Cognitive problems,self-rated changes in driving skills,driving-related discomfort and self-regulation of driving in old drivers

Ageing in general is associated with functional decline that may have an adverse effect on driving. Nevertheless, older drivers have been found to show good judgement and to self-regulate their driving, which may enable them to continue driving safely despite functional decline. The process of the self-monitoring of driving ability and the awareness of functional decline, and its association with the self-regulation of driving is, however, not fully understood. The aim of the present study was to examine the perceived changes in driving skills, the discomfort experienced in driving, and the self-regulation of driving as measured by the avoidance of certain driving situations by older drivers with different levels of self-rated cognitive problems. Eight hundred and forty Danish drivers aged 75–95 completed a structured telephone interview. The results showed that the recognition of cognitive problems was associated with an experience of improvement in higher level driving skills but also of a decline in lower level driving skills. Moreover, cognitive problems recognised by drivers were associated with discomfort in, and avoidance of, driving situations. Finally, a linear relationship between discomfort in driving and avoidance was found and this tended to be stronger for drivers recognising cognitive problems. The results indicate that older drivers who recognise problems with cognitive functions display good self-assessment of changes in their driving skills. In addition, the results suggest that driving-related discomfort is an important factor affecting the self-regulation of driving. Finally, the findings indicate that driving-related discomfort functions as an indirect self-monitoring of driving ability and may contribute to the safe driving performance of Danish older drivers.     

Addressing the road trauma burden in China: Exploring attitudes,behaviours, risk perceptions and cultural uniqueness

As China continues to motorise rapidly, solutions are needed to reduce the burden of road trauma that is spread inequitably across the community. Little is currently known about how new drivers are trained to deal with on-road challenges, and little is also known about the perceptions, behaviours and attitudes of road users in China. This paper reports on a pilot study conducted in a driver retraining facility in one Chinese city where people who have had their licence suspended for accrual of 12 demerit points in a one year period must attend compulsory retraining in order to regain their licence. A sample of 239 suspended drivers responded to an anonymous questionnaire that sought information about preferred driving speeds and perceptions of safe driving speeds across two speed zones. Responses indicated that speeds higher than the posted limits were commonly reported, and that there was incongruence between preferred and safe speeds, such that a greater proportion of drivers reported preferred speeds that were substantially faster than what were reported as safe speeds. Participants with more driving experience reported significantly fewer crashes than newly licensed drivers (less than 2 years licensed) but no differences were found in offences when compared across groups with different levels of driving experience. Perceptions of risky behaviours were assessed by asking participants to describe what they considered to be the most dangerous on-road behaviours. Speeding and drink driving were the most commonly reported by far, followed by issues such as fatigue, ignoring traffic rules, not obeying traffic rules, phone use while driving, and non-use of seatbelts, which attracted an extremely low response which seems consistent with previously reported low belt wearing rates, unfavourable attitudes towards seatbelt use, and low levels of enforcement. Finally, observations about culturally specific considerations are made from previous research conducted by the authors and others. Specifically, issues of saving face and the importance and pervasiveness of social networks and social influence are discussed with particular regard to how any future countermeasures need to be informed by a thorough understanding of Chinese customs and culture.     

Health literacy of older drivers and the importance of health experience for self-regulation of driving behaviour

This study provides much needed information on the education level of older drivers regarding the impact of health conditions and medications on personal driving safety, where they source this information, and how this knowledge influences self-regulation of driving. Random and convenience sampling secured 322 Australian drivers (63.9% males) aged 65 years and over (M = 77.35 years, SD = 7.35) who completed a telephone interview. The majority of respondents (86%) had good knowledge about health conditions (health knowledge) and driving safety, however more than 50% was classified as having poor knowledge on the effects of certain medications (medication knowledge) and driving safety. Poorer health knowledge was associated with a reduced likelihood of driving over 100 km in adjusted models. Being older and having more than one medical condition was found to increase the likelihood of self-regulation of driving. Results indicate that health knowledge was less important for predicting driving behaviour than health experience. Of great interest was that up to 85.7% of respondents reported not receiving advice about the potential impact of their medical condition and driving from their doctor. The findings indicate a need for improved dissemination of evidence-based health information and education for older drivers and their doctors.     

