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Lay Abstract: This study looked at how Australian autistic and non-autistic adults experience barriers to healthcare. We asked autistic and non-autistic adults to complete the Barriers to Healthcare Checklist Short-Form (BHC). We analysed data from 263 autistic adults and 70 non-autistic adults. We found that autistic adults experienced more barriers to healthcare than non-autistic adults. Gender diversity, feeling more anxious, having greater disability and feeling unsatisfied with social support contributed to barriers to healthcare in autistic participants. We recommend interventions such as developing and implementing a national action plan, similar to the National Roadmap for Improving the Health of People with Intellectual Disability (2021) to reduce barriers and address unmet healthcare needs of Australian autistic adults. We also recommend working with autistic adults to develop new policies and strategies, implementing environmental adaptations to health care facilities, and increasing Autism education opportunities for health professionals to address gaps in knowledge., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objectives: To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs., Design: Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis., Participants: Drivers of four-wheeled vehicles of all ages with no cognitive declines., Primary and Secondary Outcomes: MVC involvement (primary) and driving cessation (secondary)., Results: 101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p<0.001; I 2 =46.79%), and contrast sensitivity (two studies; RR 1.40 (95% CI 1.08, 1.80); p=0.01, I 2 =0.11%) and visual acuity loss (five studies; RR 1.21 (95% CI 1.02, 1.43); p=0.03, I 2 =28.49%) may increase crash risk. The results are more inconclusive for available evidence for associations of glaucoma (five studies, RR 1.27 (95% CI 0.67, 2.42); p=0.47; I 2 =93.48%) and cataract (two studies RR 1.15 (95% CI 0.97, 1.36); p=0.11; I 2 =3.96%) with crashes. Driving cessation may also be linked with glaucoma (two studies; RR 1.62 (95% CI 1.20, 2.19); p<0.001, I 2 =22.45%), age-related macular degeneration (AMD) (three studies; RR 2.21 (95% CI 1.47, 3.31); p<0.001, I 2 =75.11%) and reduced contrast sensitivity (three studies; RR 1.30 (95% CI 1.05, 1.61); p=0.02; I 2 =63.19%). Cataract surgery halved MVC risk (three studies; RR 0.55 (95% CI 0.34, 0.92); p=0.02; I 2 =97.10). Ranibizumab injections (four randomised controlled trials) prolonged driving in persons with AMD., Conclusion: Impaired vision identified through a variety of measures is associated with both increased MVC involvement and cessation. Cataract surgery can reduce MVC risk. Despite literature being highly heterogeneous, this review shows that detection of vision problems and appropriate treatment are critical to road safety., Prospero Registration Number: CRD42020172153., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Impairment of arm movement occurs in up to 85% of people post-stroke, affecting daily living activities, and quality of life. Mental imagery effectively enhances hand and daily function in people with stroke. Imagery can be performed when people imagine themselves completing the movement or imagine another person doing it. However, there is no report on the specific use of first-person and third-person imagery in stroke rehabilitation., Aims: To develop and assess the feasibility of the First-Person Mental Imagery (FPMI) and the Third-Person Mental Imagery (TPMI) programs to address the hand function of people with stroke living in the community., Methods: This study comprises phase 1-development of the FPMI and TPMI programs, and phase 2-pilot-testing of the intervention programs. The two programs were developed from existing literature and reviewed by an expert panel. Six participants with stroke, living in the community, participated in the pilot-testing of the FPMI and TPMI programs for 2 weeks. Feedback collected included the suitability of the eligibility criteria, therapist's and participant's adherence to intervention and instructions, appropriateness of the outcome measures, and completion of the intervention sessions within the specified time., Results: The FPMI and TPMI programs were developed based on previously established programs and included 12 hand tasks. The participants completed four 45-min sessions in 2 weeks. The treating therapist adhered to the program protocol and completed all the steps within the specified time frame. All hand tasks were suitable for adults with stroke. Participants followed the instructions given and engaged in imagery. The outcome measures selected were appropriate for the participants. Both programs showed a positive trend towards improvement in participants' upper extremity and hand function and self-perceived performance in activities of daily living., Conclusions: The study provides preliminary evidence that these programs and outcome measures are feasible for implementation with adults with stroke living in the community. This study outlines a realistic plan for future trials in relation to participant recruitment, training of therapists on the intervention delivery, and the use of outcome measures., Trial Registration: Title: Effectiveness of first-person and third-person motor imagery in relearning daily hand tasks for people with chronic stroke: a randomised controlled trial., Registration No: SLCTR/2017/031. Date registered: 22nd September 2017., (© 2023. The Author(s).)

