Results from Pre- Conference Survey of Participants*

1
Results from Pre- Conference Survey of
Participants

• International Older Driver Consensus Conference
• Arlington, VA
• December 1 2, 2003
• For additional information contact
• Burt Stephens, University of Florida,
• Seniors Institute for Transportation and
  Communications
• E-mail Bstephen_at_hp.ufl.edu

N 22
2
How to Identify At-Risk Drivers?
How to Identity at-risk drivers
3
Average Ratings of Effectiveness of Methods for
Identifying At-Risk Drivers
Method Current State Improved Methodology Potential Improvement
Crash Records 2.00 2.44 22
Driver Relicensing 1.89 3.00 59
Awareness Campaigns   1.70 2.56 50
Referral by Physicians 2.21 2.94 33
Counseling/Family Friends 2.39 2.70 13
Self-Appraisal   2.30 2.61 13
Formal Screening Assessment 2.50 3.33 33
(N16 - 22 Scale ranges from 4 Very
Effective to 1 Not At All Effective)
4
Experience of Conference Participants
5
DRIVER ASSESSMENTS
PROFESSIONALS EXPERIENCE TREATMENT GROUP PORTION
Performed Evaluations as part of a driver screening program 50 (N11)
People with ambulatory or sensory limitations 54
People with perceptual or cognitive limitations 82
Older persons who have voluntarily participated 64
Older persons who have been required to participate 73
Other participants including those referred from physicians because of medical conditions or functional impairments and those vision and hearing difficulties 18
Conducted Research on driver screening requirements 36 (N8)
6
REMEDIATION
PROFESSIONALS EXPERIENCE TECHNIQUE/ACTIVITY PORTION
Provide Remediation Services for drivers 27 (N6)
Retraining using multimedia presentations 33
Retraining using driving simulators 33
Retraining using off-street driving courses 17
Retraining using on-road methods 50
Utilizing in-vehicle assistive technology 33
Other including educational intervention and home exercise programs (eye hand coordination tasks, dynamic vision , saccades, quick attention changes) 33
7
REMEDIATION (Cont)
Re-design or re-engineering of vehicles or the transportation infrastructure 23 (N5)
Design of assistive technology for automobiles 40
Re-design of highway infrastructure 60
Development of communication techniques or devices 40
Other 0
Conducted Research and/or Development efforts on driver rehabilitation 14 (N3)
8
COUNSELING
PROFESSIONALS EXPERIENCE TYPES OF COUNSELING PORTION
Formal Counseling 37 (N8)
After medical diagnosis, encourage taking medication 12
Recommend eye or hearing examinations 38
Recommend use of in-vehicle assistive devices 75
Explore alternatives to driving 100
Other including recommendations for altering driving practices (such as night driving) and formal research developing support group process for ex-drivers and caregivers 25
Conducted research on counseling of drivers and /or the impacts of driving cessation 18 (N 3)
9
Assess By Components or Holistically?
Participants Response Percent
Whole driving performance needs to be considered 32
Need to first decompose driving task into its components 36
No Response 32
10
Changes Associated With Aging
11
Importance of Sensory and Perceptual Changes
ELEMENT RANK
Glare susceptibility and recovery 1
Visual Contrast Sensitivity 2.5
Judgments about size, distance and motion of objects 2.5
Pattern Perception 4
Visual Acuity 5
Visual search speed and efficiency Not Included
Should have been included in the listing, but
inadvertently omitted.
12
Importance of Cognitive Changes
ELEMENT RANK
Ability to Carry Out and Utilize Pre-Trip Planning 1
Time Sharing and Divided Attention 2
Ability to Make Quick and Accurate Decisions at Road Junctures 3
Visual Attention Abilities 4
Working Memory 5
Insufficient number of responses
13
Importance of Other Changes
ELEMENT RANK
Ability to Rotate Head and Neck 1
Limb Strength, Flexibility, Sensitivity and Range of Motion 2
Unwillingness to Drive to Unfamiliar Addresses or Locations 3
Increase Use of Prescription Medications 4
Unwillingness to Drive At Night and Under Adverse Weather Conditions 5
14
DRIVER SCREENING AND ASSESSMENT
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Protocols forSCREENING/EVALUATION

• 11 PROCEDURES RATED
• VALIDITY (Correlation between scores from the
  procedure and crash records)
• USABILITY (Level of difficulty in implementing
  the procedure)
• SUFFICIENCY (Can this procedure stand alone or
  must it be carried out in conjunction with other
  procedures?)
• COST-EFFECTIVENESS (Takes into account all of the
  proceeding characteristics and the cost of
  administration of the procedure)

