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Introduction Fall fatality rates among U.S. older adults increased 30% from 2007 to 2016. In response, the Centers for Disease Control and Prevention developed the Stopping Elderly Accidents, Deaths, and Injuries algorithm for fall risk screening, assessment, and intervention. The current Stopping Elderly Accidents, Deaths, and Injuries algorithm with 2 levels (at risk and not at risk) was adapted to an existing cohort of older adult drivers. Methods A U.S. multisite prospective cohort (N=2,990) of drivers (aged 65–79 years), from 2015 to 2017, was used for these analyses completed in January 2020–October 2020. To measure the adapted Stopping Elderly Accidents, Deaths, and Injuries key questions for fall risk screening performance in predicting future falls, adjusted logistic regression determined the area of the receiver operating characteristic curve. An adjusted mixed logistic regression modeled the association between the adapted Stopping Elderly Accidents, Deaths, and Injuries key questions and future falls. Results The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions yielded an area under the curve of 0.65 in determining any fall over 2 years. The adjusted mixed logistic regression model suggests that those at risk for falls at baseline were associated with 2.37 times higher odds of any fall (95% CI=2.00, 2.80) and 3.60 times higher odds of multiple falls (95% CI=2.88, 4.51) over 2 years. Conclusions The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions for fall risk screening yielded fair predictive ability for falls over 2 years and were strongly associated with future falls for older adult drivers. The adapted Stopping Elderly Accidents, Deaths, and Injuries key questions can be applied to existing data in nonclinical settings to strengthen fall screening and prevention at a population level.

Background Potentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers. Methods We applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the “brown-bag” review of medications for participants of the Longitudinal Research on Aging Drivers (LongROAD) study to examine the prevalence and correlates of PIM use in a geographically diverse, community-dwelling sample of older drivers (n = 2949). Proportions of participants who used one or more PIMs according to the American Geriatrics Society 2015 Beers Criteria, and estimated odds ratios (ORs) and 95% confidence intervals (CIs) of PIM use associated with participant characteristics were calculated. Results Overall, 18.5% of the older drivers studied used one or more PIM. The most commonly used therapeutic category of PIM was benzodiazepines (accounting for 16.6% of the total PIMs identified), followed by nonbenzodiazepine hypnotics (15.2%), antidepressants (15.2%), and first-generation antihistamines (10.5%). Compared to older drivers on four or fewer medications, the adjusted ORs of PIM use were 2.43 (95% CI 1.68–3.51) for those on 5–7 medications, 4.19 (95% CI 2.95–5.93) for those on 8–11 medications, and 8.01 (95% CI 5.71–11.23) for those on ≥12 medications. Older drivers who were female, white, or living in urban areas were at significantly heightened risk of PIM use. Conclusion About one in five older drivers uses PIMs. Commonly used PIMs are medications known to impair driving ability and increase crash risk. Implementation of evidence-based interventions to reduce PIM use in older drivers may confer both health and safety benefits. Trial registration Not applicable.

Objective: This study examines the prevalence of self-reported driving while intoxicated (DWI) among drivers aged 65 and older. Method: This cross-sectional study was based on baseline data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study, a multisite prospective cohort study of 2,990 older adult drivers. Alcohol-related variables from the baseline questionnaire were examined in relation to demographics, health status, and driving behaviors. A logistic regression model assessed variables associated with DWI. Results: Of the 2,990 participants, 72.7% reported consuming alcohol, 15.0% reported high-risk drinking, and 3.3% reported DWI. High-risk drinking (OR = 12.01) and risky driving behaviors (OR = 13.34) were significantly associated with at least occasional DWI. Avoidance of hazardous driving conditions (OR = 0.71) and higher level of comfort during challenging driving scenarios (OR = 0.65) were less likely to be associated with DWI. Conclusion: A large number of older adults engage in high-risk drinking and DWI. Public health education and DWI-related interventions should include older adults.

Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study came from the Longitudinal Research on Aging Drivers study, a multisite naturalistic driving study of older adults. Multivariable negative binominal modeling was used to estimate incidence rate ratios and 95% confidence intervals of hard braking events (proxies for unsafe driving behavior defined as events with a deceleration rate ≥0.4 g) associated with PIM use among older drivers. The study sample consisted of 2932 drivers aged 65–79 years at baseline, including 542 (18.5%) who used at least one PIM. These drivers were followed through an in-vehicle recording device for up to 44 months. The overall incidence of hard braking events was 1.16 per 1000 miles. Use of PIMs was associated with a 10% increased risk of hard braking events. Compared to drivers who were not using PIMs, the risk of hard braking events increased 6% for those using one PIM, and 24% for those using two or more PIMs. Use of PIMs by older adult drivers is associated in a dose-response fashion with elevated risks of hard braking events. Reducing PIM use in older adults might help improve driving safety as well as health outcomes.

The study sought to understand the relationship between in-vehicle technologies (IVTs) and self-regulatory behaviors among older drivers. In a large multi-site study of 2990 older drivers, self-reported data on the presence of IVTs and avoidance of various driving behaviors (talking on a mobile phone while driving, driving at night, driving in bad weather, and making left turns when there is no left turn arrow) were recorded. Self-reports were used to identify whether avoidance was due to self-regulation. Hierarchical logistic regressions were used to determine whether the presence of a particular IVT predicted the likelihood of a given self-regulatory behavior after controlling for other factors. Results suggest that the presence of Integrated Bluetooth/Voice Control systems are related to a reduced likelihood of avoiding talking on a mobile phone while driving due to self-regulation (OR= 0.37, 95% CI= 0.29&ndash, 0.47). The presence of a Navigation Assistance system was related to a reduced likelihood of avoiding talking on a mobile phone while driving (OR= 0.65, 95% CI= 0.50&ndash, 0.84) and avoiding driving at night due to self-regulation (OR= 0.80, 95% CI = 0.64&ndash, 1.00). Present findings suggest in-vehicle technologies may differently influence the self-regulatory behaviors of older drivers.

