitive scores (i.e., TMT B), driving habits (i.e., crashes and/or citations, exposure, and difficulty of driving) and life space (i.e., how far older adults venture from their primary dwelling) were entered into four models to predict their acceptance of AVs—operationalized according to the subscales (i.e., intention to use, perceived barriers, and well-being) and the total acceptance score of the AVUPS. Next, a partial least squares structural equation model (PLS-SEM) elucidated the relationships between, technology readiness, perceived ease of use, barriers to AV acceptance, life space, crashes and/or citations, driving exposure, driving difficulty, cognition, and intention to use AS. The regression models indicated that neither age nor cognition (TMT B) significantly predicted older drivers' perceptions of AVs; but their self-reported driving difficulty (p = 0.019) predicted their intention to use AVs: R2 = 6.18%, F (2,101) = 4.554, p = 0.040. Therefore, intention to use was the dependent variable in the subsequent PLS-SEM. Findings from the PLS-SEM (R2 = 0.467) indicated the only statistically significant predictors of intention to use were technology readiness (β = 0.247, CI = 0.087-0.411) and barriers to AV acceptance (β = −0.504, CI = 0.285-0.692). These novel findings provide evidence suggesting that technology readiness and barriers must be better understood if older drivers are to accept and adopt AS.
Article
Older adult drivers can experience age-related health declines, particularly cognitive health, that can negatively impact driving performance and lead to driver license revocation. The measurement of naturalistic in-car driving behaviour can be used to evaluate trip complexity, including diversity, length, and frequency of trips and associated destinations. This study examined measurement methods for trip complexity and driving destinations using GPS data for older adult drivers with differing health statuses, focusing primarily on cognitive health status. Older driver subgroups included four groups with relatively stable health: better overall health, better cognitive health, worse cognitive health, and worse overall health and one group with declining cognitive health. Older drivers with better health status (overall and cognitive) had higher measured trip complexity compared to those with worse health status. Two variables, mean trip distance and percent of trips driven during the workweek evening rush-hour, declined significantly (p . 0.049) in-line with cognitive declines but did not meaningfully discriminate cognitively declining older drivers from cognitively stable drivers (sensitivity: 18.8 to 43.8%; specificity: 58.0 to 93.3%). This contrast between significant group differences and non-predictive declining group changes may suggest that self-referential naturalistic driving measures are needed to identify meaningful changes in driving behaviour. In addition to the development of self-referential driving measurement systems, careful consideration of big data analysis as they apply to naturalistic driving are warranted. These include but are not limited to issues of validation, anonymity, measure-based definitions, and occurrence of outlier-type driving events like city-to-city travel.
Article
Introduction The present study uses data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study to assess the association of the frailty phenotype with reduced driving space and involvement in motor vehicle crashes. Methods The LongROAD study is a multisite prospective cohort study of participants aged 65–79 years. Fried's frailty phenotype status at baseline and self-reported restricted driving space in the past three months and at least one self-reported crash in the recent year are examined. Multivariable logistic regression was used to obtain odds ratios, adjusting for covariates and clustering by site. Results Pre-frail (i.e. only 1–2 indicators of frailty) participants had 30% higher odds (adjusted OR = 1.3, 95% CI:1.0–1.8) of reporting involvement in a crash in the prior year than non-frail participants after adjusting for sex, age, depression, word recall, average miles driven per week, and site. No association for reduced driving space for frail older drivers was found. Conclusions The frailty phenotype is associated with motor vehicle crashes, but not reduced driving space. Our findings suggest that future research should be focused on the identification of pre-frail older adult drivers to improve the health and quality of life of older adult drivers.
Article
Introduction In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients. Hypothesis/Problem The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center. Methods This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center. Results The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods. Conclusions State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
Conference Paper
Drivers aged 65 and older represent the fastest increasing demographic in the United States. However, aging can influence driving-related visual, physical, and cognitive functions which can negatively influence their driving performance. Difficulties encountered during complex traffic situations include navigating intersections, making left turns against oncoming traffic, merging into traffic, and making lane changes on limited-access highways. Several studies have used driving simulators to assess the performance of older drivers. Studies have also used neuropsychological tests to assess cognitive abilities for evaluating the skills and capabilities of older drivers. Visual screening, speed of processing information, visuospatial processing, and memory assessment were found to be key predictors of older drivers’ competence. Studies have also used functional magnetic resonance imaging (fMRI) during simulated driving to examine aspects of brain activity related to specific driving tasks. There remains a gap in the research when it comes to older drivers, neuropsychological tests, and studies using fMRI.
Article
Currently in Australia medical fitness to drive decisions for people with dementia are largely conducted by front line medical practitioners. Little is known about the processes that these practitioners use to make these decisions, and how current guidelines assist in making determinations about driving capacity. A short survey was completed by 42 practitioners. The results of the survey supported previous findings that practitioners do not feel comfortable with making the decision regarding fitness to drive for people with dementia. Practitioners relied largely on self-report or informant information regarding current driving practices. Although practitioners reported that the level of cognitive functioning was the most important factor in determining safe driving, only 25% of practitioners employed cognitive assessments. Whilst the vast majority of practitioners were aware of the fitness to drive guidelines, over half did not find them to be sufficient in enabling determinations of driving capacity. Due to this, almost all practitioners reported that they believe they have missed cases of unsafe driving in this population with over 85% endorsing the need for a more objective tool. Significantly, over three quarters of practitioners reported that they have never received training on how to make fitness to drive decisions. Given that the current driver licensing system for people with dementia depends on medical fitness to drive reviews, the lack of confidence by practitioners regarding making fitness to drive decisions can have a detrimental impact on both the safety of the individual drivers, but also the community as a whole.
Article
Naturalistic in-car driving informatics provides opportunities to identify links between driving behaviours and cognitive and physical health status. The coefficient of variation was used to evaluate deceleration event variability (1) for differences between 171 older adult drivers grouped based on physical and cognitive scores and (2) for changes that aligned with longitudinal health changes in 62 older adult drivers. Differences in older adult physical and cognitive health status were related to deceleration event variability. Greater deceleration event variability was identified in individuals with better cognitive health, with two exceptions. There were also deceleration events subsets where individuals with poorer physical health status exhibited greater variability in deceleration patterns than those with better health status. CoV-measured deceleration event variability did significantly decrease for individuals with longitudinal cognitive health decline and for individuals with longitudinal physical health declines (velocity signal only) for decelerations subsets and CoV increased for individuals with longitudinal physical health decline for acceleration and jerk signals for event deceleration subsets. These findings suggest that worse cognitive health may limit older adult driver’s ability to adapt deceleration patterns when needed, resulting in lower CoV-measured variability. However, particularly in situations that require less adaptation to deceleration patterns, worse physical health may induce unnecessary variability during deceleration events. Further investigation is warranted to determine whether differences in variability relate to successful braking collision avoidance behaviours.
