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-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.     

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 performance,perceptions of driving comfort and abilities,and self-reported driving restrictions among healthy older drivers

The objective of the present study was to examine the relationship between cognitive performance, driver perceptions and self-reported driving restrictions. A cross-sectional analysis was conducted on baseline data from Candrive II, a five-year prospective cohort study of 928 older drivers aged 70–94 years from seven cities. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) as well as the Trail Making Test, parts A and B. Driver perceptions were assessed using the Day and Night Driving Comfort Scales and the Perceived Driving Abilities scale, while driving practices were captured by the Situational Driving Frequency and Avoidance scales, as well as the Driving Habits and Intentions Questionnaire. The baseline data indicates this cohort is largely a cognitively intact group. Univariate regression analysis showed that longer Trails A and B completion times were significantly, but only modestly associated with reduced driving frequency and perceived driving abilities and comfort, as well as a significant tendency to avoid more difficult driving situations (all p < .05). Most of these associations persisted after adjusting for age and sex, as well as indicators of health, vision, mood and physical functioning. Exceptions were Trails A and B completion times and situational driving frequency, as well as time to complete Trails B and current driving restrictions. After adjusting for the confounding factors, the total MoCA score was not associated with any of the driving measure scores while the number of errors on Trails A was significantly associated only with situational driving frequency and number of errors on Trails B was significantly associated only with situational driving avoidance. Prospective follow-up will permit examination of whether baseline cognition or changes in cognition are associated with changes in driver perceptions, actual driving restrictions and on-road driving outcomes (e.g., crashes, violations) over time.     

Perception, attitudes and beliefs, and openness to change: implications for older driver education

With a rapidly aging population, strategies for improving driver safety are beginning to emerge that focus on changing driving behaviors and knowledge. We examined the perceptions of risk, beliefs and attitudes, and openness to change of 86 older participants voluntarily attending a driver education program. It appeared that most people attending these sessions were not necessarily concerned about their own driving, safety or abilities, but were interested in maintaining mobility. They were conservative and reasonably consistent in their attitudes toward traffic regulations and safe driving practices. Some gender differences emerged with more men than women being resistant to changing their driving habits, more men than women reporting that they drive after consuming alcohol and more women than men identifying a role for their families in decision-making regarding driving cessation. This suggests that educational material may need to be targeted differently for men and women. It is anticipated that psychosocial factors related to driving such as driver perception, beliefs and openness to change will be useful for maximizing the fit between education program content and outcomes.     

Correspondence between self-reported and objective measures of driving exposure and patterns in older drivers

The driving behavior of older adults has been traditionally examined using questionnaires and diaries. The accuracy of self-reports has been questioned, and in-vehicle recording devices touted as more objective measures of real-world driving. The purposes of this study were to replicate and extend prior research comparing self-report and actual measures of driving exposure and patterns. Two electronic devices were installed in the vehicles of 61 drivers (67-92 years, 59% women) who were instructed to drive as usual over 1-week. Participants completed trip logs, daily diaries, a questionnaire on usual driving habits, ratings of situational driving frequency and avoidance and a follow-up interview. Only 53% of the sample attempted to estimate how far they had driven over the week and self-estimates were inaccurate (ME = 77.5 km; CV = 44.5%). Drivers tended to miss a significant number of trips and stops in their diaries. Driving behavior over the week was fairly consistent with usual practices regarding time of day, driving in certain areas, and night driving. However, subjects drove in challenging situations more than usual. Triangulating multiple sources of electronic and self-reported data provided a better understanding about the behavior of older drivers.     

Overly cautious and dangerous: An empirical evidence of the older driver stereotypes

Negative comments regarding the competency of older drivers are frequently heard in the general population. While negative stereotypes of older drivers seem to be present, their existence has yet to be empirically validated. We thus investigated the stereotypes pertaining to older drivers in two experiments. In both experiments young adults viewed 12 simulated clips of three categories of driving behaviors (i.e., younger adults’ unsafe behaviors, older drivers’ unsafe behaviors and appropriate-safe driving behaviors) without knowing the driver's age. They were asked to rate how representative the behaviors were of a typical younger, middle-aged, or older driver. Experiment 1 showed that older drivers’ unsafe behaviors were rated as significantly more representative of the typical older driver, while young adults’ unsafe behaviors were perceived as significantly more representative of the typical younger driver. In Experiment 2, younger participants viewed the same clips but were only asked to indicate whether the observed behavior was representative or not of the typical older driver. The main findings were replicated. When asked to describe the main features of the typical older drivers, participants qualified them as being overly cautious, uncomfortable behind the wheel, and unsafe and dangerous. The potential implications on driving performance of older drivers and on driving cessation and are discussed.     

