The Influence of Hearing Impairment on Driving Avoidance Among a Large Cohort of Older Drivers.

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.

Effect of Passenger Encumbrance and Mobility Aid Use on Dwell Time Variability in Low-floor Transit Vehicles.

Public transit serves users with a broad range of physical capabilities and design needs. However information about the operational effects of diverse users interacting with the transit system is scarce. This paper examined the occurrence and effects of boarding and alighting passengers with mobility aids (wheelchairs, scooters, walkers and canes), or with large items (carts, strollers, bicycles, or carrying an infant) on bus stop dwell time in a fixed-route bus service. On-board video data from low-floor public transit buses serving Ann Arbor, Michigan were used from 199 bus stops with at least one passenger boarding or alighting with a mobility aid or encumbered with a large item, and an additional 1642 bus stops without any mobility aids or encumbrances. A sequence of linear regression models examined the relationship between dwell time and the addition of variables representing passengers with mobility aids and encumbrances, and use of the on-vehicle access ramp, beyond explanatory variables typically used in dwell time analysis. Accounting for passengers boarding/alighting with mobility aids and encumbrances (p < 0.001) and use of the access ramp (p < 0.001) increased the variance explanation of a dwell time model based on boarding passengers by fare payment, alighting passengers by door use, and passenger load from 46% to 56%. Results indicate distinct patterns in the durations for boarding and alighting by passengers with vs. without mobility aids and encumbrances, and when a ramp is used by wheeled mobility users vs. ambulatory passengers with walking aids. The findings suggest that accounting for the presence of passengers with mobility aids or encumbrances and ramp use in dwell time analyses could help transit operators make their service operationally more efficient and inclusive for all passengers and encourage more use of fixed-route transit among individuals with disabilities.

Improving Safe Mobility: An Assessment of Vehicles and Technologies among a Large Cohort of Older Drivers.

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.

Potential effects of lowering the BAC limit on injuries, fatalities, and costs.

INTRODUCTION: Potential health and cost impacts of lowering the BAC limit for U.S. drivers below .08% were explored through analyses of reductions in crash incidence, injury severity, and costs based on five scenarios with varying assumptions about how the change to a .05% BAC limit might affect alcohol-impaired driving. METHODS: Distribution of crashes by injury level and highest driver or non-occupant BAC levels for 2010, together with unit crash costs provided a base for comparison. Scenario 1 assumed all alcohol-impaired driving ceased; scenario 2 assumed all drivers obeyed the law, and scenario 3 assumed decreases in driver BAC levels would be limited to those who had been driving near the legal limit before the change. Scenario 4 was based on changes in driver BAC levels associated with a 08% to .05% BAC limit change in Australia, and scenario 5 was based on changes in alcohol-related crashes associated with the change to the .08% BAC limit in the United States. The number of casualties prevented in each scenario was estimated using relative risks of crash involvement, and changes in societal costs were estimated using the unit costs. RESULTS: Reductions ranging from 71% to 99% in fatalities, injuries, and costs related to alcohol-impaired driving were estimated in scenarios 1 and 2. Scenarios 3-5 produced smaller reductions ranging from 4% to 16% for alcohol-impaired fatalities, injuries, and costs. CONCLUSION: The wide difference between the outcomes of the two sets of scenarios reflects the sensitivity of BAC policy benefits to driver compliance behavior. PRACTICAL APPLICATION: The quantification of the reduction in the number and costs of traffic crash casualties in the set of behavioral scenarios explored in this research can inform policymakers about the extent and limits of benefits achievable by lowering the BAC limits as they consider strategies to reduce alcohol-impaired driving.

Prevalence, attitudes, and knowledge of in-vehicle technologies and vehicle adaptations among older drivers.

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.

Perceptions of alcohol-impaired driving and the blood alcohol concentration standard in the United States.

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.

Stakeholder perceptions of lowering the blood alcohol concentration standard in the United States.

