Gayla M. Cissell

Can High-Risk Older Drivers Be Identified Through Performance-Based Measures in a Department of Motor Vehicles Setting?

OBJECTIVES: To evaluate the relationship between performance‐based risk factors and subsequent at‐fault motor vehicle collision (MVC) involvement in a cohort of older drivers.

Reliability and Validity of Useful Field of View Test Scores as Administered by Personal Computer

The Useful Field of View test (UFOV 1 ) is a measure of processing speed that predicts driving performance and other functional abilities in older adults. In comparison to a number of other visual and cognitive measures, the UFOV measure has consistently been found to be the strongest predictor of motor vehicle crashes of older adults. This measure has valuable applications in that computerized, performance-based measures that are predictive of crashes in the elderly population can provide an objective criterion for determining the need for driver restriction or rehabilitation. Administration of the UFOV test has evolved from the standard version (administered via touch-screen with the Visual Attention Analyzer) to two briefer versions, which are administered on a personal desktop computer (PC) using either a touch screen or mouse response option. These new versions of the test are briefer and require less specialized equipment, making the test more portable and practical for use in clinical settings. This study examined the reliability and validity of the scores from these two new versions. Results indicate that test-retest reliabilities of the scores from the UFOV PC versions are high (rs= 0 .884 for mouse and 0.735 for touch), and performance on both PC versions correlates well with performance on the standard version (rs = 0.658 for mouse and 0.746 for touch). Furthermore, scores were highly correlated (r = 0.916) when participants used either a touch screen or a mouse to input responses. In conclusion, the reliability and validity coefficients are of sufficient magnitude to make the touch and mouse PC versions of the UFOV practical for use in clinical evaluations. UFOV is a registered trademark of Visual Awareness, Inc., Chicago, IL

Transfer of a speed of processing intervention to near and far cognitive functions.

Background: Evidence establishing the potential for modification of cognitive functioning in later adulthood has begun to accumulate. Objective: The primary goal of the current study was to evaluate, among older adults, the extent to which standardized speed of processing training transfers to similar and dissimilar speeded cognitive measures as well as to other domains of cognitive functioning. Methods: Ninety-seven older adults (mean age 73.71 years) were administered a battery of cognitive tests assessing intelligence, memory, attention, verbal fluency, visual-perceptual ability, speed of processing, and functional abilities. Forty-four of the participants received ten 1-hour sessions of speed of processing training. The remainder of participants were in a no-contact control group. Approximately 6 weeks after the pretraining assessment, all participants repeated the same battery of tests. Results: The results revealed training effects for some speed of processing measures, including performance of instrumental activities of daily living, but no transfer to other domains of cognitive functioning. Conclusion: Speed of processing training may enhance the speed at which older adults can perform instrumental activities of daily living.

The Longitudinal Impact of Cognitive Speed of Processing Training on Driving Mobility

PURPOSE To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers. DESIGN AND METHODS Older drivers with poor Useful Field of View (UFOV) test performance (indicating greater risk for subsequent at-fault crashes and mobility declines) were randomly assigned to either a speed of processing training or a social and computer contact control group. Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test (reference group) across a 3-year period. RESULTS Older drivers with poor UFOV test scores who did not receive training experienced greater mobility declines as evidenced by decreased driving exposure and space and increased driving difficulty at 3 years. Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure, space, and most aspects of driving difficulty. IMPLICATIONS Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers. Scientifically proven cognitive training regimens have the potential to enhance the everyday lives of older adults.

Do Older Drivers At-Risk for Crashes Modify Their Driving Over Time?

Five-year driving habit trajectories among older adults (n = 645) at-risk for crashes were examined. Performance measures included Useful Field of View (UFOV). Motor-Free Visual Perception Test, Rapid Walk, and Foot Tap. Self-report measures included demographics and the Driving Habits Questionnaire. Longitudinal random-effects models revealed that drivers at-risk for subsequent crashes, based upon UFOV, regulated their driving more than the lower-risk participants. Restricted driving was present at baseline for the at-risk group and was observed in longitudinal trajectories that controlled for baseline differences. Results indicate that persons at-risk for subsequent crashes increasingly limit their driving over time. Despite this self-regulation, a larger sample of such older drivers was twice as likely to incur subsequent at-fault crashes. Results suggest that self-regulation among older drivers at-risk for crashes is an insufficient compensatory approach to eliminating increased crash risk. UFOV is a registered trademark of Visual Awareness, Inc.

Ten Years Down the Road: Predictors of Driving Cessation

PURPOSE Recent prospective studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults. However, these studies have been limited to 5 years of follow-up. The current study used data from the Maryland Older Drivers Project to examine predictors of driving cessation in older adults over a 10-year period. DESIGN AND METHODS Participants (N = 1,248) completed baseline and 5-year assessments of physical and cognitive abilities. Driving status was ascertained at baseline and annually thereafter. RESULTS Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic, physical, and cognitive predictors. The final model indicated three significant predictors of driving cessation, older age at baseline (hazard ratio [HR] = 1.12, p < .001), days driven per week (HR = 0.83, p = .05), and slower speed of processing as measured by the Useful Field of View Test (HR = 1.76, p < .01). IMPLICATIONS These results underscore the importance of cognitive speed of processing to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation. Further research is needed to determine the costs and potential benefits of such screening.

Visual attention analyzer: technology to evaluate and train drivers' visual performance

While there is consensus that attention is needed to perform many daily activities, such as driving, there has not been widespread agreement on how to measure it. The UFOVTM Visual Attention Analyzer is a new instrument developed to assess the functional attentional skills required for driving and attentionally demanding occupations, and to train those skills when they are diminished or for exceptional performance. The focus of this paper is to describe the uses for this technology and discuss its validation regarding crash risk among older drivers.