The Road Map. Collisions and aging Function, skill and driving Licensing and assessment The future

Transcription

1 Senior Licensing 7th International Conference on Urban Traffic Safety Edmonton, AB April, 2015 C.T. (Chip) Scialfa University of Calgary The Road Map Collisions and aging Function, skill and driving Licensing and assessment The future 1

2 Collisions and Aging Older drivers are increasing in absolute number and proportion of the population. Driving is critical for independence, employment, social support. Unsafe drivers are a soce societal risk Are older drivers unsafe? Collisions and Aging The City of Edmonton, Office of Traffic Safety (2012). Motor Vehicle Collisions

3 Collisions and Aging Collisions and Aging GROUPEMENT DES ASSUREURS AUTOMOBILES, Automobile Statistical Plan, General Results, Private passenger vehicle,

4 Collisions and Aging Controlling for exposure, older drivers are more collision- involved, more likely to die or be seriously injured. Low-mileage bias, frailty, greater likelihood to drive some highrisk settings involving more intersections. Older drivers are more likely to be involved in collisions involving intersections, merging, yielding right-of-way, but this is true for all drivers. It is not age per se, but age-related medical conditions that cause increased risk behind the wheel. 50% of AD patients drive for at least 3 years following initial diagnosis. Many licensed AD drivers do not recognize a Stop sign! Collisions and Aging Relative importance in collision causes Speed Distraction and inattention Alcohol Improper following distance Men Age, primarily with young adults 4

5 Abilities and Driving Safety Driving as complex behavior Sub-tasks of navigation, lane control and hazard avoidance Smiley (2004) division of strategic, tactical and operational behaviors Strategic t planning route, etc. Tactical situation-dependent decisions like gap acceptance. Operational often unconscious like scanning Amenable to training! Abilities and Driving Safety Physical Strength, flexibility and range of motion. Sensory and perceptual Visual acuity, contrast sensitivity, depth perception, motion perception, peripheral vision, hearing, reaction time. Cognitive Memory, attention, vigilance, hazard perception. 5

6 Aging and Driving Abilities Medical Heart disease and risk of loss of consciousness. Neurological disorders including stroke, Parkinson s disease and dementia. DepressionD i Medications and substance abuse. Sleep disorders and fatigue. Disease and Vision Macular Degeneration 6

7 Disease and Vision - Cataract Disease and Vision - Glaucoma 7

8 Aging and Driving Abilities Physical Loss of muscle mass and muscle function with impact on speed of response. Range of motion, particularly neck rotation and role in shoulder-checking. Loss L of height/poor h posture and scanning. Aging and Driving Abilities Sensory-perceptual (largely vision) Acuity 8

9 Aging and Driving Abilities Sensory-perceptual (largely vision) Contrast sensitivity Aging and Driving Abilities Sensory-perceptual (largely vision) Visual fields and the UFOV 9

10 Aging and Driving Abilities Sensory-perceptual (largely vision) Eye movements and visual search Aging and Driving Abilities Sensory-perceptual (largely vision) Pupil size, lens opacity and light scatter 10

11 Aging and Driving Abilities Cognition Working memory (Delayed recall) Orientation (MMSE, MOCA) Attention (Visual search, Trails A) Executive control (Trails B) Processing speed (Digit symbol) Abilities and Driving Safety Physical Strength, flexibility and range of motion. Sensory and perceptual Visual acuity, contrast sensitivity, depth perception, motion perception, peripheral vision, hearing. Cognitive Memory, attention, vigilance, hazard perception. 11

12 Assessment of Fitness to Drive Medical exam for driving fitness at 75, 80 and then every 2 yrs. CCMTA publishes medical standards listing 14 medical categories that may warrant concern! Physicians receive little training in geriatrics or driving fitness Lack systematic, evidence-based rules for making decision. Other professional involvement (e.g., occupational therapists). Assessment of Fitness to Drive In addition to CCMTA standards Screening tests for cognition (MMSE, MOCA) Screening tests specific to driving Roadwise Review Used SIMARD Screen for the Identification of Medically At-Risk Drivers. DriveABLE Cognitive Assessment Tool (DCAT). On-road assessments (Class 5, DriveABLE). 12

13 Assessment of Fitness to Drive Anstey et al. (2005) review 13 studies of abilities related to driving. Good predictors included: Attention including UFOV. Reaction time. Memory. Trails A (and B). Some mental status measures. Assessment of Fitness to Drive Anstey et al. (2005) review 13 studies of abilities related to driving. Good predictors included: Heart disease. Arthritis. Falls. Head/neck flexibility. 13

14 Assessment of Fitness to Drive Bohensky et al. (2008) reviewed literature on vision tests and driving. Neither binocular acuity nor visual fields consistently predict driving difficulties. Assessment of Fitness to Drive Staplin et al (2003) report results of Maryland Older Driver Study. Best predictors of collision were flexibility, strength, working memory, UFOV, missing information, Trails A and B, high and low contrast acuity. 14

15 Assessment of Fitness to Drive Dobbs & Schopflocher (2010) tested two samples of referred elders with probable dementia. Used SIMARD Screen for the Identification of Medically At-Risk Drivers. Paper and pencil tests to assess memory, speed, attention, verbal and visuospatial skills. Outcome was DriveABLE pass or fail. Good prediction ~ 80% but 1/3 indeterminate. The Roadwise Review 15