The influence of cognitive impairment with no dementia on driving restriction and cessation in older adults

Cognitively impaired older adults may be at increased risk of unsafe driving. Individuals with insight into their own impairments may minimize their risk by restricting or stopping driving. The purpose of this study was to examine the influence of cognitive impairment on driving status and driving habits and intentions. Participants were classified as cognitively impaired, no dementia single (CIND-single), CIND-multiple, or not cognitively impaired (NCI) and compared on their self-reported driving status, habits, and intentions to restrict or quit driving in the future. The groups differed significantly in driving status, but not in whether they restricted their driving or reduced their driving frequency. CIND-multiple group also had significantly higher intention to restrict/stop driving than the NCI group. Reasons for restricting and quitting driving were varied and many individuals reported multiple reasons, both external and internal, for their driving habits and intentions. Regardless of cognitive status, none of the current drivers were seriously thinking of restricting or quitting driving in the next 6 months. It will be important to determine, in future research, how driving practices change over time and what factors influence decisions to restrict or stop driving for people with cognitive impairment.     

Examining links between cognitive markers,movement initiation and change,and pedestrian safety in older adults

ObjectiveThe purpose of this study was to determine the extent to which mobility indices (such as walking speed and postural sway), motor initiation, and cognitive function, specifically executive functions, including spatial planning, visual attention, and within participant variability, differentially predicted collisions in the near and far sides of the road with increasing age.MethodsAdults aged over 45 years participated in cognitive tests measuring executive function and visual attention (using Useful Field of View; UFoV^®), mobility assessments (walking speed, sit-to-stand, self-reported mobility, and postural sway assessed using motion capture cameras), and gave road crossing choices in a two-way filmed real traffic pedestrian simulation.ResultsA stepwise regression model of walking speed, start-up delay variability, and processing speed) explained 49.4% of the variance in near-side crossing errors. Walking speed, start-up delay measures (average and variability), and spatial planning explained 54.8% of the variance in far-side unsafe crossing errors. Start-up delay was predicted by walking speed only (explained 30.5%).ConclusionWalking speed and start-up delay measures were consistent predictors of unsafe crossing behaviours. Cognitive measures, however, differentially predicted near-side errors (processing speed), and far-side errors (spatial planning). These findings offer potential contributions for identifying and rehabilitating at-risk older pedestrians.     

The development,factor structure and psychometric properties of driving self-regulation scales for older adults: Has self-regulation evolved in the last 15 years?

The term driving self-regulation is typically used to describe the practice of drivers who avoid driving in situations that they regard as unsafe because of perceived physical impairment. Older adults report using this strategy to improve safety while retaining mobility. Self-regulation is typically assessed using the driving avoidance items from the driving habits questionnaire (DHQ) and the driver mobility questionnaire (DMQ-A). However, the psychometric properties of these measures are not well understood. Using data from 277 older drivers, exploratory factor analysis was used to test the homogeneity of three driving self-regulation scales: the DHQ, DMQ-A, and an extended DMQ-A. Good internal consistency for each of the scales was identified (all αs ≥ .9). A one factor solution was identified for two of the measures (DHQ, DMQ-A) and a two factor solution accounting for over 70% of the score variance was identified for the third measure. The two factors assessed situations that may be avoided while driving because of the “external” (e.g., weather-related) or “internal” (e.g., passenger-related) driving environments, respectively. The findings suggest that the interpretation of an overall summated scale score, or single-item interpretations, may not be appropriate. Instead, driving self-regulation may be a multifaceted construct comprised of distinct dimensions that have not been identified previously but can be reliably measured. These data have implications for our understanding of driving self-regulation by older adults and the way in which this behavior is measured.     