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RATING SCREENING OR EVALUATION PROTOCOLS
METHOD AVERAGE VALIDITY RATING AVERAGE USABILITY RATING AVERAGE SUFFICIENCY RATING AVERAGE COST-EFFECTIVENESS RATING
GRIMPS (N7-8) 2.6 3.5 1.9 2.2
TRAIL MAKING (N12-13) 3.3 3.8 2.2 3.4
AUTOMATED PSYCHO-PHYSICAL TEST (APT) (N3) 2.7 3.3 2.3 2.7
DriveABLE (N4) 4.2 4.2 4.8 3.2
DRIVING SIMULATOR (N10-12) 2.3 (RANGE 1-4) 1.8 (RANGE 1-3) 1.8 (RANGE 1-3) 1.9 (RANGE 1-5)
Includes SafeDrive sim, DriVR Fargos, Doron,
STI-SIM/STI-SIM Drive, Atari/AGC/TWI/AMOS/VISTA
Doron Precision Drive Square driVR Illusion
Technologies/RealDrive I-SIM and other
specialized systems
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RATING SCREENING OR EVALUATION PROTOCOLS (Cont)
METHOD AVERAGE VALIDITY RATING AVERAGE USABILITY RATING AVERAGE SUFFICIENCY RATING AVERAGE COST-EFFECTIVENESS RATING
VISUAL ATTENTION ANALYZER FOR UFOV (N12-13) 3.5 3.5 2.8 2.8
MOTOR VISUAL PERCEPTUAL TEST (N6) 2.8 3.0 2.2 2.7
COMPLEX REACTION TIME (N6-7) 2.7 3.6 2.1 3.0
COGNITVE BEHAVIORAL DRIVERS INVENTORY (N4) 2.8 3.0 2.5 2.2
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RATING SCREENING OR EVALUATION PROTOCOLS (Cont)
METHOD AVERAGE VALIDITY RATING AVERAGE USABILITY RATING AVERAGE SUFFICIENCY RATING AVERAGE COST-EFFECTIVENESS RATING
COGNITIVE MONEY ROAD MAP (N1) 2.0 2.0 1.0 4.0
MINI MENTAL STATUS EXAMINATION (N11-12) 3.0 2.9 2.1 3.4
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Other Driver Screening or Evaluation Procedures
Recommended

• Visual acuity Contrast sensitivity visual
  field assessment
• MVPT (not 3, because it takes 50 minutes to
  administer)
• Trail Making B only (not A)
• DPT driver performance training video
• Chart based contrast sensitivity testing
• Structured Observations for obvious physical
  impairment
• Behind the wheel evaluation
• Driver Performance Measurement (DPM)
• Situation awareness fitness for duty

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REMEDIATION
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Procedures Used to Remediate Inadequate Driver
Capabilities

• Treatment of visual impairment to see if it is
  reversible or can be remediated
• In-vehicle training with CDRS
• Counseling on self-regulation of driving
• Education about how impairment impacts driving
  skills
• Use of AAA handouts on flexibility, changing your
  route, driver safety course
• Training behind the wheel determining whether
  clients can adequately follow through and recall
  the remediations
• Prescribe limiting area of driving
• Use O.T. skills to perform activity analysis
  knowledge- base to improve the various skills

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RISK MANAGEMENT PAYOFFS FOR APPLYING METHODS
METHODS AVERAGE RANKING RANGE
Retraining Using Vehicles On-the-Road 1.8 5
Retraining Using Off-Street Driving Courses 4.1 9
Training in the Use of Adaptive Equipment 4.2 7
Application of Improved In-Vehicle Assistive Technology 4.4 7
Improved Directional and Guidance Information 4.4 6
Application of Improved Highway Design Recommendations 5.2 9
Retraining Using Advanced Driving Simulators 6.1 7
Retraining Using Computerized Multimedia Presentations 7.2 6
Greater Use of Flexible Route Transit 7.4 4
N 9 participants 1 Highest possible Ranking
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MEDICATION SIDE EFFECTS EXPERIENCED That can
affect driving
MEDICATION SIDE EFFECT No. RESPONDING
Drowsiness 5
Dizziness 4
Blurred Vision 3
Unsteadiness 4
Fainting 2
Slowed Reaction Time 5
Extrapyramidal Effect 4
N 9 Participants
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COUNSELING AND TRANSPORATION ALTERATIVES
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HOW CLIENTS GET INTO TRANSPORTATION COUNSELING
SOURCE No. RESPONSES PERCENT IN CATEGORY
Self-Determined 6 27.7
Family Members 6 24.0
Physicians 6 37.0
Motor Vehicle Dept 5 9.4
Courts 4 2.3
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Basis of Counseling Process Used

