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Results from Pre- Conference Survey of Participants*. International Older Driver Consensus Conference Arlington, VA December 1 – 2, 2003 For additional information contact: Burt Stephens, University of Florida, Seniors’ Institute for Transportation and Communications
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Results from Pre- Conference Survey of Participants* International Older Driver Consensus Conference Arlington, VA December 1 – 2, 2003 For additional information contact: Burt Stephens, University of Florida, Seniors’ Institute for Transportation and Communications E-mail: Bstephen@hp.ufl.edu * N = 22
How to Identity “at-risk drivers How to Identify “At-Risk” Drivers?
Average Ratings of Effectiveness of Methods for Identifying At-Risk Drivers (N=16 - 22; Scale ranges from 4 – Very Effective to 1 – Not At All Effective)
Importance of Sensory and Perceptual Changes * Should have been included in the listing, but inadvertently omitted.
Importance of Cognitive Changes * Insufficient number of responses
Importance of Other Changes
Protocols forSCREENING/EVALUATION • 11 PROCEDURES RATED • VALIDITY (Correlation between scores from the procedure and crash records) • USABILITY (Level of difficulty in implementing the procedure) • SUFFICIENCY (Can thisprocedure stand alone or must it be carried out in conjunction with other procedures?) • COST-EFFECTIVENESS (Takes into account all of the proceeding characteristics and the cost of administration of the procedure)
RATING SCREENING OR EVALUATION PROTOCOLS * Includes SafeDrive sim, DriVR Fargos, Doron, STI-SIM/STI-SIM Drive, Atari/AGC/TWI/AMOS/VISTA Doron Precision Drive Square driVR Illusion Technologies/RealDrive I-SIM and other specialized systems
RATING SCREENING OR EVALUATION PROTOCOLS (Cont)
RATING SCREENING OR EVALUATION PROTOCOLS (Cont)
Other Driver Screening or Evaluation Procedures Recommended • Visual acuity Contrast sensitivity visual field assessment • MVPT (not 3, because it takes 50 minutes to administer) • Trail Making B only (not A) • DPT driver performance training video • Chart based contrast sensitivity testing • Structured Observations for obvious physical impairment • Behind the wheel evaluation • Driver Performance Measurement (DPM) • Situation awareness fitness for duty
Procedures Used to Remediate Inadequate Driver Capabilities • Treatment of visual impairment to see if it is reversible or can be remediated • In-vehicle training with CDRS • Counseling on self-regulation of driving • Education about how impairment impacts driving skills • Use of AAA handouts on flexibility, changing your route, driver safety course • Training behind the wheel & determining whether clients can adequately follow through and recall the remediations • Prescribe limiting area of driving • Use O.T. skills to perform activity analysis & knowledge- base to improve the various skills
RISK MANAGEMENT PAYOFFS FOR APPLYING METHODS N = 9 participants; 1 = Highest possible Ranking
MEDICATION SIDE EFFECTS EXPERIENCED That can affect driving N = 9 Participants
HOW CLIENTS GET INTO TRANSPORTATION COUNSELING
Basis of Counseling Process Used • Personal and professional experience – 4 • Specific courses or training to develop the process – 0 • Use a standardized protocol – 2
Specific Advice Provided to Clients or Their Caregivers * N = 6
Constraints Experienced In Counseling on Transportation Alternatives • Client’s unwillingness to accept that he/she is no longer able to drive safely • Lack of reliable, affordable transportation • Lack of transportation options and knowledge as to how the options work • Lack of on-time reliable public or paratransit transportation • Lack of transportation resources in communities
Publications with the Most Definitive Statements on the Safety of Older Drivers • NHTSA Reports and Manuals • TRB Special Report 218 and Update Soon to be Published. • Holland, C.A. (2001) Older Drivers: A review. DLTR, • (http://www.roads.dft.gov.uk/roadsafety/research25) • AOTA journals and publications • AARP Publications • ADED Publications • DOT-HS-808-853, NHTSA Safe Mobility for Older People Notebook. • DOT-HS-809-582, Model Driver Screening and Evaluation Program • "Highway Research to Enhance the Safety and Mobility of Older • Road Users, " Draft dated June 21, 2000, F. Schieber for TRB • FHWA Older Driver Handbook • AMA Guide for Physicians
INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS, & NEEDED TECHNOLOGY - 1 • Affordable, reliable transportation for persons no longer capable of driving • Removal of social stigma to using alternative transportation systems • Lack of sidewalks and street lighting • Funding of new initiatives and their evaluation • Fear that older adult voters will not support initiatives that potentially threaten mobility • Lack of funding (by Medicare) for the screening and mobility counseling process
INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS, & NEEDED TECHNOLOGY - 2 • Lack of short & comprehensive screening instruments that are highly sensitive and specific for tier 1 screening • Expectation that automobiles ought to cost money, but alternative transportation ought to be cheap or free • Need for predictive clinical tests: “people often test well in the clinical setting, but do very poorly behind the wheel” • Training Courses for OT's • Physician training
INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS, & NEEDED TECHNOLOGY - 3 • Need champions to gain wide support • Criterion problem: “There is no essential agreement about what makes a "safe" driver”. • Unspoken "competition" between practitioners to create the "gold standard" • Different requirements by motor vehicle agencies for retesting and relicensing • Need to develop and implement a testing methodology that overcomes current limitations
Most Critical Research Needed - 1 Develop improved vehicle and road design to facilitate better use of diminished senses Establish the role of in-car training Evaluate interventions, rather than adopting what "experts" call "best practices" and "model programs“ Develop short, easy-to-administer, and comprehensive screening instruments with high sensitivity and specificity ratings Develop effective alternative transportation and transportation planning process Empirically determine relationships between the following: Types of driving relevant functional impairment Types of constraints on adequate compensation Types of critical driving errors Types of crashes
Most Critical Research Needed - 2 • Develop more effective retraining and route planning techniques • Develop a self-assessment tool that assures confidentiality for older persons • Research to identify when older drivers become unfit to drive - the physical, mental or functional cues • Define qualities of elderly who are still successful drivers --test their cognitive & physical ie reaction time & correlate to those that are not able to drive safely • Develop physician screening tools • Development of physician communication and training programs
Most Critical Research Needed - 3 • Develop a consensus criterion, including acceptable levels of performance and capability that can be correlated with reverse graduated driving privileges. • Research that can lead to broadly accepted screening protocols, with high reliability and validity, and are cost-effective to administer, and, ultimately, acceptable to AAMVA (et al) • Detailed task analyses of critical driving tasks across a variety of conditions • Develop a systematic way to find and create transportation alternatives
This is a start! An opportunity to obtain agreement on what we can do now to improve safe mobility of older persons and to lay out a course for the future at this International Older Driver Consensus Conference.