Reprint of “Driving avoidance by older adults: Is it always self-regulation?”

Self-regulation shows promise as a means by which older adults can continue to drive at some level without having to stop altogether. Self-regulation is generally described as the process of modifying or adjusting one's driving patterns by driving less or intentionally avoiding driving situations considered to be challenging, typically in response to an awareness that driving skills have declined. However, most studies asking older adults whether they avoid certain driving situations or have reduced the amount of driving they do under certain circumstances have not delved deeper into the motivations for such avoidance or driving reduction. There are many reasons for modifying driving that have nothing to do with self-regulation, such as no longer needing to take trips at certain times of day because of changes in preferences or lifestyles. The purpose of this study was to examine self-regulatory practices among older adults at multiple levels of driver performance and decision making, taking into account the specific motivations for avoiding particular driving situations or engaging in other driving practices. Study participants completed a computer-based questionnaire on driving self-regulation. Results suggest that self-regulation is a complex process that cannot be defined simply by the reported driving modifications made by drivers. Understanding the motivations for these behaviors is necessary and the study showed that they are varied and differ considerably across driving situations. Reasons for driving avoidance or other practices were often more closely related to lifestyle or preferences than to self-regulation. Based on these findings, three distinct groups were identified with regard to whether and for what reasons participants modified their driving.     

Self-regulatory driving practices among older adults: health, age and sex effects

The purpose of this study was to better understand how older adults self-regulate driving, and to identify differences by age, sex, and health-related functioning. Michigan drivers over age 64 were surveyed by telephone (n=961, age [mu=74.2, sigma=5.8], 56% female) about their driving-related behaviors, physical functioning, and health. Respondents were presented with scenarios involving driving to an important appointment under adverse conditions (rainy stormy weather, on alternate route in heavy freeway traffic, 200-mile trip on unfamiliar roads). Generalized logit models examined outcomes for each scenario: driving as usual, driving with modifications, and not driving. Results indicate that the effect of sex on self-regulation was significant and greater than that of age and physical functioning. Women were more likely to self-regulate by not driving. Odds ratios and 95% confidence limits for each scenario for women vs. men are 6.8 (3.8-2.0), 6.5 (3.6-12.0), and 17.7 (11.0-28.6). The effect of sex on self-regulation by modifying driving was smaller and significant only in scenarios 2 and 3. Women were more likely then men to modify driving for scenario 2 (odds ratio, 3.0 (2.0-4.5)) and scenario 3 (odds ratio 4.4 (3.1-0.1)). Overall, the study finds the relative effect of sex on self-regulation greater than that of age and physical functioning for conditions examined.     

Driving avoidance by older adults: Is it always self-regulation?

Self-regulation shows promise as a means by which older adults can continue to drive at some level without having to stop altogether. Self-regulation is generally described as the process of modifying or adjusting one's driving patterns by driving less or intentionally avoiding driving situations considered to be challenging, typically in response to an awareness that driving skills have declined. However, most studies asking older adults whether they avoid certain driving situations or have reduced the amount of driving they do under certain circumstances have not delved deeper into the motivations for such avoidance or driving reduction. There are many reasons for modifying driving that have nothing to do with self-regulation, such as no longer needing to take trips at certain times of day because of changes in preferences or lifestyles. The purpose of this study was to examine self-regulatory practices among older adults at multiple levels of driver performance and decision making, taking into account the specific motivations for avoiding particular driving situations or engaging in other driving practices. Study participants completed a computer-based questionnaire on driving self-regulation. Results suggest that self-regulation is a complex process that cannot be defined simply by the reported driving modifications made by drivers. Understanding the motivations for these behaviors is necessary and the study showed that they are varied and differ considerably across driving situations. Reasons for driving avoidance or other practices were often more closely related to lifestyle or preferences than to self-regulation. Based on these findings, three distinct groups were identified with regard to whether and for what reasons participants modified their driving.     