The proportion of people aged 65 years and older regularly traveling in motor vehicles continues to grow worldwide. In a previous convenience sample, we observed many older people using comfort accessories when traveling in vehicles, and these may contribute to the known increased risk of injury in crashes among older people. In this study, we aimed to estimate population-level use of these devices and examine associations between demographic, health, and travel behavior factors and their use. The point estimate of self-reported use of comfort accessories was 25.7% (95% confidence interval [CI] = [19.6%, 31.9%]). Cushions on the vehicle seat were the most common type used (14.3%, 95% CI = [9.7%, 19.0%]), and increasing age, female gender, and frequent vehicle travel were significantly associated with their use. Less frequently used were seat belt padding (10.5%, 95% CI = [6.3%, 14.6%]) and back/neck supports (6.5%, 95% CI = [2.7%, 10.2%]). Back/neck and multiple area pain were significantly associated with the use of the latter.

Background: Workplace musculoskeletal disorders are the leading cause of morbidity and disability in the Australian workforce. Over one in five occupational therapists report workplace musculoskeletal disorders, with almost half reporting workplace musculoskeletal symptoms. In other health professions, students and novice clinicians (≤5 years practice) experience greater risk but little is known about occupational therapy students., Methods: In this cross-sectional study, a survey including the self-reported Standardised Nordic Musculoskeletal Questionnaire was administered to occupational therapy students post work-based training. Musculoskeletal problems were defined as aches, pains, numbness or discomfort. Questions explored body sites affected, prevalence, impact on activity, need for medical assistance, demographic and workplace information. Prevalence was reported using descriptive statistics. Factors associated with workplace musculoskeletal problems over the previous 12 months and last 7 days were examined using logistic regression modelling., Results: Response rate was 53% (n = 211/397). One-third of respondents (33.6%, n = 71/211) reported a workplace musculoskeletal problem over 12 months. Nearly half (47.9%, n = 34/71) of these students reported a problem over the last 7 days. Neck was the most commonly affected area reported for musculoskeletal problems over the past 12 months (24.2%, n = 51/211) and shoulder areas affected over the past 7 days (10.9%, n = 23/211). Musculoskeletal problems preventing daily activities were reported most commonly from lower back problems over 12 months (23.9%, n = 17/71) and for shoulder problems over the last 7 days (21.9%, n = 7/32). Shoulders and knees were the most common body areas requiring medical attention. Previous musculoskeletal problems and female gender were associated with reported problems over 12 months and last 7 days (p < 0.05). Non-standard joint mobility (OR = 3.82, p = 0.002) and working in psychosocially focused caseloads (including mental health or case management) (OR = 3.04, p = 0.044) were also associated with reporting musculoskeletal problems over the last 7 days., Conclusions: One in three occupational therapy students already experience workplace musculoskeletal problems impacting daily activities and requiring medical assistance prior to graduation. High prevalence of musculoskeletal problems in this study calls for educators and researchers to find sustainable strategies to address these problems, with particular consideration to the impact of previous disorders and working in psychosocially focused caseloads on musculoskeletal health.

Background: Youth on the autism spectrum face particular challenges with community mobility and driving, contributing to reduced community participation. Skill development may be uniquely shaped by complex interactions between autistic traits, psychosocial influences and community environments. Research to guide occupational therapy practice is sparse., Objective: This short report explores the complex interplay between psychosocial and environmental influences on community mobility development, to stimulate further occupational therapy research and provide considerations for practice., Method: Because of the lack of autism specific research, we firstly discuss psychosocial and environmental influences impacting non-autistic youth, then draw on current research to identify challenges for youth on the spectrum. Finally, we propose considerations for practice and research., Conclusion: Psychosocial considerations for developing community mobility and driving include social communication, safety, navigating unpredictable community environments, emotional regulation and motivation for community participation. Future research should explore how to develop foundational community mobility skills; communication and social skills; and autistic needs for inclusive design. Supporting normative community mobility skills during adolescence may underpin transition to independence in adulthood., Significance: Broadening the focus of community mobility and driving research to understand environmental and psychosocial contexts of community environments, is necessary to provide guidance for occupational therapists supporting youth on the spectrum with independent community participation.