Thesis
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Introduction Decades of research have shown that approximately one in three older adults, aged 65 years or older, falls at least once each year (Campbell et al., 1990; World Health Organization, 2007). This is a problem in our ageing society; as the number of people in this aged cohort continues to increase, leading to an expected increase of falls and falls related medical costs in the coming years (Hendrie, Hall, Arena, & Legge, 2004). The consequences of falling are not only severe in terms of medical costs, for older adults a fall means injuries, decreases in quality of life and could even lead to death (Burns, Stevens, & Lee, 2016). The current thesis adopts an ecological approach to investigate opportunities for falls prevention. According to an ecological approach, guidance of action is mediated by the perception of ‘opportunities for action’ or ‘affordances’ (Gibson, 1979). These affordances are always action scaled; a person perceives possibilities for action in relation to his or her own action system. For instance, a curb might afford ‘stepping onto’ for me, as I have sufficient leg length and strength to perform a step up, however, it will afford ‘climbing onto’ for a toddler who’s legs might not yet have the length to afford stepping onto the curb. Perception of affordances is therefore influenced by how well a person knows his or her own capabilities or in other words how well one ‘calibrates’ perception and action. To achieve this calibration, one needs to experience of ‘explore’ one’s action system, or, as Gibson (1979) put it: "…we must perceive in order to move, but we must also move in order to perceive" (p. 213). This cyclic nature of perception forms the basis for the perception and action cycle and perceptual-motor coupling. The perception and action cycle can help to understand successful movement and therefore potentially to explain movement errors (such as the ones leading to falls) as well. If one component of the perception and action cycle is unsuccessful it could affect success in movement. For instance, if a person would not calibrate properly, making one insecure about one’s own action capabilities, it might lead to insecurities in moving around. From this it follows that for successful performance, it is important to successfully couple perception and action. Aims, Methods and Results per Study The current study incorporates four inter-related studies with differing methods. The first study (described in Chapter 2) is a systematic review, which sought to investigate the perceptual-motor calibration component of the perception and action cycle. The aim of this study was to assess in what conditions calibration occurs most efficiently, with a sub-aim to assess what is known about age-related changes in calibration. Seven databases were screened to identify literature that combined topics related to ‘perception’, ‘action’ and ‘calibration’ or ‘scaling’. Twenty-three papers satisfied the inclusion criteria. Results of the first study showed that calibration occurs rapidly if the movements performed to explore the perceptual and action coupling provide relevant information for perception. For instance, when standing height is raised by placing a participant on 10-cm high blocks, calibration occurred rapidly when participants were allowed to walk with the block (allowing much exploration), but not when only allowed standing stationary with no body movement (Mark, Balliett, Craver, Douglas, & Fox, 1990). Furthermore, this study identified a general limitation in the research on calibration; no studies have been identified that have studied calibration to changed action capabilities in an older cohort. The second, third and fourth study in this thesis (described in Chapter 4, Chapter 5 and Chapter 6) all use the same ‘curb-approach task’ to study the regulation of gait towards a target. For each trial in the curb approach task, participants were positioned at the far end of an 8m long GAITRite pressure sensitive walkway (GAITRite®, CIR Systems, Inc., Franklyn, NJ, USA). At a ‘go’ signal, participants started walking the length of the walkway (placing one footfall on a target that was randomly placed in the first 3 meters of the walk to prevent participants from performing identical walks in each trial), to the end of the walkway where a curb-like platform (L: 2m, W: 1m, H: 0.15m) was positioned. Participants stepped onto the platform and continued to the far end at which a push-button was positioned that signaled the end of the trial. 33 trials were performed per participant. Outcome measures of the curb-approach task were related to three analyses introduced in previous studies in locomotor pointing (De Rugy, Taga, et al., 2002; Montagne et al., 2000). Firstly, an analysis was introduced that assessed the changes in variability (standard deviation) of the position of foot placements. Secondly, an analysis was introduced that assessed whether the timing of the initiation of adaptations in gait (deviations from a ‘standard’ step) are related to the total amount of adjustments to be made (indicating a perception-action coupling). Finally, an analysis was introduced VII that assessed the strength of perceptual-motor coupling; the degree to which changes in step length depended on the perception of required adjustments. The second study (as described in Chapter 4) aimed to assess whether successful performance in the curb-approach task required similar perceptual-motor regulation compared to the long-jump run up. Sixteen younger adults were included and ask to perform the curb-approach task. Results confirmed the similarities between the curb-approach and the long jump approach. Regulation seemed to be initiated earlier in the curb-approach compared to the long jump, but a similar pattern was observed in decreasing variability of foot placement and an increasingly stronger perceptual-motor coupling as participants got closer to their target in both tasks. The second study concluded that the curb-approach task would provide an effective paradigm to study perceptual-motor regulation in an older cohort (for whom a long jump would be too demanding). The third study (Chapter 5) aimed to assess age-related changes in regulation in the curb approach task. In this study, the data collected from the 16 younger participants (study2) was compared to data collected from a cohort of 105 older adults. Results showed that with older age, participants showed less variability in foot placement during their approach. Furthermore, it was shown that with age, participants were more likely to adopt a strategy that involved shortening rather than lengthening of steps. Age-related changes were most prominent in the measures of strength of perceptual-motor regulation. Similar to the younger participants, older participants showed an increased strength of coupling (or in other words; made stronger adjustments) as they got closer to the curb. However, it was also shown that with age the strength of the coupling over all steps increased, indicating that the older participants made stronger gait adaptations. As the third study identified that age-related changes are most prominent in the measures of perceptual-motor coupling, it was decided to focus the final study (Chapter 6) on the question whether these changes could be related to an increased risk of falls. Ninety-eight participants were included in the analysis for this study, who first performed the curb-approach task and then were entered in a 12 –month follow-up to screen for the occurrence of gait-related falls. Results showed that participants who reported experiencing a gait-related fall showed stronger perceptual-motor coupling (stronger gait adaptations) in stepping onto the curb. Discussion and Conclusion The results of this thesis showed that the curb-approach task provides a novel and valid method to measure perceptual-motor regulation of locomotor pointing in in a low demands setting, suitable for the older cohort. Older adults showed stronger gait adaptations compared to their younger counterparts and adaptations in the step onto the curb were stronger still in on older adults prone to experiencing gait-related falls. These results suggest that, in controlling gait, humans are capable of changing the strength of perceptual-motor coupling in accordance with the difficulty of the task. With age, action capabilities decrease and the curb-approach task becomes harder; our results show that this is met with a strengthening of perceptual-motor coupling. Implications of the current thesis are that in falls risk screenings as well as falls prevention, it is important to consider the entire perception and action cycle. An ecologically-grounded functional approach to healthy aging is advocated which considers a person in relation to his/her behavior and environment (Vaz, Silva, Mancini, Carello, & Kinsella-Shaw, 2017).
