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Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits.This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices.Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics.Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

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.

This study compared a sample of Australian drivers aged 77 years and older to participants from an older driver longitudinal cohort study (Ozcandrive) and examined the relationship between resilience and self-reported driving measures within these samples. Using a survey with a subset of questions from Ozcandrive, data were collected from 237 older drivers throughout Australia. The two samples were analyzed for differences in demographics, health, resilience, and self-reported driving behavior. A series of multiple regression models were fit for each driving outcome measure for both samples. The two samples had both similarities and differences, with the largest difference observed for resilience. Strong and consistent associations were found between resilience and driving comfort, abilities, and frequency for the Australian sample. Across samples, resilience remained a significant variable in seven of 10 regression models, more than any other independent variable.

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.

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.

Evidence suggests that older driver safety may be improved by good vehicle maintenance, in-vehicle advanced technologies, and proper vehicle adaptations. This study explored the prevalence of several measures of vehicle maintenance and damage among older drivers through inspection of their vehicles. We also investigated the prevalence of in-vehicle technologies and aftermarket adaptations. Vehicle inspections were conducted by trained research staff using an objective, standardized procedure. This procedure, developed by a multidisciplinary team of researchers, was based on a review of inspection checklists used by automobile dealerships and the project team's expertise. The study used baseline data from vehicles of 2988 participants in the multi-site Longitudinal Research on Aging Drivers (LongROAD) study. Among this cohort, vehicles were well maintained, had little damage, and contained a range of advanced technologies but few aftermarket adaptations. Implications of study findings for occupational therapy practice are discussed.

As people age, some of the commonly experienced psychomotor, visual, and cognitive declines can interfere with the ability to safely drive, often leading to situational avoidance of challenging driving situations. The effect of hearing impairment on these avoidance behaviors has not been comprehensively studied. Data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study were used to assess the effect of hearing impairment on driving avoidance, using three measures of hearing. Results indicated that hearing loss plays a complex role in driving avoidance, and that an objective hearing measure was a stronger predictor than hearing aid use and self-rated hearing. Greater hearing impairment was related to less nighttime and freeway driving, more trips farther than 15 mi from home, and lower odds of avoiding peak driving times. The moderating influence of hearing on both vision and cognition is also discussed, along with study implications and future research.

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.

A particular concern with SAE Level 3 automated vehicles is the takeover transition from the automated vehicle to the driver. Prior research has employed a wide range of metrics for measuring takeover performance. However, the lack of a set of standard metrics for measuring takeover performance makes it difficult to consolidate findings and summarize the influence of different factors. This article presents a review of the metrics employed in empirical literature examining takeover transitions in Level 3 automated driving and proposes a framework for standardizing the objective takeover performance metrics.

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.

Interpersonal roadway communication is a vital component of the transportation system. Road users communicate to coordinate movement and increase roadway safety. Future autonomous vehicle research needs to account for the role of interpersonal roadway communication. This literature review synthesizes research on interpersonal interaction between drivers, bicyclists, and pedestrians while also directing attention to implications for autonomous and connected vehicle research. Articles were collected from TRID, PsycINFO, Google Scholar, and ScienceDirect using search terms relevant to driving, communication, and vulnerable road users. The synthesis documents that interpersonal communication not only takes place but is also an important and understudied aspect of safe roadway travel. The review also found that road users employ a variety of communication methods that include gestures, facial expressions, and built-in vehicular devices. Comprehension of messages is influenced by several factors including culture, context, and experience. These results shed light on potential issues and challenges of interpersonal communication and the introduction of autonomous vehicles to the roadway.

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.

OBJECTIVE There are many unknowns regarding drivers' use and acceptance of advanced vehicle technologies. This research aimed to examine drivers' perceptions of advanced driver assistance systems (ADAS). METHODS This research was conducted using structured interviews and focus groups of owners of vehicles with advanced technologies. RESULTS Drivers' perceptions about ADAS were mixed, but generally safety was considered to be the greatest value of the systems. There was recognition that the systems may result in overreliance and thus encourage distraction behaviors or other bad driving habits, and participants generally expressed that they were ultimately responsible for the vehicle's operation and needed to be ready to override the system if it failed. CONCLUSIONS The findings indicate that driver characteristics and individual factors may influence perceptions, behaviors, and interactions with safety technology, and this research is a first step toward understanding any influences. Human factors issues related to automated vehicle technologies are critical for design and deployment, including those of trust, acceptance, and understanding of systems.

Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences.

When older adults reduce their driving, there can be subsequent decreases in life satisfaction. In this cross-sectional study, we used baseline data from the multi-site Longitudinal Research on Aging Drivers (LongROAD) study to examine whether social support moderates the negative association between reduced driving and life satisfaction. The outcome variable was life satisfaction, and the main predictor variable was past-year reduced driving (yes/no). Emotional, instrumental, and informational social support were measured using PROMIS v2.0 (Patient-Reported Outcomes Measurement Information System) items. We used generalized linear regression models to examine how social support moderated the association between reduced driving and life satisfaction. Statistical adjustment for social support attenuated the negative effect of reduced driving on life satisfaction by ~10% for all three types of social support.

Seat belt use can significantly reduce fatalities in motor vehicle crashes (Kahane, 2000). Nevertheless, the current U.S. seat belt use rate of 89.6% (Enriquez & Pickrell, 2019) indicates that a relatively small but pervasive portion of the population does not wear seat belts on a full-time basis. Whereas much is known about the demographic predictors of seat belt use, far less is understood about psychological factors that predict individual proclivities toward using or not using a seat belt. In this study, we examined some of these potential psychological predictors. A probability-based web survey was conducted with 6,038 U.S. residents aged 16 or older who reported having driven or ridden in a car in the past year. We measured self-reported seat belt use and 18 psychological constructs and found that delay of gratification, life satisfaction, risk aversion, risk perception, and resistance to peer influence were positively associated with belt use. Impulsivity and social resistance orientation were negatively associated with belt use. Prior research has shown that psychological factors like delay of gratification, risk aversion/perception, and impulsivity predict other health behaviors (e.g., cigarette smoking, sunscreen use); our results extend this literature to seat belts and can aid the development of traffic safety programs targeted at non-users who-due to such factors-may be resistant to more traditional countermeasures such as legislation and enforcement.

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.

Federal, state, and local governments have a critical role in fostering the opportunity for older adults to maintain mobility and independence as current drivers as well as when they can no longer or choose not to drive. The governments of many countries have developed long-term strategic plans to address the mobility needs of the growing older adult population, and numerous jurisdictions throughout the world have established specialized work groups and formal committees to investigate the mobility needs of the aging population and to provide recommendations for future transportation policy as it relates to older adults. This chapter discusses the role federal, state, and local governments have in helping older adults maintain mobility throughout all stages of the driving continuum. The key challenges and opportunities for providing adequate mobility options are discussed as well as promising initiatives that have been undertaken to ensure a transportation system that is robust to handle the changing needs of the population.