The effect of age,gender and attitudes on self-regulation in driving

Self-regulation in driving has primarily been studied as a precursor to driving cessation in older people, who minimise driving risk and compensate for physical and cognitive decline by avoiding driving in challenging circumstances, e.g. poor weather conditions, in the dark and at busy times. This research explores whether other demographic groups of drivers adopt self-regulatory behaviours and examines the effects of affective and instrumental attitudes on self-regulation across the lifespan. Quantitative data were collected from 395 drivers. Women were significantly more likely than men to engage in self-regulation, and to be negatively influenced by their emotions (affective attitude). A quadratic effect of age on self-regulation was determined such that younger and older drivers reported higher scores for self-regulation than middle-years’ drivers. However, this effect was affected by experience such that when experience was controlled for, self-regulation increased with age. Nevertheless, anxious driving style and negative affective attitude were independent predictors of self-regulation behaviours. Results suggest that self-regulation behaviours are present across the driving lifespan and may occur as a result of driving anxiety or low confidence rather than as an effect of ageing.     

Self-rated driving habits among older adults with clinically-defined mild cognitive impairment,clinically-defined dementia,and normal cognition

Older adults with clinically-defined dementia may report reducing their driving more than cognitively normal controls. However, it is unclear how these groups compare to individuals with clinically-defined mild cognitive impairment (MCI) in terms of driving behaviors. The current study investigated self-reported driving habits among adults age 60 and older with clinical MCI (n = 41), clinical mild dementia (n = 40), and normal cognition (n = 43). Participants reported their driving status, driving frequency (days per week), and how often they avoided accessing the community, making left turns, driving at night, driving in unfamiliar areas, driving on high-traffic roads, and driving in bad weather. After adjusting for education, a MANCOVA revealed that participants with MCI and dementia avoided unfamiliar areas and high-traffic roads significantly more than normal participants. Participants with dementia also avoided left turns and accessing the community more than those with normal cognition and MCI (p < 0.05 for all). The other driving variables did not significantly differ between groups. Thus, older adults with clinically-defined MCI, as well as those with dementia, avoided some complex driving situations more than cognitively intact adults. However, all diagnostic groups had similar rates of driving cessation and frequency. Future research should examine the safety implications of such findings.     

The development and validation of two complementary measures of drivers’ hazard perception ability

Hazard perception in driving involves a number of different processes. This paper reports the development of two measures designed to separate these processes. A Hazard Perception Test was developed to measure how quickly drivers could anticipate hazards overall, incorporating detection, trajectory prediction, and hazard classification judgements. A Hazard Change Detection Task was developed to measure how quickly drivers can detect a hazard in a static image regardless of whether they consider it hazardous or not. For the Hazard Perception Test, young novices were slower than mid-age experienced drivers, consistent with differences in crash risk, and test performance correlated with scores in pre-existing Hazard Perception Tests. For drivers aged 65 and over, scores on the Hazard Perception Test declined with age and correlated with both contrast sensitivity and a Useful Field of View measure. For the Hazard Change Detection Task, novices responded quicker than the experienced drivers, contrary to crash risk trends, and test performance did not correlate with measures of overall hazard perception. However for drivers aged 65 and over, test performance declined with age and correlated with both hazard perception and Useful Field of View. Overall we concluded that there was support for the validity of the Hazard Perception Test for all ages but the Hazard Change Detection Task might only be appropriate for use with older drivers.     

能力、知识及与职业教育的关系

能力不仅是基于精神的而且是基于肉体的。知识是能力的组成部分。能力增长依赖于机体组织训练和知识水平提高。获取实际工作能力必须获取相应的感性知识。足够的肢体实践和感性知识积累是职业教育教学的重要特点。     

Trends in older driver crash involvement rates and survivability in the United States: An update

Objective

Previous research has shown that fatal crash involvement rates per licensed driver aged 70 and older declined significantly more per year in the United States than rates for middle-aged drivers aged 35–54 during 1997–2008, and per vehicle mile traveled from 1995–1996 to 2001–2002. Analyses of police-reported crash data during 1997–2005 indicated that the greater declines for older drivers were due to decreases in crash involvement and in the risk of dying in the crashes that occurred. The current study examined if trends in crash rates, crash involvements, and survivability persisted into more recent years.