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Background: Between 2012 and 2016, Greece sufered yearly more than 800 deaths from road trafc incidents (RTIs), holding one of the worst performances in the European Union for RTI-related deaths per population. Our primary aim is to identify risk factors associated with mortality to set a targeted policy framework on road safety. Methods: This is a retrospective analysis of data collected prospectively from Trafc Police. A correlation of 29 factors with adult drivers’ mortality was made, applying multivariate logistic regression models. At a second stage, a scoping literature review identifed the best possible targeted prevention measures. Results: A total of 93,019 drivers with a mean age of 42.2±0.1 years were recorded, of which 2772 (3%) died. Age above 65 (aOR 3.1, p<0.001), non-use of seatbelt (aOR 8.2, p<0.001) or helmet (aOR 2.85, p<0.001) and alcohol consumption (aOR 3.3 for cars, 4 for motorbikes, p<0.001) were the driver-related parameters with the strongest correlation with a fatal outcome. Drivers’ behavior with specifc high-risk maneuvers increased odds of death 2–4 times, depending on vehicle type. One-lane, rural road network was the environmental factor with the most signifcant impact. Based on the results of the analyses, our scoping review identifed and suggested 23 specifc measures for the Greek government and policymakers to examine. Conclusion: Human-related factors were the parameters with the strongest impact on mortality after an RTI in Greece. These fndings demonstrate an educational gap that must be primarily addressed with the introduction of missing road safety education in schools and an intensifed and innovative population awareness campaign.
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Nöroergonomi, insan beyninin iş performansı ve günlük yaşam sırasında karşılaşılan beyin fonksiyonu ve davranışları hakkında değerli bilgiler elde edebilme adına geliştirilen bir bilim dalıdır. Teori ve prensiplerini ergonomi, sinirbilim ve insan faktörlerinden alır. Nöroergonomi çalışmaları sırasında beyin yapılarını, mekanizmalarını ve işlevlerini anlamak için nörogörüntüleme teknikleri kullanılır. Nörogörüntüleme teknikleri, iki genel kategoriye ayrılır; bunlar, elektroensefalografi gibi (EEG) gibi uyaranlara cevapta nöronal aktivitenin direkt göstergeleri ve pozitron emisyon tomografisi - bilgisayarlı tomografi (PET-BT), fonksiyonel manyetik rezonans görüntüleme (fMRG), fonksiyonel yakın kızılötesi spektroskopi (fNIRS), fonksiyonel Transkranyal Doppler (fTCD) gibi nöronal aktivitenin endirekt metabolik göstergeleridir. Bu derlemede mental iş yükü ve uyanık olma durumunda kullanılan nöroergonomik yöntemler gözden geçirilmiştir.
Article
Objective: To determine which patient, provider and practice-related characteristics are associated with increased likelihood of driving-related recommendations following a neuropsychological evaluation. Method: A total of 309 clinical neuropsychologists completed a survey evaluating the frequency with which they made various driving-related recommendations (e.g., take an on-road driving test) to a variety of clinical populations. Information regarding patient characteristics (e.g., perceived likelihood of adhering to recommendations), provider-related characteristics (e.g., years in practice) and practice-related characteristics (e.g., region of North America) were also collected. Correlation coefficients and multiple linear regressions controlling for patient diagnoses were used to examine which characteristics predicted greater likelihood of driving recommendations broadly. Significant characteristics were then entered into regressions to examine independent contributions of each characteristic to the likelihood of each individual driving recommendation. Results: Neuropsychologists reported giving a range of driving recommendations to most clinical populations, with the exception of patients with psychiatric diagnoses. Several characteristics (e.g., patient impairment) were associated with greater likelihood of driving recommendations broadly. After controlling for diagnoses, three significant predictors emerged: higher frequency of individualized recommendations, greater caregiver presence, and greater number of recommendations given. All three characteristics generally predicted frequency of all individual driving recommendations. Conclusions: While patients’ diagnoses may be indicative of whether they receive driving-related recommendations, certain patient and provider-related factors also uniquely contribute to the likelihood of driving-related recommendations after neuropsychological assessment.
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Evidence suggests that drivers with cataract self-regulate their driving, but there is a lack of objective information. This study compared speed behavior in older drivers with and without cataract and how the parameter is influenced by road traffic complexity and driver characteristics. The study included 15 drivers with cataract and a control group of 20 drivers. Visual status was assessed using visual acuity, contrast sensitivity, and intraocular straylight. Speed management was studied using a driving simulator. Driving difficulty and self-regulation patterns were evaluated by means of the Driver Habits Questionnaire (DHQ). The cataract group showed a significant decrease in visual function in all the parameters evaluated (p < 0.05). These drivers tended to drive at lower speeds than the control group. Road characteristics, gender, and intraocular straylight in the better eye were identified as significant predictors of speed management. Drivers with cataract experience greater driving difficulty, particularly when driving at night (p < 0.05). Drivers with cataract reduce their driving speed more than older drivers without visual impairment. The straylight parameter may be a good indicator of each driver’s subjective perception of their own visual ability to drive. This work helps shed light on the mechanisms through which age-related visual impairment influences driving behavior.
Article
Objective: We studied which current fatal at-fault crashes would occur despite the most advanced current active safety devices (up to SAE level 2 of driving automation) and how frequent these crashes would be. Methods: We carried out a cross-sectional study of passenger cars that were first registered during the period 1st January 2010 to 31st December 2017 in Finland. To gain the true exposure for these cars, we accessed the national Vehicular and Driver Data Register to obtain the mileage information and the registration count for the study period of 2010-17. Similarly, we accessed the registry of Finnish road accident investigation teams and included all fatal at-fault crashes among the cars in our study for the same period. We used a real world reference technology for each active safety system in our analysis and chose one car brand as an example. This gave us exact system specifications and enabled testing the operation of the systems on the road. We performed field tests to gain further information on the precise operation of the safety systems in different operating conditions. Finally, we gathered all information on the studied active safety systems and analyzed the investigated at-fault fatal crashes case-by-case using our four level method. Results: Cars in our study were the primary party in 113 investigated fatal accidents during the years 2010-17. In 87 of the accidents, the leading cause of death was the injuries due to the crash, and these cases were classified as "unavoidable" (n = 58, 67 %), "avoidable" (n = 26, 30 %) or unsolved (n = 3, 3 %). Of the 58 "unavoidable" crashes 21 (36 %) were suicides, 21 (36%) involved active driver input which would have prevented the safety system operation, 15 (17 %) featured circumstances beyond the safety system performance and in one loss-of-control crash the driver had disabled the relevant safety system (electronic stability control). The registration years of the cars in our study (2010-17) totaled 3,772,864 and during this period, the cars travelled 75.9 billion kilometers. The crash incidence of the "unavoidable" at-fault fatal crashes was 0.76-0.80 fatal crashes per billion kilometers and 15-16 fatal crashes per million registration years. Conclusions: We calculated a crash incidence for the "unavoidable" crashes which was 20-27% smaller than the observed crash rate of ESC-fitted passenger cars in our previous study. We concluded that suicides, active driver input until the crash, and challenging weather and road conditions are the most difficult factors for current active safety systems. Our analysis did not account for issues such as system usability or driver acceptance and therefore our results should be regarded as something that is currently theoretically achievable. However, the observed incidence is a good reference for automated driving development and the crash rate of automated cars.
