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Studies over the past two decades have attempted to document and understand factors related to crashes involving older drivers to develop more effective countermeasures to reduce the frequency and severity of these crashes. Studies in which vehicle acceleration data can be recorded have begun to explore the relationship between rapid deceleration events (RDEs) and functional abilities among older drivers as a surrogate measure of unsafe driving. Recent naturalistic driving studies with older adults have found differing results using different thresholds to define an RDE. The present study examined the relationship among RDE rates, demographics, visual abilities, cognitive abilities, and driving comfort among a large cohort of older drivers, using two definitions of RDEs—longitudinal deceleration of 0.35 g or greater (RDE35) and longitudinal deceleration of 0.75 g or greater (RDE75). The study utilized objective driving, objective functioning, and reported driving comfort data from 2774 participants of the multi-site AAA Longitudinal Research on Aging Drivers (LongROAD) study. RDE rates for each threshold were calculated per 1000 miles driven. Multivariate regression models with backward elimination were developed to examine how outcome measures were related to RDE rates. Too few RDE75 events were found for meaningful analysis. RDE35 rates were significantly associated with several covariates. RDE35 rates were related to declining functional abilities, but many other factors also played a significant role in the rate of RDE35s among older drivers, diminishing the value of using RDE35 rates as a surrogate measure of driving safety. In addition, because the AAA LongROAD sample was relatively healthy and high functioning, other ability-related covariates may also be significantly related to RDE35s but the lack of variance in these measures in the current study prevented these effects from emerging.

The objective of this study was to evaluate the cost of serving one additional youth in the Big Brothers Big Sisters of America (BBBS) program. We used a marginal cost approach which offers a significant improvement over previous methods based on average total cost estimates. The data consisted of eight years of monthly records from January 2008 to August 2015 obtained from program administrators at one BBBS site in the Mid-Atlantic. Results show that the BBBS marginal cost to serve one additional youth was $80 per mentor-month of BBBS mentoring (irrespective of program type). The cost to offer services for the average match duration of 19 months per marginal added youth was $1,503. The marginal costs per treated program participant in school-based versus community-based programs were $1,199 and $3,301, respectively. Marginal cost estimates are in the range of youth mentoring programs with significant returns on investment but are substantially higher than prior BBBS unit cost estimates reported using less robust estimation methods. This cost analysis can better inform policy makers and donors on the cost of expanding the scale of local BBBS programs as well as suggest opportunities for cost savings.

Airbnb hosts rent their homes to guests as an alternative to traditional hospitality settings. Airbnb venues are not uniformly regulated for allowing smoking or requiring fire-safety amenities. This study quantified the reported prevalence of fire-safety amenities in 413,339 Airbnb venues that allow smoking in 43 cities in 17 countries. Proportions of host-reported smoke detectors and carbon monoxide (CO) alarms, and those that allow smoking were calculated. Across the entire sample 9.3% (n = 38,525) allowed smoking. An overall evaluation of those venues shows that 46% (n = 17,569) had smoke detectors compared to 64% of the 374,814 venues that do not allow smoking, a statistically significant difference (X2 = 5277 p 0.01). A similar difference is found between venues that allow smoking and had CO alarms (19%, n = 7176) and the 33% of venues that prohibit smoking (X2 = 3442, p 0.01). Among this sample, most Airbnb venues that allow smoking are less likely to have safety amenities.

Driving is the preferred source of personal transportation for older adults. However, personal transportation is not limited to owning and operating a car and can be conceptualized as utilization of different modes of transportation to meet personal mobility needs. The aims of this study are to describe the types and number of alternate transport sources of transportation used by older drivers and to explore whether the distances driven by older drivers vary by their use of alternate transport. This is a cross-sectional analysis of the baseline data from the Longitudinal Research on Aging Drivers (LongROAD) cohort study, which includes healthy drivers aged 65–79 years. The results suggest that most older drivers have at least one alternate source of transportation; most commonly riding as a passenger with a friend or family member (87%). Those who reported riding as passengers (OR=0.69 [95% CI: 0.54–0.87]), riding a train (OR=0.63 [95% CI: 0.49–0.81], using a taxi/ride share (OR=0.75 [95% CI: 0.58–0.96]), or riding a bus (OR=0.75 [95% CI: 0.56–0.99]) were less likely to drive shorter distances. The odds of driving only shorter distances was significantly lower among those who reported 1, 2, or 3+ types of alternate transport sources relative to those who reported no types. Communities should consider how to improve access to alternate transport sources for older adults, so as to mitigate the adverse health and social impacts of restricting driving.

This study aimed to compare an in-class Seniors on the MOVE (Mature Operators Vehicular Education) interactive multi-session driving curriculum with a self-guided MOVE curriculum for older adults. Using a two group randomized design, we sought to determine if there are between-group differences in older drivers' knowledge and safety behaviors among participants. Forty-four participants with an average age of 79 years (SD=7.1) were randomly assigned to the original MOVE program (SOM-A) or a lower resource (SOM-B) self-guided intervention. SOM-A is a four session program designed to improve older drivers safety knowledge and better understand skills for safer driving. SOM-B is a self-guided program with one required in-class session and one optional session. Subsequent to completion of both curricula, participants were offered CarFit, a comprehensive check of how well a senior driver and their vehicle work together. Baseline, post-intervention and 6-month follow up questionnaires were completed by participants. We found significant differences (p=.01) in the mean driving safety knowledge scores when comparing participants in SOM-A (3.7, SD 2.0) to those in SOM-B (0.87, SD 2.6). With regard to behavioral outcomes, we focused on always wearing a seatbelt, talking with a health care provider about driving ability, and sitting 10-12 inches from the steering wheel. The vast majority of participants reported always wearing their seat belts (SOM-A 100%, SOM-B 92%, p=1.0), and very few reported talking with their doctors (SOM-A Baseline - 0%, Follow up 1 - 0%, p=n/a). Mean behavior change scores for participants sitting 10-12 inches from the steering wheel were significantly more likely among SOM-A (mean=.65, SD=.5) participants than those in SOM-B (mean=.29, SD=.5, p=.01) at first follow-up. Taken together, these findings suggest that the more intensive program is more effective and that driving safety programs focused on behaviors to self evaluate driving abilities continue to be needed to help older drivers remain safer on the road as they age. The involvement of health care providers in such efforts may be an untapped potential. Language: en