Introduction: Driving is one of the main modes of transport with safe driving requiring a combination of visual, cognitive and physical skills. With population ageing, the number of people living with vision impairment is set to increase in the decades ahead. Vision impairment may negatively impact an individual's ability to safely drive. The association between vision impairment and motor vehicle crash involvement or driving participation has yet to be systematically investigated. Further, the evidence for the effectiveness of vision-related interventions aimed at decreasing crashes and driving errors has not been synthesised., Methods and Analysis: A search will be conducted for relevant studies on Medline (Ovid), EMBASE and Global Health from their inception to March 2020 without date or geographical restrictions. Two investigators will independently screen abstracts and full texts using Covidence software with conflicts resolved by a third investigator. Data extraction will be conducted on all included studies, and their quality assessed to determine the risk of bias using the Joanna Briggs Institute Critical Appraisal Tools. Outcome measures include crash risk, driving cessation and surrogate measures of driving safety (eg, driving errors and performance). The results of this review will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. Meta-analysis will be undertaken for outcomes with sufficient data and reported following the Meta-analyses of Observational Studies in Epidemiology guideline. Where statistical pooling is not feasible or appropriate, narrative summaries will be presented following the Synthesis Without Meta-analysis in systematic reviews guideline., Ethics and Dissemination: This review will only report on published data thus no ethics approval is required. Results will be included in the Lancet Global Health Commission on Global Eye Health, published in a peer-reviewed journal and presented at relevant conferences., Prospero Registration Number: CRD42020172153., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Importance: Autistic adults face decreased community participation for employment, education, and social activities plus barriers to driving and transportation. However, little is known about their experiences of moving around community environments., Objective: To explore contextual issues and experiences of independent community mobility and driving for autistic adults and to determine the modes of community mobility, regions studied, and methodologies used., Data Sources: Seven databases were searched from 2000 to 2019. All empirical research relating to autism, community mobility, and driving for people older than age 5 yr was mapped. Studies examining experiences of community mobility and driving were selected for scoping review., Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews methodology was used. Thirteen studies reporting specifically on autistic adults' experiences with public transportation, driving, and pedestrian navigation of community environments were included. These studies were analyzed using concepts from the Person-Environment-Occupation-Performance Model., Findings: Nine studies examined experiences of autistic adults. Seven studies explored proxy perspectives. Those studies examining driving primarily focused on learner driver experiences. Although most studies reported on personal and environmental factors, some studies reported on broader social communication and personal narrative factors. None used inclusive methodology involving autistic adults., Conclusions and Relevance: A broader focus on the contextual experiences of community mobility and driving is needed to support participation of autistic adults in their communities. Linking community mobility experiences with participation outcomes and expanding research to include experienced drivers and nonurban populations is an important component of this work., What This Article Adds: Occupational therapy interventions should address community mobility and driving skills before school transition. Autistic adults' skill development may be affected by person factors such as motivation, anxiety, social skills, communication, and occupational performance desires. Environmental factors such as parental concerns, community safety, pedestrian environments, traffic volume, and public transportation design are important. Further research partnering with autistic adults could better inform future occupational therapy interventions for community mobility and driving., (Copyright © 2020 by the American Occupational Therapy Association, Inc.)

This process evaluation explores relationships between program outcomes and intervention implementation in a trial evaluating "Behind the Wheel," an education-based safe-transport program for older drivers. Participants (intervention group) were 190 Sydney drivers aged ⩾75 years ( M = 80 ± 4years). Process measures included fidelity, dose delivered, and received. Outcomes were self-reported driving regulation and objectively measured driving exposure. Relationships were explored using regression models. Older drivers who took ownership of driving retirement and self-regulation by developing plans were more likely to reduce their weekly driving, (β = 38 km, 95% confidence interval (CI) = [7.5,68.7]), and night driving (β = 7 km, 95% CI = [3.5, 10.4]). Drivers of older age (odds ratio [ OR ] = 1.1/year older, 95% CI = [1.05, 1.3]) had greater odds of developing driving retirement plans. Female drivers ( OR = 2.7,95% CI = [1.1, 6.9]), drivers with poorer function ( OR = 1.2/5-point decrease on DriveSafe, 95% CI = [1.04, 1.4]), and worse health ( OR = 1.2/additional medication, 95% CI = [1.02, 1.5]) had greater odds of developing safe mobility plans. This program had greatest impact with older, lower functioning drivers. A stronger message was delivered and received, as intended, to older drivers with lower function and poorer health. Our logic model can help channel resources to drivers who benefit most.

Autistic adults have decreased independence in community mobility and driving, which is associated with decreased participation in work, education and community participation. This is the first exploration of the development of community mobility, driving and participation skills over adolescence and emerging adulthood. Interviews with 15 mothers of autistic youth, capable of independence, were qualitatively analysed using grounded theory. Four major themes emerged: mothers gently pushing, teaching, letting go and working towards hopes and dreams. These results suggest earlier intervention across adolescence to address social skills, communication and anxiety in normative community environments, is required for successful development of community mobility and driving skills. Further understanding the critical role of confidence, feeling safe and accepted, could ultimately improve independence.