Article
The increase in the number of older adult drivers in developed countries has raised safety concerns due to the decline in their sensory, motor, perceptual, and cognitive abilities which can limit their driving capabilities. Their driving safety could be enhanced by the use of modern Automated Driver Assistance Systems (ADASs) and might totally resolved by full driving automation. However, the acceptance of these technologies by older adult drivers is not yet well understood. Thus, this study investigated older adult drivers’ intention to use six ADASs and full driving automation through two questionnaires with 115 and 132 participants respectively in Rhode Island, USA. A four-dimensional model referred to as the USEA model was used for exploring older adult drivers’ technology acceptance. The USEA model included perceived usefulness, perceived safety, perceived ease of use, and perceived anxiety. Path Analysis was applied to evaluate the proposed model. The results of this study identified the important factors in older adult drivers’ intention to use ADASs and full driving automation, which could assist stakeholders in improving technologies for use by older drivers.
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Background: No papers have examined the relationship between socio-demographic characteristics and cognitive performance in oldest old subjects (i.e, > = 80 years old) asking for driving license renewal. We hypothesize that, even in this highly functioning population, age, sex, and education influence cognitive performance, expressed as total or single domain (raw) test scores. This research question allows to describe, identify, and preserve independence of subjects still able to drive safely. Methods: We examined cross-sectionally a cohort of > = 80 years old subjects (at enrollment) asking for driving license renewal in the Milan area, Italy, 2011-2017. The analysis was restricted to 3378 first and 863 second visits where individual's cognitive performance was evaluated. According to the study protocol, the Mini Mental State Examination (MMSE) test was administered at the first visit for driving license renewal and the Montreal Cognitive Assessment (MoCA) test at the second visit, following an additional renewal request. Ordinary least squares regression models were fitted at either time points. In each model, we included age, sex, and education as independent variables, whereas the dependent variable was total or single domain score for either test. In total, we fitted 15 regression models to assess our research hypothesis. Results: The median subject in our sample reached the maximum scores on domains targeting operational and tactical abilities implied in safe driving, but had sub-optimal scores in the long-term memory domain included among the strategic abilities. In multiple models, being > = 87 (versus 80- < 86 years old) significantly decreased the mean total and memory scores of MMSE, but not those of the MoCA. Females (versus males) had significantly higher mean total and long-term memory scores of either tests, but not other domains. Mean total and single domain scores increased for increasing education levels for either tests, with increments for high school graduates being ~ 2 of those with (at most) a junior high school diploma. Conclusions: Sex and education, as well as age to a lesser extent, predict cognitive functioning in our oldest old population, thus confirming that concepts like cognitive reserve and successful ageing are valuable constructs in the identification of older subjects still able to drive.
Article
As ageing population is growing faster, traffic accidents involving elderly drivers become a serious social problem in South Korea. The present study aims to examine the impact of environmental characteristics on the injury severity of accidents involving elderly drivers in Seoul, South Korea. To achieve the purpose, the study divided elderly drivers into the following two groups: young-elderly drivers aged 65–69 years and middle- and old-aged drivers over 69 years old. The study also analysed non-elderly drivers aged 30 to 64 years as the comparative group. The study used the generalised ordered logit model, which is widely used to analyse data with ordinal scales. The findings from the study draw attention to the fact that (1) the characteristics of traffic accidents by injury severity considerably differed by age group. (2) risk of accident severity involving elderly drivers increase in areas with heavy traffic volumes and facilities that may create a complex driving condition to elderly drivers, (3) since elderly drivers tend to require longer response time with impaired vision under complex driving environment, it increased the risk of traffic accidents that older drivers face a higher risk of fatal injuries than younger counterparts. Thus, in order to reduce traffic accidents involving elderly drivers, the traffic safety policies should take environmental characteristics as well as the human factor concerning elderly drivers’ difficulties because of ageing and longer cognitive response time. This study contributes to the research in traffic accidents involving elderly drivers in that not only the accident characteristics (human factors, road condition, weather), mostly used for traffic accident analysis, but also environmental factors concerning the urban characteristics of Seoul Metropolitan City were analysed to compare the risk of traffic accidents and accident severity by age groups.
Article
The number of crashes and fatalities rate in the Commonwealth of Kentucky, U.S., have been higher than the national average for the past decades. It has been hypothesized that the distinct socioeconomic conditions of the state could be contributing to and explaining these trends. This study investigated the influence of socioeconomic characteristics on highway safety in Kentucky and attempted to identify the high-risk driver groups, based on crash data and the socioeconomic and demographic features of their residence zip codes. The quasi-induced exposure technique and binary logistic regression were employed to develop a predictive modeling approach for determining the probability of being the at-fault driver in a single- and two-unit crashes, based on socioeconomic characteristics of the driver residence zip code. The study identified that socioeconomic features such as income, poverty level, employment, age, gender, rurality, and number of traffic-related convictions of a driver’s zip code influence their likelihood to be at fault in a two-unit crash, while for single-unit crashes, in addition to these variables, educational attainment had also an impact. Younger and older drivers living in zip codes with low socioeconomic conditions have a higher probability to be the at-fault driver in both single- and two-unit crashes. The conclusions of the study can be used to determine the regions (zip codes) and driver groups with higher likelihood to be the at-fault driver in a crash and develop effective safety programs for the target groups.
