Active training and driving-specific feedback improve older drivers' visual search prior to lane changes

Assessing the effectiveness of psychoeducational interventions on driving behavior: A systematic review and meta-analysis

This review aimed to quantitatively summarize the evidence concerning the effectiveness of psychoeducational interventions on driving behavior. A final pool of 138 studies, totaling approximately 97,000 participants, was included in the analyses and covered all types of driving behavior targeted by the interventions. Using a random effects model, significant results were found for almost all driving outcomes, both post-intervention and long-term. The strongest effect was for reducing distracted driving at post-intervention (d = 1.87 [1.12, 2.60], Z = 4.94, p < 0.001). The only non-significant effects were for reducing errors in the long term (d = 0.50 [-0.87, 1.86], Z = 0.71, p = 0.48) and driving under the influence at post-intervention (d = 0.35 [0.00, 0.71], Z = 1.96, p = 0.05). Concerning which type of intervention was more effective, feedback, training and motivational ones appear to work best. Educational interventions show only weak effects, while awareness interventions seem mostly ineffective. Overall, our results show that most interventions can reduce different types of driving behaviors, but there are specific aspects to be considered based on the targeted behavior.

Effect of educational intervention addressing inaccurate self-assessment of driving performance in older Japanese adults

To maintain road safety for older drivers as well as other road users, it is important to provide interventions that improve self-awareness and behaviors in older drivers. We developed an intervention that provides feedback on accuracy of self-awareness of driving performance using a workbook, and examined its effectiveness using a prospective design with a follow-up after two months. Japanese drivers aged between 69 and 87 (Mean = 73.96) years were assigned to either the intervention group (n = 26) or the wait-list control group (n = 27). All participants were asked to assess their own driving performance by completing a questionnaire. They also completed an on-road driving assessment that involved driving on a public road while wearing an electronic device that measured their actual driving behaviors, accompanied by a driving instructor who sat in the passenger seat and assessed the participant's driving performance (expert assessment). Thereafter, only the intervention group received the immediate intervention (first wave). One month later, the intervention group completed the booster intervention by post. Two months after the first wave, both groups completed the questionnaire and on-road driving assessment again (second wave). Result revealed that discrepancy between self-assessment and expert assessment reduced in only the intervention group between the two waves. This finding suggests that the intervention was able to improve the accuracy of self-assessment. Furthermore, the expert assessment improved in the intervention group between the two waves, but this change was not observed in the control group. Similar trend was evident for vehicle speed at intersections with a stop sign but the result was not statistically significant. Changes in head rotation at intersections requiring turn in the intervention group did not differ from those in the control group. Improved accuracy of self-assessment as a result of the intervention could have led to improved general driving performance, but did not influence head rotation.

Are interventions effective at improving driving in older drivers?: A systematic review

Background

With the aging of the population, the number of older drivers is on the rise. This poses significant challenges for public health initiatives, as older drivers have a relatively higher risk for collisions. While many studies focus on developing screening tools to identify medically at-risk drivers, little research has been done to develop training programs or interventions to promote, maintain or enhance driving-related abilities among healthy individuals. The purpose of this systematic review is to synopsize the current literature on interventions that are tailored to improve driving in older healthy individuals by working on components of safe driving such as: self-awareness, knowledge, behaviour, skills and/or reducing crash/collision rates in healthy older drivers.

Methods

Relevant databases such as Scopus and PubMed databases were selected and searched for primary articles published in between January 2007 and December 2017. Articles were identified using MeSH search terms: (“safety” OR “education” OR “training” OR “driving” OR “simulator” OR “program” OR “countermeasures”) AND (“older drivers” OR “senior drivers” OR “aged drivers” OR “elderly drivers”). All retrieved abstracts were reviewed, and full texts printed if deemed relevant.

Results

Twenty-five (25) articles were classified according to: 1) Classroom settings; 2) Computer-based training for cognitive or visual processing; 3) Physical training; 4) In-simulator training; 5) On-road training; and 6) Mixed interventions. Results show that different types of approaches have been successful in improving specific driving skills and/or behaviours. However, there are clear discrepancies on how driving performance/behaviours are evaluated between studies, both in terms of methods or dependent variables, it is therefore difficult to make direct comparisons between these studies.

Conclusions

This review identified strong study projects, effective at improving older drivers’ performance and thus allowed to highlight potential interventions that can be used to maintain or improve older drivers’ safety behind the wheel. There is a need to further test these interventions by combining them and determining their effectiveness at improving driving performance.

