older driver safety outside the field of occupational therapy aded conference august 3, 2014 susan...
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Older Driver SafetyOutside the Field of Occupational
Therapy
ADED ConferenceAugust 3, 2014
Susan CohenAmericans For Older Driver [email protected]
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TransportationFederal & State
AgingFederal &
State
ResearchUniversity & TRB
National Organizations
Occupational Therapy
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● Mission: “To save lives, prevent injuries, and reduce economic costs due to road traffic crashes.”o Over 45 years of NHTSA o Highway fatality rates are the lowest they’ve
been since 1949.
National Highway Traffic Safety Administration (NHTSA)
Trans. Federal
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● 1989 Older Driver Program established o To “reduce traffic-related fatalities and injuries.”
● 2005 - NHTSA compiled research and expertise to create Older Driver Traffic Safety Plan
National Highway Traffic Safety Administration (NHTSA) (continued)
Trans. Federal
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● Builds on the 2005 Older Driver Traffic Safety Plan.
● Identified 3 program initiatives:1. Build communications for older drivers and
caregivers.2. Establish and maintain partnerships to
enhance older driver safety efforts.3. Develop and promote driver licensing
policies.
Older Driver Program: Five-Year Strategic Plan 2012-2017 (DOT HS 811432) December 2010
Trans. Federal
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Initiative 3. Develop and Promote Driver Licensing Policies● Renewal Procedures: accelerated renewal cycles; in-
person license renewal; screening protocol for DMV counter personnel
● Medical Advisory Boards: include MABs in state licensing and renewal policies; guidelines on the structure, role and responsibilities of the MAB
● Training for Law Enforcement & Health Care Providers: create templates for states on● information on referring to MAB; ● cue card for law enforcement
Older Driver Program: Five-Year Strategic Plan 2012-2017 (continued)
Trans. Federal
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● NHTSA’s new plan to address older driver safety concerns.● Wants to create “evidence-based countermeasures to
reduce risk to older - and all - drivers.”● Broken into three time periods.
o The 2 years following the plan’s implementation.o 3-5 years after.o Beyond the 5 year plan.
Does not commit NHTSA to anything. This is a “roadmap for the administration to follow.”
Traffic Safety for Older People 5 Year Plan (DOT HS 811 837) August 2013
Trans. Federal
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● 4 Core Elements to the plano Datao Vehicleo Behavioro Pedestrian Safety
Also, an overarching element: define “older.”
Traffic Safety for Older People 5 Year Plan (continued)(DOT HS 811 837) August 2013
Trans. Federal
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● Recommendations to states based on more than 10 years of research.
● Proposed in 2012. Released in December 2013.● It addresses “... driver licensing and medical
review of at-risk drivers, medical and law enforcement education, roadway design, and collaboration with social services and transportation services providers.”
NHTSA Guideline No. 13Trans.
Federal
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● Driver licensing and medical review of at-risk drivers:○ In-person renewal of driver licenses for those
over a specified age.○ Provide referring medical providers with
immunity from civil liability○ Train licensing staff to identify medically at-
risk drivers.○ Provide outreach and training to medical
providers and law enforcement.
NHTSA Guideline No. 13 (continued)Trans.
Federal
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● NHTSA has no authority over states; no federal requirements for states’ policies on older drivers. Recommendations only.o States are responsible for their own
traffic/vehicle/driver laws. o The federal government influences state road safety
measures by channeling money into state highway safety departments.
● Currently, there are 50 different older driver licensing policies that are not based on research.
● Only now are older drivers beginning to appear on States’ Strategic Highway Safety Plans
NHTSA Guideline No.13 (continued)Trans.
Federal
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● Originally created in 2003. ● 2nd Edition currently available. DOT HS 811 298 June
2010● Joint effort of NHTSA and American Medical
Association (AMA no longer involved). ● Intended to train physicians to evaluate driving
safety of older patients.