PURPOSE: This study sought to better understand the past change in the legal blood alcohol concentration (BAC) standard from 0.10% to 0.08% in the United States, as well as explore stakeholder perceptions about potential health and other impacts of further lowering the standard below 0.08%. METHODS: In-depth interviews were conducted with representatives of 20 organizations considered to have an interest and investment in the potential impacts of strategies to decrease alcohol-impaired related crashes and injuries. Interviews were conducted by a trained moderator, using a structured guide. RESULTS: Themes from the interviews are presented for several discussion topics explored for both the earlier change in the legal BAC limit from 0.10% to 0.08% and a potential lowering of the limit below 0.08%. Topics included arguments for and against change; organizational position on the change; stakeholders on both sides of the issue; strategies to support or oppose the change; health and economic impacts; and enforcement and adjudication challenges. CONCLUSIONS: Collectively, results suggest that moving the BAC standard below the current level will require considerable effort and time. There was strong, but not complete, agreement that it will be difficult, and maybe infeasible in the short-term, for states to implement a BAC standard lower than 0.08%.

Characteristics of informal caregivers who provide transportation assistance to older adults.

The study aim was to gain a better understanding of the characteristics of informal caregivers who provide transportation assistance and to explore the types and frequency of this assistance. A telephone survey was administered to a representative sample of 268 informal caregivers (age 45-80) who provide transportation assistance to older adults (age 70 and older) in Michigan. Responses were analyzed overall and by the caregiver sex and care recipient age. Informal transportation caregivers were: most often women; on average 61 years old; generally college educated; employed full- or part-time jobs; relatively healthy; providing care to a parent/family member 1-4 times per week, living close to the care recipient; and providing assistance by giving rides. Less than one-half of caregivers sought information to help them provide assistance. No significant burden was reported and there were few differences by sex of the caregiver of the age group of the care recipient.

Use, perceptions, and benefits of automotive technologies among aging drivers.

Advanced in-vehicle technologies have been proposed as a potential way to keep older adults driving for as long as they can safely do so, by taking into account the common declines in functional abilities experienced by older adults. The purpose of this report was to synthesize the knowledge about older drivers and advanced in-vehicle technologies, focusing on three areas: use (how older drivers use these technologies), perception (what they think about the technologies), and outcomes (the safety and/or comfort benefits of the technologies). Twelve technologies were selected for review and grouped into three categories: crash avoidance systems (lane departure warning, curve speed warning, forward collision warning, blind spot warning, parking assistance); in-vehicle information systems (navigation assistance, intelligent speed adaptation); and other systems (adaptive cruise control, automatic crash notification, night vision enhancement, adaptive headlight, voice activated control). A comprehensive and systematic search was conducted for each technology to collect related publications. 271 articles were included into the final review. Research findings for each of the 12 technologies are synthesized in relation to how older adults use and think about the technologies as well as potential benefits. These results are presented separately for each technology. Can advanced in-vehicle technologies help extend the period over which an older adult can drive safely? This report answers this question with an optimistic "yes." Some of the technologies reviewed in this report have been shown to help older drivers avoid crashes, improve the ease and comfort of driving, and travel to places and at times that they might normally avoid.

Older adults' driving reduction and cessation: perspectives of adult children.

PURPOSE OF THE STUDY: Adult children are often directly affected by aging parents' decision to limit or stop driving. This qualitative study examined the process of driving reduction and cessation (DRC) from the perspective of adult children, with a focus on family communication. DESIGN AND METHODS: Four focus group interviews were conducted with 37 adult children (29/37 female; mean age = 45.5) of older parents using a structured protocol. Transcripts were analyzed by two independent coders to identify major themes. RESULTS: Themes represented three aspects of the DRC process: family communication and dynamics (i.e., discussion, negotiation, and planning; avoidance and side stepping; resignation and refusal), taking action to end a parent's driving career (i.e., engaging a third party; taking away the car), and post-cessation reflection (i.e., relief; social benefits; resentment and guilt). IMPLICATIONS: Despite the potential benefits of planning for DRC, families are unsure about how best to approach this topic. Adult children worry about assuming responsibility for their parents' transportation needs and their parents' reactions to restricted mobility. Despite a reluctance to communicate openly about DRC, adult children and their parents share similar and significant concerns that merit increased attention.

Self-regulatory driving practices among older adults: health, age and sex effects.