Background: Opioid medications are important therapeutic options to mitigate the harmful effects of pain but can also impair driving ability. We sought to explore opioid use, pain levels, and driving experiences among older drivers. Methods: Cognitively intact drivers ages 65 to 79 years were recruited for the multisite AAA Longitudinal Research on Aging Drivers (LongROAD) study (n = 2990). This cross-sectional analysis used data from the baseline questionnaire and “brown-bag” medication review. Results: Among LongROAD participants (47% male, 88% white, 41% aged 65 to 69 years), 169 (5.7%) reported currently taking an opioid, with a median daily dose of 20 morphine milligram equivalents. Participants did not differ significantly in opioid use by age, gender, race, or ethnicity (P > .05). After adjustment for age, gender, race and ethnicity, participants who were taking opioids (vs not) were significantly more likely to report self-regulated driving reduction and reduced driving ability. However, these effects became nonsignificant when hospitalization, impaired physical function and other factors associated with opioid use were controlled. Conclusions: In this study from a large, geographically diverse sample of older adults, there was an association between opioid use and several self-reported measures of driving behavior and ability. However, future work should clarify the effects on driving of opioid use from the effects of the painful medical conditions for which the opioids are being taken. Clinicians should continue to discuss the risks and benefits of opioid medications with patients, including risks related to driving safety.

We surveyed self-reported lifetime health conditions (using National Health and Aging Trends Study questions) and related driving reduction in a large multi-site older driver cohort (n = 2,990) from the AAA Longitudinal Research on Aging Drivers (LongROAD) Study’s baseline assessment. Those reporting reduced driving (n = 337) largely attributed reduction to musculoskeletal (29%), neurologic (13%), and ophthalmologic (10%) conditions. Women reported health condition-related driving reduction more often than men (14% versus 8%, p

Vehicle automation offers promise for improving safe transportation, access to mobility, and quality of life. However, at least in the early stages of automation, human drivers remain an integral component of the system and their acceptance and use of the automated technology needs to be much better understood. One factor that has emerged as a strong influence on the acceptance and use of automated technology is trust. We used regression analyses to address two research questions. The first was: What factors are associated with the extent to which individuals report trust in automated technology after a simulated automated drive experience? The second research question was: How are trust in automated technology, control preferences (both preference for control specifically related to driving and more general preference for control), and experience with technology associated with objective measures intended to capture acceptance of automated technology? With regard to the first research question, we found that driving-specific control preferences were significantly related to reported trust. Specifically, after experiencing a simulated drive that required switching between manual and automated modes, the extent to which individuals reported that they trusted the automated technology was significantly higher among those who also reported being comfortable with other drivers behind the wheel. While specific results were mixed with regard to the second research question, we did find evidence that trust in automated driving, at least as reported after a simulated experience with the technology, was an important component of acceptance of the technology.

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.

Introduction Although the number of alcohol-impaired driving (AID) fatalities has declined over the past several years, AID continues to be a serious public health problem. The purpose of this effort was to gain a better understanding of the U.S. driving population's perceptions and thoughts about the impacts of lowering the blood alcohol concentration (BAC) driving standard below.08% on AID, health, and other outcomes. Methods A questionnaire was administered to a nationally representative sample of licensed drivers in the U.S. (n = 1011) who were of age 21 or older on driving habits, alcohol consumption habits, drinking and driving habits, attitudes about drinking and driving, experiences with and opinions of drinking and driving laws, opinions about strategies to reduce drinking and driving, general concerns about traffic safety issues, and demographics. Results One-third of participants supported lowering the legal BAC standard, and participants rated a BAC standard of .05% to be moderately acceptable on average. 63.9% indicated that lowering 30 the BAC to .05% would have no effect on their decisions to drink and drive. Nearly 60% of respondents lacked accurate knowledge of their state's BAC standard. Conclusions Public support for lowering the BAC standard was moderate and was partially tied to beliefs about the impacts of a change in the BAC standard. The results suggest that an opportunity for better educating the driving population about existing AID policy and the implications for lowering the BAC level on traffic injury prevention. Practical applications The study results are useful for state traffic safety professionals and policy makers to have a better understanding of the public's perceptions of and thoughts about BAC standards. There is a clear need for more research into the effects of lowering the BAC standard on crashes, arrests, AID behavior, and alcohol-related behaviors.

Background: There are approximately 42 million licensed drivers aged 65 years or older in the United States, who face unique age-related risks while driving. While physical activity affects several chronic conditions thought to be associated with motor vehicle crashes (MVCs), it is unclear if increased physical activity leads to fewer MVCs. This study explores whether self-reported vigorous and moderate physical activity is associated with MVCs in the previous year. Methods: Using cross-sectional data from the LongROAD study, a large multisite prospective cohort study of 2990 older adult drivers, we examined variables related to physical activity and performed a multivariate regression analysis to examine the association of physical activity health behaviors with self-reported MVCs. Results: Overall, 41.2% of participants reported vigorous and 69.6% of participants reported moderate exercise at least once per week. Eleven percent of participants reported at least 1 MVC in the previous year. Neither vigorous nor moderate physical activity was significantly associated with self-reported MVCs in the previous year. Select variables that were significantly associated with self-reported MVC included self-reported unsafe driving practices (odds ratio [OR] 1.55, confidence interval [CI] 1.05-2.29), and fall in the past 12 months (OR 1.46, CI 1.14-1.85). Conclusions: We were unable to detect a significant association between self-reported physical activity and MVCs in the past year among this group of older drivers. Use of objective measures of activity may better clarify this relationship.

PURPOSE Analyses compared older drivers from urban, suburban, and rural areas on perceived importance of continuing to drive and potential impact that driving cessation would have on what they want and need to do. METHODS The AAA LongROAD Study is a prospective study of driving behaviors, patterns, and outcomes of older adults. A cohort of 2,990 women and men 65-79 years of age was recruited during 2015-2017 from health systems or primary care practices near 5 study sites in different parts of the United States. Participants were classified as living in urban, surburban, or rural areas and were asked to rate the importance of driving and potential impact of driving cessation. Logistic regression models adjusted for sociodemographic and driving-related characteristics. FINDINGS The percentages of older drivers rating driving as "completely important" were 76.9%, 79.0%, and 83.8% for urban, suburban, and rural drivers, respectively (P = .009). The rural drivers were also most likely to indicate driving cessation would have a high impact on what they want or need to do (P < .001). After adjustment for sociodemographic and driving-related characteristics, there was a 2-fold difference for rural versus urban older drivers in odds that driving cessation would have a high impact on what they need to do (OR = 2.03; 95% CI: 1.60-2.58). CONCLUSIONS Older drivers from rural areas were more likely to rate driving as highly important and the prospect of driving cessation as very impactful. Strategies to enhance both the ability to drive safely and the accessibility of alternative sources of transportation may be especially important for older rural adults.