HOW SUCCESSFUL WAS THIS EFFORT??
Physician’s Guide to: Assessing and Counseling Older Drivers (2nd Edition)
Trans. Federal
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● An evaluation of the Physician’s guide.o http://dx.doi.org/10.1080/02701960.2010.528273o by Thomas M. Meuser, David B. Carr, Cheryl Irmiter, Joanne G.
Schwartzberg, and Gudmundur F. Ulfarssono Published November 4, 2010
● Funded by a grant from NHTSA and AMA.● The Guide “provides background information and a detailed
rationale for the application of medical principles to the driving task. In-office approaches to screening and assessment receive significant attention including a suggested group of tests called the Assessment of Driving Related Skills (ADReS Battery)... the Guide teaches how to frame the broader topic of personal mobility and discuss results in a way that balances patients’ independence needs with larger public safety concerns.”
The American Medical Association Older Driver Curriculum for Health Professionals: Changes in Trainee Confidence, Attitudes, and Practice Behavior
Trans. Federal
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● A quiz was taken by physicians with the Guide.● A five-module, multimedia Curriculum has been
designed around The Guide that includes slides, video case segments, and handouts for live presentations.o Presentation for physicians and other trainee
groups.o Information was gathered from 22 of these live
presentations by different teams in 12 states. The presentations were then updated appropriately.
● Curriculum’s goal: “provide core knowledge and techniques necessary for a clinician to evaluate driver fitness in a typical care encounter.”
● This critique the summation of 693 physician participants.
AMA Older Driver Curriculum Critique Pt. 2
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● Data shows physicians widely adopted the AMA recommendations.
● Physicians:o now use chart documentationo incorporated driving questions into the clinical
approacho coordination with patient and family to support
driving retiremento use of integrative assessment approacho use of the Trail Making Test for screening
Largest adoption of the Guide occurred in questioning of patients (31% of post-test respondents).
The Critique Pt. 3: Results Trans. Federal
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● “Targeted, evidence-based educational programming can enhance the medical care of older patients with respect to driver fitness.”
● AMA curriculum focused on the minority who are at risk due to medical conditions that directly affect driving.
● AMA Guide and Curriculum encourage action to detect relevant conditions as they emerge and before driving may be compromised.
● Physicians alone not responsible for this task. It also falls to older drivers’ families, law enforcement, driver licensing officials, social service professionals, and the older driver. o Physicians must work with these people.
The Critique Pt. 4: The ConclusionTrans.
Federal
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EDUCATIONAL• How to Understand and Influence
Older Drivers (2006)• DriveWell Toolkit--Promoting Older
Driver Safety and Mobility in Your Community (2007)
• Adapting Motor Vehicles for Older Drivers (2007)
DATATraffic Safety Facts--Annual fact
sheets on older population--1993-2013
SAFETY 1N NUMB3RS
NHTSA PublicationsTrans.Federal
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RESEARCH• Functional Assessments, Safety Outcomes, and Driving Exposure
Measures for Older Drivers (DOT HS 811 630) (2012)• Pedal Application Errors (DOT HS 811 597) March 2012
NHTSA Publications (continued)Trans.
Federal
• Licensing Procedures for Older Drivers (DOT HS 811 833) September 2013
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Focus on Features and Design of Roadways:• Highway Design Handbook for Older
Drivers and Pedestrians (2001)
• Travel Better, Travel Longer, a Pocket Guide to Improve Traffic Control and Mobility for Our Older Population (FHWA-OP-03-098)(2003)
Federal Highway Administration Trans.Federal
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Federal Highway Administration
Focus on State Efforts for Older Driver Safety (2007)
Trans.Federal
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● NTSB is an independent federal agency charged with investigating every civil aviation accident and all major transportation accidents. Their mission is to advance transportation safety.o November 2010 - NTSB organized a public
forum for experts and interested organizations to discuss older driver safety. discussed older driver’s decreased injury
tolerance, vehicle design efforts to make driving easier, and ways one can assess an older driver.
