Chapter 3  Table of Contents

Research Agenda
For Older Drivers

The primary safety issue facing older drivers is how to adapt driving practices to accommodate declining functional capabilities while still maintaining necessary mobility. NHTSA's research agenda focuses on identifying those capabilities that are critical to safety, determining the driving practices that are appropriate for those capabilities, developing information for assisting individuals in making the proper choices, and cultivating licensing and enforcement policies that protect public safety while maintaining the mobility of older drivers.
BR> In contrast to the research needs of younger drivers, the research needed to ensure the safety and mobility of older drivers has been well defined. This chapter includes a brief description of the Agency's previous research and programmatic activities and specifies the direction of future research on older drivers.

Summary of Prior Research
NHTSA has had a research interest in the safety of older drivers for many years. The Agency initiated a series of projects in the mid-1970's to improve the safety of older drivers. These projects focused on identifying the problems of older drivers, with an emphasis on attempting to understand the role of declining health and ways to inform older drivers and assess their driving capabilities.

Medical Limitations In the early 1980's, NHTSA sponsored an in-depth study of heart-attack victims that found, contrary to expectation, that those with myocardial infarction actually had a better safety record than their age, sex, and regionally-matched controls. The study also indicated that very few of those who had a heart attack reported it on their driver license application at time of renewal.

Agency research also investigated potential improvements in the assessment of driver visual capabilities. This research identified a number of complex visual problems related to safe driving performance. Unfortunately, due to the nature of the tests and limitations of the technology available at that time, tests of these complex visual skills were not sufficiently reliable to establish new vision standards. This research provided evidence that most common visual problems, such as poor visual acuity, appeared not to have an adverse affect on driving safety. Most drivers suffering from poor acuity are aware of their problems and may adapt their driving accordingly.
BR> While certain medical conditions are apparent to those that contract them, others are not. Drivers with conditions in the former group seem to adapt their driving habits appropriately. However, individuals suffering from conditions in the latter group seem not to adjust their driving to compensate for their declining capabilities. These conditions include dementias and certain other cognitive problems involving attending to simultaneous events.

Driver Licensing More than a decade ago, the Agency developed profiles of older-driver crashes and recommended licensing practices for older drivers. Working with the American Association of Motor Vehicle Administrators (AAMVA), NHTSA developed a series of guidelines designed to assist the States in dealing with an array of driving problems. Among the guidelines were those that dealt with functional ability, certification of license examiners and a model driver screening and evaluation program. These programs were based upon what practitioners and the research consultants thought were the best available practices. Unfortunately, basic epidemiological data needed to develop the policy guidelines did not exist at that time.

Retraining The Agency worked with the private sector to develop and evaluate retraining programs for mature drivers. Driver licensing research led to development of a driver manual to help older drivers become familiar with and take appropriate action about their declining capabilities. Older people did accept, learn and retain the written information. However, an evaluation of the crash and violation records of those receiving the information failed to show any significant reduction when compared with a control group.

The Agency developed and distributed special informational materials on occupant protection for older drivers, studied how older persons obtain information, and identified potential distributors of safety information to older drivers and pedestrians.

Scientific Knowledge Base NHTSA staff were actively involved with the Transportation Research Board (TRB) study on Transportation in an Aging Society: Improving Mobility and Safety for Older Persons, Special Report 218.

NHTSA's most recent research efforts on behalf of the older driver stem from the Agency's 1988 Traffic Safety Plan for Older Persons, published in response to the recommendations of the TRB report on aging. This plan outlines a number of research and development activities spread across several areas, including problem identification, occupant protection, driver licensing, pedestrians, consumer information, crash avoidance, and crashworthiness.

Following the Plan, the Agency conducted a number of research, development, and outreach activities. In order to complete the intended problem-identification objectives, Agency staff conducted an extensive literature review on aging and driving and an analysis of existing national data.

