Cognitive Interventions to Improve Older Driver Safety

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Cognitive Interventions to Improve Older Driver
Safety

• International Conference on Aging, Disability and
  Independence
• Karlene Ball
• UAB Center for Translational Research on Aging
  and Mobility
• Supported by NIA Grants R44AG18202, U01AG14289,
  P50AG11684

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Background

• There is abundant evidence that Speed of
  Processing, particularly as measured with the
  UFOV test, is related to driving competence
  among older drivers.

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UFOV and DrivingCrashes
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UFOV and DrivingSimulator Performance
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UFOV and DrivingOn-Road Performance
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Background

• In addition, recent cognitive intervention
  studies have shown that Speed of Processing can
  be enhanced with a standardized training protocol.

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ACTIVE STUDY

• Randomized, controlled single-blind clinical
  trial.
• Diverse sample of 2,832 community-dwelling adults
  aged 65.
• Retained 87 at 2 year follow-up.
• Ball et al. Effects of Cognitive Training
  Interventions with Older Adults A Randomized
  Controlled Trial. JAMA, 2003, 288, 18.

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Initial Training Effects

• Each intervention reliably improved the targeted
  cognitive ability at post test in
• 87 of Speed trained
• 74 of Reasoning trained
• 26 of Memory trained

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Booster Training Effects

• Booster training enhanced performance of Speed
  and Reasoning participants.
• Cognitive gains were maintained for 2 years,
  particularly among booster participants.

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Significance

• Cognitive interventions helped normal elderly
  persons perform better on multiple measures of
  the specific cognitive ability for which they
  were trained.
• Training gains were comparable with, or greater
  than, the amount of decline that has been
  reported in previous studies over a 7 - 14 year
  period among older adults without dementia.

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ACTIVE study
Expected Decline
Training Gains
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Background

• Enhanced processing speed results in improved
  driving performance, as well as improvements in
  other Timed Instrumental Activities of Daily
  Living.

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Functional Timed IADL
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Cognitive Intervention

• Speed of Processing training has been shown in
  multiple studies to result in
• Fewer dangerous driving maneuvers
• Improved hazard detection in simulations
• Faster reaction times to road signs
• Increased mobility
• Improved Timed IADLs
• Roenker et al. Speed of Processing and Driving
  Simulator Training Result in Improved Driving
  Performance. Human Factors, 2003, 45, 218-233.
• Edwards et al., Transfer of a Speed of Processing
  Intervention to Near and Far Cognitive Functions,
  Gerontology, 2002, 48, 329-340.

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Home-Based Training

• Most recently, modification of the standardized
  Speed of Processing training protocol have been
  evaluated for home use.

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Comparison of Standard Training to Home-based
Training

• STANDARD
• Lab-based
• Trainer-facilitated
• Computer-based
• 8-10 sessions
• 5 weeks

• HOME-BASED
• Home-based
• Self-administered
• Videotape-based
• 8-10 sessions
• 5 weeks

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Study Design
Eligibility Screening
Baseline Cognitive Testing
Standard
Home Based
Social Contact
No Contact
Post Training Cognitive Testing
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Participants

• 266 community-living adults gt age 65
• Mean age 75
• 87 Caucasian, 13 African American
• 45.5 female, 54.5 male
• Eligibility criteria
• MMSE gt 23
• Intact vision (acuity and contrast sensitivity)
• Slow processing speed (UFOV)

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Results Improvements in Processing Speed
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Results

• Participants who self-administered home-based
  Speed training improved their processing speed
  significantly more than either control group
  (pslt.0001).
• Their improvement was 80 as great as that of
  those who underwent guided, lab-based training,
  and did not differ statistically from that group
• (p .33).

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Results

• The post-test performance of no-contact (no
  training) and social-contact (internet training)
  control groups was virtually identical (p
  .999).
• 80 of individuals randomized to home-based
  training completed the training program on their
  own.

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Implication

• Individuals with poor processing speed can
  improve their processing speed at home using
  widely available technology such as a TV and VCR.

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Conclusions

• There is converging evidence that measures of
  visual information processing, such as UFOV,
  are predictive of driving ability.
• Such measures can be quickly and easily
  administered. (5 minutes)
• Speed of visual information processing (UFOV)
  can be increased, resulting in improved driving
  outcomes.

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Conclusions

• Collectively these findings suggest a program of
  early detection and remediation for both visual
  and cognitive impairments. Such a program will
  help to sustain mobility in older adults.

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Future Directions

• Longitudinal field studies (MVA continuation).
• What are the health care costs associated with
  mobility loss (driving cessation)?
• What are the health benefits of continued
  mobility?
• What are the long-term benefits of cognitive
  training?