• Personal and professional experience 4
• Specific courses or training to develop the
  process 0
• Use a standardized protocol 2

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Specific Advice Provided to Clients or Their
Caregivers
Types of Advise Percent
Information on transit, taxis an/or senior service pickups 83
Delivery of prescriptions, groceries 67
Guidance on organizing and booking transport requests 50
Guidance on how to obtain information (e.g., phone services, internet services, etc.) 33
Guidance on the use of new communications technologies (e.g., WI-FI, cellular phones, etc) 17
Information to family members and other caretakers on how to handle transport requests 100
N 6
28
Constraints Experienced In Counseling on
Transportation Alternatives

• Clients unwillingness to accept that he/she is
  no longer able to drive safely
• Lack of reliable, affordable transportation
• Lack of transportation options and knowledge as
  to how the options work
• Lack of on-time reliable public or paratransit
  transportation
• Lack of transportation resources in communities

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INFORMATION AVAILABLE AND NEEDED
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Publications with the Most Definitive Statements
on the Safety of Older Drivers

• NHTSA Reports and Manuals
• TRB Special Report 218 and Update Soon to be
  Published.
• Holland, C.A. (2001) Older Drivers A review.
  DLTR,
• (http//www.roads.dft.gov.uk/roadsafety/resear
  ch25)
• AOTA journals and publications
• AARP Publications
• ADED Publications
• DOT-HS-808-853, NHTSA Safe Mobility for Older
  People Notebook.
• DOT-HS-809-582, Model Driver Screening and
  Evaluation Program
• "Highway Research to Enhance the Safety and
  Mobility of Older
• Road Users, " Draft dated June 21, 2000, F.
  Schieber for TRB
• FHWA Older Driver Handbook
• AMA Guide for Physicians

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INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS,
NEEDED TECHNOLOGY - 1

• Affordable, reliable transportation for persons
  no longer capable of driving
• Removal of social stigma to using alternative
  transportation systems
• Lack of sidewalks and street lighting
• Funding of new initiatives and their evaluation
• Fear that older adult voters will not support
  initiatives that potentially threaten mobility
• Lack of funding (by Medicare) for the screening
  and mobility counseling process

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INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS,
NEEDED TECHNOLOGY - 2

• Lack of short comprehensive screening
  instruments that are highly sensitive and
  specific for tier 1 screening
• Expectation that automobiles ought to cost money,
  but alternative transportation ought to be cheap
  or free
• Need for predictive clinical tests people often
  test well in the clinical setting, but do very
  poorly behind the wheel
• Training Courses for OT's
• Physician training

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INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS,
NEEDED TECHNOLOGY - 3

• Need champions to gain wide support
• Criterion problem There is no essential
  agreement about what makes a "safe" driver.
• Unspoken "competition" between practitioners to
  create the "gold standard"
• Different requirements by motor vehicle agencies
  for retesting and relicensing
• Need to develop and implement a testing
  methodology that overcomes current limitations

34
RESEARCH NEEDS
35
Most Critical Research Needed - 1

• Develop improved vehicle and road design to
  facilitate better use of diminished senses
• Establish the role of in-car training
• Evaluate interventions, rather than adopting what
  "experts" call "best practices" and "model
  programs
• Develop short, easy-to-administer, and
  comprehensive screening instruments with high
  sensitivity and specificity ratings
• Develop effective alternative transportation and
  transportation planning process
• Empirically determine relationships between the
  following
• Types of driving relevant functional impairment
• Types of constraints on adequate compensation
• Types of critical driving errors
• Types of crashes

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Most Critical Research Needed - 2

• Develop more effective retraining and route
  planning techniques
• Develop a self-assessment tool that assures
  confidentiality for older persons
• Research to identify when older drivers become
  unfit to drive - the physical, mental or
  functional cues
• Define qualities of elderly who are still
  successful drivers --test their cognitive
  physical ie reaction time correlate to those
  that are not able to drive safely
• Develop physician screening tools
• Development of physician communication and
  training programs

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Most Critical Research Needed - 3

• Develop a consensus criterion, including
  acceptable levels of performance and capability
  that can be correlated with reverse graduated
  driving privileges.
• Research that can lead to broadly accepted
  screening protocols, with high reliability and
  validity, and are cost-effective to administer,
  and, ultimately, acceptable to AAMVA (et al)
• Detailed task analyses of critical driving tasks
  across a variety of conditions
• Develop a systematic way to find and create
  transportation alternatives

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This is a start!
An opportunity to obtain agreement on what we
can do now to improve safe mobility of older
persons and to lay out a course for the future
at this International Older Driver Consensus
Conference.