Emerging evidence suggests that atypical changes in driving behaviors may be early signals of mild cognitive impairment (MCI) and dementia. This study aims to assess the utility of naturalistic driving data and machine learning techniques in predicting incident MCI and dementia in older adults. Monthly driving data captured by in-vehicle recording devices for up to 45 months from 2977 participants of the Longitudinal Research on Aging Drivers study were processed to generate 29 variables measuring driving behaviors, space and performance. Incident MCI and dementia cases (n = 64) were ascertained from medical record reviews and annual interviews. Random forests were used to classify the participant MCI/dementia status during the follow-up. The F1 score of random forests in discriminating MCI/dementia status was 29% based on demographic characteristics (age, sex, race/ethnicity and education) only, 66% based on driving variables only, and 88% based on demographic characteristics and driving variables. Feature importance analysis revealed that age was most predictive of MCI and dementia, followed by the percentage of trips traveled within 15 miles of home, race/ethnicity, minutes per trip chain (i.e., length of trips starting and ending at home), minutes per trip, and number of hard braking events with deceleration rates ≥ 0.35 g. If validated, the algorithms developed in this study could provide a novel tool for early detection and management of MCI and dementia in older drivers.

The US older adult population is projected to considerably increase in the future, and continued driving mobility is important for health aspects in populations with fewer transportation alternatives. This study evaluated whether frailty is associated with low-mileage driving (&lt, 1865 miles per year) and driving cessation among older adults. Baseline demographics and health data were collected for 2990 older drivers via in-person assessments and questionnaires, with 2964 reporting baseline frailty data. Multivariable log-binomial regression models were used to evaluate the association between baseline frailty status and low-mileage driving. Multivariable Cox proportional hazards regression were used to evaluate the association between baseline frailty status and driving cessation. For every unit increase in frailty, the estimated adjusted risk of driving fewer than 1865 miles/year increased by 138% (adjusted risk ratio: 2.38, 95% CI: 1.63&ndash, 3.46). Relative to older drivers who were not frail, the adjusted hazard ratios of driving cessation were 4.15 (95% CI: 1.89&ndash, 9.10) for those classified as prefrail and 6.08 (95% CI: 1.36&ndash, 27.26) for those classified as frail. Frailty is positively associated with low-mileage driving status and driving cessation in a dose-response fashion. Public health interventions that reduce frailty, such as physical activity, may help older drivers maintain safe and independent mobility.

Background: Older adult drivers may experience decreases in driving safety with age or health status change. Discussing driving safety may help them plan for driving restriction and eventual cessation. Here, we sought to examine conversations between older adults and their family members and physicians. Methods: In this multi-site cross-sectional analysis of baseline data from the AAA Longitudinal Research on Aging Drivers (LongROAD) cohort study, we measured the prevalence and characteristics of family and physician driving discussions. We examined associations between having driving discussions and participant characteristics using multivariate logistic regression. Results: Of 2990 current drivers aged 65 to 79 years (53% female, 85.5% White), only 14.2% reported discussing driving safety with family and 5.5% had discussions with physicians. Men (adjusted OR, 1.32; 95% CI, 1.05 to 1.66) and those with Master9s degrees or higher (adjusted OR, 1.65; 95% CI, 1.27 to 2.13) more often had family discussions. Those with at least a Master9s degree were also more likely to speak with their physician (adjusted OR, 1.77; 95% CI, 1.17 to 2.68). Conclusion: Few older adults had driving safety conversations with their family or physicians. Practical and effective interventions are needed to engage family and physicians in assisting older adults with risk assessment and driving cessation planning to maintain mobility and well-being.

Background and Objectives Balancing both driver mobility and safety is important for the well-being of older adults. However, research on the association of physical function with these 2 driving outcomes has yielded inconsistent findings. This study examined whether physical functioning of older drivers, as measured by the Short Physical Performance Battery (SPPB), is associated with either driving space or crash involvement. Methods Using cross-sectional data of active drivers aged 65–79 years from the AAA Longitudinal Research on Aging Drivers (LongROAD) study (n = 2,990), we used multivariate log-binomial and logistic regressions to estimate the associations of the SPPB with either self-reported restricted driving space in the prior 3 months or any crashes in the past year. Interaction with gender was assessed using likelihood ratio tests. Results After adjustment, older drivers with higher SPPB scores (higher physical functioning) had lower prevalence of restricted driving space (8–10 vs. 0–7, prevalence ratio [PR] = 0.88, 95% confidence interval [CI]: 0.78–0.99; 11–12 vs. 0–7, PR = 0.78, 95% CI: 0.61–0.99). Fair (8–10), but not good (11–12), scores were significantly associated with reduced crash involvement (8–10 vs. 0–7, odds ratio [OR] = 0.71, 95% CI: 0.60–0.84). Gender was not a significant effect modifier. Discussion and Implications This study provides evidence that higher physical functioning is associated with better driving mobility and safety and that the SPPB may be useful for identifying at-risk drivers. Further research is needed to understand physical functioning’s longitudinal effects and the SPPB’s role in older driver intervention programs.

Introduction The present study uses data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study to assess the association of the frailty phenotype with reduced driving space and involvement in motor vehicle crashes. Methods The LongROAD study is a multisite prospective cohort study of participants aged 65–79 years. Fried's frailty phenotype status at baseline and self-reported restricted driving space in the past three months and at least one self-reported crash in the recent year are examined. Multivariable logistic regression was used to obtain odds ratios, adjusting for covariates and clustering by site. Results Pre-frail (i.e. only 1–2 indicators of frailty) participants had 30% higher odds (adjusted OR = 1.3, 95% CI:1.0–1.8) of reporting involvement in a crash in the prior year than non-frail participants after adjusting for sex, age, depression, word recall, average miles driven per week, and site. No association for reduced driving space for frail older drivers was found. Conclusions The frailty phenotype is associated with motor vehicle crashes, but not reduced driving space. Our findings suggest that future research should be focused on the identification of pre-frail older adult drivers to improve the health and quality of life of older adult drivers.