16 The Roadwise Review Based on Maryland Older Driver Study (Staplin et al., 2003). Marketed and distributed by AAA/CAA as a screening tool for driving safety. Now available a abe on-line. The Roadwise Review Tests Walking speed Head/neck flexibility High and Low Contrast Acuity Visualizing Missing Information UFOV Working Memory Visual Search (Trails A and B) 16

17 The Roadwise Review The Roadwise Review ~ 70 healthy older adults (Mean = 70 yrs) Currently driving. MMSE = 28 of 30. Good acuity, CSF and color vision. Given Roadwise Review. Self-reported at-fault collisions and violations. 17

18 The Roadwise Review The Roadwise Review Results At level of correlations, no test associated with collisions or driving difficulties. Roadwise Review tests together could not predict collisions. Roadwise Review together could predict 25% of variance in self-reported driving difficulties. Using Maryland ODS cut-points did not predict a single collision-involved driver. 18

19 Hazard Perception and Driving 20% of all deaths on roadway involve fixed roadway hazards (Insurance Institute of Highway Safety, 2010). Among inexperienced drivers (40% of collisions involved failure to scan roadway for hazards (McKnight & McKnight, 2003). Among older adults, 50% of deaths involve striking another vehicle, 10% a fixed object (Transport Canada, 2001). 19

20 Hazard Perception Hazard Perception Tests U.K. incorporated hazard perception into licensing in past decade. Australian states of Victoria, Queensland and Northern Territory have same. North America Driver-Zed ed (AAA Foundation for Traffic Safety) for training purposes. 20

21 Hazard Perception Tests Involve identification of hazards in dynamic driving scenes. Discriminate novice, experienced and older drivers. Predict accidents and on-road performance. Amenable to training. Used for licensure. See Hazard Example 21

22 Assessment of Fitness to Drive Predicting collision risk from screening tests is difficult. Need tests that adequately capture abilities required for safe driving. Need outcome measures es that are realistic. Assessment of Fitness to Drive Ross, Cordazzo & Scialfa (2014) Almost 70 healthy, current drivers between 56 and 89 yrs. No remarkable collision history. Almost 50 older adults with cognitive impairment. No remarkable collision history. Two-hour lab assessment including vision, Roadwise Review and dynamic HPT Then given on-road Class 5 evaluation. 22

23 Assessment of Fitness to Drive Assessment of Fitness to Drive Ross, Cordazzo & Scialfa (2014) More than 50% failed on-road test! (see also Dobbs et al., 1998). Common errors involve scanning, speed, intersections, turns, changing lane position. Obvious implications for re-training. 23

24 Assessment of Fitness to Drive Ross, Cordazzo & Scialfa (2014) Among healthy older adults, with hazard perception, vision and strength tests, predict pass-fail on-road test with 80% accuracy. Among cognitively impaired older adults, need more information to predict on-road performance with this accuracy. Screening tests take ~ 20 min. Issues in Assessment Who is tested? Most studies test healthy older adults. Need studies involving special populations. What is the outcome measure? Self-reports, p, collision risk, on-road tests or simulators. What is the benchmark for success? Statistical significance, effect size, odds ratios, sensitivity and specificity. 24

25 Assessing the System AMA funds Senior Driver Experience Study More than 25 interviews with older drivers, families physicians and driving evaluators. Approximately 300 questionnaires to older drivers, physicians and driving evaluators. Two focus groups. Emphasis is on access, fairness, cost, transparency. Assessing the System 25

26 Assessing the System Assessing the System Results Most were satisfied with their family physician s treatment of them and with the license renewal process. Two-thirds visited a family physician as part of the license renewal process. More than 40% had been given a screening test. No evidence health status or driving history predicted if they were given a screening test or on-road evaluation. 26

27 Assessing the System Results Lack of consistent information (from physicians and ADFM) about the steps involved in the evaluation process. Concerns about the fairness, significance and validity of screening tests, particularly computerized testing, used to evaluate driver fitness (e.g, DriveABLE s DCAT, the SIMARD-MD). Some interviewees were upset that they were not allowed to take an on-road test because they had performed poorly on a screening test. Recommendations Augment transparency and access to information about the driver fitness evaluation system. Educate health care professionals and system experts in aging and driving safety. Implement best practices for screening driver fitness. Multi-source information gathering (e.g., driver history, family opinion, CCMTA, screening tests) Develop guidelines for screening tools. Evaluate ALL drivers more rigorously and regularly. Provide incentives for re-training. Focus on at-risk populations. 27

28 Training Older Adults in Hazard Perception Recommendations Consider issue in broader context of driver safety. In-vehicle technologies and the aging driver. Autonomous vehicles and driver over-reliance, adaptation. Consider issue in broader context of mobility. Mass transit. Pedestrian safety and health. Urban design. 28

29 The Team AUTO21, NSERC, Alberta Motor Association, Micheline Deschënes, David Borkenhagen, Scheila Cordazzo, Rachel Ross, Kut Kemala, John Lyon, Mark Horswill, Mark Wetton, David Stewart and many others! Thank you! Perceptual and Cognitive Aging Lab University of Calgary 29