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Older Driver Safety Outside the Field of Occupational Therapy

Older Driver Safety Outside the Field of Occupational Therapy. ADED Conference August 3, 2014. Susan Cohen Americans For Older Driver Safety 443-520-9716 scohen@afods.org. Aging Federal & State. Transportation Federal & State. National Organizations. Research University & TRB.

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Older Driver Safety Outside the Field of Occupational Therapy

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  1. Older Driver Safety Outside the Field of Occupational Therapy ADED Conference August 3, 2014 Susan Cohen Americans For Older Driver Safety 443-520-9716 scohen@afods.org

  2. Aging Federal & State Transportation Federal & State National Organizations Research University & TRB Occupational Therapy

  3. National Highway Traffic Safety Administration (NHTSA) Trans. Federal • Mission: “To save lives, prevent injuries, and reduce economic costs due to road traffic crashes.” • Over 45 years of NHTSA • Highway fatality rates are the lowest they’ve been since 1949.

  4. National Highway Traffic Safety Administration (NHTSA) (continued) Trans. Federal • 1989 Older Driver Program established • To “reduce traffic-related fatalities and injuries.” • 2005 - NHTSA compiled research and expertise to create Older Driver Traffic Safety Plan

  5. Older Driver Program: Five-Year Strategic Plan 2012-2017 (DOT HS 811432) December 2010 Trans. Federal • Builds on the 2005 Older Driver Traffic Safety Plan. • Identified 3 program initiatives: • Build communications for older drivers and caregivers. • Establish and maintain partnerships to enhance older driver safety efforts. • Develop and promote driver licensing policies.

  6. Older Driver Program: Five-Year Strategic Plan 2012-2017 (continued) Trans. Federal Initiative 3. Develop and Promote Driver Licensing Policies • Renewal Procedures: accelerated renewal cycles; in-person license renewal; screening protocol for DMV counter personnel • Medical Advisory Boards: include MABs in state licensing and renewal policies; guidelines on the structure, role and responsibilities of the MAB • Training for Law Enforcement & Health Care Providers: create templates for states on • information on referring to MAB; • cue card for law enforcement

  7. Traffic Safety for Older People 5 Year Plan (DOT HS 811 837) August 2013 Trans. Federal • NHTSA’s new plan to address older driver safety concerns. • Wants to create “evidence-based countermeasures to reduce risk to older - and all - drivers.” • Broken into three time periods. • The 2 years following the plan’s implementation. • 3-5 years after. • Beyond the 5 year plan. • Does not commit NHTSA to anything. This is a “roadmap for the administration to follow.”

  8. Traffic Safety for Older People 5 Year Plan (continued) (DOT HS 811 837) August 2013 Trans. Federal • 4 Core Elements to the plan • Data • Vehicle • Behavior • Pedestrian Safety • Also, an overarching element: define “older.”

  9. NHTSA Guideline No. 13 Trans. Federal • Recommendations to states based on more than 10 years of research. • Proposed in 2012. Released in December 2013. • It addresses “... driver licensing and medical review of at-risk drivers, medical and law enforcement education, roadway design, and collaboration with social services and transportation services providers.”

  10. NHTSA Guideline No. 13 (continued) Trans. Federal • Driver licensing and medical review of at-risk drivers: • In-person renewal of driver licenses for those over a specified age. • Provide referring medical providers with immunity from civil liability • Train licensing staff to identify medically at-risk drivers. • Provide outreach and training to medical providers and law enforcement.

  11. NHTSA Guideline No.13 (continued) Trans. Federal • NHTSA has no authority over states; no federal requirements for states’ policies on older drivers. Recommendations only. • States are responsible for their own traffic/vehicle/driver laws. • The federal government influences state road safety measures by channeling money into state highway safety departments. • Currently, there are 50 different older driver licensing policies that are not based on research. • Only now are older drivers beginning to appear on States’ Strategic Highway Safety Plans

  12. Physician’s Guide to: Assessing and Counseling Older Drivers (2nd Edition) Trans. Federal • Originally created in 2003. • 2nd Edition currently available. DOT HS 811 298 June 2010 • Joint effort of NHTSA and American Medical Association (AMA no longer involved). • Intended to train physicians to evaluate driving safety of older patients. HOW SUCCESSFUL WAS THIS EFFORT??