Objective: The aging of the population in the United States and elsewhere has brought increasing attention to the issue of safe driving and mobility among older adults. The overall objective of this research was to use naturalistic data collection to better understand driving exposure and driving patterns, 2 important contributors to crash risk. Methods: Data came from a study conducted at the University of Michigan Transportation Research Institute as part of the Integrated Vehicle-Based Safety System (IVBSS) program. A total of 108 randomly sampled drivers took part, with the sample stratified by age and sex. The age groups examined were 20 to 30 (younger), 40 to 50 (middle-aged), and 60 to 70 years old (older). Sixteen late-model Honda Accords were used as research vehicles and were driven by participants as their personal vehicles over the study period. Roughly the first 2 weeks of vehicle use comprised the baseline driving period, during which the IVBSS technologies were turned off (i.e., no warnings were presented to the drivers) but all onboard data were collected. For this article, only data from the baseline period were analyzed to limit any confounding effects that the safety technology may have had on driving behavior. Results: Results indicated that when looking at age independent of sex, older drivers (age 60–70) took fewer trips, drove fewer minutes, were less likely to drive at night, and had fewer high decelerations and speeding events than the youngest age group (20–30). They were also less likely to drive during peak morning traffic and on high-speed roads than their middle-age counterparts (40–50). Across all age groups, there were few differences by sex, with the exception that females drove fewer miles and fewer minutes and had fewer high decelerations than males. When both age and sex were taken into account, it was often the group of females age 60–70 that appeared to account for many of the age and sex differences found in driving exposure and patterns. Conclusions: Future research in this area would benefit from larger scale and longitudinal study designs so that changes in driving exposure and patterns over time among large samples of drivers could be examined.

This article has two aims. The first is to present results that partly explain why some automobile drivers choose to use their seatbelts only part time, thereby exposing themselves to unnecessary risk. The second is to offer and illustrate the "cardinal decision issue perspective"((1)) as a tool for guiding research and development efforts that focus on complex real-life decision behaviors that can entail wide varieties of risk, including but not limited to inconsistent seatbelt use. Each of 24 young male participants drove an instrumented vehicle equipped to record continuously seatbelt use as well as other driving data. After all trips were finished, each participant completed an interview designed to reconstruct how he made randomly selected seatbelt-use decisions under specified conditions. The interview also examined whether and how drivers established "decision policies" regarding seatbelt use. Such policies were good predictors of inconsistent seatbelt use. Drivers who had previously adopted policies calling for consistent seatbelt use were significantly more likely than others to actually drive belted. Meta-decisions about seatbelt policy adoption appeared to rest on factors such as whether the driver had ever been asked to consider selecting a policy. Whether a driver made an ad hoc, on-the-spot seatbelt-use decision was associated with a perceived need to make such a decision. Finally, participants with full-time policies were especially likely to deploy their seatbelts by default, without recognizing the need to decide about belt use on a trip-by-trip basis. We end with recommendations for reducing inconsistencies in seatbelt use in actual practice.

The purpose of the present study was to gain a better understanding of the types of in-vehicle technologies being used by older drivers as well as older drivers' use, learning, and perceptions of safety related to these technologies among a large cohort of older drivers at multiple sites in the United States. A secondary purpose was to explore the prevalence of aftermarket vehicle adaptations and how older adults go about making adaptations and how they learn to use them. The study utilized baseline questionnaire data from 2990 participants from the Longitudinal Research on Aging Drivers (LongROAD) study. Fifteen in-vehicle technologies and 12 aftermarket vehicle adaptations were investigated. Overall, 57.2% of participants had at least one advanced technology in their primary vehicle. The number of technologies in a vehicle was significantly related to being male, having a higher income, and having a higher education level. The majority of respondents learned to use these technologies on their own, with "figured-it-out-myself" being reported by 25%–75% of respondents across the technologies. Overall, technologies were always used about 43% of the time, with wide variability among the technologies. Across all technologies, nearly 70% of respondents who had these technologies believed that they made them a safer driver. With regard to vehicle adaptations, less than 9% of respondents had at least one vehicle adaptation present, with the number of adaptations per vehicle ranging from 0 to 4. A large majority did not work with a professional to make or learn about the aftermarket vehicle adaptation.

Advances are being made in vehicle technologies that may help older adults compensate for some of the declines in abilities associated with aging. These advances hold promise for increasing vehicle safety, reducing injuries, and making the driving task more comfortable. However, important research gaps remain with regard to how various advanced technologies impact the safety of older drivers, as well as older drivers' perceptions about these technologies. This special issue contains seven original contributions that address these issues. Specific topics include the: congruence of design guidelines with the needs and abilities of older drivers, transfer of control between automated and manual driving, use of in-vehicle monitoring technology, motivations for technology use and assigned meanings, technology valuation, and effects on driving behavior.

Motor vehicle crashes represent a significant public health problem, with elevated rates for both older and young drivers. Advances in automated vehicle technology hold promise for increasing vehicle safety. However, at least in the early stages, vehicle automation may lead to new or yet unstudied risks or errors, especially for vulnerable groups such as older drivers. The purpose of this study was to examine differences in how older and younger drivers react to the transfer of control between automated and manual driving. A total of 72 participants are being recruited from three age groups (16–19, 65–75, and 25–45). Participants are presented with a simulated driving environment containing manual driving modes with multiple transition scenarios. They also complete a questionnaire on their experience/comfort with various technologies, as well as a structured interview to explore perceptions about the drive (e.g., expectations, acceptance, and trust in the automation). To date, 26 participants have been enrolled: 52% are age 65–75 and 48% age 25–45. All are active drivers (65% drive every day and 87% at least 5 days per week). Most report using various technologies for communication (email, 100%; smart phones, 96%; social networks, 91%; online chatting/instant messaging). In addition, most are very satisfied with these technologies (87%), report that they save time and give more flexibility (96%), and were easy to learn how to use (91%). Fuller detail on results from the questionnaires, simulated drives, and structured interviews are reported in this presentation as well as differences identified between older and younger drivers.

Eligible LongROAD participants were 65–79 years old; drove ≥ once/week with a valid license; received primary care at the site’s healthcare system; lacked significant cognitive impairment; spoke English; and primarily drive one car (1996 model or newer) with an empty port for the study GPS device. Potentially-eligible individuals (sampled from healthcare system patients) received letters and subsequent calls. Over 12 months, the sites mailed 18,078 letters. On average, 25% of those reached by phone declined to eligibilty questions; among those giving a reason, being “too busy” or “don’t like research” were most common. Among those screened for eligibility, the most common reasons for ineligibility were not driving (38%) or having an ineligibile residence (26%) or vehicle (17%). Recruitment yield (enrollments per letters mailed) was 9.8% (range: 5.4%-17%). This presentation highlights recruitment challenges and offers strategies to overcome recruitment barriers.

