Visual field loss and falls requiring hospitalisation: results from the eFOVID study.

BACKGROUND: Visual fields are important for postural stability and ability to manoeuvre around objects. OBJECTIVE: Examine the association between visual field loss and falls requiring hospitalisation in adults aged 50 +. METHODS: Older adults aged 50+ with and without visual field loss were identified using a fields database obtained from a cross-section of ophthalmologists' practices in Western Australia (WA). Data were linked to the Hospital Morbidity Data Collection and WA Hospital Mortality System to identify participants who experienced falls-related hospitalisations between 1990 and 2019. A generalised linear negative binomial regression model examined the association between falls requiring hospitalisation for those with and without field loss, based on the better eye mean deviation (mild: -2 to -6 dB, moderate: -6.01 dB to -12 dB, severe < -12.01 dB) in the most contemporaneous visual field test (3 years prior or if not available, 2 years after the fall), after adjusting for potential confounders. RESULTS: A total of 31 021 unique individuals of whom 6054 (19.5%) experienced 11 818 falls requiring hospitalisation during a median observation time of 14.1 years. Only mean deviation index of <-12.01 dB (severe) was significantly associated with an increased rate of falls requiring hospitalisations by 14% (adjusted IRR 1.14, 95% CI 1.0-1.25) compared with no field loss, after adjusting for potential confounders. Other factors included age, with those aged 80+ having an increased rate (IRR 29.16, 95% CI 21.39-39.84), other comorbid conditions (IRR 1.49, 95% CI 1.38-1.60) and diabetes (IRR 1.25, 95% CI 1.14-1.37). Previous cataract surgery was associated with a decreased rate of falls that required hospitalisations by 13% (IRR 0.87, 95% CI 0.81-0.95) compared with those who did not have cataract surgery. CONCLUSION: The findings highlight the importance of continuous clinical monitoring of visual field loss and injury prevention strategies for older adults with visual field loss.

[ADAS and automation-a relevant contribution to maintaining mobility of older drivers?] / Fahrerassistenzsysteme und automatisiertes Fahren ­ ein relevanter Beitrag zum Erhalt der Mobilität im Alter?

Driving is the most important and safest form of mobility for the majority of senior citizens. However, physical and mental performance gradually decline with age, which can lead to more problems, critical situations or even accidents. Vehicle technology innovations such as advanced driver assistance systems (ADAS) have the potential to increase the road safety of older people and maintain their individual mobility for as long as possible.This overview article aims to identify ADAS that have the greatest potential to reduce the number of accidents involving older drivers. For this purpose, the accident and damage occurrence as well as the driving behaviour and compensation strategies of older people are examined in more detail. Suitable ADAS should compensate for typical driver errors, reduce information deficiencies and have a high level of acceptance. For older drivers, emergency braking, parking assistance, navigation, intersection assistance and distance speed control systems as well as systems for detecting blind spots and obstacles appear to be particularly suitable.Some of the disadvantages of ADAS are the lack of market penetration, acceptance problems and interface designs that have not yet been optimally adapted to the needs of older users. For older drivers in particular, it appears to be a priority to develop coherent and integrated solutions in the sense of cooperative assistance instead of pushing ahead with high and full automation with many system limits and exceptions, which can place high demands on attention, for example if the vehicle has to be taken over in a critical situation.

[Driving competence in older age: psychological assessment and interventions]. / Fahrkompetenz im Alter: Psychologische Diagnostik und Interventionen.

The article introduces the issue of psychological assessment and training for driving safety, driving competence, and the mobility of older drivers. The psychological methods for assessing driving competence and the training approaches for maintaining mobility in old age are outlined and illustrated with examples. Preserving driving ability in old age remains a task for which development needs and research gaps must be specified. Although periodic mandatory examinations based on age do not yield any relevant improvement in enhancing traffic safety, they do not cause harm and are widely accepted. It is desirable to move away from a theory focusing on deficits of older age and instead develop an assessment of the comprehensive functions, abilities, and resources of elderly drivers to help preserve the mobility and participation of that specific demographic in traffic.