Objective: Around a quarter of older occupants use some type of comfort or orthopedic aftermarket accessory on the vehicle seat while traveling in a vehicle. The aim of this study was to investigate the effect of comfort accessories on the performance of the seat belt restraint system in a frontal crash in terms of potential injury implications for older occupants. Methods: Eight frontal sled tests (43 km/h, 32  g ) were carried out on a deceleration sled fitted with a three-point lap-sash seat belt and a front passenger seat from a common Australian passenger car for each test. A 5 th percentile Hybrid III anthropometric test device (ATD) was positioned in the seat and measurements were recorded for head center of gravity acceleration, chest acceleration, neck forces and moments and sternal deflection. Tests were carried out in a baseline condition and with seven comfort accessories. Each comfort accessory was inserted between the ATD and vehicle seat as it is intended to be used, with the ATD otherwise positioned as close as possible to the baseline test position. Results: Initial distance between the seat belt anchor and ATD hip was associated with a statistically significant decrease in Head Injury Criterion and increase in sternal deflection. Submarining was related to the ATD torso recline angle and angle of the lap belt from the seat belt anchor. Conclusions: Accessories placed between the seat back and the lumbar region of an occupant have the potential to increase the risk of submarining due to a change in posture and should be avoided if such a change in posture when seated with an accessory is excessive. Sitting on seat cushions resulted in the greatest increase in seat belt anchor to hip distances and hence largest increase in sternal deflection. Given the fragility, frailty and particular importance of chest injuries among older vehicle occupants, further investigation is needed to determine whether these changes in ATD sternal deflection observed with seat cushion use results in injury threshold limits being exceeded and whether pretensioners and load limiters would ameliorate these effects without causing other negative changes in occupant response or kinematics.

Background: Work-related musculoskeletal problems impact everyday function, working ability, and quality of life. Unaddressed musculoskeletal problems can lead to major injury and loss of function, contributing to participation restrictions, economic loss and the increasing burden of disease worldwide. Medical science laboratory technicians are not immune with reported work-related musculoskeletal problems between 40 and 80%. Similar data is not available for medical science students, who may be the most vulnerable at the beginning of their careers. This study investigated the prevalence, common sites, impact and potential solutions for work-related musculoskeletal problems in medical science students during their university laboratory training., Methods: A Standardised Nordic Musculoskeletal Questionnaire was administered to medical science students at a local university in Sydney, Australia, to evaluate the prevalence, site and impact of work-related musculoskeletal problems. Problems were defined as an ache, pain, discomfort or numbness in body regions within 12 months and last 7 days in this period. The questionnaire was administered between April and June 2017., Results: The response rate was 38.2% (n = 110/288). Over a third (n = 38/110) reported a laboratory related musculoskeletal problem in the last 12 months and just over a fifth (n = 24/110) within 7 days. The lower back (30% and 17%), neck (24% and 10%) and upper back (21% and 10%) were the most common sites of problems reported within a 12 month and 7 day period respectively. Problems reported in the lower back, neck and upper back prevented daily activities in the majority of cases (between 63 to 83%) with many seeking physician or health professional assistance (between 13 to 83%). Solutions suggested by respondents included better seating designs, rest periods and education about correct working posture., Conclusions: Some medical science students during their laboratory training are already experiencing high levels of musculoskeletal problems, even before they enter the workforce. While the response rate was low affecting generalizability, the extent of problems limiting activity and needs to seek assistance of those reporting problems is of concern. Strategies are suggested to address ergonomic and postural training, as part of university curriculums, including the identification of problems for early intervention to facilitate sustainable workforces.

Background: A nested process evaluation, within a randomised controlled trial, will explore relationships between program outcomes and quality of intervention implementation of the Lifestyle-Integrated Functional Exercise Program in older people with vision impairment. The Lifestyle-Integrated Functional Exercise Program is a home-based strength and balance program that has been shown to reduce falls in high risk populations. A pilot study showed positive trends in improvements in physical function in older people with vision impairment after participation in the program. The program will be delivered by Orientation and Mobility Specialists, who are experienced in working with people with vision impairment., Methods: The process evaluation has a mixed methods design. This includes quantitative (fidelity checklist score, number of completed sessions, survey data and a habit formation scale), as well as qualitative (open responses from program staff and semi-structured interviews with study participants) data. Process evaluation measures include program adherence (fidelity), complete delivery (dose delivered), participant receipt (dose received) and participant enactment. Using the Behaviour Change Wheel, a logic model was built to explain the intended inputs, outputs, outcomes and relationships to the behaviour change techniques in the Lifestyle-Integrated Functional Exercise Program in older people with vision impairment., Discussion: The findings of the process evaluation will inform the provision of fall prevention programs in older people with vision impairment by Orientation and Mobility Specialists. To date, there are no proven falls prevention programs which aim to improve physical function and reduce falls in older people with vision impairment. This process evaluation will contribute new knowledge about the implementation of a strength and balance program in this population., Trial Registration: ACTRN12616001186448 . Registered 29 August 2016.

