Beth T. Stalvey

DRIVING AVOIDANCE AND FUNCTIONAL IMPAIRMENT IN OLDER DRIVERS

The purpose of this study was to examine the association between visual and cognitive impairment in older drivers and their avoidance of potentially challenging, driving situation. A group of 257 older drivers participated in assessments of visual sensory function, eye health and cognitive function including the useful field of view test, and completed a structured questionnaire on driving exposure and how frequently they avoided challenging driving situations. Results replicated earlier studies showing that many older drivers limit their exposure to driving situations which are generally believed to be more difficult (e.g. rain, night, heavy traffic, rush hour). Furthermore, older drivers with objectively determined visual and/or attentional impairments reported more avoidance than those free of impairments; those with the most impairment reported avoiding more types of situations than other less impaired or non-impaired drivers. Older drivers with a history of at-fault crashes in the prior five years reported more avoidance than those who had crash-free records. Future research should evaluate the potentially beneficial role of self-regulation in enhancing older driver safety, particularly in those older drivers with visual and attentional processing impairments who have elevated crash risk.

The Life Space Questionnaire: A Measure of the Extent of Mobility of Older Adults

Mobility in older adults is typically discussed in terms of component maneuvers including analy sis of gait and postural instability; activities that depend on mobility such as bathing, dressing, or shopping; or adverse events during mobility such as falls or motor vehicle crashes. None of these approaches reflects a key aspect of mobility-the extent of movement within a persons environment, or life space in the gerontological literature. Here we describe this concept as it applies to mobility and present a questionnaire instrument designed to measure life space in community-dwelling older adults. Results indicate that the Life Space Questionnaire (LSQ) is reliable and has construct and criterion validity in a sample of olderadults. The LSQ can be used to establish the spatial extent of an older persons mobility and may ultimately be useful as an outcome measure in studies evaluating interventions designed to enhance mobility and inde pendence in community-dwelling older populations.

The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers

Visual processing impairment increases crash risk among older drivers. Many older drivers meet the legal requirements for licensing despite having vision impairments that elevate crash risk. In this study, 365 older drivers who were licensed, visually-impaired, and crash-involved in the prior year were randomly assigned to an intervention group or usual-eye-care control group to evaluate the efficacy of an educational intervention that promoted the performance of self-regulatory practices. The educational curriculum was designed to change self-perceptions about vision impairment and how it can impact driver safety and to promote the avoidance of challenging driving situations through self-regulation, leading to reductions in driving exposure. Analyses compared the intervention and control groups at pre-test and 6 months post-test with respect to self-reported perceptions about vision and driving practices. At post-test, drivers who had received the educational intervention were more likely to acknowledge that the quality of their eyesight was less than excellent, report a higher frequency of avoiding challenging driving situations (e.g. left-turns) and report performing more self-regulatory practices (e.g. three right-turns) as compared to controls. Additionally, drivers in the educational intervention group reported significantly fewer days, fewer places and fewer trips made per week as compared to those not receiving the educational intervention. These findings imply that visually-impaired older drivers at higher risk for crash involvement may benefit from educational interventions by reducing their driving exposure and increasing their avoidance of visually challenging driving situations. A critical future step in this research program will be to examine whether this educational intervention has an impact on the safety of these high-risk older drivers by reducing their crash involvement in the years following the educational intervention.

Timed instrumental activities of daily living tasks: relationship to visual function in older adults.

Purpose. To identify instrumental activities of daily living (IADL) tasks whose completion time is related to visual function in older adults. Methods. Visual function (acuity, contrast sensitivity, and useful field of view) and the time to complete 17 visual tasks of everyday life were measured in a sample of 342 older adults (mean age 71 years, range 56 to 86) recruited from eye clinics. The timed IADL (TIADL) tasks included a variety of visual activities such as reading ingredients on cans of food and instructions on medicine bottles, finding a phone number in a directory, locating items on a crowded shelf and in a drawer, and using a screwdriver. Results. Multiple regression analysis indicated that poorer scores for acuity, contrast sensitivity, and useful field of view were independently associated with longer times to complete visual TIADL tasks, even after adjusting for age, educational level, depression, and general health. Cognitive status also had a significant, independent association with timed task performance. Conclusions. Older adults’ timed performance in everyday tasks is related to various aspects of visual function independent of the influences of other functional and health problems and advanced age. This suggests that TIADL tasks may eventually be useful as performance outcomes in intervention evaluations targeted at reversing vision impairment or minimizing its impact. To understand the relationship between vision impairment and TIADL task performance in older adults, cognitive impairment needs to be taken into account because it has a relatively strong and independent relationship with visual TIADL task performance.

Self-perceptions and Current Practices of High-risk Older Drivers: Implications for Driver Safety Interventions.