Background As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. Methods The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging. Results A total of 2990 active drivers aged 65–79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and “brown-bag review” of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March–May 2015. Recruitment and enrollment were completed between July 2015 and March 2017. Conclusions Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults.

The crash rate per mile driven among older adults is higher than that of most age groups and comparable to that of the youngest, most inexperienced drivers. The low-mileage bias posits that the elevated rate among older adults results from an increased rate among those who accrue the fewest annual miles. This study evaluated whether low physical capacity among older drivers, measured by the National Health and Aging Trends Study (NHATS) Expanded Short Physical Performance Battery (SPPB) and Fried’s frailty phenotype, increases the risk of being low-mileage drivers. Data were collected for 2,990 older drivers via questionnaires and assessments in addition to 61,528 person-months of driving data. Multivariable log-binomial regression was used to estimate risk ratios. Those with fair and good function had 0.53 (95% CI: 0.40-0.69) and 0.60 (0.47-0.78) times the risk of driving fewer than 3,000 miles/year and 0.45 (0.26-0.77) and 0.48 (0.32-0.72) times the risk of driving fewer than 1,865 miles/year, respectively, compared to those with poor function. For an increase from not frail to pre-frail and from pre-frail to frail, the risk of driving fewer than 3,000 or 1,865 miles/year increased 1.36 (1.11-1.65) or 2.38 (1.63-3.46) times, respectively. Having low physical capacity is associated with an increased risk of low annual mileage. Given the known association between low-mileage driver status and increased crash rates and the modifiable nature of the risk factors examined in this study, interventions aimed at improving physical capabilities may lead to an improvement in safety among older drivers.

Given the high current prevalence of dementia and expected increases in the coming years, it is increasingly important to understand and address the process of transitioning from driving to non-driving among older drivers with dementia and the potential role of self-regulation (e.g., avoiding challenging driving situations). The purpose of this Alzheimer’s Association-funded study was to examine differences in self-regulation between older drivers with and without dementia. Fifty-two active drivers age 65 or older (16 with dementia; 36 healthy controls), completed a validated self-regulation questionnaire and standardized assessment of cognition, vision, and psychomotor skills. The dementia group reported some awareness of cognitive challenges (lower driving-related abilities to remember things and concentrate on multiple things at a time than the comparison group). Similarly, the dementia group performed significantly worse on memory tasks and complex reaction time in the objective assessment. Both groups were confident they could drive safely where they needed to go. However, the dementia group reported being less comfortable driving in several situations (unprotected left turns, unfamiliar areas, alone, rush hour traffic, backing up). Despite lower driving comfort among the dementia group, there were few differences in self-regulation between the groups. The only statistically significant difference was that more of the dementia group had reduced their driving in the past year. There were no differences in self-regulation between groups for any of the specific driving situations for which the dementia group reported feeling less comfortable. Full study results will be presented along with implications for programs and future research.

The primary objective of this study was to better understand how self-regulatory driving practices at multiple levels of driver decision making are influenced by various factors. Specifically, the study investigated patterns of tactical and strategic self-regulation among a sample of 246 Australian older drivers. Of special interest was the relative influence of several variables on the adoption of self-regulation, including self-perceptions of health, functioning, and abilities for safe driving and driving confidence and comfort.The research was carried out at the Monash University Accident Research Centre, as part of its Ozcandrive study, a partnership with the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive), and in conjunction with the University of Michigan Transportation Research Institute (UMTRI). Candrive/Ozcandrive represents the first study to follow a large group of older drivers over several years and collect comprehensive self-reported and objectively derived data on health, functioning, and driving. This study used a subset of data from the Candrive/Ozcandrive study. Upon enrolling in the study, participants underwent a comprehensive clinical assessment during which data on visual, cognitive, and psychomotor functioning were collected. Approximately 4 months after study enrollment, participants completed the Advanced Driving Decisions and Patterns of Travel (ADDAPT) questionnaire, a computer-based self-regulation instrument developed and pilot-tested at UMTRI.Self-regulation among older adults was found to be a multidimensional concept. Rates of self-regulation were tied closely to specific driving situations, as well as level of decision making. In addition, self-regulatory practices at the strategic and tactical levels of decision making were influenced by different sets of factors.Continuing efforts to better understand the self-regulatory practices of older drivers at multiple levels of driver performance and decision making should provide important insights into how the transition from driving to nondriving can be better managed to balance the interdependent needs of public safety and personal mobility.

Until recently, objective data have been lacking on the extent to which older adults modify their driving by driving less or avoiding situations considered challenging; a process commonly referred to as self-regulation. Advances in technology now make it possible to examine driving exposure, patterns, and habits using low-cost global positioning system (GPS) technology to record a vehicle’s location on a continuous basis along with the date and time. The purpose of this exploratory study was to better understand the process of self-regulation among older adults by examining their trip-specific driving patterns using objectively-derived GPS measures of driving and comparing these patterns with drivers’ self-reports. The study used a sample of 156 adults age 75 or older, recruited from the greater Melbourne area of Australia as part of the Ozcandrive project, a partnership between Monash University Accident Research Centre and the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive), a prospective cohort study of older drivers. Objective driving data were collected through equipment installed in participants’ personal vehicles. Participants were asked to drive as they normally would with the equipment installed in their vehicle. After approximately the first 4 months of driving with the device, data were downloaded and participants completed a computer-based questionnaire on self-regulation of driving. Results suggest that there was correspondence, albeit not perfect, between some objective driving measures and their comparable self-reported measures, but a lack of correspondence for others. For avoidance of various driving situations, comparisons were statistically significant for driving at night, driving in unfamiliar areas, and on high speed roads. For each driving situation, participants’ actual driving predicted the likelihood of reporting trying to avoid that situation, although perfect one-to-one correspondence between the self-reported and objective data on self-regulatory driving patterns was lacking. For measures of driving exposure, self-reported and objective driving exposure measures were correlated, but participants tended to underreport their average number of days per week and kilometers per week driven. This discrepancy between self-reported and objective measures is of concern as the ability to measure driving exposure not only contributes to a better understanding of the complex process of self-regulation, but is also a critical element in understanding crash risk.