In 1989, the Agency convened a conference to establish a benchmark on current knowledge about aging and driving performance in order to define the research and developments needed to improve the safety and mobility of older drivers. This conference, cosponsored by the National Institute on Aging (NIA), the Federal Highway Administration (FHWA), and the Centers for Disease Control (CDC), was attended by more than 200 internationally known gerontological specialists in medical and behavioral research and applications.

Following one of the recommendations of the conference attendees, Agency staff were instrumental in establishing a TRB Task Force on the safety and mobility of older drivers. The purpose of this ongoing task force is to provide a forum for discussing older-driver research issues by individuals representing diverse disciplines and developing a coordinated set of research problem statements for the use of Federal and State government agencies and private-sector organizations. This Task Force co-sponsored a conference on assessing driver competency.

In 1989 and 1991, NHTSA established interagency agreements with the NIA. NIA had funded a group of longitudinal studies of functional abilities of older persons. The interagency agreement permitted NHTSA to obtain driving information from older persons in two of their study sites, rural Iowa and New Haven, Connecticut. This teamwork permitted the investigation of the role of older drivers' medical conditions and functional ability in their driving safety and personal mobility. This research has led to a much better understanding of the changing driving patterns associated with medical conditions and functional limitations.

What We Know The research with NIA confirms earlier hypotheses that most older drivers seem to be taking appropriate steps in controlling when and where they drive based upon their declining capabilities. However, there appears to be certain groups of older drivers who do not appropriately limit their driving because they are unaware of their declining capabilities. Drivers in this latter group are especially difficult to identify, as the procedures currently necessary to detect the medical conditions thought to be associated with driving problems are time consuming, complex, and expensive. Simple methods proposed to regulate problem older drivers also tend to place unnecessary limitations on drivers who do not pose safety problems.

It also appears that older women are much more likely to stop driving than are men of the same age, and they give "lack of confidence" as their main reason for quitting. Results indicate that it is much easier to predict when an individual is likely to stop driving voluntarily than it is to predict their involvement with traffic violations.

Directions for Current and Future Research
This section describes NHTSA's research program for addressing safety problems unique to older drivers. It does not address the Agency's research on older vehicle occupants or pedestrians.

Problem Identification Much of what we need to do is to understand the changes that occur with aging as they relate to driving and provide information to drivers to allow them to evaluate those changes. The following research projects are necessary to obtain fundamental information required to develop program strategies.

Establish Crash Risk for Various Medical/Functional Sufficient epidemiologic data now exist to begin to establish statistical relationships between some medical conditions and driving problems. Accordingly, this research effort will determine the conditions under which older drivers pose a threat to public safety and thus need to be identified and controlled. This study will establish the statistical link between crash risk, moving violations, and various physical and mental conditions. It will also identify the extent to which individuals with conditions that affect driving performance correctly modify their behavior and drive safely. The results of this study will serve as a basis for developing informational, licensing, and enforcement programs.

Determine the Conditions Under Which Driving by Older Persons Should be Regulated Recent literature indicates that most older drivers compensate for their limitations in what appears to be an appropriate manner. A major function of law-enforcement and driver-licensing agencies will be to identify and regulate those drivers who do not self-regulate, i.e., those who continue to drive in situations in which they pose safety risks. To assist licensing agencies in establishing appropriate regulatory approaches, the Agency will determine the characteristics of drivers that do not adequately self-regulate and the conditions, if any, under which they may be able to drive while preserving safety.

Document Mobility Consequences of Giving Up Driving Many States are reluctant to take away or even restrict licenses of older drivers, particularly those who live in rural areas, because there may be no transportation alternatives. Societal problems are likely to arise if these people cannot get around. Some key issues are whether communities have the resources to supply specialized transportation to older drivers who lose their licenses and whether these older people are willing to use transit systems in light of limited service and concern for personal safety. In cooperation with the Federal Transit Administration and the Administration on Aging, this research will document a broad array of concerns of older people and prepare a checklist to permit community planners to assess the degree to which there are remedies for these concerns within their community.