  13. Trans. Federal The American Medical Association Older Driver Curriculum for Health Professionals: Changes in Trainee Confidence, Attitudes, and Practice Behavior • An evaluation of the Physician’s guide. • http://dx.doi.org/10.1080/02701960.2010.528273 • by Thomas M. Meuser, David B. Carr, Cheryl Irmiter, Joanne G. Schwartzberg, and Gudmundur F. Ulfarsson • Published November 4, 2010 • Funded by a grant from NHTSA and AMA. • The Guide “provides background information and a detailed rationale for the application of medical principles to the driving task. In-office approaches to screening and assessment receive significant attention including a suggested group of tests called the Assessment of Driving Related Skills (ADReS Battery)... the Guide teaches how to frame the broader topic of personal mobility and discuss results in a way that balances patients’ independence needs with larger public safety concerns.”

  14. AMA Older Driver Curriculum Critique Pt. 2 Trans. Federal • A quiz was taken by physicians with the Guide. • A five-module, multimedia Curriculum has been designed around The Guide that includes slides, video case segments, and handouts for live presentations. • Presentation for physicians and other trainee groups. • Information was gathered from 22 of these live presentations by different teams in 12 states. The presentations were then updated appropriately. • Curriculum’s goal: “provide core knowledge and techniques necessary for a clinician to evaluate driver fitness in a typical care encounter.” • This critique the summation of 693 physician participants.

  15. The Critique Pt. 3: Results Trans. Federal • Data shows physicians widely adopted the AMA recommendations. • Physicians: • now use chart documentation • incorporated driving questions into the clinical approach • coordination with patient and family to support driving retirement • use of integrative assessment approach • use of the Trail Making Test for screening • Largest adoption of the Guide occurred in questioning of patients (31% of post-test respondents).

  16. The Critique Pt. 4: The Conclusion Trans. Federal • “Targeted, evidence-based educational programming can enhance the medical care of older patients with respect to driver fitness.” • AMA curriculum focused on the minority who are at risk due to medical conditions that directly affect driving. • AMA Guide and Curriculum encourage action to detect relevant conditions as they emerge and before driving may be compromised. • Physicians alone not responsible for this task. It also falls to older drivers’ families, law enforcement, driver licensing officials, social service professionals, and the older driver. • Physicians must work with these people.

  17. Trans. Federal NHTSA Publications EDUCATIONAL • How to Understand and Influence Older Drivers (2006) • DriveWell Toolkit--Promoting Older Driver Safety and Mobility in Your Community (2007) • Adapting Motor Vehicles for Older Drivers (2007) DATA Traffic Safety Facts--Annual fact sheets on older population--1993-2013 SAFETY 1N NUMB3RS

  18. NHTSA Publications (continued) Trans. Federal • RESEARCH • Functional Assessments, Safety Outcomes, and Driving Exposure Measures for Older Drivers (DOT HS 811 630) (2012) • Pedal Application Errors (DOT HS 811 597) March 2012 Licensing Procedures for Older Drivers (DOT HS 811 833) September 2013

  19. Trans. Federal Federal Highway Administration Focus on Features and Design of Roadways: • Highway Design Handbook for Older Drivers and Pedestrians (2001) • Travel Better, Travel Longer, a Pocket Guide to Improve Traffic Control and Mobility for Our Older Population (FHWA-OP-03-098)(2003)

  20. Federal Highway Administration Trans. Federal Focus on State Efforts for Older Driver Safety (2007)

  21. National Transportation Safety Board (NTSB) Trans. Federal • NTSB is an independent federal agency charged with investigating every civil aviation accident and all major transportation accidents. Their mission is to advance transportation safety. • November 2010 - NTSB organized a public forum for experts and interested organizations to discuss older driver safety. • discussed older driver’s decreased injury tolerance, vehicle design efforts to make driving easier, and ways one can assess an older driver. • NTSB has a “most wanted” list. The most wanted list does not include older driver safety.