Older driver training programs: A systematic review of evidence aimed at improving behind-the-wheel performance

Age- and health-related changes, alongside declines in driving confidence and on-road exposure, have been implicated in crashes involving older drivers. Interventions aimed at improving behind-the-wheel behavior are diverse and their associated impact remains unclear. This systematic review examined evidence on older driver training with respect to (1) road safety knowledge; (2) self-perceived changes in driving abilities; and (3) behind-the-wheel performance. Method Nine databases were searched for English-language articles describing randomized controlled trials (RCTs) and non-RCTs of driver training interventions aimed at those aged 55+ who did not have medical or other impairments that precluded licensure. Quality appraisals were conducted using Cochrane's Risk of Bias Tool (RoB) and Risk Of Bias In Non-randomized Studies - of Interventions tool (ROBINS - I). [PROSPERO; registration no. CRD42018087366]. Results Twenty-five RCTs and eight non-RCTs met the inclusion criteria. Interventions varied in their design and delivery where classroom-based education, or a combination of classroom-based education with on-road feedback, improved road safety knowledge. Training tailored to individual participants was found to improve self-perceived and behind-the-wheel outcomes, including crashes. Conclusions Interventions comprised of tailored training can improve knowledge of road safety, changes to self-perception of driving abilities, and improved behind-the-wheel performance of older drivers. Future research should compare modes of training delivery for this driver population to determine the optimal combinations of off- and/or on-road training. Practical applications Training programs aimed at older drivers should be supported by theory and research evidence. By conducting comparative trials with a sufficient sample size alongside well-defined outcomes that are designed in accordance with reporting guidelines, the most effective approaches for training older drivers will be identified.

Driving safety improves after individualized training: An RCT involving older drivers in an urban area

Objective: This study aimed to reproduce the results of a previous investigation on the safety benefits of individualized training for older drivers. We modified our method to address validity and generalizability issues. Methods: Older drivers were randomly assigned to one of the 3 arms: (1) education alone, (2) education + on road training, and (3) education + on road + simulator training. Older drivers were recruited from a larger urban community. At the pre- and posttests (separated by 4 to 8 weeks) participants followed driving directions using a Global Positioning System (GPS) navigation system. Results: Our findings support the positive influence of individualized on-road training for urban-dwelling older drivers. Overall, driving safety improved among drivers who received on-road training over those who were only exposed to an education session, F(1, 40) = 11.66, P = .001 (26% reduction in total unsafe driving actions [UDAs]). Statistically significant improvements were observed on observation UDAs (e.g., scanning at intersections, etc.), compliance UDAs (e.g., incomplete stop), and procedural UDAs (e.g., position in lane). Conclusion: This study adds to the growing evidence base in support of individualized older driver training to optimize older drivers' safety and promote continued safe driving.

Video Feedback Intervention to Enhance the Safety of Older Drivers With Cognitive Impairment

OBJECTIVE

To demonstrate that g-force technology can be used to help older adults with cognitive impairment improve their driving safety as part of an in-car video feedback intervention.

METHOD

Unsafe driving events triggered g-forces leading to capture of video clips. The program included 3 mo of monitoring without intervention, 3 mo of intervention (weekly written progress reports, a DVD of unsafe driving events, and weekly telephone contacts), and 3 mo of postintervention monitoring.

RESULTS

Mean total unsafe driving events per 1,000 miles were reduced from baseline by 38% for 9 of 12 participants during the intervention and by 55% for 7 participants during postintervention monitoring. Mean total unsafe driving severity scores per 1,000 miles were reduced from baseline by 43% during the intervention and by 56% during postintervention monitoring.

CONCLUSION

Preliminary results suggest that driving safety among older drivers with cognitive impairment can be improved using a behavior modification approach aimed at problem behaviors detected in their natural driving environment.

Older Adults with Mild Cognitive Impairments Show Less Driving Errors after a Multiple Sessions Simulator Training Program but Do Not Exhibit Long Term Retention

The driving performance of individuals with mild cognitive impairment (MCI) is suboptimal when compared to healthy older adults. It is expected that the driving will worsen with the progression of the cognitive decline and thus, whether or not these individuals should continue to drive is a matter of debate. The aim of the study was to provide support to the claim that individuals with MCI can benefit from a training program and improve their overall driving performance in a driving simulator. Fifteen older drivers with MCI participated in five training sessions in a simulator (over a 21-day period) and in a 6-month recall session. During training, they received automated auditory feedback on their performance when an error was noted about various maneuvers known to be suboptimal in MCI individuals (for instance, weaving, omitting to indicate a lane change, to verify a blind spot, or to engage in a visual search before crossing an intersection). The number of errors was compiled for eight different maneuvers for all sessions. For the initial five sessions, a gradual and significant decrease in the number of errors was observed, indicating learning and safer driving. The level of performance, however, was not maintained at the 6-month recall session. Nevertheless, the initial learning observed opens up possibilities to undertake more regular interventions to maintain driving skills and safe driving in MCI individuals.