Medications and traffic accidents involving older drivers: do Spanish primary healthcare physicians know enough?

BACKGROUND: Our aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics. METHODS: A cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample. RESULTS: On a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants. CONCLUSIONS: Family doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

The relationship between central and mid-peripheral motion perception and the hazard perception test in younger and older adults.

INTRODUCTION: Vision standards for driving are typically based on visual acuity, despite evidence that it is a poor predictor of driving safety and performance. However, visual motion perception is potentially relevant for driving, as the vehicle and surroundings are in motion. This study explored whether tests of central and mid-peripheral motion perception better predict performance on a hazard perception test (HPT), which is related to driving performance and crash risk, than visual acuity. Additionally, we explored whether age influences these associations, as healthy ageing impairs performance on some motion sensitivity tests. METHODS: Sixty-five visually healthy drivers (35 younger, mean age: 25.5; SD 4.3 years; 30 older adults, mean age: 71.0; SD 5.4 years) underwent a computer-based HPT, plus four different motion sensitivity tests both centrally and at 15° eccentricity. Motion tests included minimum displacement to identify motion direction (Dmin ), contrast detection threshold for a drifting Gabor (motion contrast), coherence threshold for a translational global motion stimulus and direction discrimination for a biological motion stimulus in the presence of noise. RESULTS: Overall, HPT reaction times were not significantly different between age groups (p = 0.40) nor were maximum HPT reaction times (p = 0.34). HPT response time was associated with motion contrast and Dmin centrally (r = 0.30, p = 0.02 and r = 0.28, p = 0.02, respectively) and with Dmin peripherally (r = 0.34, p = 0.005); these associations were not affected by age group. There was no significant association between binocular visual acuity and HPT response times (r = 0.02, p = 0.29). CONCLUSIONS: Some measures of motion sensitivity in central and mid-peripheral vision were associated with HPT response times, whereas binocular visual acuity was not. Peripheral testing did not show an advantage over central testing for visually healthy older drivers. Our findings add to the growing body of evidence that the ability to detect small motion changes may have potential to identify unsafe road users.

Prevention of road crashes in older adults: perspectives on facilitators, barriers and the role of the family doctor.

BACKGROUND: People over 64 years have a high fatality rate when they are involved in traffic accidents. Besides, older victims of road crashes are expected to rise in the future due to population aging. The purpose of the study was to document their perception on the role of the family doctor, the main facilitating factors, and the perceived barriers to the temporary or permanent restriction of their driving. METHODS: This qualitative study used focus group methodology. A sample of 16 people over 65 years old was obtained through a series of segmentation criteria at an active participation centre for older adults in a small town in Jaén province (Spain). All were invited to participate in a discussion during which they were asked to express their opinions and subjective experiences concerning the role of their family doctor. The group conversation was taped, fully transcribed and analysed, and codes were generated with both deductive and inductive methods. RESULTS: After merging the codes to generate themes, we identified 9 relevant categories: perception of age-related risk, road safety, role of public authorities, driver assessment centre, role of the family doctor, role of the family, proposals for addressing traffic accidents in older adults, consequences of the driving prohibition, and public transport. All categories help to explain the subjective driving and traffic safety experiences of older road users. CONCLUSIONS: Although family doctors do not usually ask their older patients about road driving, they are highly valued by these patients. Thus, family doctors have a great potential to act, along with the family members, for the benefit of older patients' traffic safety, in ways that can prevent their involvement in road crashes and reduce the negative consequences of having to stop driving if necessary.

Caregiver Prediction of Driving Fitness in Older Adults with Dementia.