Examination of driving comfort and self-regulatory practices in older adults using in-vehicle devices to assess natural driving patterns

Several studies have shown that age, gender, visual problems and confidence are associated with self-regulatory practices such as reduced exposure and avoidance of night and highway driving. To date, however, self-regulation has only been examined through self-report. The purpose of this study was to further our understanding of the association between driver characteristics, perceptions and self-regulation by monitoring the patterns of 61 drivers (mean age 80.4 ± 5.5; 59% women) for one week using in-vehicle devices. Usual self-regulatory practices were assessed using the Situational Driving Frequency (SDF) and Avoidance (SDA) Scales, while perceptions were measured using the Driving Comfort and Perceived Driving Abilities Scales. Additional evidence for test-retest reliability was obtained with a separate sample of 39 older drivers. Lower comfort and poorer perceived abilities were significantly related to actual behavior: reduced exposure (km, duration) in general and at night, average and maximum radii from home and driving in challenging situations (such as on highways). Neither sex nor age was associated with any of the driving indicators. While longitudinal studies are required to determine temporality (when drivers change their behavior) and directionality (does lower comfort lead to driving restrictions or vice versa), this is the first study to demonstrate that driver perceptions are associated with actual self-regulatory practices.     

Self-regulation of driving and its relationship to driving ability among older adults

Although it is known that older drivers limit their driving, it is not known whether this self-regulation is related to actual driving ability. A sample of 104 older drivers, aged between 60 and 92, completed a questionnaire about driving habits and attitudes. Ninety of these drivers also completed a structured on-road driving test. A measure of self-regulation was derived from drivers' self-reported avoidance of difficult driving situations. The on-road driving test involved a standard assessment used to determine fitness to drive. Driving test scores for the study were based on the number of errors committed in the driving tests, with weightings given according to the seriousness of the errors. The most commonly avoided difficult driving situations, according to responses on the questionnaire, were parallel parking and driving at night in the rain, while the least avoided situation was driving alone. Poorer performance on the driving test was not related to overall avoidance of difficult driving situations. Stronger relationships were found between driving ability and avoidance of specific difficult driving situations. These specific driving situations were the ones in which the drivers had low confidence and that the drivers were most able to avoid if they wished to.     

The relationship between cognitive ability,insight and self-regulatory behaviors: Findings from the older driver population

Self-regulation is often promoted as a coping strategy that may allow older drivers to drive safely for longer. Self-regulation depends upon drivers making an accurate assessment of their own ability and having a willingness to practice self-regulatory behaviors to compensate for changes in ability. The current study explored the relationship between older drivers’ cognitive ability, their driving confidence and their use of self-regulation. An additional study aim was to explore the relationship between these factors and older drivers’ interest in driving programs. Seventy Australian drivers aged 65 years and over completed a questionnaire about their driving and a brief screening measure of cognitive ability (an untimed Clock Drawing Test). While all participants reported high levels of confidence regarding their driving ability, and agreed that they would continue driving in the foreseeable future, a notable proportion performed poorly on the Clock Drawing Test. Compared to older drivers who successfully completed the Clock Drawing Test, those who failed the cognitive test were significantly less likely to report driving self-regulation, and showed significantly less interest in being involved in driving programs. Older drivers with declining cognitive abilities may not be self-regulating their driving. This group also appears to be unlikely to self-refer to driving programs.     

Examining signs of driver sleepiness,usage of sleepiness countermeasures and the associations with sleepy driving behaviours and individual factors