It has been consistently reported that women self-regulate their driving more than men. Volunteer drivers aged 75 years and older from the suburban outskirts of Sydney, Australia joined a longitudinal study in 2012-2014. GPS in-vehicle monitoring was used to objectively measure driving and surveys of driving patterns. The study included 343 drivers (203/343, 59% men) with an average age of 80 years. Our results revealed that men were 3.85 times more likely to report driving beyond their local shire during the past year (95% CI 2.03-5.72) and 1.81 times more likely to report that they do not avoid night driving (95% CI 1.21-3.22). In contrast sex was not predictive of any objective measure of driving during a one-week period of monitoring. These findings suggest that men and women report different self-regulation practices but that actual driving exposure is quite similar. These findings can inform strategies to promote safe mobility., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim and Background: There is growing evidence around the impact of injury and recovery trajectories but little focuses on older people, despite rising burden. The aim of this review was to describe the evidence for postinjury functioning and health-related quality of life (HRQoL) in older people., Method: A systematic search of three databases and an extensive search of the grey literature was carried out on prospective injury outcome studies in older people (age ≥65 years) that used a generic health status outcome measure. The search results were reported using PRISMA reporting guidelines, and risk of bias was assessed using a modification of the Quality in Prognosis Studies tool., Results: There was limited evidence on functioning and HRQoL postinjury in older people. There were 367 studies identified, with 13 eligible for inclusion. Most focused on hip fracture or traumatic brain injury. Older people appeared to have poorer postinjury functioning and HRQoL compared with younger adults or preinjury levels. Poor preinjury function, pre-existing conditions and increasing age were associated with poorer outcomes, whereas preinjury-independent living was associated with better outcomes., Discussion: The studies were heterogeneous, limiting synthesis. There was a lack of evidence around the impact of injury on older people in terms of paid work and unpaid work. It was unclear if existing injury outcome guidelines are appropriate for older people., Conclusions: Further research is required on older people's postinjury course, outcomes and determinants. This will require standardised methodologies and qualitative studies. The findings will inform clinical care, policy development, health and compensation systems., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objective: Real-world driving studies, including those involving speeding alert devices and autonomous vehicles, can gauge an individual vehicle's speeding behavior by comparing measured speed with mapped speed zone data. However, there are complexities with developing and maintaining a database of mapped speed zones over a large geographic area that may lead to inaccuracies within the data set. When this approach is applied to large-scale real-world driving data or speeding alert device data to determine speeding behavior, these inaccuracies may result in invalid identification of speeding. We investigated speeding events based on service provider speed zone data., Methods: We compared service provider speed zone data (Speed Alert by Smart Car Technologies Pty Ltd., Ultimo, NSW, Australia) against a second set of speed zone data (Google Maps Application Programming Interface [API] mapped speed zones)., Results: We found a systematic error in the zones where speed limits of 50-60 km/h, typical of local roads, were allocated to high-speed motorways, which produced false speed limits in the speed zone database. The result was detection of false-positive high-range speeding. Through comparison of the service provider speed zone data against a second set of speed zone data, we were able to identify and eliminate data most affected by this systematic error, thereby establishing a data set of speeding events with a high level of sensitivity (a true positive rate of 92% or 6,412/6,960)., Conclusions: Mapped speed zones can be a source of error in real-world driving when examining vehicle speed. We explored the types of inaccuracies found within speed zone data and recommend that a second set of speed zone data be utilized when investigating speeding behavior or developing mapped speed zone data to minimize inaccuracy in estimates of speeding.

Objective: Good seat belt fit and positioning is important for crash protection. Older drivers experience problems in achieving good seat belt fit and often reposition seat belts and/or use seat cushions. Comfort influences these behaviours. This work examines the impact of functional morbidities on belt positioning and accessory use and whether comfort mediates this relationship METHODS: Mediation analysis was used to examine the relationship between morbidities affecting physical function, comfort, belt repositions and seat cushion use among 380 drivers aged 75 years and older., Results: Musculoskeletal morbidities increase the likelihood of seat belt repositioning (OR 1.37, 95% CI 1.12-1.67) and comfort partially mediates this relationship (P = 0.03). Morbidities of any type also increase the likelihood of seat cushion use (OR 1.15 95% CI 1.04-1.27), but comfort plays no role in this relationship (P = 0.87)., Conclusion: Greater awareness among older drivers is needed, to ensure behavioural modifications do not impair their crash protection., (© 2016 AJA Inc.)