Objectives: To determine whether caregiver opinion of fitness to drive and the level of assistance needed for functional activities are useful in determining the need for a Comprehensive Driving Evaluation.Methods: This study examined a sample (N = 179) of drivers with dementia. Caregivers completed a questionnaire that included caregiver opinion of driving fitness and the Functional Assessment Questionnaire (FAQ). A univariate simple logistic regression model was used to examine the relationship of road test failure with caregiver opinion of driving fitness and FAQ scores. From the significant predictive variables from the univariate test, multiple logictic regression models were used to examine possible combination of variables as predictors of road test failure.Results: The combination of caregiver opinion of driving fitness and the FAQ sub-item for memory were found to have modest ability in predicting failure on a standardized on-road driving assessment (AUC 0.727).Conclusions: Caregiver opinion of driving fitness and most individual higher order activities of daily living were found to be independent predictors of failure on a standardized road test.Clinical Implications: Caregiver opinion of driving fitness and ratings of functional activities may be useful for families and clinicians in considering whether an adult with dementia should be more carefully assessed for fitness to drive.

Nighttime driving: visual, lighting and visibility challenges.

PURPOSE: Nighttime driving is dangerous and is one of the most challenging driving situations for most drivers. Fatality rates are higher at night than in the day when adjusted for distances travelled, particularly for crashes involving pedestrians and cyclists. Although there are multiple contributory factors, the low light levels at night are believed to be the major cause of collisions with pedestrians and cyclists at night, most likely due to their reduced visibility. Understanding the visibility problems involved in nighttime driving is thus critical, given the increased risk to road safety. RECENT FINDINGS: This review discusses research that highlights key differences in the nighttime road environment compared to the day and how this affects visual function and driving performance, together with an overview of studies investigating how driver age and visual status affect nighttime driving performance. Research that has focused on the visibility of vulnerable road users at nighttime (pedestrians and cyclists) is also included. SUMMARY: Collectively, the research evidence suggests that visual function is reduced under the mesopic lighting conditions of night driving and that these effects are exacerbated by increasing age and visual impairment. Light and glare from road lighting and headlights have significant impacts on vision and night driving and these effects are likely to change with evolving technologies, such as LED streetlighting and headlights. Research also highlights the importance of the visibility of vulnerable road users at night and the role of retroreflective clothing in the 'biomotion' configuration for improving their conspicuity and hence safety.

[Physical parameters and physical function in older drivers with driving-related anxiety: the Nakagawa Study].

AIM: This study investigated whether driving-related anxiety was independently associated with physical parameters and physical function in community-dwelling older people. METHODS: Participants were 523 community-dwelling older drivers (353 men and 170 women). Participants self-reported driving-related anxiety when driving in familiar environments, and completed physical assessments: visual impairment, auditory impairment, cerebrovascular disease (CVD), hand grip strength, knee extension strength, timed up and go (TUG), chair stand, one leg standing with open eyes, functional reach, vertical jump, preferred gait speed and maximal gait speed. Participants were divided into a driving-related anxiety group (72.8±5.1 years; 21 men, seven women) and a no-anxiety (non-anxiety) group (70.7±4.7 years; 325 men, 163 women). We examined physical performance differences between the anxiety and non-anxiety groups using analysis of covariance, and investigated the relationship between anxiety, physical function and performance using logistic regression analysis (forward stepwise selection). RESULTS: The driving-related anxiety group was significantly older, with higher rates of visual impairment, auditory impairment, and CVD than the non-anxiety group. The anxiety group exhibited independently poorer TUG and maximal gait speed (P<0.05 for both). Logistic regression analysis revealed significant relationships between anxiety and visual impairment (odds ratio [OR]: 5.6, 95% confidence interval [CI]: 2.5-12.6), auditory impairment (OR: 3.0, 95% CI: 1.3-7.0), TUG (OR: 1.46, 95% CI: 1.1-1.9) and CVD (OR: 3.1, 95% CI: 1.0-9.4) (P<0.05 for all). CONCLUSIONS: Driving-related anxiety was significantly associated with worse physical performance, visual impairment, auditory impairment, and CVD in community-dwelling older drivers.

Risk-Exposure Density and Mileage Bias in Crash Risk for Older Drivers.