Improving Understanding of Vehicle Crashworthiness for Older Occupants The increased frailty of older persons in crashes raises the question whether increased levels of protection can be obtained with improved vehicle or safety-systems design. As part of crashworthiness research, NHTSA will analyze crash data to determine the nature of injuries older persons sustain due to restraint systems (lap/shoulder, airbag, etc), compared to injuries sustained by younger people. Since older drivers are more likely to be involved in side impact crashes, these crashes will be investigated to determine the extent to which older occupants are over-involved in fatal injuries.

Identify Causes of Older-Driver Crashes at Intersections This research will investigate the causes of older-driver crashes at intersections, particularly those involving left turns. Depending on the outcome of these analyses, this will serve as a basis for developing either new advanced-technology in-vehicle devices to assist the driver or training and informational materials for drivers.

Identify Barriers to Physician Referral of Patients for License Reexamination In most States, laws require physicians to report patients whose medical conditions may make them unsafe drivers. However, there are marked differences in the laws and practices of different States. Different State laws, such as those requiring reporting certain conditions or providing immunity to those reporting, undoubtedly affect the rate of reporting unsafe drivers. This study will investigate the legal, ethical and practical barriers to effective reporting by physicians and explore the relationship between improving safety and improving reporting requirements by physicians. This study will include an investigation of the actual influence on safety and mobility in States with different reporting requirements.

Identify the practical problems in family/friend reporting of functionally limited drivers There are marked differences across the States in laws requiring families and friends to report a potentially unsafe driver to the licensing agency for reexamination. At least one State does not permit reporting, and others require that individuals called in for reexamination be given the name of the individual reporting them. This study will examine the influence of these differences and recommend steps for improving the process.

Program Development
The following research projects focus on developing strategies for addressing problem areas and generating suitable countermeasure elements to address specific issues.

Develop Performance Assessment Techniques Current DMV tests do not detect the conditions that appear to be most problematic. Detecting problem older drivers will require testing for different capabilities under different conditions than are currently in use. Performance tests that closely approximate the driving situations of older drivers and their functional limitations will be developed and validated. Performance tests will also be developed and validated for rehabilitation specialists, particularly in the areas of dementia and perceptual difficulties associated with split-attention tasks.

Many of the functional difficulties that potentially interfere with safe driving are brought about by medical incidents. Testing individuals with limitations from these medical events requires more extensive and complex procedures. Accordingly, performance tests will be designed for those professionals most able to perform the diagnostic testing and training.

Develop Strategies for Meeting Mobility Needs of Older Former Drivers In cooperation with the Federal Transit Administration and the Administration on Aging, this research will develop strategies for meeting the transportation requirements of older people who can no longer drive. Recognizing that the transportation infrastructures in different communities may be vastly dissimilar, this effort will design informational packages, training materials, program descriptions and guidelines for use at the State and community level.

Develop Improved Intersection Negotiating Practices Based upon in-depth analyses of the problem, NHTSA will develop either behavioral or human-factor solutions to improving intersection negotiation. The behavioral alternative will develop assessment, informational, and training programs designed to overcome some of the current limitations. The other alternative will apply advanced technology solutions, such as Intelligent Vehicle-Highway Systems (IVHS), to these problems.

Develop Empirical Guidelines for Medical Practitioners Current medical guidelines for advising older persons about continuing driving are largely based on best professional judgment rather than empirical data relating conditions to safety problems. There is some evidence that existing guidelines may unnecessarily restrict mobility. This research will develop practical guidelines for physicians, based on ongoing NHTSA epidemiological research.

Develop Guidelines for Assisting Older Drivers in Making Decisions About Driving Following the development of appropriate assessment procedures based on the Agency's epidemiological research, NHTSA will develop a series of guidelines to aid the process of identifying problem older drivers and assisting them to make appropriate decisions regarding driving. Guidelines for older people themselves will provide "self-test" procedures that they may use to determine the extent to which they should limit their driving. Guidelines for families and caregivers will provide methods for dealing with the older driver and for discretely informing the licensing agency of the need to re-examine the functionally-impaired driver. Guidelines for police officers will address the need to report problem drivers and provide methods for identifying drivers who display symptoms of functional limitations or medical conditions that may make them unsafe on the road.