● NTSB has a “most wanted” list. The most wanted list does not include older driver safety.
National Transportation Safety Board (NTSB)Trans.
Federal
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● 50 States: 50 State DOTs and 50 Driver Licensing Requirements
● Changes in Requirements through law and regulation change--State law makers and regulatory agencies (DMV)
STATE DRIVER LICENSING Trans.State
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NOTEWORTHY STATES--Both Good and Bad
Maryland--Model Medical Advisory Board; 8 year license renewal, In-Person every 16 years
Missouri—Training Video for Licensing Office Counter Staff; Subcommiittee on Elder Mobility and Safety (SEMS) of the Missouri Coalition For Highway Safety
Illinois--Only state with behind the wheel requirement for older drivers
Virginia—DMV November 2013 “Mature Driver Study” ; 2014 passed law to require shorter renewal cycle for 75+
STATE DRIVER LICENSING Trans.State
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NOTEWORTHY STATES--Both Good and Bad (continued)
Iowa--second largest older driver population, 5-booklets to educate older drivers; on-going research
Florida--largest older driver population; Safe Mobility For Life Coalition; “Florida’s Guide for Aging Drivers” (May 2012)
Kansas—2014-KS Highway Patrol developed Medical Conditions and Driving brochure; March 2014 Older Driver Summit
STATE DRIVER LICENSING Trans.State
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October 1, 2006--The date that Federal law requires states to have an approved Strategic Highway Safety Plan. (SAFETEA-LU)● SHSP developed after consultation with stakeholders● Uses state, regional or local crash data● Identifies and analyzes highway safety problems● Required to address 4 E’s: engineering, education,
enforcement and EMS● Includes projects or strategies to reduce or eliminate safety
hazards Access to Federal highway $$ under the Highway Safety Improvement Program for states with a SHSP.
STATE HIGHWAY SAFETY EFFORTS Trans.State
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Only a few states have older drivers identified as a target area to improve highway safety
Some states that include older drivers in SHSP:Florida—”Aging Road User Strategic Safety Plan”
New Hampshire—convene an Older Driver Task Force
Wisconsin—Action Plan includes exploring continuing medical education credits for physicians who take online course on Wisconsin laws and rules for driving with medical conditions
STATE HIGHWAY SAFETY EFFORTS(continued) Trans.
State
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In response to lack of social services for older adults● Created the Administration on Aging (AoA) to administer
program of grants to states to provide community based services, including nutrition
● Resulted in creation of 56 state agencies on aging ● 618 area agencies on aging
1965: Congress Passes Older Americans ActAging. Federal
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Act amended in 2006● Added mental health focus● State plans to include assessment and provision of
services to “older individuals with limited English proficiency”
● Title IV Activities for Health, Independence and Longevity○ funds civic engagement activities,○ community innovations for aging in place and NORCs○ building awareness of cognitive impairments○ innovations to improve transportation○ community planning for aging population
1965: Congress Passes Older Americans Act(continued) Aging.
Federal
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Mission: to build capacity of its member agencies to help older persons and persons with disabilities live with dignity and choices in their homes and communities for as long as possible.Members are Area Agencies on AgingAdvocates for funding of Older Americans Act
National Association of Area Agencies on Aging (n4a)
Aging. Federal
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Mission: “We strive to increase transportation options for older adults and enhance their ability to live more independently within their communities throughout the U.S.● Established in 2006● Federally funded training and technical assistance center ● Administered by Easter Seals, Inc. in partnership with n4a● www.seniortransportation.net● Recently revamped website includes page on “Older Driver
Safety and Transition From Driving”● Links for educational materials for drivers and families
National Center on Senior TransportationAging. Federal
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● Founded the AAA Foundation for Traffic Safety in 1947o Mission statement: “Prevent traffic deaths and
injuries through research into their causes and to educate the public about strategies to prevent crashes and reduce injuries.”