Objectives: To ascertain whether a safe-transportation program can change driving exposure while maintaining community participation of older drivers., Design: Randomized controlled trial., Setting: Northwest Sydney., Participants: Drivers aged 75 and older (mean 80 ± 4) (n = 380)., Intervention: Intervention group participated in an individualized, one-on-one safe-transportation program adapted from the Knowledge Enhances Your Safety curriculum. A registered occupational therapist delivered the intervention in two sessions held approximately 1 month apart., Measurements: An in-vehicle monitoring device hardwired into participants' vehicles measured driving exposure. Community participation was measured using the Keele Assessment of Participation. A staging algorithm based on the Precaution Adoption Process Model measured behavior change toward increased and sustained driving self-regulation. Main outcomes were distance driven per week over 12 months and community participation. Secondary outcomes were behavior change, depressive symptoms, and alternate transportation use. Generalized estimating equations were used to model effect on driving exposure, adjusting for weekly measures, and ordinal regression was used to analyze differences in behavior change profiles between groups using an intention-to-treat approach., Results: Participants were randomized after baseline assessment-190 each to the intervention and control groups. One hundred eighty-three of 190 completed the intervention and 366 of 380 completed the study. On average, participants drove 140 ± 167 km/wk. Although there was no significant difference between the groups in distance driven per week over 12 months (between-group difference -5.5 km, 95% confidence interval (CI) = -24.5-13.5 km, p = .57), intervention group participants showed greater readiness to engage in self-regulatory driving practices, such as reporting avoiding driving at night or at rush hours, than control group participants (odds ratio (OR) = 1.6, 95% CI = 1.1-2.3, P = .02). At 12 months, use of alternate transportation was similar (between-group difference 0.1, 95% CI = -1.4-1.6, P = .90). Although there was no difference in community participation (between-group difference -0.1, 95% CI = -0.6-0.3, P = .59), older drivers with low function in the intervention group were 3.1 times as likely to report depressive symptoms (95% CI = 1.04-9.2, P = .04) than those with low function in the control group., Conclusion: An individualized safe-transportation program can promote behavior change but did not translate to significant differences in weekly mileage after 12 months. Longer follow-up may detect changes over time., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Objective: Even small increases in vehicle speed raise crash risk and resulting injury severity. Older drivers are at increased risk of involvement in casualty crashes and injury compared to younger drivers. However, there is little objective evidence about older drivers' speeding. This study investigates the nature and predictors of high-range speeding among drivers aged 75-94 years., Methods: Speed per second was estimated using Global Positioning System devices installed in participants' vehicles. High-range speeding events were defined as traveling an average 10+km/h above the speed limit over 30 seconds. Descriptive analysis examined speeding events by participant characteristics and mileage driven. Regression analyses were used to examine the association between involvement in high-range speeding events and possible predictive factors., Results: Most (96%, 182/190) participants agreed to have their vehicle instrumented, and speeding events were accurately recorded for 97% (177/182) of participants. While 77% (136/177) of participants were involved in one or more high-range events, 42% (75/177) were involved in greater than five events during 12-months of data collection. Participants involved in high-range events drove approximately twice as many kilometres as those not involved. High-range events tended to be infrequent (median = 6 per 10,000 km; IQR = 2-18). The rate of high-range speeding was associated with better cognitive function and attention to the driving environment., Conclusion: This suggests those older drivers with poorer cognition and visual attention may drive more cautiously, thereby reducing their high-range speeding behavior.

The data presented in this article are related to the research manuscript "Predictors of older drivers' involvement in rapid deceleration events", which investigates potential predictors of older drivers' involvement in rapid deceleration events including measures of vision, cognitive function and driving confidence (A. Chevalier et al., 2016) [1]. In naturalistic driving studies such as this, when sample size is not large enough to allow crashes to be used to investigate driver safety, rapid deceleration events may be used as a surrogate safety measure. Naturalistic driving data were collected for up to 52 weeks from 182 volunteer drivers aged 75-94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Accelerometer data were recorded 32 times per second and Global Positioning System (GPS) data each second. To measure rapid deceleration behavior, rapid deceleration events (RDEs) were defined as having at least one data point at or above the deceleration threshold of 750 milli-g (7.35 m/s 2 ). All events were constrained to a maximum 5 s duration. The dataset provided with this article contains 473 events, with a row per RDE. This article also contains information about data processing, treatment and quality control. The methods and data presented here may assist with planning and analysis of future studies into rapid deceleration behaviour using in-vehicle monitoring.

