May/June 2018

Research Review: Improving Elders' Driving Safety
By Tara Kelley-Baker, PhD
Today's Geriatric Medicine
Vol. 11 No. 3 P. 30

In 2016, 221.7 million people were licensed to drive in the United States. Among them were 41.7 million drivers aged 65 and older. This means nearly one in five drivers belongs to the elder drivers age group, which is increasing faster than any other group. The largest single-year percentage increase in licensed drivers occurred among those between the ages of 75 and 79, increasing by 4.98% during 2015. Licensed drivers aged 85 and older increased by 4.62% in 2016, making it the second fastest growing demographic group during that year.1

With this increase in representation on the road comes another increase. Looking at a 10-year trend from 2007 through 2016, the National Highway Traffic Safety Administration (NHTSA) found that, in general, more older drivers had been involved in fatal crashes than younger drivers. In fact, those aged 65 and older experienced the largest percentage increases compared with any other age group.2 NHTSA also reported that adults aged 65 and older made up 18% of all traffic fatalities and 10% of all injuries in 2015. This translated to 6,165 older adults killed and an estimated 240,000 injured in motor vehicle traffic.3

Analysis indicates that fatal crash rates begin to increase around the ages of 70 to 74 and are highest among drivers aged 85 and older. However, this trend has been attributed largely to elders' increased susceptibility to injury and medical complications rather than an increased risk of crash involvement.4 Many older drivers report self-regulating their driving behavior in some way. For instance, elders often limit their driving in bad weather, avoid driving at night, limit driving to only local areas, or avoid high-speed roads.5

Countermeasures to Improve Safety
In light of the increasing numbers of older drivers on American roadways and the critical relationship between elders' driving and their independence,6 a number of countermeasures are being introduced. Most recently, special interest has been given to in-vehicle technologies, which have the potential to improve driving safety for older adults and increase their driving longevity. For many older drivers these technologies are viewed as beneficial in counteracting age-related changes in driving performance.7

Certain features, such as voice-command systems, have been found to increase older driver safety, yet design matters when it comes to how drivers interact with technologies.8,9 Drivers of all ages must feel comfortable and at ease with these features and must be able to use them correctly to enjoy their potential safety benefits. Additionally, aftermarket vehicle modifications and adaptive equipment are available for drivers with vehicles not yet equipped with such technology that also can assist with functional impairments and make driving more comfortable.10

The LongROAD Study
In 2012, in an effort to better understand and meet the safe mobility needs of older adult drivers, the AAA Foundation for Traffic Safety launched the Longitudinal Research on Aging Drivers (LongROAD) study, bringing together a multidisciplinary research team from six institutions. The aims of LongROAD are to better understand the following:

• the major protective and risk factors of safe driving;

• the effects of medical conditions and medications on driving behavior and safety;

• the mechanisms through which older adults self-regulate their driving behaviors to cope with functional declines;

• the extent, use, and effects of new vehicle technology and aftermarket vehicle adaptations among older drivers; and

• the determinants and health consequences of driving cessation during the process of aging.

A recently published research brief from this project focused specifically on identifying the types of in-vehicle technologies being used by older drivers and understanding how they are used, learned, and perceived in terms of their safety benefits.11 The study also explored the prevalence of aftermarket vehicle adaptations and how older adults go about making these adaptations and learning how to use them.

Across all of the technologies studied, more than one-half were always or often used. However, participants reported considerable lack of use for some technologies, with more than 60% of participants saying they rarely or never use semiautomated parking assist, in-vehicle concierge, and voice control.11 This may be the case because older drivers are having difficulty learning how to use many of these systems. Further research is needed to understand the reasons these technologies are seldom used.

Although in-vehicle technologies were present in nearly 60% of vehicles driven by LongROAD study participants, there was an increased likelihood of having these technologies among participants with higher income and education levels. This may not be surprising, as the majority of the technologies are available only at additional cost. Those with higher incomes may have more disposable income to purchase vehicles that include advanced technologies. Therefore, the benefits of these technologies may be limited to certain groups.

Value of Aftermarket Adaptations
A number of aftermarket options are available to older drivers to make their vehicles safer and enable them to remain longer behind the wheel.12 Yet LongROAD found that fewer than 9% of participants used in-vehicle aftermarket adaptations. Among those with adaptations, most respondents reported they did not work with professionals to determine whether adaptive equipment was appropriate or correctly installed.11 Consequently, older drivers may risk making incorrect and/or unneeded adaptations. Several groups have worked to communicate helpful information to older drivers. For example, NHTSA developed an informational brochure based on the experience of driver rehabilitation specialists and other professionals who work with people requiring adaptive devices for their motor vehicles.13 Recently, for Older Driver Safety Awareness Week (December 3–7, 2018), the American Occupational Therapy Association listed several interventions that can empower older drivers and their families, including 14 adaptive equipment features.14 Many of these help not only the drivers themselves but also caregivers who are transporting older passengers. They include the following:

• low-effort steering modifications;