The impairing effect from sleepiness is a major contributor to road crashes. The ability of a sleepy driver to perceive their level of sleepiness is an important consideration for road safety as well as the type of sleepiness countermeasure used by drivers as some sleepiness countermeasures are more effective than others. The aims of the current study were to determine the extent that the signs of driver sleepiness were associated with sleepy driving behaviours, as well as determining which individual factors (demographic, work, driving, and sleep-related factors) were associated with using a roadside or in-vehicle sleepiness countermeasure. A sample of 1518 Australian drivers from the Australian State of New South Wales and the neighbouring Australian Capital Territory took part in the study. The participants’ experiences with the signs of sleepiness were reasonably extensive. A number of the early signs of sleepiness (e.g., yawning, frequent eye blinks) were related with continuing to drive while sleepy, with the more advanced signs of sleepiness (e.g., difficulty keeping eyes open, dreamlike state of consciousness) associated with having a sleep-related close call. The individual factors associated with using a roadside sleepiness countermeasure included age (being older), education (tertiary level), difficulties getting to sleep, not continuing to drive while sleepy, and having experienced many signs of sleepiness. The results suggest that these participants have a reasonable awareness and experience with the signs of driver sleepiness. Factors related to previous experiences with sleepiness were associated with implementing a roadside countermeasure. Nonetheless, the high proportions of drivers performing sleepy driving behaviours suggest that concerted efforts are needed with road safety campaigns regarding the dangers of driving while sleepy.     

Novice drivers' accidents and violations--a failure on higher or lower hierarchical levels of driving behaviour

The study compared accident and offence rates of 28 500 novice drivers in Finland. The purpose was to study differences in accident and offence rates between male and female novice drivers of different age. The drivers reported in a mailed questionnaire, how many accidents they had been involved in and how much they had driven during their whole driving career. All the drivers had a driving experience of 6–18 months. Information about offences for a 2-year period was obtained from an official register of drivers' licences. The drivers were classified into three age brackets: 18–20, 21–30 and 31–50 years. The effect of driving experience was controlled by dividing the drivers into different mileage brackets. The data was analysed and the results were discussed in the framework of the hierarchical model of driving behaviour. Young novice drivers and especially young male drivers showed more problems connected to the higher hierarchical levels of driving behaviour than middle-aged novice drivers. The number of accidents and offences was highest among the young males and their accidents took place more often at night than female or older drivers' accidents. Female drivers showed more problems connected to the lower hierarchical levels of driving behaviour, e.g. problems in vehicle handling skills. Ways of measuring accident risk of different driver groups were also discussed, as well as the usefulness and reliability of self-reports in accident studies.     

The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers

Visual processing impairment increases crash risk among older drivers. Many older drivers meet the legal requirements for licensing despite having vision impairments that elevate crash risk. In this study, 365 older drivers who were licensed, visually-impaired, and crash-involved in the prior year were randomly assigned to an intervention group or usual-eye-care control group to evaluate the efficacy of an educational intervention that promoted the performance of self-regulatory practices. The educational curriculum was designed to change self-perceptions about vision impairment and how it can impact driver safety and to promote the avoidance of challenging driving situations through self-regulation, leading to reductions in driving exposure. Analyses compared the intervention and control groups at pre-test and 6 months post-test with respect to self-reported perceptions about vision and driving practices. At post-test, drivers who had received the educational intervention were more likely to acknowledge that the quality of their eyesight was less than excellent, report a higher frequency of avoiding challenging driving situations (e.g. left-turns) and report performing more self-regulatory practices (e.g. three right-turns) as compared to controls. Additionally, drivers in the educational intervention group reported significantly fewer days, fewer places and fewer trips made per week as compared to those not receiving the educational intervention. These findings imply that visually-impaired older drivers at higher risk for crash involvement may benefit from educational interventions by reducing their driving exposure and increasing their avoidance of visually challenging driving situations. A critical future step in this research program will be to examine whether this educational intervention has an impact on the safety of these high-risk older drivers by reducing their crash involvement in the years following the educational intervention.     

