Results from Pre- Conference Survey of Participants*

International Older Driver Consensus ConferenceArlington, VA

December 1 – 2, 2003

For additional information contact:Burt Stephens, University of Florida,

Seniors’ Institute for Transportation and CommunicationsE-mail: Bstephen@hp.ufl.edu

* N = 22

How to Identity “at-risk drivers

How to Identify “At-Risk” Drivers?

Method Current State Improved Methodology

Potential % Improvement

Crash Records 2.00 2.44 22Driver Relicensing 1.89 3.00 59Awareness 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

Average Ratings of Effectiveness of Methods for Identifying At-Risk Drivers

(N=16 - 22; Scale ranges from 4 – Very Effective to 1 – Not At All Effective)

Experience of Conference Participants

DRIVER ASSESSMENTSPROFESSIONALS’

EXPERIENCETREATMENT GROUP PORTION

Performed Evaluations as part of a driver screening program

50% (N=11)

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% (N=8)

REMEDIATIONPROFESSIONALS’

EXPERIENCETECHNIQUE/ACTIVITY PORTION

Provide Remediation Services for drivers

27% (N=6)

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%

Re-design or re-engineering of vehicles or the transportation infrastructure

23% (N=5)

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% (N=3)

REMEDIATION (Cont)

COUNSELING PROFESSIONALS’

EXPERIENCETYPES OF COUNSELING PORTION

Formal Counseling 37% (N=8)

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)

Assess By Components or Holistically?

Participant’s Response Percent

Whole driving performance needs to be considered

32

Need to first decompose driving task into its components

36

No Response 32

Changes Associated With Aging

Importance of Sensory and Perceptual Changes

ELEMENT RANKGlare 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.

Importance of Cognitive Changes

ELEMENT RANKAbility 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

Importance of Other Changes

ELEMENT RANKAbility 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

DRIVER SCREENING AND ASSESSMENT

Protocols for

SCREENING/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)

METHOD AVERAGE VALIDITY RATING

AVERAGEUSABILITY

RATING

AVERAGESUFFICIENCY

RATING

AVERAGECOST-

EFFECTIVENESSRATING

GRIMPS (N=7-8)

2.6 3.5 1.9 2.2

TRAIL MAKING(N=12-13)

3.3 3.8 2.2 3.4

AUTOMATED PSYCHO-PHYSICAL TEST (APT)(N=3)

2.7 3.3 2.3 2.7

DriveABLE(N=4)

4.2 4.2 4.8 3.2

DRIVING SIMULATOR*(N=10-12)

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

RATING SCREENING OR EVALUATION PROTOCOLS

METHOD AVERAGE VALIDITY RATING

AVERAGEUSABILITY

RATING

AVERAGESUFFICIENCY

RATING

AVERAGECOST-

EFFECTIVENESSRATING

VISUAL ATTENTION ANALYZER FOR UFOV(N=12-13)

3.5 3.5 2.8 2.8

MOTOR VISUAL PERCEPTUAL TEST(N=6)

2.8 3.0 2.2 2.7

COMPLEX REACTION TIME(N=6-7)

2.7 3.6 2.1 3.0

COGNITVE BEHAVIORAL DRIVER’S INVENTORY(N=4)

2.8 3.0 2.5 2.2

RATING SCREENING OR EVALUATION PROTOCOLS (Cont)

RATING SCREENING OR EVALUATION PROTOCOLS (Cont)

METHOD AVERAGE VALIDITY RATING

AVERAGEUSABILITY

RATING

AVERAGESUFFICIENCY

RATING

AVERAGECOST-

EFFECTIVENESSRATING

COGNITIVE MONEY ROAD MAP(N=1)

2.0 2.0 1.0 4.0

MINI MENTAL STATUS EXAMINATION(N=11-12)

3.0 2.9 2.1 3.4

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

REMEDIATION

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

RISK MANAGEMENT PAYOFFS

FOR APPLYING METHODSMETHODS AVERAGE

RANKINGRANGE

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

MEDICATION SIDE EFFECTS EXPERIENCEDThat 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

COUNSELING AND TRANSPORATION ALTERATIVES

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

Basis of Counseling Process Used

Personal and professional experience – 4 Specific courses or training to develop the

process – 0 Use a standardized protocol – 2

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

Constraints Experienced In Counseling on Transportation Alternatives

Client’s unwillingness to accept that he/she is no longer able to drive safely

Lack of reliable, affordable transportationLack of transportation options and

knowledge as to how the options work Lack of on-time reliable public or

paratransit transportationLack of transportation resources in

communities

INFORMATION AVAILABLE AND NEEDED

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/research25) • 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

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

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

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

RESEARCH NEEDS

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

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

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

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.