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Accidents rank third among the top 10 leading causes of death in Louisiana, claiming more than 2,000 lives out of a total of almost 33,000 deaths. Drivers’ characteristics (age and gender), the geometry of the roadways, driving on the major roadways, the day of the week, and the wet or dry condition or the road have been associated with crash severity. This study applies unordered multinomial logistic models to investigate causes leading to crash severity in Louisiana. Several models were estimated and the best results were retained for presentation and discussion. Consistent with previous research, findings suggest that drivers’ gender and age matter for traffic safety. Individually, male and older drivers are too risky. Major roads, weekdays, dry surfaces, and road geometry increase the risk of fatal accidents. Male drivers are prone to severe and fatal accidents while old drivers are vulnerable to all types of accidents. Young drivers and female drivers feature among cases of injury and moderate accidents. Evidence suggests that crash severity is not ethnicity specific, contrary to some studies. This study is relevant because it builds a new dataset for safety research, identifies risk factors, and informs the aim of public safety policy to reduce loss of life, injuries, and costs resulting from motor vehicle accidents.
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To enable older drivers to maintain mobility without endangering public safety, it is necessary to develop more effective means of assessing their fitness-to-drive as alternatives to an on-road driving test. In this study, a functional ability test, simulated driving test, and on-road driving test were carried out for 136 older drivers. Influencing factors related to fitness-to-drive were selected based on the correlation between the outcome measure of each test and the pass/fail outcome of the on-road driving test. Four potential alternatives combining different tests were considered and three modeling techniques were compared when constructing the fitness-to-drive assessment model for the elderly. As a result, 92 participants completed all of the tests, of which 61 passed the on-road driving test and the remaining 31 failed. A total of seven influencing factors from all types of tests were selected. The best model was trained by the technique of gradient boosted machine using all of the seven factors, generating the highest accuracy of 92.8%, with sensitivity of 0.94 and specificity of 0.90. The proposed fitness-to-drive assessment method is considered an effective alternative to the on-road driving test, and the results offer a valuable reference for those unfit‐to‐drive older drivers to either adjust their driving behavior or cease driving.
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Driving is a complicated process whose consequences can be serious and irreversible if medical impairments affect key functional abilities. Dementia and cognitive decline from other etiologies (e.g., stroke, brain injury) can also impair driving abilities, so it is important to understand their potential consequences. The crash histories of 1,691 drivers from Missouri reported to state authorities from various sources in 2001 to 2005 as having cognitive impairment and 11,615 age- and gender-matched controls were compared. The results showed that about 30% of the cognitively impaired drivers had been in a crash in the 3 years before being reported to state authorities, compared with only 7% of controls in the same period. Cognitively impaired drivers who crashed were also found to be more often involved in multiple crashes [19.8% Alzheimer’s disease (AD), 21.5% cognitive impairment, 30.3% brain injury] than the controls (8%). Cognitively impaired drivers were in significantly more fatal and disabling injury crashes (4.7% AD, 4.3% cognitive impairment, 7% brain injury) than controls (2.7%). Earlier identification of cognitive impairment and intervention for driver fitness may reduce the frequency of crashes for older drivers. The challenges of those who turn out to be medically unfit to drive must be addressed with improved transportation support.
Due to the rapid ageing of the population, the number of traffic accidents involving elderly drivers has dramatically increased in Northeast Asia countries including South Korea. In order to ensure the mobility of elderly drivers and prevent the risk of accidents, it is necessary to consider various factors, which may affect elderly drivers while driving in urban areas. The primary goal of this study is to examine the characteristics of elderly drivers' traffic accidents in urban areas using spatial econometrics models. The study reveals that the highly populated areas (e.g. commercial areas, employment centres, and subway station catchment areas) have a higher risk of accidents involving elderly drivers. Also, due to an increase in cognitive response time and physical ageing of the elderly, the factors which represent complex driving condition for elderly drivers (e.g. traffic islands, intersections, and school zones) are found to be positively associated with the risk of accidents.
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A series of pilots and studies of Mobility-as-a-Service have launched out in recent years, but services are generally recognized as still at the early stage of development, whether in terms of its concept, the level of urban construction and the acceptance of travellers. According to the earlier explorative study of MaaS in a workshop in the UK, the result referred to the lack of consensus among stakeholders and the mismatch of value propositions between service providers and users. This leads to the early market not fully considering the requirements of the different group of travellers, especially for the older people. Therefore, this study reviewed previous literature and summarized the logic relation of the relevant factors, in order to provide the evidence for future sustainable development of MaaS on the aspect of increasing older travellers’ social participation.
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Background: Car accidents due to unexpected forward or backward runaway by older drivers are a serious social problem. Although the cause of these accidents is often attributed to stepping on the accelerator instead of the brake, it is difficult to induce such pedal application errors systematically with usual drive simulators. We developed a simple personal computer system that induces the pedal errors, and investigate the effects of age on the error behaviors. Methods: The system consisted of a laptop computer and a three-pedal foot mouse. It measured response time, accuracy, and flexibility of pedal operation to visual stimuli. The system displayed two open circles on the computer display, lighting one of the circles in a random order and interval. Subjects were instructed to press the foot pedal with their right foot as quickly as possible when the circle was lit; the ipsilateral pedal to the lit circle in a parallel mode and the contralateral pedal in a cross mode. When the correct pedal was pressed, the light went off immediately, but when the wrong pedal was pressed, the buzzer sounded and the light remained on until the correct pedal was pressed. During a 6-min trial, the mode was switched between parallel and cross every 2 min. During the cross mode, a cross mark appears on the display. The pedal responses were evaluated in 52 subjects divided into young (20-29 years), middle-aged (30-64 years), and older (65-84 years) groups. Additionally, the repeatability of the pedal response characteristic indicators was examined in 14 subjects who performed this test twice. Results: The mean response time was 95 ms (17%) longer in the older group than in the young group. More characteristically, however, the older group showed 2.1 times more frequent pedal errors, fell into long hesitations (response freezing > 3 s) 16 times more often, and took 1.8 times longer period to correct the wrong pedal than the young groups. The indicators of pedal response characteristics showed within-individual repeatability to the extent that can identify the age-dependent changes. Conclusions: Hesitations and extended error correction time can be associated with increased crash risk due to unexpected runaway by older drivers. The system we have developed may help to uncover and evaluate physiological characteristics related to crash risk in the elderly population.
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Older drivers are most at risk of serious and fatal injury in crashes per vehicle mile driven compared with other age groups owing to a combination of cognitive decline and increased fragility. A smartphone coaching application targeting risky driving behaviors (e.g., speeding, hard braking), was iteratively designed to ensure older driver acceptance and usability. A 12-week field operational test examined driving performance of 28 drivers aged 65 to 78 from Kansas and Minnesota using the RoadCoach app and an ABA reversal design. Participants’ baseline driving behaviors were recorded for 3 weeks, followed by a 6-week experimental phase of real-time app coaching, and concluded with a 3-week baseline phase with no feedback provided. Compared with the pretreatment phase, there was a significant reduction in the rates of hard braking and stop sign violations associated with system use. A protection effect was observed through the posttreatment phase. Excessive speeding violations were not significantly different across the phases; however, there were modest declines in the proportion of miles traveled 15 mph above the speed limit in the posttreatment phase compared with the prior two phases. No significant effect was found for excessive acceleration and aggressive turning measures posttreatment, despite an observed increase in both rates during the treatment phase compared with pretreatment. Overall, the results indicate that the RoachCoach app may be an effective intervention to reduce several risky driving behaviors while in use and may result in prolonged behavior changes (i.e., reduced hard braking and stop sign violations) after treatment cessation.