Driving Simulator Training Is Associated with Reduced Inhibitory Workload in Older Drivers

Background: In demanding cognitive tasks, older people mostly experience more problems than younger people, and their brain workload is higher. An overloaded or exhausted mental workload is frequently associated with unsafe driving behavior. In this paper, we hypothesize that 10 active training sessions in a driving simulator positively influence brain workload, which relates to a beneficial increase in on-road driving performance. Methods: Ninety-one healthy active drivers (62–87 years) were randomly assigned to: (a) a driving simulator-training group; (b) an attention-training group; or (c) a control group. The dependent variables of this training study were brain workload (theta Fz/alpha Pz), and performance in three tasks, for which inhibition of inadequate responses (Stroop, Negative Priming, and Flanker) is required. Seventy-seven participants (85% of the total sample) completed the training. Training gains were analyzed by using a multiple regression analysis with planned comparisons. Results: The results revealed that the driving simulator training reduced brain workload during performance of the inhibition tasks. The performance of the simulator group during the inhibition tasks did not improve, but the participants completed the tasks with less brain workload compared to the attention-training group. Conclusion: Adding to our first paper on the Drive-Wise project, this paper now focuses on the superiority of the driving simulator training, compared to attention-training in regards to reducing brain workload. The change in brain workload seems to be associated with a positive change in drivers’ behavior on the road. Hence, a driving simulator training lasting only ten sessions leads to beneficial neuroplastic changes. This demonstrates brain plasticity of older people and its possible positive influence in real driving behavior.

Functional Changes and Driving Performance in Older Drivers: Assessment and Interventions

With the increasing aging of the population, the number of older drivers is rising. Driving is a significant factor for quality of life and independence concerning social and working life. On the other hand, driving is a complex task involving visual, motor, and cognitive skills that experience age-related changes even in healthy aging. In this review we summarize different age-related functional changes with relevance for driving concerning sensory, motor, and cognitive functions. Since these functions have great interindividual variability, it is necessary to apply methods that help to identify older drivers with impaired driving abilities in order to take appropriate measures. We discuss three different methods to assess driving ability, namely the assessment of (i) functions relevant for driving; (ii) driving behavior in real traffic; and (iii) behavior in a driving simulator. We present different measures to improve mobility in older drivers, including information campaigns, design of traffic and car environment, instructions, functional training, and driving training in real traffic and in a driving simulator. Finally, we give some recommendations for assessing and improving the driving abilities of older drivers with multi-modal approaches being most promising for enhancing individual and public safety.

A systematic review of technology-based interventions for unintentional injury prevention education and behaviour change

OBJECTIVE

The aims of this literature review are to (1) summarise how computer and mobile technology-based health behaviour change applications have been evaluated in unintentional injury prevention, (2) describe how these successes can be applied to injury-prevention programmes in the future and (3) identify research gaps.

METHODS

Studies included in this systematic review were education and behaviour change intervention trials and programme evaluations in which the intervention was delivered by either a computer or mobile technology and addressed an unintentional injury prevention topic. Articles were limited to those published in English and after 1990.

RESULTS

Among the 44 technology-based injury-prevention studies included in this review, 16 studies evaluated locally hosted software programmes, 4 studies offered kiosk-based programmes, 11 evaluated remotely hosted internet programmes, 2 studies used mobile technology or portable devices and 11 studies evaluated virtual-reality interventions. Locally hosted software programmes and remotely hosted internet programmes consistently increased knowledge and behaviours. Kiosk programmes showed evidence of modest knowledge and behaviour gains. Both programmes using mobile technology improved behaviours. Virtual-reality programmes consistently improved behaviours, but there were little gains in knowledge. No studies evaluated text-messaging programmes dedicated to injury prevention.

CONCLUSIONS

There is much potential for computer-based programmes to be used for injury-prevention behaviour change. The reviewed studies provide evidence that computer-based communication is effective in conveying information and influencing how participants think about an injury topic and adopt safety behaviours.