Methods

Trends for drivers 70 and older were compared with trends for drivers aged 35–54 for U.S. national fatal passenger vehicle crash involvements per 100,000 licensed drivers during 1997–2012 and for U.S. national fatal passenger vehicle crash involvements per vehicle miles traveled in 1995–1996, 2001–2002, and 2008. Using police-reported crash data during 1997–2008 from 20 U.S. states, trends in involvement rates in non-fatal crashes of various severities per 100,000 licensed drivers and changes in the odds of death and the odds of death or serious injury in a crash were compared between older and middle-aged drivers.

Results

During 2007–2012, declines in national fatal crash involvement rates per licensed driver were similar for drivers 70 and older and middle-aged drivers (18 percent each). However, when considering the entire study period, fatal crash involvement rates continued to reflect a substantially larger decline for drivers 70 and older than for middle-aged drivers (42 vs. 30 percent per licensed driver during 1997–2012, 39 vs. 26 percent per vehicle mile traveled from 1995–2006 to 2008). When analyses of police-reported crash data were extended through 2008, non-fatal injury crash involvement rates per licensed driver declined more for older than for middle-aged drivers (39 vs. 30 percent), and unlike in prior research, average annual declines were significantly larger for drivers 80 and older. Property damage-only crash involvement rates similarly declined significantly more for older than for middle-aged drivers (15 vs. 3 percent). Drivers 70 and older in 1997 were 3.5 times more likely than middle-aged drivers to die in a crash, and this ratio declined to 3.2 by 2008.

Conclusions

Although declines in fatal crash involvement rates in recent years have not differed between older and middle-aged drivers, this did not undo earlier gains for older drivers. The recent slowing in the relative magnitude of the decline for older drivers may be related to the differential effect of the U.S. recession on fatal crash involvements of drivers in these age groups. The decreased likelihood of being involved in a crash of any severity and increased survivability when a crash occurred held when examining data through 2008, and for drivers 80 and older, significant declines in crash involvement relative to middle-aged drivers extended to non-fatal injury crashes.     

Findings from the Candrive/Ozcandrive study: Low mileage older drivers,crash risk and reduced fitness to drive

Previous research has found that only older drivers with low annual driving mileages had a heightened crash risk relative to other age groups. These drivers tend to drive mainly in urban areas, where the prevalence of complex traffic situations increases crash risk. However it might also be that some drivers may have reduced their driving due to perceived or actual declines in driving fitness.     

Predictors of driving exposure and avoidance in a field study of older drivers from the state of Maryland

Using structural equation modeling techniques, this study examines causal models of driving avoidance and exposure among older adults. Prior studies have revealed that past incidence of falls, Useful Field of View (UFOV) test performance, and Trails Making test performance are predictive of subsequent motor vehicle crash involvement [Owsley, C., Ball, K., McGwin Jr., G., Sloane, M.E., Roenker, D.L., White, M.F., Overley, E.T., 1998. Visual processing impairment and risk of motor vehicle crash among older adults. J. Am. Med. Assoc. 279 (14), 1083-1088; Sims, R.V., McGwin, G., Pulley, L., Roseman, J.M., 2001. Mobility impairments in crash-involved older drivers. J. Aging Health 13 (3), 430-438; Stutts, J.C., 1998. Do older drivers with visual nd cognitive impairments drive less? J. Am. Geriatr. Soc. 46, 854-861]. Data analyses used these indices, along with age, health, measures of physical functioning, and additional measures of cognitive functioning, to examine driving exposure and avoidance behaviors. A field sample of 4,234 drivers, 55 years of age and older, were recruited from the Maryland Motor Vehicles Administration after renewing their driver's licenses. A performance-based assessment, which included the Gross Impairment Screening battery and task 2 of the UFOV test, was completed by participants. A sub-sample of participants (n=815) were interviewed by telephone about their health and mobility 3-6 months following the initial assessment at a renewal center. In addition to age and gender, latent variables for health status, physical functioning, cognitive functioning, driving exposure, and driving avoidance were created. Direct and indirect causal paths were specified. Age, gender, health status, and cognitive functioning had direct effects on both driving exposure and driving avoidance; physical functioning did not have a direct effect on driving exposure or avoidance. The implications of these findings are discussed as they relate to designing interventions to promote mobility.     