The purpose of this study was to better understand how older adults self-regulate driving, and to identify differences by age, sex, and health-related functioning. Michigan drivers over age 64 were surveyed by telephone (n=961, age [mu=74.2, sigma=5.8], 56% female) about their driving-related behaviors, physical functioning, and health. Respondents were presented with scenarios involving driving to an important appointment under adverse conditions (rainy stormy weather, on alternate route in heavy freeway traffic, 200-mile trip on unfamiliar roads). Generalized logit models examined outcomes for each scenario: driving as usual, driving with modifications, and not driving. Results indicate that the effect of sex on self-regulation was significant and greater than that of age and physical functioning. Women were more likely to self-regulate by not driving. Odds ratios and 95% confidence limits for each scenario for women vs. men are 6.8 (3.8-2.0), 6.5 (3.6-12.0), and 17.7 (11.0-28.6). The effect of sex on self-regulation by modifying driving was smaller and significant only in scenarios 2 and 3. Women were more likely then men to modify driving for scenario 2 (odds ratio, 3.0 (2.0-4.5)) and scenario 3 (odds ratio 4.4 (3.1-0.1)). Overall, the study finds the relative effect of sex on self-regulation greater than that of age and physical functioning for conditions examined.

Cellular phone use while driving at night.

OBJECTIVE: Use of a cellular phone has been shown to negatively affect one's attention to the driving task, leading to an increase in crash risk. At any given daylight hour, about 6% of US drivers are actively talking on a hand-held cell phone. However, previous surveys have focused only on cell phone use during the day. Driving at night has been shown to be a riskier activity than driving during the day. The purpose of the current study was to assess the rate of hand-held cellular phone use while driving at night, using specialized night vision equipment. METHODS: In 2006, two statewide direct observation survey waves of nighttime cellular phone use were conducted in Indiana utilizing specialized night vision equipment. Combined results of driver hand-held cellular phone use from both waves are presented in this manuscript. RESULTS: The rates of nighttime cell phone use were similar to results found in previous daytime studies. The overall rate of nighttime hand-held cellular phone use was 5.8 +/- 0.6%. Cellular phone use was highest for females and for younger drivers. In fact, the highest rate observed during the study (of 11.9%) was for 16-to 29-year-old females. CONCLUSIONS: The high level of cellular phone use found within the young age group, coupled with the increased crash risk associated with cellular phone use, nighttime driving, and for young drivers in general, suggests that this issue may become an important transportation-related concern.

A direct observation study of nighttime safety belt use in Indiana.

INTRODUCTION: Nearly all direct observation studies of safety belt use are conducted exclusively during daylight hours. Recent work has suggested that safety belt use at night may differ from daytime belt use. METHODS: An observational study of nighttime safety belt use, utilizing specialized night vision equipment, was conducted in Indiana surrounding the Click It or Ticket 2006 safety belt mobilization activities. A pre- and a post-mobilization statewide direct observation survey was conducted at night coinciding with daytime safety belt use data collection conducted by the state of Indiana. Daytime and nighttime belt use rates were compared. RESULTS: The comparisons across the mobilization period revealed a significant increase during the day, but a significant decrease at night. Comparisons between daytime and nighttime belt use revealed no overall difference during the pre wave, but a significant difference during the post wave. Finally, many common daytime trends in belt use were also found at night, with the exception of the typical age and seating position effects. DISCUSSION: The mobilization activities had a positive effect on daytime belt use, but no effect on nighttime belt use, likely resulting in the differences between daytime and nighttime belt use observed during the post wave. IMPACT ON INDUSTRY: The findings of this study suggest that safety belt mobilizations implemented only during the day do not influence nighttime safety belt use. Changes to how these programs are implemented or additional programs specifically targeting belt use at night should be considered, along with continued monitoring of nighttime belt use.

Differences in safety belt use by race.

The purpose of the study was to identify daytime differences in safety belt use by race. Safety belt use was investigated in a direct observation survey of drivers and front-outboard passengers throughout Michigan. Data were weighted to calculate statewide safety belt use rates by race. Race was assessed visually by trained observers. The study showed that motor vehicle occupants identified as Black had significantly lower safety belt use than those occupants identified as White or Other.

The effect of changing from secondary to primary safety belt enforcement on police harassment.

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.

Driving and alternatives: older drivers in Michigan.

METHOD: A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive. RESULTS: Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years. IMPACT ON INDUSTRY: Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.