● 2004 - Began analyzing senior crash rates and judging the effectiveness of state motor vehicle license renewal policies.
AAA - American Automobile Association
National Organizations
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● Research: major research contributor; continuously funds older driver research. Examples:
1. 2007--Enhancement of Driving Performance Among Older Drivers
2. 2008—Medical Fitness to Drive and a Voluntary State Reporting Law (analysis of Missouri law)
3. July 2014—Driver License Renewal Policies and Fatal Crash Involvement Rates of Older Drivers, United States, 1985-2011
AAA - American Automobile Association (continued)
National Organizations
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● Dedicated to keeping seniors driving for as long as they safely can.o Offer online and classroom courses for seniors.
http://seniordriving.aaa.com/ ● Roadwise Review CD-ROM (Mac and PC Versions) (2006)● Publications/brochures:
○ How to Help an Older Driver, A Guide for Planning Safe Transportation (2000)
○ Smart Feature for Older Drivers (2012)--describes features of cars that may be helpful to older adults (automatic tailgate closer, heated seats, heated side mirrors, etc.)
AAA - American Automobile Association - National Office and Clubs
National Organizations
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Two Organizations:AARP Services, Inc.
37,000,000 + membersFor Profit—sells insurance, travel,
etc.AARP Foundation—non-profit
Research arm: AARP Public Policy Institute
AARPNational
Organizations
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AARP Public Policy Institute produces:Fact SheetsApril 2011 “How the Travel Patterns of Older Adults Are Changing: Highlights From the 2009 National Household Travel Survey”
Research ReportsApril 2013 “Weaving It Together: A Tapestry of Transportation Funding for Older Adults”
AARP (continued)National
Organizations
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● Mission: provide leadership in transportation innovation and progress through research and information exchange. o “Human factor” added to their list of interests
in the 1950s.● Older Drivers:
o Worked on 26 projects involving or pertaining to older drivers and their needs. These include: data collection projects,
testing in-vehicle modifications and their effectiveness, and developing visibility requirements for older drivers.
TRB - Transportation Research Board Research
TRB
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● Committees:o Standing Committee on Safe Mobility of Older
Persons (ANB60) formed in the 1990s. Subcommittees:
Enhancing Older Women’s Safe Mobility Medical Advisory Board and Driver
Licensing Transportation Options for Seniors
TRB - Transportation Research Board (continued) Research
TRB
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o Thousands of U.S. and international transportation officials
o Five Day Program with almost 750 sessions and workshops
o Exhibits from TRB’s sponsors and participating commercial organizations
o TRB committees meet
TRB - Annual Meeting in D.C.Research
TRB
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● Published in 2004 by the TRB as Volume of the 500 Series.o National Cooperative Highway Research
Program (NCHRP) developed the 500 Series of guides to assist state and local agencies in reducing injuries and fatalities.
o The guides correspond to emphasis areas outlined in the AASHTO Strategic Highway Safety Plan.
o Each guide includes a general description of the problem, the strategies/countermeasures to address the problem, and a model implementation process.
A Guide for Reducing Collisions Involving Older Drivers Research
TRB
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● Strategy 3.1 C1: Strengthen the Role of Medical Advisory Boardso Medical Advisory Boards mainly serve in a policy
setting/advisory capacity and rarely see individual patients.
o Examples of state MAB’s: Maryland MAB very active in identifying individuals
with medical impairments. California MAB only convenes for policy.
o Information on MABs should be available for the general public via MVA’s and State Medical Association’s websites.
o Legislation might have to change to empower MABs; some states lack clear guidelines for assisting MABs (so some rely on volunteers).