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The present study examined State of Michigan Traffic Crash Reports filed between 2015 and 2019 to explore the interaction between age and liability for crashes at stop-sign-controlled intersections. A driver’s liability for a crash was derived from the “Hazardous Action” field in each crash report. The likelihood of assigning liability to an elderly driver was examined in light of pre-crash actions defined in each report’s “Actions Prior to Crash” field. Logistic regression was applied to calculate odds ratios used to explain the likelihood. Furthermore, Random Forest machine learning technique was used to predict driver liability based on pre-crash actions. Distraction, number of travel lanes, and driving under the influence of alcohol or drugs were significant predictors of the likelihood that an elderly driver was at-fault in a crash. A “going straight” pre-crash action by an elderly driver was the best indicator of liability, regardless of the pre-crash action by a young driver. For interaction scenarios, an elderly driver going straight at a stop-sign-controlled intersection was associated with a lower likelihood of being liable for a crash. Turning actions increased the likelihood of the elderly driver being liable for a crash. The results can be used to appraise countermeasures that improve the safety of elderly drivers at stop-controlled intersections.
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Purpose of Review Loss of the ability to drive is highly associated with depressive symptoms in older persons. There are many reasons why an individual may give up driving, poor vision being an important one. Given the high prevalence of glaucoma in this population and the critical role that vision plays in the ability to drive, it is therefore important to consider how glaucomatous vision loss plays into the ability to drive safely. Recent Findings In this review article, we will summarize the literature on the topic of glaucoma and driving and the studies that have been done to evaluate this topic. Studies of both the self-perceived impact of glaucomatous visual field loss on driving as well as studies that include on-road and simulated driving experiments will be reviewed. Summary We will discuss how patients with glaucoma may be assessed for their driving safety and review how we treat and evaluate these patients in our own practices.
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Introduction: Certain cognitive and physical conditions have been associated with increased risk of injury, particularly risk of vehicle crashes among older car drivers. This study aims to examine the association of seven select medical conditions among hospitalised road users compared to other hospitalised injuries, and to estimate the hospitalised injury rates of car drivers, car passengers and pedestrians with these medical conditions. Method: An examination of road transport and nonroad transport hospitalised injury involving adults aged ≥50 years identified during 2003-2012 in New South Wales, Australia was conducted. Medical conditions were identified from hospital diagnosis records. Conditional fixed effects logistic regression conditioned on the matched cases and comparison-cohort estimated odds ratios for each medical condition by road user type. Results: There were 35,134 road transport injuries (10,664 car drivers and 4,907 pedestrians) and 447,858 nonroad transport injuries. Individuals with vision disorders, cardiovascular disease including stroke, diabetes, and osteoarthritis had higher odds of hospitalisation for an injury as a car driver compared to all other hospitalised injuries. Individuals with diagnoses of dementia or alcohol dependence had a lower odds of an injury hospital admission as a road user (excluding pedestrians) compared to all other hospitalised injuries. Conclusions: As the population ages, there are likely to be more older road users with comorbidities that may affect their ability to drive or safely cross the road. Community mobility strategies need to take into account the influence of comorbid health conditions for older adults.
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Introduction This study (1) provides annual population estimates of fatal and nonfatal injury incidence rates for older adults for 2004–2017; (2) determines if trends differ by whether the injury was fatal or nonfatal, a fall or nonfall injury, and for nonfatal injuries, minor or serious; and (3) investigates whether trends vary by age, sex, and race. Methods This study used National Vital Statistics System and National Health Interview Survey data covering the population of adults aged ≥65 years for 2004–2017. Fatal injury incidence rates were estimated using negative binomial models; nonfatal injury incidence rates were estimated using Poisson models. All models compared overall risk and trend differences by year, age, sex, and race, and interactions between year and age, sex, and race. All analyses were conducted in 2019. Results Fatal injury incidence was stable over time, but this apparent stability masked a 35% increase in fatal falls and a 17% decrease in fatal nonfall injuries. Increases in fall-related deaths were concentrated among those aged ≥85 years, men, and white older adults. The trend in fatal falls accelerated over time for those aged ≥85 years and white older adults. By contrast, there was a large increase in nonfatal injury incidence, occurring across all injury types. Nonfatal injury risk grew with age and was higher for women and white older adults, but trends did not vary by age, sex, or race. Conclusions Large increases in fatal and nonfatal injuries underscore the urgency of national implementation of fall prevention programs and expanding fall prevention efforts to more general injury prevention.
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The aim of this study was to evaluate the effects of driver-related factors on crash involvement of four different types of commercial vehicles—express buses, local buses, taxis, and trucks—and to compare outcomes across types. Previous studies on commercial vehicle crashes have generally been focused on a single type of commercial vehicle; however, the characteristics of drivers as factors affecting crashes vary widely across types of commercial vehicles as well as across study sites. This underscores the need for comparative analysis between different types of commercial vehicles that operate in similar environments. Toward these ends, we analyzed 627,594 commercial vehicle driver records in South Korea using a mixed logit model able to address unobserved heterogeneity in crash-related data. The estimated outcomes showed that driver-related factors have common effects on crash involvement: greater experience had a positive effect (diminished driver crash involvement), while traffic violations, job change, and previous crash involvement had negative effects. However, the magnitude of the effects and heterogeneity varied across different types of commercial vehicles. The findings support the contention that the safety management policy of commercial drivers needs to be set differently according to the vehicle type. Furthermore, the variables in this study can be used as promising predictors to quantify potential crash involvement of commercial vehicles. Using these variables, it is possible to proactively identify groups of accident-prone commercial vehicle drivers and to implement effective measures to reduce their involvement in crashes.
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Older adults have become a larger part of the driving population, but whether they are at increased risk of being involved in fatal crashes remains unclear. Methods: We performed a systematic review of studies investigating fatal crash involvement of older vs non-older drivers by searching the following databases: PubMed, Cochrane Library, Embase, LILACS, SciELO, Web of Science, and ProQuest. Studies that used fatal crash involvement rates per distance driven as a measure of frequency were selected for meta-analysis. Results: We analyzed 14 studies published between 2001 and 2018. Of these, 12 reported a higher rate of fatal crashes involving older drivers than non-older drivers; 9 of them used involvement rates per distance driven, which is considered the most appropriate metric. The meta-analysis revealed high heterogeneity between studies. The meta-regression attributed 40% of the heterogeneity to age (older vs non-older drivers) (p<0.005). Conclusion: Age appears to be associated with higher driver involvement rates for fatal crashes among older persons. PROSPERO registration number: CRD42020169441.