INTRODUCTION: Appropriate self-regulation of driving - that is, adjusting one's driving patterns by driving less or avoiding specific situations considered challenging - shows promise as a strategy for extending safe driving. However, results on the extent of self-regulatory practices among older drivers vary considerably across studies. METHOD: The purpose of this study was to develop and test a questionnaire to measure self-regulation at multiple levels of driver performance and decision making, using a sample of older drivers comprised of individuals with clinically-determined functional impairments, as well as older adults recruited from the general population. RESULTS: Results suggest that the questionnaire is a user-friendly instrument for gathering information from older adults about their self-regulatory practices which has good construct validity. Feedback on the questionnaire was positive. Construct validity of the questionnaire was assessed by comparing the recruitment populations along various dimensions on which they might be expected to differ (e.g., self-rated health and functioning, abilities for safe driving, and feelings of driving comfort/safety) and looking for correlations between variables that one would reasonably expect to be correlated. CONCLUSIONS: Overall, participants rated their general health and functioning, and abilities for safe driving quite highly. However, participants from the clinic population rated themselves lower than participants from the general population on several abilities including seeing clearly during the day and night, remembering things, and processing information. While participants reported high levels of driving comfort and safety for most driving situations, the clinic population reported lower levels of comfort and safety for every driving circumstance except driving alone. High correlations were found between comfort and safety and the absolute mean scores were nearly identical for each driving circumstance. Finally, the clinic population was more likely to report trying to avoid driving at night, in unfamiliar areas, and on the expressway, as well as chatting with passengers. IMPACT ON THE INDUSTRY: Results of this pilot work provide insights into the self-regulatory driving process that could eventually inform efforts to extend safe mobility among older adults. Language: en

Driving is a complex task that involves psychomotor, visual, and cognitive functional abilities. As people age they may experience declines in driving abilities as a result of age-related medical conditions and the medications used to treat these conditions. This study was a detailed synthesis of the literature that addressed 16 advanced in-vehicle technologies. This synthesis focused on how older drivers use these technologies, what they think about them, and safety and/or comfort benefits of these technologies. This presentation will also report on training, education, and research needs in technology applications for driving.

It is estimated that approximately one-third of people with dementia continue to drive. Compared with the general driving population, drivers with dementia are at an increased risk of unsafe motor vehicle operation. Self-screening is often the basis for self-regulation of driving. It is not known how well self-screening as a predominant strategy works for drivers with memory impairment. This descriptive study explored the perceptions of 22 dyads of drivers with memory impairment and their family members through 44 structured telephone interviews within 4 months after specialized driving assessment to gain insights into their level of agreement on the driver's health, functioning, and critical driving behaviors. Drivers and family members were in fair agreement about current driving patterns and driver self-regulation (such as avoiding driving at night, in bad weather, or in unfamiliar areas). However, when reports of functional ability (such as vision, strength, and flexibility) were compared, drivers rated their fitness more highly than those abilities were rated by their family members on most measures. Moreover, there was poor agreement between drivers and family members on reported occurrence of driving behaviors suggestive of impairment in critical driving skills. These results have implications for health care and other professionals engaged in determining driver fitness. The findings suggest limited value in self-screening or in family reports when assessing fitness to drive in persons with memory impairment. Professionals should exercise caution in relying on reports from family members or drivers, especially with respect to reported driving fitness and driving behaviors.

In the coming decades, about one in five drivers will be aged 65 or more years in many Western nations. Given the increased fatal crash risk of older adults coupled with the continuing need for effective mobility, the issue of older adult safety and mobility is complex. Indeed, researchers have suggested that this issue has two interdependent, underlying goals for research and programs: to help those who are able to drive safely continue to do so and to identify and provide community mobility support to those who are no longer able to drive. This article briefly discusses the issues and research needs related to older adult safety and mobility including population and driving trends, crash risks, skills needed for safe driving, the effects of medical conditions and medicines on driving skills, screening and assessment, strategies for extending safe driving, and driving cessation and the use of alternative transportation options.

The objectives of this paper are to review the published research findings about the role of self-regulation in older driver safety and to report on an exploratory study to better understand the self-regulatory practices of older drivers as demonstrated through the avoidance of a number of specific driving situations including making left turns and driving alone, at night, in bad weather, in high traffic, and on the expressway and through restricting driving to familiar or local areas only.As part of a larger study on the development and testing of a self-screening instrument by older drivers, data on self-regulation were compared with data on driving-related abilities collected through clinical and on-road assessments for 68 drivers age 65 and older.Findings indicate that 25% of subjects reported self-regulating their driving in some way. Of those who self-regulated, five individuals reported avoiding just one type of driving situation, six reported avoiding two, one reported avoiding three, and five reported avoiding four types of situations. The most frequently reported situations were avoiding driving at night (19.1%) in bad weather (8.8%), and driving only in local areas (13.2%). Women were considerably more likely than men to report self-regulatory practices. Consistent with the findings of low avoidance of driving situations, subjects generally reported high levels of confidence, with the exception of driving at night, for which over one third of women reported being "not at all confident." Overall, subjects were least confident driving at night, in bad weather, and on express ways. Results from a logistic regression model indicate that subjects did appear to self-regulate their driving at night based on their performance on the on-road driving assessment (p.01). That is, for every 10-unit decrease in driving score (with lower scores indicating poorer driving performance), subjects were 1.6 times more likely to self-regulate.Continuing research on the extent to which older drivers appropriately self-regulate their driving is warranted. Future studies should focus on objectively measuring self-regulation, possibly through instrumented vehicle studies, and comparing these measures with clinically determined functional abilities and driving performance. It is also important to take into account differences in self-regulation by sex, as well as the effects of confidence in driving ability and insight into functional impairments on self-regulation.