Objective 3.1 C: Identify Older Drivers at Increased Risk of Crashing and Intervene
ResearchTRB
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● Strategy 3.1 C2: Update Procedures for Assessing Medical Fitness to Driveo Existing guidelines for medically at-risk drivers are
outdated and based on disease diagnosis (NOT level of functional impairment).
o State motor vehicle departments must review and update their guidelines. Instead of this, states could support the AAMVA in
creating an updated set of nationally recommended guidelines.
o In-person license renewals are key. No in-mail renewal processes.
o Example: In Utah, drivers are required to identify any medical problems when renewing their license.
Objective 3.1 C (continued)Research
TRB
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● Strategy 3.1 C3: Encourage External Reporting of Impaired Drivers to Licensing Authoritieso Only six states require physicians to report
patients with potential driving impairments. o Thirty-one states provide immunity from legal
action to physicians who do report patients.o Physicians should be educated on the
importance of discussing driving with their patients/self-reporting if the physician believes the driver has been compromised.
o Reports are not typically made anonymously, but the referral source is often kept confidential.
More Strategies... ResearchTRB
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● Local driving schoolso Not every school is qualified to evaluate and retrain
older drivers. Those who do though have proven useful and effective.
● It is recommended that states have specific guidelines in place to impose appropriate restrictions on licenses of impaired drivers.
● Model Driver Screening and Evaluation Program in Marylando Included driver counseling and rehabilitation. o More research needed to determine the long-term
effects of this program.● 2001 - a study shows cataract surgery reduces an older
driver’s risk of crashing.
Strategy 3.1 C4: Provide Remedial Assistance to Help Functionally Impaired Older Drivers Research
TRB
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● UMTRI - “dedicated to achieving safe and sustainable transportation for a global society.”o Since it began in 1965, UMTRI has facilitated
over 1,000 short-term and long-term research projects. These projects pertain to these fields: accident data collection and traffic safety
analysis bioengineering human factors mechanical engineering psychology economics public policy
University of Michigan Transportation Research Institute (UMTRI) Research
University
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● One of UMTRI’s main Human Factors concerns is Senior Mobility.o UMTRI has facilitated numerous projects
concerning older driver safety. These projects include: the evaluation and development of self-assessment
material for older drivers including UMTRI’s own Driving Decisions Workbook.
surveys of older drivers evaluating devices meant to assist older drivers on-road assessment of drivers focus-groups
o Also works to improve the communication between seniors and families.
UMTRI’s Senior Mobility (continued) Research
University
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o Recent Projects Include: How to Create, Implement, Sustain, and
Evaluate Travel Training for Older Adults: A Handbook
Self-Regulatory Practices by Older Adults Transportation Patterns of Older Drivers in
Rural Michigan
UMTRI’s Senior Mobility(continued)
ResearchUniversity
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● Held in Detroit, MI every ten years.● 2004 Conference: the 1st time the conference occurred. It
attracted representatives from 17 states and 6 different countries. This conference was sponsored by the Governor’s Traffic Safety Advisory Council (GTSAC).
● In 2014, the conference focused on new developments in older driver safety that have occurred since 2004.
UMTRI’s North American Conference on Elderly Mobility
ResearchUniversity
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● The key topics included:o Housing and Land Useo Alternative Transportationo Infrastructure and Vehicleso Driver Education and Trainingo Driver Screening and Assessment
● In 2014, the event was sponsored by the Federal Highway Administration (FHWA).
UMTRI’s North American Conference on Elderly Mobility (continued)
ResearchUniversity
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● Features the Center for Vulnerable Road User Safety that conducts research on teen and older drivers, bicyclists, and pedestrians.o Senior Mobility Awareness, Safety, and Health
(SMASH) Group conducts research on Older Driver Safety. When conducting research, they consider these three ideas: Personal vehicles are the primary means
of transportation and independence in the U.S.
Senior drivers are overrepresented in crash rates on a per mile basis.
Older drivers’ fragility increases their risk of injury if they are involved in a crash crash.
Virginia Tech Transportation Institute Research
University
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● TREDS - Training, Research, and Education For Driving Safetyo Their older adults initiative is led by TREDS
Deputy Director Jill Rybar, MPH. This initiative:
● works with different local organizations to promote driver safety within communities (specifically, they focus on older drivers).