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Traffic injury trends have changed with safety developments. To establish effective preventive measures against traffic fatalities, the factors influencing fatalities must be understood. The present study evaluated data from a national medical database to determine the changes in these factors over time, as this has not been previously investigated. This observational study retrospectively analysed data from the Japanese Trauma Data Bank. Vehicle passengers involved in collisions from 2004–2008 and 2016–2017 were included. Data were compared between the two study periods, and between fatal and non-fatal patients within each period. Multivariate logistic regression analyses were performed to determine the factors influencing fatalities. In 2016–2017, patients were older and had lower fatality rates. In 2004–2008, fatalities were more likely to involve older male front-seat passengers with low d-BP, BT, and GCS values, and high AIS of the neck and abdomen. However, in 2016–2017, fatalities were more likely to involve older males with low GCS, high AIS of the abdomen, and positive focused assessment with sonography for trauma results. Our study identified independent factors influencing vehicle passenger fatalities, which will likely continue to evolve with the aging of the population and changing manners of injury.
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Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills. To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers. Prospective cohort study with 3 years of follow-up, 1990-1993. Ophthalmology clinic assessment of community-based sample. A total of 294 drivers aged 55 to 87 years at enrollment. Motor vehicle crash occurrence. Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations. Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.
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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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The youngest and oldest drivers have the highest crash risk, but the problem lies predominantly in the youngest age groups because elderly drivers have low exposure. The elderly driver problem will increase gradually as their share of the population increases but will remain relatively small. The bulk of the problem will continue to reside among drivers younger than age 65, particularly the youngest drivers.
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The question of the risks older drivers face, and impose on others, was addressed by examining as a function of age and sex: (a) driver involvement in crashes in the same high severity range; (b) the threat drivers pose to pedestrians; and (c) the contribution of motor vehicle fatalities to overall mortality. National data files provide source information on traffic fatalities, population, number of licensed drivers, distance of travel, and mortality from all causes. Involvement rates in severe crashes are inferred from fatality data using recently published relations linking occupant survivability to age and sex. In no case among 14 measures examined did the value at the oldest age for which data were available (varied from source to source) exceed that for young drivers. Although some risks that drivers face may increase at older ages to levels above their minimum values, the increases are small compared to the substantial reductions in distances driven with increasing age; thus, reductions in mobility may be a more dominant correlate of aging than reductions in driving safety.
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A method for comparing death rates of groups of injured persons was developed, using hospital and medical examiner data for more than 2,000 persons. The first step was determination of the extent to which injury severity as rated by the Abbreviated Injury Scale correlates with patient survival. Substantial correlation was demonstrated. Controlling for severity of the primary injury made it possible to measure the effect on mortality of additional injuries. Injuries that in themselves would not normally be life threatening were shown to have a marked effect on mortality when they occurred in combination with other injuries. An Injury Severity Score was developed that correlates well with survival and provides a numerical description of the overall severity of injury for patients with multiple trauma. Results of this investigation indicate that the Injury Severity Score represents an important step in solving the problem of summarizing injury severity, especially in patients with multiple trauma. The score is easily derived, and is based on a widely used injury classification system, the Abbreviated Injury Scale. Use of the Injury Severity Score facilitates comparison of the mortality experience of varied groups of trauma patients, thereby improving ability to evaluate care of the injured.
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This paper examines the degree to which older drivers impose an "excess" risk of death or injury serious enough to require hospitalization on other road users; that is, the amount of risk older drivers impose on others above and beyond the amount imposed by drivers who are not yet old. A data set linking crash information from police accident reports to hospital discharge data in Wisconsin, 1991, was used to analyze excess risk associated with older drivers in two ways. First, the difference in the rate of serious injuries to other road users per 100 million driver age-group miles was used to estimate the total number of serious injuries resulting from the excess risk imposed on others by older drivers. Second, statistical models were used to infer the association between driver age and crash severity while conditioning on a variety of crash-specific information. Drivers aged 65-74 did not appear to impose excess risk of either deaths or injuries requiring hospitalization in either the aggregate or individual level analyses. Drivers aged 75 and over are associated with increased injuries to others, although the actual number is very small; the individual crash-level analysis suggests that a non-trivial part of the excess risk found in the aggregate analysis is a product of confounding.
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Risk of fatal crash involvement was calculated for older drivers relative to drivers aged 40-49 in the United States during the years 1994-1995. The results indicated that drivers ages 65-69 were 2.26 times more at risk for multiple-vehicle involvements at intersections compared with 1.29 times more at risk in all other situations. The comparable figures for drivers aged 85 and older were 10.62 for multiple-vehicle involvements at intersections compared with 3.74 for all other situations. The relative crash risk was particularly high for older drivers at uncontrolled and stop sign-controlled locations; when traveling straight or when just starting to enter the intersection; and when the specific behavioral error in the crash was failure to yield. Countermeasures will likely involve reducing or simplifying the need to detect and evaluate moving traffic coming from the left and right when at intersections. This can be accomplished by traffic signals with protected left turns, four-way stop signs, and one-way streets. Whereas such devices involve significant cost in terms of dollars and travel delay, their cost-effectiveness may have to be revisited as the United States population continues to age.
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An exploratory study is being conducted jointly by the California Department of Motor Vehicles and the National Highway Traffic Safety Administration to develop a licensing agency assessment battery for elderly drivers with dementia or other aging-related medical conditions. A preliminary battery of nondriving tests and road tests is described; test results for a small pilot sample are presented, and the tests are evaluated in terms of their utility for detecting functional impairment and predicting driving performance. Some considerations that shape construction of a test battery for licensing agency use are discussed in relation to these goals and the givens of a driver licensing environment.
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This paper reports on the usefulness of five brief tests of cognitive function for identifying older drivers who may be at increased risk of crash involvement; it also examines the broader issue of whether impaired cognitive function is associated with increased crash risk in the older driver population. Data for the study were collected from 3238 drivers aged 65 and older applying for renewal of their North Carolina driver's license. The specific cognitive assessments examined include the Trail Making Test parts A and B, the Short Blessed Orientation-Memory-Concentration test of cognitive impairment, a modification of the American Association of Retired Persons 'Reaction Time' test, and a timed Traffic Sign Recognition test. Information on crash involvements during the 3-year period prior to testing was obtained by linkage with the North Carolina driver history file. Although the individual tests were not found to be particularly effective screening tools for identifying subsets of high risk drivers, cognitive test performance remained significantly associated with crash risk even after controlling for driver age, race and measures of driving exposure. Drivers who scored in the lowest 10% on the cognitive tests were approx. 1.5 times more likely to be in crashes than were drivers who scored in the highest 10%. Implications for the counseling and licensing of older drivers are discussed, along with recommendations for future research.