Age-dependent visual exploration during simulated day- and night driving on a motorway: a cross-sectional study

Background

Central and peripheral vision is needed for object detection. Previous research has shown that visual target detection is affected by age. In addition, light conditions also influence visual exploration. The aim of the study was to investigate the effects of age and different light conditions on visual exploration behavior and on driving performance during simulated driving.

Methods

A fixed-base simulator with 180 degree field of view was used to simulate a motorway route under daylight and night conditions to test 29 young subjects (25–40 years) and 27 older subjects (65–78 years). Drivers’ eye fixations were analyzed and assigned to regions of interests (ROI) such as street, road signs, car ahead, environment, rear view mirror, side mirror left, side mirror right, incoming car, parked car, road repair. In addition, lane-keeping and driving speed were analyzed as a measure of driving performance.

Results

Older drivers had longer fixations on the task relevant ROI, but had a lower frequency of checking mirrors when compared to younger drivers. In both age groups, night driving led to a less fixations on the mirror. At the performance level, older drivers showed more variation in driving speed and lane-keeping behavior, which was especially prominent at night. In younger drivers, night driving had no impact on driving speed or lane-keeping behavior.

Conclusions

Older drivers’ visual exploration behavior are more fixed on the task relevant ROI, especially at night, when driving performance becomes more heterogeneous than in younger drivers.

The drive-wise project: driving simulator training increases real driving performance in healthy older drivers

Background: Age-related cognitive decline is often associated with unsafe driving behavior. We hypothesized that 10 active training sessions in a driving simulator increase cognitive and on-road driving performance. In addition, driving simulator training should outperform cognitive training.

Methods: Ninety-one healthy active drivers (62–87 years) were randomly assigned to one of three groups: (1) a driving simulator training group, (2) an attention training group (vigilance and selective attention), or (3) a control group. The main outcome variables were on-road driving and cognitive performance. Seventy-seven participants (85%) completed the training and were included in the analyses. Training gains were analyzed using a multiple regression analysis with planned orthogonal comparisons.

Results: The driving simulator-training group showed an improvement in on-road driving performance compared to the attention-training group. In addition, both training groups increased cognitive performance compared to the control group.

Conclusion: Driving simulator training offers the potential to enhance driving skills in older drivers. Compared to the attention training, the simulator training seems to be a more powerful program for increasing older drivers' safety on the road.

Using the community health assessment to screen for continued driving

This project used the interRAI based, community health assessment (CHA) to develop a model for identifying current elder drivers whose driving behavior should be reviewed. The assessments were completed by independent housing sites in COLLAGE, a non-profit, national senior housing consortium. Secondary analysis of data drawn from older adults in COLLAGE sites in the United States was conducted using a baseline assessment with 8042 subjects and an annual follow-up assessment with 3840 subjects. Logistic regression was used to develop a Driving Review Index (DRI) based on the most useful items from among the many measures available in the CHA assessment. Thirteen items were identified by the logistic regression to predict drivers whose driving behavior was questioned by others. In particular, three variables reference compromised decision-making abilities: general daily decisions, a recent decline in ability to make daily decisions, and ability to manage medications. Two additional measures assess cognitive status: short-term memory problem and a diagnosis of non-Alzheimers dementia. Functional measures reflect restrictions and general frailty, including receiving help in transportation, use of a locomotion appliance, having an unsteady gait, fatigue, and not going out on most days. The final three clinical measures reflect compromised vision, little interest or pleasure in things normally enjoyed, and diarrhea. The DRI focuses the review process on drivers with multiple cognitive and functional problems, including a significant segment of potentially troubled drivers who had not yet been publicly identified by others. There is a need for simple and quickly identified screening tools to identify those older adults whose driving should be reviewed. The DRI, based on the interRAI CHA, fills this void. Assessment at the individual level needs to be part of the backdrop of science as society seeks to target policy to identify high risk drivers instead of simply age-based testing.

Reduced comparison speed during visual search in late life depression

Slowed information processing is a prominent deficit in late-life depression (LLD). To better differentiate processing speed components in LLD, we examined characteristics of visual search performance in 32 LLD and 32 control participants. Data showed specific slowing in the comparison stage of visual search in LLD, rather than in encoding/response stages, but also greater overall slowing in LLD during inefficient versus efficient search. We found no group differences on traditional neuropsychological measures of processing speed. Slowed processing speed in LLD may be specific rather than general, which underscores the need to link components of processing speed to underlying neural circuitry.