The role of cognitive and visual abilities as predictors in the Multifactorial Model of Driving Safety

Objective

The current study evaluated part of the Multifactorial Model of Driving Safety to elucidate the relative importance of cognitive function and a limited range of standard measures of visual function in relation to the Capacity to Drive Safely. Capacity to Drive Safely was operationalized using three validated screening measures for older drivers. These included an adaptation of the well validated Useful Field of View (UFOV) and two newer measures, namely a Hazard Perception Test (HPT), and a Hazard Change Detection Task (HCDT).

Method

Community dwelling drivers (n = 297) aged 65–96 were assessed using a battery of measures of cognitive and visual function.

Results

Factor analysis of these predictor variables yielded factors including Executive/Speed, Vision (measured by visual acuity and contrast sensitivity), Spatial, Visual Closure, and Working Memory. Cognitive and Vision factors explained 83–95% of age-related variance in the Capacity to Drive Safely. Spatial and Working Memory were associated with UFOV, HPT and HCDT, Executive/Speed was associated with UFOV and HCDT and Vision was associated with HPT.

Conclusion

The Capacity to Drive Safely declines with chronological age, and this decline is associated with age-related declines in several higher order cognitive abilities involving manipulation and storage of visuospatial information under speeded conditions. There are also age-independent effects of cognitive function and vision that determine driving safety.     

An examination of the environmental,driver and vehicle factors associated with the serious and fatal crashes of older rural drivers

Motor vehicle crashes involving rural drivers aged 75 years and over are more than twice as likely to result in a serious or fatal injury as those involving their urban counterparts. The current study examined some of the reasons for this using a database of police-reported crashes (2004–2008) to identify the environmental (lighting, road and weather conditions, road layout, road surface, speed limit), driver (driver error, crash type), and vehicle (vehicle age) factors that are associated with the crashes of older rural drivers. It also determined whether these same factors are associated with an increased likelihood of serious or fatal injury in younger drivers for whom frailty does not contribute to the resulting injury severity. A number of environmental (i.e., undivided, unsealed, curved and inclined roads, and areas with a speed limit of 100 km/h or greater) and driver (i.e., collision with a fixed object and rolling over) factors were more frequent in the crashes of older rural drivers and additionally associated with increased injury severity in younger drivers. Moreover, when these environmental factors were entered into a logistic regression model to predict whether older drivers who were involved in crashes did or did not sustain a serious or fatal injury, it was found that each factor independently increased the likelihood of a serious or fatal injury. Changes, such as the provision of divided and sealed roads, greater protection from fixed roadside objects, and reduced speed limits, appear to be indicated in order to improve the safety of the rural driving environment for drivers of all ages. Additionally, older rural drivers should be encouraged to reduce their exposure to these risky circumstances.     

Hostility,driving anger,and dangerous driving: The emerging role of hemispheric preference

Background

Various studies have implicated psychosocial variables (e.g., hostility) in risk of dangerous driving and traffic accidents. However, whether these variables are related to more basic neurobiological factors, and whether such associations have implications for the modification of psychosocial risk factors in the context of driving, have not been examined in depth. This study examined the relationship between hemispheric preference (HP), hostility and self-reported dangerous driving, and the ability to affect driving anger via hemisphere activating cognitive exercises (HACE).

Methods

In Study 1, 254 Turkish students completed questionnaires of hostility, HP and driving behavior. In Study 2, we conducted a “proof of concept” experimental study, and tested effects of left, right and neutral HACE on driving anger, by exposing N = 650 Turkish students to written scenarios including either logical (left hemisphere), visuo-spatial (right hemisphere) or “mild doses” of both types of contents (control).

Results

In Study 1, left-HP was associated with higher hostility and with more dangerous driving, and hostility mediated the relationship between L-HP and reported driving behavior. In Study 2, only right-HACE led to immediate significant reductions in self-reported driving anger.

Conclusions

Left-HP is related to hostility and to dangerous driving, and it may be possible to partly reduce driving anger by right-HACE. Future studies must replicate these findings with objective measures, more enduring interventions and longer follow-ups.