Older adults, like their younger counterparts, depend on the automobile for approximately 90% of their travel, either as drivers or passengers. This article considers a variety of resources that are now available to assist rehabilitation specialists and related healthcare professionals in providing programs and information to their older patients. The authors provide a comprehensive listing, in chart format, of programs, Web sites, and informational materials to assist older people in remaining safely mobile later in life. The authors also discuss programs that are presently available, safe mobility guides that can be adapted for local use, driver assessment and rehabilitation programs, driver self-assessment tools (including one available through AAA offices nationwide), vehicle adaptations, social service programs, and assisting with transportation options. The authors conclude by encouraging rehabilitation specialists to think about their clients' transportation needs, particularly as they are leaving a hospital or rehabilitation setting to return to independent living.

Driver license renewal policies in the United States vary from state to state in terms of the length of the renewal cycle, requirements for accelerated renewal for older drivers, and other renewal provisions. This article briefly outlines some of these state-to-state differences and comments on the impact of those differences, particularly for senior citizens. The authors note that 17 states have special renewal provisions for older drivers, including requirements for in-person renewal, vision tests, or other testing or certification (e.g., written and road tests). Few states require physician or other professional reporting of unfit drivers to licensing agencies, although many encourage physician reporting or at least do not forbid it. Based on the outcomes of these special renewal provisions for older drivers, as well as other information available to licensing agencies, agency personnel have several choices: allow the driver to keep his or her license, refuse to renew the license or suspend, revoke or restrict the license (e.g., prohibit night driving), or shorten the renewal cycle. The article concludes by commenting on the lack of research data about how well these policies are doing in reducing crash-related injuries and deaths, particularly among older drivers. This lack of data on the effectiveness of specific renewal provisions, coupled with the expenses of additional testing and review, may explain the variations in policies in different states.

The purpose of the study was to investigate whether changing Michigan's safety belt law from secondary to primary (standard) enforcement resulted in police harassment. The study investigated safety-belt-enforcement-related harassment by considering three measures: citizen complaints arising from enforcement of the safety belt law; citation over-representation, that is, a statistical determination of whether certain groups received more citations than would be expected based upon their presence in the driving population and their rate of violating the safety belt use law; and self-reported harassment among the population of people who receive safety belt citations. Safety-belt-related harassment complaints were very uncommon both before and after primary enforcement. Implementation of primary enforcement did not lead to an increase in citation over-representation, and, therefore, safety-belt-related harassment by sex, race, or age. The vast majority of people receiving safety belt citations reported officer behavior as professional and did not feel that they were singled out for their citation. However, a sizeable minority of Blacks and young people report perceptions of safety-belt-related harassment. Results suggest that states with secondary enforcement should continue their efforts to change to primary enforcement, but should also make a strong effort to educate both law enforcement and the public about the harassment issue.

A study investigated the effects on safety belt citations of the change in police enforcement of Michigan's mandatory safety belt law that went into effect on March 10,2000. Safety belt citation records were obtained from Michigan courts for one full year before and one full year after the change from secondary to standard enforcement. Analysis of the records indicated an overall increase of 9% in safety belt citations and an 8% increase in the number of individuals cited. No effects from the change to standard enforcement were found for the distribution of safety belt citations by sex, age, and race, overall, or for both day- and nighttime periods. The proportion of persons receiving multiple safety belt citations in one year remained at 11%, and the average number of citations per cited person remained at 1.1 per year. Individuals who continued to receive citations after standard enforcement were more likely to be males age 16 to 22. No effect on the number of child-restraint citations was found. Changes in the disposition of cases included an increase in the proportion of guilty outcomes and a decrease in the proportion of cases dismissed.

Introduction: To evaluate the four-year outcome of Michigan's graduated driver licensing (GDL) program, motor-vehicle crash data for 16-year-old drivers in 1996 (pre-GDL), and 1998-2001 (post-GDL) were analyzed. Method: Relative risks and 95% confidence intervals for several crash types were computed, and pre-post-GDL population-based crash rates were compared. Reductions in crash risks among 16-year-olds previously found in 1998 and 1999 were generally maintained in 2000 and 2001. Results: Reductions in crash risk among 16-year-olds from 1996 to 2001 were 29% for all, 44% for fatal, 38% each for nonfatal-injury and fatal-plus-nonfatal-injury, 32% for day, 31% for evening, 59% for night, 32% for single-vehicle, and 28% for multi-vehicle crashes. Even after adjusting for more general population-wide changes among drivers 25 years and older that might have contributed to changes in 16-year-old crash risk, reductions remained impressive (19% for all crashes in 2001). Impact on Industry: As one approach to reducing teenage motor-vehicle morbidity and mortality, GDL remains promising.

PURPOSE: This study aims to assess whether the Driving Decisions Workbook, a self-assessment instrument for older drivers, increased self-awareness and general knowledge. This study also assessed perceptions regarding its usefulness, particularly as a tool for facilitating discussions within families of older drivers. A secondary purpose of the study was to determine if problems identified by drivers in the workbook related to problems they had with actual driving. DESIGN AND METHODS: The Driving Decisions Workbook was administered along with a questionnaire and a road test. A convenience sample of 99 licensed drivers aged 65 and above was used. RESULTS: After completing the workbook, about three fourths of the participants reported being more aware of changes that could affect driving. Fourteen percent reported that they had discovered a change in themselves of which they had not been previously aware. All respondents found the workbook to be at least a little useful and thought the workbook could help facilitate family discussions. Workbook responses were positively correlated with overall road test scores. Significant correlations were also noted between the road test and a majority of workbook subsection responses. IMPLICATIONS: This study indicates that the workbook may be a useful first-tier assessment instrument and educational tool for the older driver. It may encourage an older driver to drive more safely and/or to seek clinical assessment, and help in facilitating discussions about driving within their families.

Background: Seventeen states enacted graduated driver licensing (GDL) programs that were implemented from 1996 through 1999 and for which evaluations are of interest. Methods: We received evaluation results reported for six states for which data were available. Summarizing results is difficult in other than the most global terms because of differences in pre-GDL programs, differences in GDL programs, and differences in evaluation methodology. Results: All states identified some crash reduction among teen drivers following GDL implementation. This positive effect was observed across different geographic regions, and with different GDL programs. Simple counts are down—fewer teens are experiencing crashes and becoming injured. After calculating crash rates to adjust for changes over time in populations or licensed drivers, reductions generally were still found. Population-adjusted risks of injury/fatal crash involvement of 16-year-old drivers in Florida and Michigan were reduced by 11% and 24%, respectively. Population-adjusted risks of any crash involvement of 16-year-old drivers in Michigan and North Carolina were reduced by 25% and 27%, respectively. Reductions in night (restricted hours) crash risk were impressive in Florida, Michigan, and North Carolina. A comparison state design was only possible in the Florida evaluation, and results showed greater crash reductions under GDL. Change-point analyses of Michigan's crash data trends over time provided additional support of GDL's effectiveness in reducing crashes. Discussion: Taken as a whole, and including the preliminary findings from California, Ohio, and Pennsylvania, these reports demonstrate the early effectiveness of GDL in reducing the crash risk of teen drivers. The impact of these studies and others to come will guide future research, practice, and policy.