• seatbelt adaptations that allow drivers to more easily pull the belt across the body without twisting;

• hand controls to assist with accelerator or brake functions;

• a removable grab bar that gives the driver something to hold onto when getting in and out of the vehicle;

• an OnStar subscription for navigation and emergency services assistance;

• extra or extended mirrors to broaden peripheral vision and expand the field of view;

• swing-out seats that extend the seat beyond the car threshhold so drivers need not maneuver around the steering column to get in;

• a siren detector for those who are hearing impaired;

• bioptics that can be attached to eyeglasses to assist a driver with very low vision;

• tire pressure sensors;

• traction control sensors;

• wireless back-up cameras that can be mounted to the dashboard;

• seat cushions; and

• pedal foot extensions.

In collaboration with the American Society on Aging, AARP, and American Occupational Therapy Association, AAA developed CarFit, which trains professionals to conduct a comprehensive 12-point check of an older adult's vehicle and make recommendations for needed adjustments. The program enables trained CarFit technicians, under the supervision of CarFit event coordinators and working with occupational therapists or qualified driver rehabilitation specialists, to observe an older adult driver in his or her vehicle and use the opportunity to open a conversation and provide collateral materials for follow-up action.

Greater efforts should be made to promote these relatively simple modifications and to highlight the importance of their proper installation. Because modifying a vehicle can vary greatly depending on an individual driver's needs, it is recommended that drivers consult with their families, physicians, and driver rehabilitation specialists before they purchase and install any equipment. Additionally, some automotive insurance companies may cover costs of adaptive equipment.

Although the proper installation and use of adaptive equipment is recommended by occupational specialists and other professionals, more formal research and evaluation on their potential benefits would help garner greater support for their use. Future research using the data collected by the LongROAD study will help to analyze the presence of vehicle modifications and their relationship to functional declines.

— Tara Kelley-Baker, PhD, is the data and information group leader at the AAA Foundation for Traffic Safety. She is the contract manager for the Longitudinal Research on Aging Drivers study.

References
1. Older drivers set record for second year. Federal Highway Administration website. https://www.fhwa.dot.gov/pressroom/fhwa1720.cfm. Published November 27, 2017.

2. National Highway Traffic Safety Administration. Traffic safety facts research note: 2016 fatal motor vehicle crashes: overview. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812456. Published October 2017.

3. National Highway Traffic Safety Administration. Traffic safety facts, 2015 data: older population. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812372. Published February 2017.

4. Older drivers. Insurance Institute for Highway Safety, Highway Loss Data Institute website. http://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people/2015. Published November 2016.

5. Molnar LJ, Eby DW. The relationship between self-regulation and driving-related abilities in older drivers: an exploratory study. Traffic Inj Prev. 2008;9(4):314-319.

6. Chihuri S, Mielenz TJ, DiMaggio CJ, et al. Driving cessation and health outcomes in older adults: a LongROAD study. AAA Foundation for Traffic Safety website. https://aaafoundation.org/wp-content/uploads/2017/12/DrivingCessationandHealthOutcomesReport.pdf. Published July 2015.

7. Gish J, Vrkljan B, Grenier A, Van Miltenburg B. Driving with advanced vehicle technology: a qualitative investigation of older drivers' perceptions and motivations for use. Accid Anal Prev. 2017;106:498-504.

8. Voice command systems help older drivers focus on the road. Insurance Institute for Highway Safety, Highway Loss Data Institute website. http://www.iihs.org/iihs/sr/statusreport/article/52/9/2. Published December 7, 2017.

9. Strayer DL, Cooper JM, Goethe RM, McCarty MM, Getty D, Biondi F. Visual and cognitive demands of using in-vehicle infotainment systems. AAA Foundation for Traffic Safety website. https://aaafoundation.org/wp-content/uploads/2017/11/VisualandCognitive.pdf. Published September 2017.

10. Silverstein N, Gottlieb A, Van Ranst E. Use of video intervention to increase elders' awareness of low-cost vehicle modifications that enhance driving safety and comfort. Transp Res Rec. 2005;1922:15-20.

11. Eby DW, Molnar LJ, Zakrajsek J, et al. Use, learning and perceptions of in-vehicle technologies, and vehicle adaptations among older drivers: a LongROAD study. http://aaafoundation.org/wp-content/uploads/2018/01/UseLearningPerceptionsLongROADBrief.pdf. Published October 2017.

12. Bouman J, Pellerito JM. Preparing for the on-road evaluation. In: Pellerito JM Jr, ed. Driver Rehabilitation and Community Mobility: Principles and Practice. St. Louis, MO: Elsevier Mosby; 2006.

13. National Highway Traffic Safety Administration. Adapting motor vehicles for older drivers. https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/hs810732.pdf. Published February 2007.

14. Thursday: interventions that can empower drivers and families. American Occupational Therapy Association website. https://www.aota.org/Conference-Events/Older-Driver-Safety-Awareness-Week/Thursday-full-article.aspx