By 2020, there will be more than 40 million older drivers on U.S. roadways.1 Older drivers face elevated risks of injury and death from car crashes and some may pose risks to the surrounding community, as a variety of impairments (cognitive, mental, physical, or sensory) and medications common in older adults can affect driving ability.2 At the same time, premature driving restrictions may negatively impact older adults’ well-being because of the important link between mobility, independence and good health.2 Almost all older adults will someday face the decision about whether to retire from driving,3 which requires a careful analysis of these risks and benefits. And almost always, such decisions are difficult and emotional. Physicians have a unique and critical role in guiding older drivers because they are trusted by patients and their families, are in a position to have access to information about an individual’s physical and cognitive conditions that might affect driving ability, and have ethical and legal obligations related to patient and community safety.2, 4 This information includes disease diagnosis or prescribed medications that may induce sleepiness or impact cognitive processing speed.5, 6 However, physicians are often reluctant to discuss with a patient their medical fitness to drive.2, 7 Physicians have reported that they find it difficult tell a driver it’s time to “hand over the keys” because of limited training or experience with counseling older drivers, inadequate knowledge of relevant state policies, fears of damaging the physician-patient relationship, or concern about the potentially devastating impact of this transition on an older driver’s life.2 Because of these concerns, as well as competing demands during office visits, physicians may wait to bring up driving until a family member reports a concern or there is a crash other “red flag.”4 But consider this: most Americans will outlive their safe driving ability by approximately 7 to 10 years.3 Therefore, “driving retirement” is inevitable for most older adults.8 Older adults may stop or limit their driving for a variety of reasons, such as physical conditions (for example, declining vision), financial concerns (such as the expense of owning a car), or anxieties about driving.9 Whatever the catalyst, driving retirement can be a profound and distressing experience for an older adult. However, advance planning for driving retirement offers the potential to ease an older adult’s transition from driving to other forms of transportation and possibly to strengthen, rather than harm, the physician-patient relationship. Physicians may want to consider using “anticipatory guidance” with their older patients; this practice is used in pediatrics to prepare parents for coming physical and developmental phases10 but might also be useful in geriatrics. For example, advance planning for driving retirement might be incorporated into discussions about issues relevant to older adults, including home safety, financial security, and mobility. Advance planning for driving retirement is a multi-faceted process that should address a variety of issues.8, 11 First, efforts to help older drivers plan to retire from driving should consider their readiness for change and their ability and willingness to find and use alternative sources of transportation. Older drivers (and concerned family members) should anticipate the older adult’s transportation needs, especially the need to travel for work, shopping, participation in community activities, and visits to family and friends. Older adults should also consider transportation options besides driving. These options might include the availability and willingness of family or friends to provide rides (although older adults may be reluctant to become a “burden”). Senior ride services and public transit should also be explored; ideally, local databases would be available to guide discussions. Older drivers should also consider the relative costs of various forms of transportation, including driving, using available simple financial worksheets. Driving retirement discussions should also address the emotional factors associated with driving,8 especially those related to loss of mobility, independence and self-esteem. Thus these conversations should consider an individual’s motivation for driving, emotional stake in driving, social connectedness related to driving, and ability to learn new approaches to transportation.12 Advance planning for driving retirement should also include a discussion of what an older driver would want to do if, in the future, a new or worsening medical condition begins to affect driving safety. While some at-risk older drivers may trust the recommendation of a trusted physician or family member, others may demand a higher “standard of proof” (such as failure to pass a formal on-road driving examination). There are various options for screening and assessment of an older driver’s ability, although there is still debate about which on- or off-road tests work best to measure risk. The ideal screening test—one that is evidence-based, simple, accurate, predictive and easy-to-administer in a busy clinical setting—does not yet exist. Physicians should consider formalizing discussions about driving retirement by using an “Advance Driving Directive” to document a patient’s wishes. These are non-binding worksheets designed to facilitate conversations about future driving-related decisions, including formal testing and driving retirement.4 They encourage the older driver to identify a trusted individual to help inform future decisions about driving, especially in the case that significant cognitive impairments develop. Ideally, planning for driving retirement should be part of a larger, comprehensive process of planning for aging that covers health and health care, social supports, and environmental factors such as housing and community transportation.13 This process must involve older individuals as well as community planners, the business and medical care communities, and local governments, all working together to support the mobility, independence and social well-being of older adults.13 Within the healthcare setting, advance planning for driving retirement may be too long and complicated a process to complete during a single office visit, especially in the face of competing priorities and time demands. A decision aid may help with the process,14 but older adults will need support from multi-disciplinary teams that may involve general and specialist physicians, nurses, case managers, social workers, and physical and occupational therapists. But the need for a systems-based approach should not minimize the important role physicians play in discussing driving issues with patients and in advocating for more institutional and societal support. Driving is a key activity of daily living (ADL); just as physicians routinely consider other ADLs, such as the ability to obtain and prepare food or manage finances, they should help patients assess their driving ability and, when appropriate, facilitate discussions about driving retirement. Advance planning for driving retirement should become routine in our clinical practices—and in our homes—in order to support older adults and promote their health, safety and independence.