There is little objective evidence about the extent older drivers' are involved in speeding or factors that may influence this behaviour. Particular concern exists for the increasing number of older drivers with poor or declining cognitive and visual function. This study investigates whether a reduction in speeding forms part of the self-restrictive driving behaviour evident when older drivers experience poor cognitive and visual function. Driving data over 12 months were collected from 182 volunteers aged 75-94years. Driving speed was estimated using Global Positioning System location, and speed limit data was based on a service-provider database. Speed events were defined as driving 1km/h or more, with 3% tolerance, above a single speed limit, averaged over 30s. Almost all participants (99%) were involved in speed events. While, 16-31% of participants experienced a meaningful decline in cognitive or visual function during the 12-months, these declines were not predictive of a change in speed events. Our results indicate speeding behaviour in this age group was highly prevalent, but less so for the oldest drivers whereby the rate of speed events was 7% lower per year older (IRR=0.93, 95%CI=0.89-0.96). Older drivers with worse function were less involved in speed events (unadjusted for distance driven) during 12 months of observation. Weekly distance driven decreased over the year by approximately 0.45km with every week of monitoring for these older drivers. When distance driven was taken into account, decreased function was not predictive of involvement in speed events, indicating the reduction in speed events may be achieved by older drivers with lower function reducing distance driven. These results are important for developing policy to address speeding behaviour of the growing population of older drivers to reduce the incidence of crashes and resulting casualties., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Safety concerns together with aging of the driving population has prompted research into clinic-based driving assessments. This study investigates the relationship between the DriveSafe and DriveAware assessments and restriction of driving. Community-dwelling adults aged more than 75 (n = 380) were recruited in New South Wales, Australia. Questionnaires were administered to assess driving habits and functional assessments to assess driving-related function. Self-reported restriction was prevalent in this cross-sectional sample (62%) and was related to DriveSafe scores and personal circumstances but not DriveAware scores. DriveSafe scores were correlated with better performance on the Trail-Making Test (TMT; β = -2.94, p < .0001) and better contrast sensitivity (β = 48.70, p < .0001). Awareness was associated with better performance on the TMT (β = 0.08, p < .0001). Our data suggest that DriveSafe and DriveAware are sensitive to deficits in vision and cognition, and drivers with worse DriveSafe scores self-report restricting their driving., (© The Author(s) 2015.)

The data presented in this article are related to the research article entitled "A longitudinal investigation of the predictors of older drivers׳ speeding behavior" (Chevalier et al., 2016) [1], wherein these speed events were used to investigate older drivers speeding behavior and the influence of cognition, vision, functional decline, and self-reported citations and crashes on speeding behavior over a year of driving. Naturalistic speeding behavior data were collected for up to 52 weeks from volunteer drivers aged 75-94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Global Positioning System (GPS) data were recorded at each second and determined driving speed through triangulation of satellite collected location data. Driving speed data were linked with mapped speed zone data based on a service-provider database. To measure speeding behavior, speed events were defined as driving 1 km/h or more, with a 3% tolerance, above a single speed limit, averaged over 30 s. The data contains a row per 124,374 speed events. This article contains information about data processing and quality control.

Objective: This article aims to describe seat belt wearing patterns and quality of seat belt fit among drivers aged 75 years and older. A secondary aim is to explore associations between body shape, comfort, and seat belt use patterns., Methods: This is an observation and survey study of a cohort of 380 drivers aged 75 years and over. During home visits, photographs were taken of the drivers in their vehicles for later analysis of belt fit and a short survey was also administered to collect demographic data and information about seat belt use and comfort. Seat belt fit and use of belt and seat accessories were analyzed from the photographs., Results: Data from 367 participants with photographs were analyzed. Whereas 97% reported using a seat belt and 90% reported their seat belt to be comfortable, 21% reported repositioning their seat belt to improve comfort. Good sash and lap belt fit were achieved in 53 and 59% of participants, respectively, but only 35% achieved overall good fit. Both poor sash and lap belt fit were observed in 23% of participants. Drivers who were in the obese category had over twice the odds (95% confidence interval [CI], 1.2-4.1) of having a poor lap belt fit than those in the normal body mass index [BMI] range, and drivers who were overweight had 1.8 times the odds (95% CI, 1.1-2.9) of having poor lap belt fit. Older females also had twice the odds (95% CI, 1.3-3.5) of poor lap belt fit compared to older males, regardless of BMI. Sash belt fit did not vary significantly by BMI, stature, or gender. However older drivers who reported that they had not made any adjustments to the D-ring height had 1.7 times the odds of having poor sash belt fit than those who made adjustments (1.2-2.9). Females were 7.3 times more likely to report comfort problems than males (95% CI, 3.2, 16.3) but there was no association between reported comfort and BMI or seat belt fit. Drivers who reported comfort problems had 6 times the odds (3.2-13.6) of also reporting active repositioning of the belt., Conclusions: The results suggest that older drivers face challenges in achieving comfortable and correct seat belt fit. This may have a negative impact on crash protection. Belt fit problems appear to be associated with body shape, particularly high BMI and gender. There is a need for further investigation of comfort accessories; in the interim, older drivers and occupants should be encouraged to use features such as D-ring adjusters to improve sash belt fit.