  22. Trans. State STATE DRIVER LICENSING • 50 States: 50 State DOTs and 50 Driver Licensing Requirements • Changes in Requirements through law and regulation change--State law makers and regulatory agencies (DMV)

  23. Trans. State STATE DRIVER LICENSING NOTEWORTHY STATES--Both Good and Bad Maryland--Model Medical Advisory Board; 8 year license renewal, In-Person every 16 years Missouri—Training Video for Licensing Office Counter Staff; Subcommiittee on Elder Mobility and Safety (SEMS) of the Missouri Coalition For Highway Safety Illinois--Only state with behind the wheel requirement for older drivers Virginia—DMV November 2013 “Mature Driver Study” ; 2014 passed law to require shorter renewal cycle for 75+

  24. Trans. State STATE DRIVER LICENSING NOTEWORTHY STATES--Both Good and Bad (continued) Iowa--second largest older driver population, 5-booklets to educate older drivers; on-going research Florida--largest older driver population; Safe Mobility For Life Coalition; “Florida’s Guide for Aging Drivers” (May 2012) Kansas—2014-KS Highway Patrol developed Medical Conditions and Driving brochure; March 2014 Older Driver Summit

  25. Trans. State STATE HIGHWAY SAFETY EFFORTS October 1, 2006--The date that Federal law requires states to have an approved Strategic Highway SafetyPlan. (SAFETEA-LU) • SHSP developed after consultation with stakeholders • Uses state, regional or local crash data • Identifies and analyzes highway safety problems • Required to address 4 E’s: engineering, education, enforcement and EMS • Includes projects or strategies to reduce or eliminate safety hazards Access to Federal highway $$ under the Highway Safety Improvement Program for states with a SHSP.

  26. Trans. State STATE HIGHWAY SAFETY EFFORTS(continued) Only a few states have older drivers identified as a target area to improve highway safety Some states that include older drivers in SHSP: Florida—”Aging Road User Strategic Safety Plan” New Hampshire—convene an Older Driver Task Force Wisconsin—Action Plan includes exploring continuing medical education credits for physicians who take online course on Wisconsin laws and rules for driving with medical conditions

  27. 1965: Congress Passes Older Americans Act Aging. Federal In response to lack of social services for older adults • Created the Administration on Aging (AoA) to administer program of grants to states to provide community based services, including nutrition • Resulted in creation of 56 state agencies on aging • 618 area agencies on aging

  28. 1965: Congress Passes Older Americans Act(continued) Aging. Federal Act amended in 2006 • Added mental health focus • State plans to include assessment and provision of services to “older individuals with limited English proficiency” • Title IV Activities for Health, Independence and Longevity • funds civic engagement activities, • community innovations for aging in place and NORCs • building awareness of cognitive impairments • innovations to improve transportation • community planning for aging population

  29. National Association of Area Agencies on Aging (n4a) Aging. Federal Mission: to build capacity of its member agencies to help older persons and persons with disabilities live with dignity and choices in their homes and communities for as long as possible. Members are Area Agencies on Aging Advocates for funding of Older Americans Act

  30. National Center on Senior Transportation Aging. Federal Mission: “We strive to increase transportation options for older adults and enhance their ability to live more independently within their communities throughout the U.S. • Established in 2006 • Federally funded training and technical assistance center • Administered by Easter Seals, Inc. in partnership with n4a • www.seniortransportation.net • Recently revamped website includes page on “Older Driver Safety and Transition From Driving” • Links for educational materials for drivers and families

  31. AAA - American Automobile Association National Organizations • Founded the AAA Foundation for Traffic Safety in 1947 • Mission statement: “Prevent traffic deaths and injuries through research into their causes and to educate the public about strategies to prevent crashes and reduce injuries.” • 2004 - Began analyzing senior crash rates and judging the effectiveness of state motor vehicle license renewal policies.