● refers families to community resources that evaluate driving fitness.
● offers technical assistance in program planning, delivery, and evaluation.
University of California, San Diego’s TREDS
ResearchUniversity
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● Home to Dr. Karlene E. Ball who compares seniors’ visual and cognitive capabilities with their mobility difficulties (with an emphasis on driving).o A member of the Transportation Research Board
(TRB)’s National Research Council.o Operates within UAB’s Department of
Psychologyo Her 2010 study showed that cognitive training
can reduce an older driver’s crash risk.
University of Alabama at Birmingham
ResearchUniversity
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● Gerontology Program is home to Dr. Thomas M. Meuser, an expert in driver fitness and mobility transitions in aging. Also the head of the Graduate Gerontology Program at UMSL.
University of Missouri - St. Louis Research
University
o “Physician Input on Cited Older Drivers” - Current one year project Meuser is working on. Goal is to improve Missouri’s medical evaluation for at-risk drivers. Has worked on this in the past, but continues to make
improvements.o Developed the Assessment of Readiness for Mobility Transition
(ARMT) with colleague Dr. Marla Berg-Weger. Received a $30,000 grant from the UM Research Board to test its validity. Designed to identify seniors who may have difficulty transitioning away from driving.
o A member of St. Louis Consortium for Older Driver Education & Research (SCODER).
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● Founded in 1974, NIA is one of 27 Institutes and Centers that constitute the National Institutes of Health (NIH).o Mission:
Support and conduct genetic, biological, clinical, behavioral, social, and economic research on aging.
Foster the development of research and clinician scientists in aging.
Provide research resources. Disseminate information about aging and
advances in research to the public, health care professionals, and the scientific community among a variety of audiences.
o NIA conducts research on Older Drivers that can be found in their numerous publications or on their website.
National Institute on Aging (NIA) Transportation
Federal
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● The leading voice on aging issues for Area Agencies on Aging (AAAs) and Title IV Native American Aging Programs. Through advocacy, training, and technical assistance n4a supports national networks of AAAs and Title IV Programs.
National Association of Area Agencies on Aging (n4a) Transportation
Federal
o One of n4a’s main programs involves senior transportation. They work to improve public transportation in order to further senior mobility. They support this by: Co-administering the National Center on Senior Transportation
(NCST). Advocacy efforts such as the Senior Transportation Task Force. Assisting older adults seeking transportation via the Eldercare
Locator. Technical Assistance to AAAs and Title IV Programs.
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● Founded in 2012 after the death of 20-year old Nathan Krasnopoler.o In 2011, Nathan was fatally injured while
biking near his apartment by an at-fault 83-year old driver .
o Without looking, the driver turned right into the bike lane.
o The driver failed to call an ambulance or notify pedestrians.
o The driver received two points on her license and a fine of less than $300.
Americans For Older Driver Safety (AFODS)
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● AFODS mission: empower older adults to extend their years of safe driving and remain mobile for life through education, research, and policy advances.
AFODS - National Focus
o Currently developing an older driver safety curriculum appropriate for baby boom generation.
o Compiling a website to act as reference material for public and experts in the field.
o Advocating for national initiatives to facilitate state implementation of NHTSA Guideline 13: provide states with educational materials for the public; physician education materials & information to provide patients; law enforcement training materials; advocating for driver license policy change by developing model laws and regulations.
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● Accomplishmentso Significant Media Attention and starting a social media
campaigno Hosted a briefing with the Maryland General Assemblyo Published a Maryland-specific policy briefo Forged a partnership with MD MVA
● Goals: Developo A national educational clearinghouse of evidence
based publications and training materialso Model laws and regulations on older driver safetyo Standard curriculum for older adult driving refresher
classes that include both classroom behind-the-wheel components
AFODS