This report presents a comprehensive roadmap for how to help make travel training meet the mobility needs of older persons. The report includes an executive summary, a detailed handbook, and a supplemental research report. The handbook, Part I, provides an extensive set of guidelines for transit agencies and human services providers on how to build and implement training programs to help older adults who are able to use fixed route public transit. The supplemental research report, Part II, reviews the research plan that produced this report as well as the case studies used to formulate the overall strategic program.The handbook in Part I addresses the primary components of an effective travel training program. It defines the target market for travel training; identifies incentives and barriers to participation in training programs and subsequent use of conventional public transit; presents effective marketing and outreach strategies; describes opportunities and techniques for customized training; identifies and describes methods to monitor outcomes, refine techniques, and sustain ridership; and outlines how to address cost-effectiveness from the perspective of the provider as well as the recipient of training efforts. The handbook focuses on practical implementation, drawing on experience from programs currently in use throughout the country.

This report presents a comprehensive roadmap for how to help make travel training meet the mobility needs of older persons. The report includes an executive summary, a detailed Handbook, and a supplemental research report. The Handbook, Part I, provides an extensive set of guidelines for transit agencies and human services providers on how to build and implement training programs to help older adults who are able to use fixed route public transit. The supplemental research report, Part II, reviews the research plan that produced this report as well as the case studies used to formulate the overall strategic program. Individual chapters in part II are: Introduction to Travel Training; Travel Training Practices; Characteristics of Successful Travel Training Programs; In-Depth Case Studies; Additional Case Studies; Key Research Questions and Findings; and Suggestions for Further Research.

This article discusses older drivers and the need to strike a balance between driving skill assessment, programs that maintain long-term safe driving, and programs that promote mobility and independence for older people who can no longer drive safely. It highlights a conference organized by Committee on Safe Mobility for Older Adults (ANB60) and the conference's four areas of focus: changing demographics, changing health care environment, changing and emerging caregivers and changing policy.

Although the vast majority of active, older drivers are safe drivers, health conditions and related functional declines associated with increasing age can affect driving ability. This is a concern for older drivers, their families, and the public, as well as government agencies. To address these issues, the Canadian Institutes of Health Research (CIHR) Team in Driving in Older Persons (Candrive II) Research Program was funded in 2008 to create a prospective cohort of older active drivers to be followed for several years. In 2009 an Australian collaboration (Ozcandrive) joined the project funded by an Australian Research Council (ARC) Linkage Grant. This special issue describes the preliminary findings of the Candrive/Ozcandrive prospective study of 1300 older drivers in Canada, Australia and New Zealand. The methodology for the study, description of the cohort and findings related to older driver health and effects on driving, as well as the utility of some existing older driver assessment tools used on this population, are described. Future findings from this ongoing study will lead to insights into older driver safety and tools that will ideally help keep older drivers safely on the road.

The populations of many nations and, indeed, the entire world are growing older. As people age, they are more likely to experience medical conditions and take medications that can make operating a personal automobile more difficult. Once driving abilities begin to decline, older adults are often faced with decreased ability to travel to the places that they both want and need to go, due largely to the lack of non-driving options needed for personal mobility. Thus, due to the preference for and pervasiveness of the personal automobile for satisfying mobility needs, there is a global need to keep older adults driving for as long as they can safely do so. In this synthesis of the literature we explored the question: Has the time come for an older driver vehicle? Great gains in safe mobility for older adults could be made by designing automobiles that take into account, and help overcome, some of the deficits in abilities common in older people. This review provides a background and rationale for an older driver vehicle, including discussions of relevant trends, age-related declines in functional abilities, and the adverse consequences of decreased mobility; discusses research and issues related to vehicle design and advanced technology; explores crashworthiness issues and the unique requirements for older adults; and discusses issues related to marketing a vehicle that has been designed for older drivers. Has the time come for an older driver vehicle? We answer this question with a qualified “yes.” There is global opportunity to improve the safety, mobility, and quality of life of older adults by designing vehicles and technologies that help overcome common age-related deficits. The marketing of these vehicles to older consumers, however, will be challenging and will likely require further market research.

This paper describes select results of a pilot test of automated speed enforcement devices (ASEDs) in Michigan. A mail response survey of drivers (1,209 respondents) showed the general public favors use of ASEDs in select situations, particularly in school zones, in areas where traffic enforcement is dangerous for police, for heavy trucks, and in construction zones. The survey also showed opposition to ASED use on freeways, on bridges, and on "all roads." In general, observed speeders and persons who reported having multiple citations in the previous two years were in greater opposition to the use of ASEDs than the general population.

Self-regulation shows promise as a means by which older adults can continue to drive at some level without having to stop altogether. Self-regulation is generally described as the process of modifying or adjusting one's driving patterns by driving less or intentionally avoiding driving situations considered to be challenging, typically in response to an awareness that driving skills have declined. However, most studies asking older adults whether they avoid certain driving situations or have reduced the amount of driving they do under certain circumstances have not delved deeper into the motivations for such avoidance or driving reduction. There are many reasons for modifying driving that have nothing to do with self-regulation, such as no longer needing to take trips at certain times of day because of changes in preferences or lifestyles. The purpose of this study was to examine self-regulatory practices among older adults at multiple levels of driver performance and decision making, taking into account the specific motivations for avoiding particular driving situations or engaging in other driving practices. Study participants completed a computer-based questionnaire on driving self-regulation. Results suggest that self-regulation is a complex process that cannot be defined simply by the reported driving modifications made by drivers. Understanding the motivations for these behaviors is necessary and the study showed that they are varied and differ considerably across driving situations. Reasons for driving avoidance or other practices were often more closely related to lifestyle or preferences than to self-regulation. Based on these findings, three distinct groups were identified with regard to whether and for what reasons participants modified their driving.