  32. AAA - American Automobile Association (continued) National Organizations • Research: major research contributor; continuously funds older driver research. Examples: • 2007--Enhancement of Driving Performance Among Older Drivers • 2008—Medical Fitness to Drive and a Voluntary State Reporting Law (analysis of Missouri law) • July 2014—Driver License Renewal Policies and Fatal Crash Involvement Rates of Older Drivers, United States, 1985-2011

  33. AAA - American Automobile Association - National Office and Clubs National Organizations • Dedicated to keeping seniors driving for as long as they safely can. • Offer online and classroom courses for seniors. • http://seniordriving.aaa.com/ • Roadwise Review CD-ROM (Mac and PC Versions) (2006) • Publications/brochures: • How to Help an Older Driver, A Guide for Planning Safe Transportation (2000) • Smart Feature for Older Drivers (2012)--describes features of cars that may be helpful to older adults (automatic tailgate closer, heated seats, heated side mirrors, etc.)

  34. AARP National Organizations Two Organizations: AARP Services, Inc. 37,000,000 + members For Profit—sells insurance, travel, etc. AARP Foundation—non-profit Research arm: AARP Public Policy Institute

  35. AARP (continued) National Organizations AARP Public Policy Institute produces: Fact Sheets April 2011 “How the Travel Patterns of Older Adults Are Changing: Highlights From the 2009 National Household Travel Survey” Research Reports April 2013 “Weaving It Together: A Tapestry of Transportation Funding for Older Adults”

  36. TRB - Transportation Research Board Research TRB • Mission: provide leadership in transportation innovation and progress through research and information exchange. • “Human factor” added to their list of interests in the 1950s. • Older Drivers: • Worked on 26 projects involving or pertaining to older drivers and their needs. • These include: data collection projects, testing in-vehicle modifications and their effectiveness, and developing visibility requirements for older drivers.

  37. TRB - Transportation Research Board (continued) Research TRB • Committees: • Standing Committee on Safe Mobility of Older Persons (ANB60) formed in the 1990s. • Subcommittees: • Enhancing Older Women’s Safe Mobility • Medical Advisory Board and Driver Licensing • Transportation Options for Seniors

  38. TRB - Annual Meeting in D.C. Research TRB • Thousands of U.S. and international transportation officials • Five Day Program with almost 750 sessions and workshops • Exhibits from TRB’s sponsors and participating commercial organizations • TRB committees meet

  39. A Guide for Reducing Collisions Involving Older Drivers Research TRB • Published in 2004 by the TRB as Volume of the 500 Series. • National Cooperative Highway Research Program (NCHRP) developed the 500 Series of guides to assist state and local agencies in reducing injuries and fatalities. • The guides correspond to emphasis areas outlined in the AASHTO Strategic Highway Safety Plan. • Each guide includes a general description of the problem, the strategies/countermeasures to address the problem, and a model implementation process.

  40. Objective 3.1 C: Identify Older Drivers at Increased Risk of Crashing and Intervene Research TRB • Strategy 3.1 C1: Strengthen the Role of Medical Advisory Boards • Medical Advisory Boards mainly serve in a policy setting/advisory capacity and rarely see individual patients. • Examples of state MAB’s: • Maryland MAB very active in identifying individuals with medical impairments. • California MAB only convenes for policy. • Information on MABs should be available for the general public via MVA’s and State Medical Association’s websites. • Legislation might have to change to empower MABs; some states lack clear guidelines for assisting MABs (so some rely on volunteers).

  41. Objective 3.1 C (continued) Research TRB • Strategy 3.1 C2: Update Procedures for Assessing Medical Fitness to Drive • Existing guidelines for medically at-risk drivers are outdated and based on disease diagnosis (NOT level of functional impairment). • State motor vehicle departments must review and update their guidelines. • Instead of this, states could support the AAMVA in creating an updated set of nationally recommended guidelines. • In-person license renewals are key. • No in-mail renewal processes. • Example: In Utah, drivers are required to identify any medical problems when renewing their license.