Develop Training and Informational Programs With the expected increase in the number of older drivers, many of whom will have declining functional capabilities, the Agency will focus on developing new ways of improving their driving. For example, rehabilitation specialists have been teaching stroke patients, head-injured patients, and others to drive again. This study will identify and examine existing training programs to determine the extent to which they actually reduce crashes and help those who should correctly reduce or eliminate their driving. With new technology available, and better understanding of the role of functional limitations on driving, there may be new possibilities to improve both individual and group training of older and functionally impaired drivers. The study will document methods useful for retraining older drivers, recommend improvements to existing programs, and develop model procedures for use in retraining older drivers.

Advanced Technology This effort will identify conventional and advanced technology vehicle design features to prevent crashes typical of older drivers. The potential role of advanced technology to extend the driving careers of older people still needs to be identified. Devices and systems that may aid younger drivers may not aid older drivers, and may, in fact, be detrimental to their driving performance. Studies of advanced technology will ensure that proposed systems do not inadvertently degrade older driver safety and performance by overloading their decision-making or informational capacity.

Program Evaluation
The following research projects examine existing programs to document their implementation processes or assess the extent to which they meet their outcome objectives.

Evaluate Safety Benefit of License Re-examination Requirements Currently, there is lack of agreement on the necessity for the licensing agency to require older drivers, particularly those with clean records, to come to the agency for license renewal. Most older drivers prefer to judge for themselves, or have their physician or family aid them in deciding when, where, or whether they should drive. Many legislators and licensing administrators believe that it is necessary to have older drivers renew in-person so that their behavior can be observed to determine if they need to be examined further. This research will evaluate the outcomes of these alternative licensing procedures.

Evaluate NHTSA/AAMVA Model Driver Screening and Evaluation Program Many States are eager to institutionalize methods to deal with older drivers. NHTSA's Model Driver Screening and Evaluation Program provides a set of guidelines for consideration and adoption by State motor vehicle administrators. Many of the actions recommended in this program appear to duplicate the actions of self-regulating older drivers. The extent to which this program can detect problem drivers is unknown. This research effort will document implementation procedures and evaluate the safety consequences of the model program.

Evaluate Safety Outcomes of Self/Community Appraisal of Driving Limitations To the extent that older drivers regulate their driving to fit their declining capabilities, the driver-licensing system serves as a back-up system or safety net. Under this supposition, the main function of licensing would be to ensure that drivers who continue to drive in situations beyond their capabilities are identified, tested, and, if it is reasonable to do so, licensed for appropriate restricted driving conditions.

The focus of the Agency's research and development effort is to produce guidelines for older drivers, their families, and caregivers to facilitate self-regulation of driving. The more effective these guidelines are in accomplishing their objectives, the more the licensing system functions in its back-up mode. This may result in the need to shift emphasis areas within licensing agencies.

This evaluation will follow the development of the Agency's guidelines and will assess their impact on older-driver safety. This effort will evaluate the guidelines' potential for correctly changing the driving actions of functionally-limited older drivers and determine the subsequent effects of increased self-regulation of older drivers on the roles played by driver-licensing agencies.

Evaluate Programs to Maintain Mobility of Former Drivers Making the transition from driver to rider status for older persons is not easy. Current programs must be evaluated to help ensure that older people who no longer drive can continue to meet their transportation requirements. NHTSA, FHWA, the Federal Transit Administration, the Administration on Aging, and the National Institute on Aging have jointly proposed programs to address the mobility needs of these former drivers. This effort will evaluate such programs to ensure that they meet the needs of the senior citizen.

DOT HS 807 957

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