Road safety in an aging population: risk factors, assessment, interventions, and future directions

Anstey, Kaarin J.; Eramudugolla, Ranmalee; Ross, Lesley A.; Lautenschlager, Nicola T.; Wood, Jenifer

doi:10.1017/s1041610216000053

Cited by 16 publications

(4 citation statements)

References 71 publications

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“…Moreover, MCI is difficult to diagnose accurately within a primary care setting which is the first stage in the majority of fitness to drive evaluations [38]. We recommend that on-road driving performance and validated tests of driving skills be the key focus of driving assessments.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Driving Safety in Older Adults with Mild Cognitive Impairment

Anstey

Eramudugolla

Chopra

et al. 2017

JAD

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Background: With population aging, drivers with mild cognitive impairment (MCI) are increasing; however, there is little evidence available regarding their safety.Objective: We aimed to evaluate risk of unsafe on-road driving performance among older adults with MCI.Method: The study was a cross-sectional observational study, set in Canberra, Australia. Participants were non-demented, current drivers (n = 302) aged 65 to 96 years (M = 75.7, SD = 6.18, 40% female) recruited through the community and primary and tertiary care clinics. Measures included a standardized on-road driving test (ORT), a battery of screening measures designed to evaluate older driver safety (UFOV®, DriveSafe, Multi-D), a neurocognitive test battery, and questionnaires on driving history and behavior.Results: Using Winblad criteria, 57 participants were classified as having MCI and 245 as cognitively normal (CN). While the MCI group had a significantly lower overall safety rating on the ORT (5.61 versus 6.05, p = 0.03), there was a wide range of driving safety scores in the CN and MCI groups. The MCI group performed worse than the CN group on the off-road screening tests. The best fitting model of predictors of ORT performance across the combined sample included age, the Multi-D, and DriveSafe, classifying 90.4% of the sample correctly.Conclusion: Adults with MCI exhibit a similar range of driving ability to CN adults, although on average they scored lower on off-road and on-road assessments. Driving specific tests were more strongly associated with safety ratings than traditional neuropsychological tests.

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Section: Discussionmentioning

confidence: 99%

Assessment of Driving Safety in Older Adults with Mild Cognitive Impairment

Anstey

Eramudugolla

Chopra

et al. 2017

JAD

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“… 6 Many people can live a long time with a cataract before a diagnosis is made and surgery is performed. 22 Unfortunately, drivers with a cataract or cataracts, even involving only one eye, have 2.5 times more risk of causing a car crash than those without a cataract. 6 22 47 This is why general practitioners should be very vigilant when patients talk about difficulties experienced when driving at night or under foggy conditions.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive

et al. 2018

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ObjectivesThe aim of this study is to quantify the importance of loss of contrast sensitivity (CS) and its relationship to loss of visual acuity (VA), driving restrictions and daytime, on-road driving evaluations in drivers aged 70+.DesignA predictive cross-sectional study.SettingVolunteer participants to a drivers’ refresher course for adults aged 70+ delivered by the Swiss Automobile Club in western Switzerland from 2011 to 2013.Participants162 drivers, male and female, aged 70 years or older.Clinical predictorsWe used a vision screener to estimate VA and the The Mars Letter Contrast Sensitivity Test to test CS.OutcomesWe asked drivers to report whether they found five driving restrictions useful for their condition; restrict driving to known roads, avoid driving on highways, avoid driving in the dark, avoid driving in dense traffic and avoid driving in fog. All participants also underwent a standardised on-road evaluation carried out by a driving instructor.ResultsModerate to severe loss of CS for at least one eye was frequent (21.0% (95% CI 15.0% to 28.1%)) and often isolated from a loss of VA (11/162 cases had a VA ≥0.8 decimal and a CS of ≤1.5 log(CS); 6.8% (95% CI 3.4% to 11.8%)). Drivers were more likely (R2=0.116, P=0.004) to report a belief that self-imposed driving restrictions would be useful if they had reduced CS in at least one eye. Daytime evaluation of driving performance seems limited in its ability to correctly identify difficulties related to CS loss (VA: R2=0.004, P=0.454; CS: R2=0.006, P=0.332).ConclusionCS loss is common for older drivers. Screening CS and referring for cataract surgery even in the absence of VA loss could help maintain mobility. Reduced CS and moderate reduction of VA were both poor predictors of daytime on-road driving performances in this research study.

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“…Existing research has tended to focus on younger drivers, with less focus on the mature driver population. This is despite the number of older drivers increasing [64,65], a pattern that is expected to continue into the future [66].…”

Section: Study Strengthsmentioning

confidence: 99%

Traffic offending and deterrence: An examination of recidivism amongst drivers in Victoria, Australia born prior to 1975

et al. 2020

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To deter the performance of illegal driving behaviours, traffic infringement notices may be issued. Whilst there is a substantial body of research that has examined rates of reoffending following a traffic infringement, there have been few studies examining the length of time to next traffic offence. Where this research has been conducted, the findings do not provide current understandings, given the substantial changes in traffic sanctioning over time. The aim of this study was to address this gap, by examining risk factors for recidivism following a driver receiving a traffic infringement notice, as well as the time to next traffic offence. Licensing and infringements data held in the Driver Licensing System (DLS), maintained by the road authority in Victoria, Australia were used. All drivers included in the study were born prior to 1975, and received their first Victorian drivers licence between 1994 and 2016. Data from 203,620 drivers were used. Cox proportional hazards modelling was undertaken to examine factors associated with recidivism within 12 months of receiving a traffic infringement. 131,691 (64.7%) drivers had received at least one traffic infringement in Victoria, Australia since receiving their Victorian driver's licence. Factors found to be associated with longer time to further traffic offending in the year that followed the first infringement included being female; receiving a first Victorian driver's licence when aged 45+ years; and being licenced 10+ years. Traffic infringements deter some groups of Victorian drivers, but not others. If drivers are to be deterred from further illegal driving behaviour, it is important other countermeasures are developed and trialled.

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Road safety in an aging population: risk factors, assessment, interventions, and future directions

Cited by 16 publications

References 71 publications

Assessment of Driving Safety in Older Adults with Mild Cognitive Impairment

Assessment of Driving Safety in Older Adults with Mild Cognitive Impairment

Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive

Traffic offending and deterrence: An examination of recidivism amongst drivers in Victoria, Australia born prior to 1975

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