Many older drivers with visual problems meet the legal requirements for licensing despite having functional impairments that elevate crash risk. In a sample of visually impaired older drivers, over half believed that their vision was not likely to cause them to crash. Eighty percent acknowledged that they would feel more protected against crashing if they avoided certain driving situations. However, 75 percent of the sample reported never or rarely avoiding such situations (e.g. left turns, interstate highways). Almost 70 percent of drivers reported high self-efficacy in their ability to self-regulate and use alternative strategies. These data imply that behavioral interventions promoting compensatory strategies of self-regulation may be useful in maintaining mobility while improving the safety of high-risk older drivers. These findings serve as baseline for our ongoing study evaluating whether an educational intervention will increase self-regulation and improve older driver safety.

The development and efficacy of a theory-based educational curriculum to promote self-regulation among high-risk older drivers

Knowledge Enhances Your Safety (KEYS) is a curriculum developed for older drivers who maintain driving privileges while coping with visual limitations that increase crash risk. KEYS’ goal is to promote safe driving through self-awareness of vision impairment and adopting self-regulatory strategies. We discuss KEYS’ theoretical framework based on the tenants of the Social Cognitive Theory, Health Belief and Transtheoretical Models, and Principles of Self-Regulation and Regulatory Self-Efficacy. Baseline and 6-month posttest evaluations tested its efficacy in terms of theoretical construct outcomes. KEYS’ participants improved self-perceptions of vision impairment, perceived a greater number of benefits in the performance of self-regulatory behaviors, and moved closer to the preparation and action/maintenance stages of change. Results indicate that high-risk older drivers benefit from educational interventions that promote self-awareness and self-regulation of driving. Future work will evaluate KEYS’ efficacy for high-risk older drivers in promoting driver behavior changes and its impact on crash involvement.

Educating Older African Americans about the Preventive Importance of Routine Comprehensive Eye Care

Older African Americans have higher rates of vision impairment and lower utilization rates of comprehensive eye care, compared to Caucasians. InCHARGE is an eye health education program for this population that promotes prevention through the annual, dilated comprehensive eye examination. This study, using a pre-/postdesign, evaluated whether InCHARGE imparted knowledge about prevention and strategies for reducing barriers to care. The program was presented to 85 older African Americans in 5 senior centers in Montgomery, AL. Changes in attitudes about annual eye care were assessed by a questionnaire before and 3 months after InCHARGE. At baseline, most (> 85%) responded it would not be difficult for them to find an ophthalmologist or optometrist, and the exam cost was not a problem. Twenty-five percent reported problems finding transportation to the doctor and covering the eyeglasses cost. Forty-four percent reported not having an eye exam in the past year; 13% reported not having one within 2 years. Three months after InCHARGE, those who reported that they could find a way to get to the doctor increased (X2 = 3.8, p = 0.04). After InCHARGE, 72% said they either had received or scheduled an eye exam. Responses to a question about what was learned from InCHARGE indicated that the InCHARGEs key messages about comprehensive eye care were successfully imparted to most. This study suggests that older African Americans in the urban south have positive attitudes about eye care, even before an eye health education presentation. Following InCHARGE, they identified transportation problems less frequently as a barrier, indicated that they learned InCHARGEs key message and had plans for seeking routine, preventive eye care. A next step is to verify through medical record review the extent to which the high rates of self-reported eye care utilization reflect behavior.

Effect of an Eye Health Education Program on Older African Americans' Eye Care Utilization and Attitudes about Eye Care

UNLABELLED We examined the impact of an eye health education program for older African Americans on attitudes about eye care and utilization, using a randomized trial design in a community setting. Participants were older African Americans attending activities at senior centers: Ten centers were randomized to an eye health education (InCHARGE) or social-contact control presentation. InCHARGE addressed the importance of annual dilated comprehensive examination and strategies reducing barriers to care. The control presentation was on the importance of physical activity. Outcomes were attitudes about eye care 6 months post event through questionnaire and eye care utilization during 12 months post event through medical record abstraction. At baseline, more than 80% participants in both arms said transportation and finding, communicating, and trusting a doctor were not problematic and agreed that yearly care was important. One-fourth said eye examination cost was problematic; one-half said spectacle cost was problematic. There were no group differences 6 months post event. During the 12 months pre event, the dilated exam rate was similar in the groups (38.3% InCHARGE, 40.8% control) and unchanged during the 12 moiths post event. Results suggest fewer than half of older African Americans received annual dilated eye care. Group-administered eye health education did not increase this rate. Even before the program, they had positive attitudes about care, yet many cited examination and spectacle cost as problematic, which was not mitigated by health education. Evidence-based strategies in a community setting for increasing eye care utilization rate in older African Americans have yet to be identified. Policy changes may be more appropriate avenues for addressing cost. TRIAL REGISTRATION NCT00591110, www.ClinicalTrials.gov