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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.
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To examine the secular trends of mortality from motor vehicle crashes, the authors compiled annual population and mortality data for the United States from 1910 to 1994 and performed an age-period-cohort analysis through graphical presentation, median polish, and Poisson regression modeling. During the 85-year study period, death rates from motor vehicle crashes showed two peaks, first in 1935-39 and then in 1965-69. Age and period effects accounted for 94% of the variation in motor vehicle mortality in men and 84% of the variation in women. Age patterns of motor vehicle mortality varied greatly with birth cohorts: for those who were born before 1910, death rates increased with age; for those born after 1910, death rates peaked at age 20-24 years for men and at age 15-19 years for women. A crossover characterized by a downward trend in death rates among the elderly and an upward trend among adolescents and young adults was observed in both sexes. The complex age, period, and cohort patterns of motor vehicle mortality are likely to have been shaped by changes in traffic patterns and driver behavior, and by improvements in safety design and emergency medical service systems.
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To evaluate the association between chronic medical conditions, functional, cognitive, and visual impairments and driving difficulty and habits among older drivers. Cross-sectional study. Mobile County, Alabama. A total of 901 residents of Mobile County, Alabama aged 65 or older who possessed a driver's license in 1996. Information on demographic characteristics, functional limitations, chronic medical conditions, driving habits, and visual and cognitive function were collected via telephone. The three dependent variables in this study were difficulty with driving, defined as any reported difficulty in > or = 3 driving situations (e.g. at night), low annual estimated mileage, defined as driving less than 3000 miles in 1996, and low number of days ( < or = 3) driven per week. A history of falls, kidney disease or stroke was associated with difficulty driving. Older drivers with a history of kidney disease were more likely to report a low annual mileage than subjects without kidney disease. Low annual mileage was also associated with cognitive impairment. In general, older drivers with a functional impairment were more likely to drive less than 4 days per week. Older drivers with a history of cataracts or high blood pressure were more likely to report a low number of days driven per week, while subjects with visual impairment were at increased risk of experiencing difficulty driving as well as low number of days driven per week. The results underscore the need to further understand the factors negatively affecting driving independence and mobility in older drivers, as well as the importance of improved communication between older adults and health care professionals regarding driving.
Article
Using multiple national data systems, the roles of fragility (susceptibility to injury) versus excessive crash involvement in the increased fatality risk of older drivers per vehicle-mile of travel (VMT) were estimated. For each age and gender group, deaths per driver involved in a crash (a marker of fragility) and drivers involved in crashes per VMT (a marker of excessive crash involvement) were computed. Compared with drivers ages 30-59, those younger than 20 and those 75 or older both had much higher driver death rates per VMT. The highest death rates per mile driven, 13-fold increases, were observed among drivers age 80 or older, who also had the highest death rates per crash. Fragility began to increase at ages 60-64 and increased steadily with advancing age, accounting for about 60-95% of the excess death rates per VMT in older drivers, depending on age group and gender. Among older drivers, marked excesses in crash involvement did not begin until age 75, but explained no more than about 30-45% of the elevated risk in this group of drivers; excessive crashes explained less of the risk among drivers ages 60-74. In contrast, crash over-involvement was the major factor contributing to the high risk of death among drivers younger than 20, accounting for more than 95% of their elevated death rates per VMT. Although both fragility and crash over-involvement contributed to the excess death rates among older drivers per VMT, fragility appeared to be of over-riding importance. These findings suggest that measures to improve the protection of older vehicle occupants in crashes should be vigorously pursued.
Designing vehicle interiors for the mature driver. Presented at Aging and Driving Symposium
  • M Vala
Vala M. Designing vehicle interiors for the mature driver. Presented at Aging and Driving Symposium, February 19-20, 2001, Southfield, MI. Des Plaines, IL: Association for the Advancement of Automotive Medicine.
Mobility and independence: changes and challenges for older drivers
  • Je Burkhardt
  • Am Berger
  • M Creedon
21 Burkhardt JE, Berger AM, Creedon M, et al. Mobility and independence: changes and challenges for older drivers. Report to the US Department of Health and Human Services and the National Highway Traffic Safety Administration Coordinating Council on Mobility and Access, 1998.
An aging population: fragile, handle with care DC: National Highway Traffic Safety Administration
  • Sc Wang
Wang SC. An aging population: fragile, handle with care. Washington, DC: National Highway Traffic Safety Administration. Available: http://www.nhtsa.dot.gov/departments/nrd-50/ciren/um_fragile.html. Accessed: 27 July 2001.
Nationwide personal transportation survey DC: US Department of Transportation Available: http://www-cta.ornl.gov/npts
  • Federal Highway Administration
Federal Highway Administration. 1995 Nationwide personal transportation survey. Washington, DC: US Department of Transportation, 1997. Available: http://www-cta.ornl.gov/npts/1995/ Doc/index.shtml. Accessed: 28 January 2002.
Age effects on thoracic injury tolerance. SAE technical paper series 962421
  • Q Zhou
  • S W Rouhana
  • J W Melvin
Zhou Q, Rouhana SW, Melvin JW. Age effects on thoracic injury tolerance. SAE technical paper series 962421. Warrendale, PA: Society of Automotive Engineers, 1996.
Restraint system optimization for an older occupant population. Presented at Aging and Driving Symposium
  • R Kent
Kent R. Restraint system optimization for an older occupant population. Presented at Aging and Driving Symposium, 19-20 February 2001, Southfield, MI. Des Plaines, IL: Association for the Advancement of Automotive Medicine.
Report to the US Department of Health and Human Services and the National Highway Traffic Safety Administration Coordinating Council on Mobility and Access
  • J E Burkhardt
  • A M Berger
  • M Creedon
Burkhardt JE, Berger AM, Creedon M, et al. Mobility and independence: changes and challenges for older drivers. Report to the US Department of Health and Human Services and the National Highway Traffic Safety Administration Coordinating Council on Mobility and Access, 1998.
An aging population: fragile, handle with care
  • S C Wang
Wang SC. An aging population: fragile, handle with care. Washington, DC: National Highway Traffic Safety Administration. Available: http://www.nhtsa.dot.gov/departments/nrd-50/ciren/um_fragile.html. Accessed: 27 July 2001.