Crash rates per mile indicate a high risk of vehicle crash in older drivers. A reliance on mileage alone may underestimate the risk exposure of older drivers because they tend to avoid highways and travel more on nonfreeways (e.g., urban roads), which present greater hazards. We introduce risk-exposure density as an index of exposure that incorporates mileage, frequency of travel, and travel duration. Population-wide driver fatalities in the United States during 2002-2012 were assessed according to driver age range (in years: 16-20, 21-29, 30-39, 40-49, 50-59, 60-69, ≥70) and sex. Mileage, frequency, and duration of travel per person were used to assess risk exposure. Mileage-based fatal crash risk increased greatly among male (relative risk (RR) = 1.73; 95% CI: 1.62, 1.83) and female (RR = 2.08; 95% CI: 1.97, 2.19) drivers from ages 60-69 years to ages ≥70 years. Adjusting for their density of risk exposure, fatal crash risk increased only slightly from ages 60-69 years to ages ≥70 years among male (RR = 1.09; 95% CI: 1.03, 1.15) and female (RR = 1.22; 95% CI: 1.16, 1.29) drivers. While ubiquitous in epidemiologic research, mileage-based assessments can produce misleading accounts of driver risk. Risk-exposure density incorporates multiple components of travel and reduces bias caused by any single indicator of risk exposure.

Differential Contributions of Selective Attention and Sensory Integration to Driving Performance in Healthy Aging and Alzheimer's Disease.

OBJECTIVES: Patients with Alzheimer's disease (AD) demonstrate deficits in cross-cortical feature binding distinct from age-related changes in selective attention. This may have consequences for driving performance given its demands on multisensory integration. We examined the relationship of visuospatial search and binding to driving in patients with early AD and elderly controls (EC). METHODS: Participants (42 AD; 37 EC) completed search tasks requiring either luminance-motion (L-M) or color-motion (C-M) binding, analogs of within and across visual processing stream binding, respectively. Standardized road test (RIRT) and naturalistic driving data (CDAS) were collected alongside clinical screening measures. RESULTS: Patients performed worse than controls on most cognitive and driving indices. Visual search and clinical measures were differentially related to driving behavior across groups. L-M search and Trail Making Test (TMT-B) were associated with RIRT performance in controls, while C-M binding, TMT-B errors, and Clock Drawing correlated with CDAS performance in patients. After controlling for demographic and clinical predictors, L-M reaction time significantly predicted RIRT performance in controls. In patients, C-M binding made significant contributions to CDAS above and beyond demographic and clinical predictors. RIRT and C-M binding measures accounted for 51% of variance in CDAS performance in patients. CONCLUSIONS: Whereas selective attention is associated with driving behavior in EC, cross-cortical binding appears most sensitive to driving in AD. This latter relationship may emerge only in naturalistic settings, which better reflect patients' driving behavior. Visual integration may offer distinct insights into driving behavior, and thus has important implications for assessing driving competency in early AD. (JINS, 2018, 24, 486-497).

Aiding medical professionals in fitness-to-drive screenings for elderly drivers: development of an office-based screening tool.

ABSTRACTBackground:Elderly drivers are an increasing group in society. Previous research has found that functional and cognitive abilities are more important for driving abilities than biological age. In an attempt to conserve independent mobility for elderly drivers, many researchers have focused on elderly drivers diagnosed with cognitive decline (mild cognitive impairment or mild Dementia). This study is the first to focus on elderly drivers with cognitive complaints or suspected of diminished fitness to drive by an (in)formal caregiver as an at-risk group. METHODS: The main objective of this study was to develop a fitness to drive screening tool for elderly drivers to be used in a doctor's office. Furthermore, this study investigated the additional value of driving simulator tests in the assessment of fitness to drive. Both screenings (functional abilities and driving simulator test) were benchmarked against the official Belgian fitness to drive licensing procedure. RESULTS: One-hundred thirty-six elderly drivers participated in a functional abilities screening, a driving simulator assessment and an on-road driving test. Sixty-five percent of the sample was considered fit to drive. Visual acuity, physical flexibility, and knowledge of road signs were found to be the best predictive set of tests for the on-road fitness to drive outcome. A performance based driving simulator assessment increased predictive accuracy significantly. CONCLUSION: The proposed screening procedure saves part of the at-risk elderly driver population from stressful and costly on-road driving evaluations. This procedure provides more information of an individual driver's specific driving parameters. This opens doors for personalized older driver training to maintain independent mobility in later life.