  42. More Strategies... Research TRB • Strategy 3.1 C3: Encourage External Reporting of Impaired Drivers to Licensing Authorities • Only six states require physicians to report patients with potential driving impairments. • Thirty-one states provide immunity from legal action to physicians who do report patients. • Physicians should be educated on the importance of discussing driving with their patients/self-reporting if the physician believes the driver has been compromised. • Reports are not typically made anonymously, but the referral source is often kept confidential.

  43. Strategy 3.1 C4: Provide Remedial Assistance to Help Functionally Impaired Older Drivers Research TRB • Local driving schools • Not every school is qualified to evaluate and retrain older drivers. Those who do though have proven useful and effective. • It is recommended that states have specific guidelines in place to impose appropriate restrictions on licenses of impaired drivers. • Model Driver Screening and Evaluation Program in Maryland • Included driver counseling and rehabilitation. • More research needed to determine the long-term effects of this program. • 2001 - a study shows cataract surgery reduces an older driver’s risk of crashing.

  44. University of Michigan Transportation Research Institute (UMTRI) Research University • UMTRI - “dedicated to achieving safe and sustainable transportation for a global society.” • Since it began in 1965, UMTRI has facilitated over 1,000 short-term and long-term research projects. These projects pertain to these fields: • accident data collection and traffic safety analysis • bioengineering • human factors • mechanical engineering • psychology • economics • public policy

  45. UMTRI’s Senior Mobility (continued) Research University • One of UMTRI’s main Human Factors concerns is Senior Mobility. • UMTRI has facilitated numerous projects concerning older driver safety. These projects include: • the evaluation and development of self-assessment material for older drivers including UMTRI’s own Driving Decisions Workbook. • surveys of older drivers • evaluating devices meant to assist older drivers • on-road assessment of drivers • focus-groups • Also works to improve the communication between seniors and families.

  46. UMTRI’s Senior Mobility(continued) Research University • Recent Projects Include: • How to Create, Implement, Sustain, and Evaluate Travel Training for Older Adults: A Handbook • Self-Regulatory Practices by Older Adults • Transportation Patterns of Older Drivers in Rural Michigan

  47. UMTRI’s North American Conference on Elderly Mobility Research University • Held in Detroit, MI every ten years. • 2004 Conference: the 1st time the conference occurred. It attracted representatives from 17 states and 6 different countries. This conference was sponsored by the Governor’s Traffic Safety Advisory Council (GTSAC). • In 2014, the conference focused on new developments in older driver safety that have occurred since 2004.

  48. UMTRI’s North American Conference on Elderly Mobility (continued) Research University • The key topics included: • Housing and Land Use • Alternative Transportation • Infrastructure and Vehicles • Driver Education and Training • Driver Screening and Assessment • In 2014, the event was sponsored by the Federal Highway Administration (FHWA).

  49. Virginia Tech Transportation Institute Research University • Features the Center for Vulnerable Road User Safety that conducts research on teen and older drivers, bicyclists, and pedestrians. • Senior Mobility Awareness, Safety, and Health (SMASH) Group conducts research on Older Driver Safety. When conducting research, they consider these three ideas: • Personal vehicles are the primary means of transportation and independence in the U.S. • Senior drivers are overrepresented in crash rates on a per mile basis. • Older drivers’ fragility increases their risk of injury if they are involved in a crash crash.

  50. University of California, San Diego’s TREDS Research University • TREDS - Training, Research, and Education For Driving Safety • Their older adults initiative is led by TREDS Deputy Director Jill Rybar, MPH. • This initiative: • works with different local organizations to promote driver safety within communities (specifically, they focus on older drivers). • refers families to community resources that evaluate driving fitness. • offers technical assistance in program planning, delivery, and evaluation.

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