Older female drivers: An emerging transport safety and mobility issue in Australia

This paper describes an investigation of safety, mobility and travel patterns in a sample of older women drivers and former drivers aged 60 years and over. Participants provided information on general health and functional abilities, travel and driving patterns, driving experiences and confidence, difficulty with and avoidance of driving situations, self-assessment of driving ability, crash and infringement history, the process and experiences leading up to stopping driving, and satisfaction with current mobility. The sample was a fairly active group, travelling frequently and substantial distances, and generally satisfied with their level of mobility. Current drivers were strongly interested in keeping driving for as long as possible, expressed strong concerns about the prospect of stopping driving and reported little evidence of self-regulation. In contrast, former drivers were less negative about driving cessation and mostly reported successful retirement from driving with few negative mobility consequences. Further, a number of relationships between crash involvement and driving experience, confidence of being a safe driver, and problems in driving situations were found. These findings have added to our understanding of the issues concerning the safety and mobility of older women. Implications for the promotion of safe driving practices are discussed.     

Impact of age and cognitive demand on lane choice and changing under actual highway conditions

Previous research suggests that drivers change lanes less frequently during periods of heightened cognitive load. However, lane changing behavior of different age groups under varying levels of cognitive demand is not well understood. The majority of studies which have evaluated lane changing behavior under cognitive workload have been conducted in driving simulators. Consequently, it is unclear if the patterns observed in these simulation studies carry over to actual driving. This paper evaluates data from an on-road study to determine the effects of age and cognitive demand on lane choice and lane changing behavior. Three age groups (20–29, 40–49, and 60–69) were monitored in an instrumented vehicle. The 40's age group had 147% higher odds of exhibiting a lane change than the 60's group. In addition, drivers in their 60's were less likely to drive on the leftmost lane compared to drivers in their 20's and 40's. These results could be interpreted as evidence that older adults adopt a more conservative driving style as reflected in being less likely to choose the leftmost lane than the younger groups and less likely to change lanes than drivers in their 40's. Regardless of demand level, cognitive workload reduced the frequency of lane changes for all age groups. This suggests that in general drivers of all ages attempt to regulate their behavior in a risk reducing direction when under added cognitive demand. The extent to which such self-regulation fully compensates for the impact of added cognitive demand remains an open question.     

Measuring situational avoidance in older drivers: An application of Rasch analysis

Situational avoidance is a form of driving self-regulation at the strategic level of driving behaviour. It has typically been defined as the purposeful avoidance of driving situations perceived as challenging or potentially hazardous. To date, assessment of the psychometric properties of existing scales that measure situational avoidance has been sparse. This study examined the contribution of Rasch analysis to the situational avoidance construct. Three hundred and ninety-nine Australian drivers (M = 66.75, SD = 10.14, range: 48–91 years) completed the Situational Avoidance Questionnaire (SAQ). Following removal of the item Parallel Parking, the scale conformed to a Rasch model, showing good person separation, sufficient reliability, little disordering of thresholds, and no evidence of differential item functioning by age or gender. The residuals were independent supporting the assumption of unidimensionality and in conforming to a Rasch model, SAQ items were found to be hierarchical or cumulative. Increased avoidance was associated with factors known to be related to driving self-regulation more broadly, including older age, female gender, reduced driving space and frequency, reporting a change in driving in the past five years and poorer indices of health (i.e., self-rated mood, vision and cognitive function). Overall, these results support the use of the SAQ as a psychometrically sound measure of situational avoidance. Application of Rasch analysis to this area of research advances understanding of the driving self-regulation construct and its practice by drivers in baby boomer and older adult generations.     

Associations between age,gender, psychosocial and health characteristics in the Candrive II study cohort

The relations among driving-related psychosocial measures (e.g., driving comfort, attitudes toward driving) and measures of self-reported health were examined in the context of driver characteristics (i.e., age and gender) within the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive II) baseline data, available for the cohort of 928 drivers, 70 years of age and older. Older members of the cohort had lower comfort scores and poorer perceptions of their driving abilities. Men reported significantly higher levels of driving comfort than women. When analyses including health were controlled for age and gender, significant relations with health status were evident for most of the psychosocial measures. These findings extend previous research and suggest that attitudes, beliefs, and perceptions about driving may be influenced by health status and act as mediators in the self-regulation process.     

