Jerri D. Edwards

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.

The Impact of Speed of Processing Training on Cognitive and Everyday Functions

We combined data from six studies, all using the same speed of processing training program, to examine the mechanisms of training gain and the impact of training on cognitive and everyday abilities of older adults. Results indicated that training produces immediate improvements across all subtests of the Useful Field of View test, particularly for older adults with initial speed of processing deficits. Age and education had little to no impact on training gain. Participants maintained benefits of training for at least 2 years, which translated to improvements in everyday abilities, including efficient performance of instrumental activities of daily living and safer driving performance.

Cumulative Meta-analysis of the Relationship Between Useful Field of View and Driving Performance in Older Adults: Current and Future Implications

Purpose. Driving is a complex behavior that requires the utilization of a wide range of individual abilities. Identifying assessments that not only capture individual differences, but also are related to older adults’ driving performance would be beneficial. This investigation examines the relationship between the Useful Field of View (UFOV) assessment and objective measures of retrospective or concurrent driving performance, including state-recorded accidents, on-road driving, and driving simulator performance. Method. The PubMed and PsycINFO databases were searched to retrieve eight studies that reported bivariate relationships between UFOV and these objective driving measures. Cumulative meta-analysis techniques were used to combine the effect sizes in an attempt to determine whether the strength of the relationship was stable across studies and to assess whether a sufficient number of studies have been conducted to validate the relationship between UFOV and driving performance. Results. A within-group homogeneity of effect sizes test revealed that the samples could be thought of as being drawn from the same population, Q [7] = 11.29, p (one-tailed) = 0.13. Therefore, the effect sizes of eight studies were combined for the present cumulative meta-analysis. The weighted mean effect size across the studies revealed a large effect (Cohen’s d = 0.945), with poorer UFOV performance associated with negative driving outcomes. This relationship was robust across multiple indices of driving performance and several research laboratories. Conclusions. This convergence of evidence across numerous studies using different methodologies confirms the importance of the UFOV assessment as a valid and reliable index of driving performance and safety. Recent prospective studies have confirmed a relationship between UFOV performance and future crashes, further supporting the use of this instrument as a potential screening measure for at-risk older drivers.

The impact of speed of processing training on cognitive and everyday performance

The purpose of the present investigation was to examine the impact of speed of processing training on the cognitive and everyday abilities of older adults with initial processing speed or processing difficulty. Participants were randomized to either a speed of processing intervention or a social- and computer-contact control group. Results indicate that speed of processing training not only improves processing speed, as indicated by performance on the Useful Field of View test (UFOV®), but also transfers to certain everyday functions, as indicated by improved performance on Timed Instrumental Activities of Daily Living (Timed IADL). Transfer of speed of processing training to other cognitive domains was not evident. This study provides additional evidence that speed of processing training has the potential to enhance everyday functions that maintain independence and quality of life, particularly when the training is targeted toward individuals who most need it. Further study is needed to learn about the long-term effects of such training in relation to everyday abilities.

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.

Cognitive training decreases motor vehicle collision involvement of older drivers.

OBJECTIVES: To test the effects of cognitive training on subsequent motor vehicle collision (MVC) involvement of older drivers.

Driving Cessation and Health Trajectories in Older Adults

BACKGROUND Older adults who cease driving have poorer health than those who continue to drive. However, it is unclear whether the transition to driving cessation itself results in health declines or whether driving cessation subsequently exacerbates health declines over time. METHODS The current study addresses these questions using multilevel modeling among 690 older adults from the Advanced Cognitive Training for Independent and Vital Elderly study. Driving status and health, as indicated by the SF-36 questionnaire, self-rated health, physical performance (Turn 360 degrees Test), and depressive symptoms were assessed at baseline and at 1-, 2-, 3-, and 5-year follow-up visits. RESULTS The transition to driving cessation was accompanied by significant declines in physical and social functioning, physical performance, and physical role (ps < .05). Health declines after driving cessation were steeper for general health. CONCLUSIONS The transition to driving cessation is associated with health declines for older adults as measured by several indicators. Additionally, general health declines more sharply following driving cessation. These findings highlight the importance of interventions to sustain driving mobility among older adults.

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.

Driving Status and Three-Year Mortality Among Community-Dwelling Older Adults

BACKGROUND Driving cessation can lead to myriad negative consequences for older adults. The purpose of these analyses was to examine driving status as a predictor of mortality among community-dwelling older adults. METHODS This prospective cohort study included 660 community-dwelling adults ranging in age between 63 and 97 years. Between 2000 and 2004, participants completed performance-based assessments of vision, cognition, and physical abilities and indexes of health, depression, self-efficacy, and driving habits. Follow-up telephone interviews were completed approximately 3 years later. RESULTS Among community-dwelling older adults, older age, health, poor near visual acuity, depressive symptoms, compromised cognitive status, and being a nondriver are associated with increased risk for a 3-year mortality. Nondrivers were four to six times more likely to die than drivers during the subsequent 3-year period. CONCLUSIONS The ability to drive represents both a sign of cherished independence and underlying health and well-being for older adults. Retaining this ability is an important health concern in the United States.