Background: Safe-transport is important to well-being in later life but balancing safety and independence for older drivers can be challenging. While self-regulation is a promising tool to promote road safety, more research is required to optimise programs., Methods: Qualitative research was used to inform the choice and adaptation of a safe-transport education program for older drivers. Three focus groups were conducted with older drivers living in northwest Sydney to explore four key areas related to driving in later life including aged-based licensing, stopping or limiting driving, barriers to driving cessation and alternative modes of transportation. Data were analysed using content analysis., Results: Four categories emerged from the data; bad press for older drivers, COMPETENCE not age, call for fairness in licensing regulations, and hanging up the keys: It's complicated! Two key issues being (1) older drivers wanted to drive for as long as possible but (2) were not prepared for driving cessation; guided the choice and adaption of the Knowledge Enhances Your Safety (KEYS) program. This program was adapted for the Australian context and focus group findings raised the need for practical solutions, including transport alternatives, to be added. Targeted messages were developed from the data using the Precaution Adoption Process Model (PAPM), allowing the education to be tailored to the individual's stage of behaviour change., Conclusion: Adapting our program based on insights gained from community consultation should ensure the program is sensitive to the needs, skills and preferences of older drivers.

Objectives: To explore and deepen understanding of factors influencing driving exposure for older drivers., Design: Cross-sectional., Setting: Baseline data on function and driving exposure from 1 week of driving were evaluated., Participants: A convenience sample of 380 drivers aged 75 and older, residing in northwest Sydney, was recruited. Participants were required to be the primary drivers of their own vehicle., Measurements: Driver function was evaluated using the DriveSafe and DriveAware clinic-based assessments to measure visual attention to the driving environment and awareness of driving ability. Demographic information was obtained through interview. An in-vehicle monitoring device with data logger and GPS receiver, was used to measure driving exposure in 362 of 380 participants' vehicles. Driving exposure outcomes were total distance driven, furthest distance traveled from home, and average trip length. Factors influencing these exposure outcomes were analyzed using generalized linear regression., Results: Drivers typically drove 100 km in local and surrounding areas during the week. Function was predictive of all driving exposure outcomes. Drivers with lower levels of function drove fewer kilometers and took shorter trips closer to home. Age, health status, and personal circumstance (e.g., rural residence) also influenced exposure, but sex did not., Conclusion: Using objective measures, this study provides evidence that function, age, health status, and personal circumstance influence driving exposure of older drivers. Understanding how older people use driving to preserve their independence is important for exploring safe driving strategies for older people., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)

Background: There are concerns over safety of older drivers due to increased crash involvement and vulnerability to injury. However, loss of driving privileges can dramatically reduce independence and quality of life for older members of the community. The aim of this trial is to examine the effectiveness of a safe transport program for drivers aged 75 years and older at reducing driving exposure but maintaining mobility., Methods and Design: A randomised trial will be conducted, involving 380 drivers aged 75 years and older, resident in urban and semi-rural areas of North-West Sydney. The intervention is an education program based on the Knowledge Enhances Your Safety (KEYS) program, adapted for the Australian context. Driving experience will be measured objectively using an in-vehicle monitoring device which includes a global positioning system (GPS) to assess driving exposure and an accelerometer to detect rapid deceleration events. Participation will be assessed using the Keele Assessment of Participation (KAP). Data will be analysed on an intention-to-treat basis; the primary outcomes include driving exposure, rapid deceleration events and scores for KAP. Secondary outcomes include self-reported measures of driving, socialisation, uptake of alternative forms of transport, depressive symptoms and mood. A detailed process evaluation will be conducted, including examination of the delivery of the program and uptake of alternative forms of transport. A subgroup analysis is planned for drivers with reduced function as characterized by established cut-off scores on the Drivesafe assessment tool., Discussion: This randomised trial is powered to provide an objective assessment of the efficacy of an individually tailored education and alternative transportation program to promote safety of older drivers but maintain mobility., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000543886.