First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: a prospective cohort study.

BACKGROUND: Driving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation. METHODS: Fifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants' natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status. RESULTS: The odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1-0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1-0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01-0.4). CONCLUSIONS: The findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence.

Reliability and validity of the English and Malay versions of the Driving and Riding Questionnaire: a pilot study amongst older car drivers and motorcycle riders.

OBJECTIVES: This study aimed to examine the reliability and validity of the English and Malay versions of the Driving and Riding Questionnaire. STUDY DESIGN: An observational study with a mix-method approach by utilising both questionnaire and short debriefing interviews. METHODS: Forward and backward translations of the original questionnaire were performed. The translated questionnaire was assessed for clarity by a multidisciplinary research team, translators, and several Malay native speakers. A total of 24 subjects participated in the pilot study. Reliability (Cronbach's alpha) and validity (content validity) of the original and translated questionnaires were examined. RESULTS: The English and Malay versions of the Driving and Riding Questionnaire were found to be reliable tools in measuring driving behaviours amongst older drivers and riders, with Cronbach's alpha of 0.9158 and 0.8919, respectively. For content validity, the questionnaires were critically reviewed in terms of relevance, clarity, simplicity, and ambiguity. The feedback obtained from participants addressed various aspects of the questionnaire related to the improvement of wordings used and inclusion of visual guide to enhance the understanding of the items in the questionnaire. This feedback was incorporated into the final versions of the English and Malay questionnaires. CONCLUSION: The findings of this study demonstrated both the English and Malay versions of the Driving and Riding Questionnaire to be valid and reliable.

Driving comfort, enjoyment and acceptance of automated driving - effects of drivers' age and driving style familiarity.

Automated driving has the potential to improve the safety and efficiency of future traffic and to extend elderly peoples' driving life, provided it is perceived as comfortable and joyful and is accepted by drivers. Driving comfort could be enhanced by familiar automated driving styles based on drivers' manual driving styles. In a two-stage driving simulator study, effects of driving automation and driving style familiarity on driving comfort, enjoyment and system acceptance were examined. Twenty younger and 20 older drivers performed a manual and four automated drives of different driving style familiarity. Acceptance, comfort and enjoyment were assessed after driving with standardised questionnaires, discomfort during driving via handset control. Automation increased both age groups' comfort, but decreased younger drivers' enjoyment. Younger drivers showed higher comfort, enjoyment and acceptance with familiar automated driving styles, whereas older drivers preferred unfamiliar, automated driving styles tending to be faster than their age-affected manual driving styles. Practitioner Summary: Automated driving needs to be comfortable and enjoyable to be accepted by drivers, which could be enhanced by driving style individualisation. This approach was evaluated in a two-stage driving simulator study for different age groups. Younger drivers preferred familiar driving styles, whereas older drivers preferred driving styles unaffected by age.

Predictors of Readiness for Mobility Transition in Older Drivers.

We administered the Assessment of Readiness for Mobility Transition (ARMT) to 301 older drivers and compared total scores with participant characteristics. Overall, 18% of participants were not attitudinally ready for mobility transition, while 19% were very ready. Notably, participants with hospitalizations in the past year were either very ready for mobility transition (20% vs 14% without hospitalizations) or not ready at all (30% vs 17%). Significant health events may polarize reactions towards mobility transition. Individualizing communication about driving cessation readiness could help address such differing views. To further consider its effectiveness, ARMT could be utilized in mobility transition counseling interventions.

Self-reported health conditions and related driving reduction in older drivers.