The traffic behaviour of elderly male automobile drivers in Gothenburg,Sweden

406 drivers over 60 years of age with automobile licences issued in Gothenburg, Sweden, were asked by a questionnaire about their driving habits in 1971. 126 drivers around 40 years of age have constituted a comparison group. A large proportion of the older drivers declared that they no longer drove their cars. More than half the number of drivers over 75 years of age and a quarter of the drivers between 65 and 69 years of age had given up driving voluntarily because of age and illness. Self-selection thus seems to be one of several factors of great importance when judging the traffic safety risks of elderly drivers. The annual distance driven by the older driver groups was shorter than in the younger age-group. The older drivers used their cars for other purposes than younger drivers and they also avoided driving in darkness, on icy roads, and in unknown cities to a far greater extent than younger drivers. The total number of accidents and offences during the older drivers' whole life-span as drivers was lower than the corresponding figures in the younger age-group. In our opinion this may depend on the shorter annual distance driven by the older drivers, the change in traffic density in the investigation area, but also to a great extent on the older drivers awareness of their reduced capacity. Their accident and offence rate during a three-year-period is quite similar to the rate in the comparison group.     

On-road behaviour of younger and older novices during the first six months of driving

Newly qualified drivers are known to have greater crash involvement than more experienced drivers, but does the on-road driving behaviour of young novices differ from that of older novices who might be expected to be more mature and to have different driving needs? Both younger and older novices were compared with experienced drivers in their behaviour driving an instrumented car on three occasions. The three drives were conducted within the novices’ first few months of becoming qualified. All drivers, including both groups of novices, increased their average road speed over the three drives, and all increased their tendency to cut across the central lane marker on bends. The older novices showed some indications of becoming more cautious with experience, by doubling their headway after six months, and by increasing the number of times they glanced into their mirrors at critical points. This increased caution may be attributable to the driving experiences of the older novices, who had experienced twice the crash rate of the younger novices during their first six months of driving.     

Age, skill, and hazard perception in driving

This study examined the effects of age and driving experience on the ability to detect hazards while driving; namely, hazard perception. Studies have shown that young-inexperienced drivers are more likely than experienced drivers to suffer from hazard perception deficiencies. However, it remains to be determined if this skill deteriorates with advancing age. Twenty-one young-inexperienced, 19 experienced, and 16 elderly drivers viewed six hazard perception movies while connected to an eye tracking system and were requested to identify hazardous situations. Four movies embedded planned, highly hazardous, situations and the rest were used as control. Generally, experienced and older-experienced drivers were equally proficient at hazard detection and detected potentially hazardous events (e.g., approaching an intersection, pedestrians on curb) continuously whereas young-inexperienced drivers stopped reporting on hazards that followed planned, highly hazardous situations. Moreover, while approaching T intersections older and experienced drivers fixated more towards the merging road on the right while young-inexperienced drivers fixated straight ahead, paying less attention to potential vehicles on the merging road. The study suggests that driving experience improves drivers’ awareness of potential hazards and guides drivers’ eye movements to locations that might embed potential risks. Furthermore, advanced age hardly affects older drivers’ ability to perceive hazards, and older drivers are at least partially aware of their age-related limitations.     

Driver distraction: the effects of concurrent in-vehicle tasks, road environment complexity and age on driving performance

This paper presents the findings of a simulator study that examined the effects of distraction upon driving performance for drivers in three age groups. There were two in-vehicle distracter tasks: operating the vehicle entertainment system and conducting a simulated hands-free mobile phone conversation. The effect of visual clutter was examined by requiring participants to drive in simple and complex road environments. Overall measures of driving performance were collected, together with responses to roadway hazards and subjective measures of driver perceived workload. The two in-vehicle distraction tasks degraded overall driving performance, degraded responses to hazards and increased subjective workload. The performance decrements that occurred as a result of in-vehicle distraction were observed in both the simple and complex highway environments and for drivers in different age groups. One key difference was that older drivers traveled at lower mean speeds in the complex highway environment compared with younger drivers. The conclusions of the research are that both in-vehicle tasks impaired several aspects of driving performance, with the entertainment system distracter having the greatest negative impact on performance, and that these findings were relatively stable across different driver age groups and different environmental complexities.