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 = 2990) 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<.001). Mobility affects well-being; health professionals should consider that health conditions may cause older adults to reduce driving. Gender differences deserve attention in future research and education efforts.

Gender effect on driving cessation in pre-dementia and dementia phases: results of the 3C population-based study.

OBJECTIVES: Aging entails deterioration in sensory, physical, and cognitive functions, raising doubt in the driving capacity of older drivers, especially when the deficits are severe, as in dementia. Many older drivers, especially women, adapt their driving habits in order to compensate for these deficits and eventually stop driving. The present prospective study assessed driving cessation in men and women throughout the dementia process, including a 2-year pre-dementia phase. METHODS: The study was based on a three-city cohort of subjects who were aged 65 years and older in 2000 and followed for more than 10 years. Active dementia detection was conducted at each follow-up. The probability of driving cessation was assessed in men and women during the 2-year pre-dementia phase and until 5 years after diagnosis. RESULTS: In the 2-year pre-dementia phase, both men and women ceased driving earlier than drivers with no central nervous system pathology (p < 0,001), and women ceased driving earlier than men. A total of 45% of men and 74% of women had already ceased driving at dementia diagnosis. In contrast, the probability of cessation within 3 years after diagnosis was similar between men and women. CONCLUSION: The study showed that, in this French urban population, few demented drivers, especially women, were still driving after diagnosis. Those who continued to drive 3 years after the diagnosis all had Alzheimer-type dementia. There is certainly a need for physicians to help these drivers to adapt their driving activity to their deficits and to prepare them to stop driving. Copyright © 2016 John Wiley & Sons, Ltd.

Fatigue in Younger and Older Drivers: Effectiveness of an Alertness-Maintaining Task.

OBJECTIVE: The aim of this study was to examine the effects of an alertness-maintaining task (AMT) in older, fatigued drivers. BACKGROUND: Fatigue during driving increases crash risk, and previous research suggests that alertness and driving in younger adults may be improved using a secondary AMT during boring, fatigue-eliciting drives. However, the potential impact of an AMT on driving has not been investigated in older drivers whose ability to complete dual tasks has been shown to decline and therefore may be negatively affected with an AMT in driving. METHOD: Younger ( n = 29) and older drivers ( n = 39) participated in a 50-minute simulated drive designed to induce fatigue, followed by four 10-minute sessions alternating between driving with and without an AMT. RESULTS: Younger drivers were significantly more affected by fatigue on driving performance than were older drivers but benefitted significantly from the AMT. Older drivers did not demonstrate increased driver errors with fatigue, and driving did not deteriorate significantly during participation in the AMT condition, although their speed was significantly more variable with the AMT. CONCLUSION: Consistent with earlier research, an AMT applied during fatiguing driving is effective in improving alertness and reducing driving errors in younger drivers. Importantly, older drivers were relatively unaffected by fatigue, and use of an AMT did not detrimentally affect their driving performance. APPLICATION: These results support the potential use of an AMT as a new automotive technology to improve fatigue and promote driver safety, though the benefits of such technology may differ between different age groups.

Looking Forward and Looking Back: Older Adults' Views of the Impacts of Stopping Driving.

This project aimed to identify the impact of driving cessation from the perspectives of older drivers and former drivers. Participants included 17 adults aged 65-88 years residing in a city in Northwestern Ontario, Canada. Using a semi-structured interview guide (with questions regarding mobility, personal impact, impact on others, engagement with life, and finances), two focus groups were held with nine current drivers, and one-on-one interviews were held with six former drivers and two current drivers. Two themes emerged concerning stopping driving. The first theme included discussions on experiencing lifestyle changes, relationship impacts, and emotional impacts. The second, the adjustment to stopping driving, included practical adaptations, and emotional responses such as appreciation, resistance, acceptance, and being positive. Although the impacts of stopping driving were substantial, there were few discrepancies between what was anticipated and what was experienced. This information could assist with developing interventions to ease the transition to former-driver status.