Jim Langford

Effectiveness of Mandatory License Testing for Older Drivers in Reducing Crash Risk Among Urban Older Australian Drivers

Most licensing jurisdictions in Australia maintain mandatory assessment programs targeting older drivers, whereby a driver reaching a specified age is required to prove his or her fitness to drive through medical assessment and/or on-road testing. Previous studies both in Australia and elsewhere have consistently failed to demonstrate that age-based mandatory assessment results in reduced crash involvement for older drivers. However studies that have based their results upon either per-population or per-driver crash rates fail to take into account possible differences in driving activity. Because some older people maintain their driving licenses but rarely if ever drive, the proportion of inactive license-holders might be higher in jurisdictions without mandatory assessment relative to jurisdictions with periodic license assessment, where inactive drivers may more readily either surrender or lose their licenses. The failure to control for possible differences in driving activity across jurisdictions may be disguising possible safety benefits associated with mandatory assessment. The current study compared the crash rates of drivers in Melbourne, Australia, where there is no mandatory assessment and Sydney, Australia, where there is regular mandatory assessment from 80 years of age onward. The crash rate comparisons were based on four exposure measures: per population, per licensed driver, per distance driven, and per time spent driving. Poisson regression analysis incorporating an offset to control for inter-jurisdictional road safety differences indicated that there was no difference in crash risk for older drivers based on population. However drivers aged 80 years and older in the Sydney region had statistically higher rates of casualty crash involvement than their Melbourne counterparts on a per license issued basis (RR: 1.15, 1.02–1.29, p = 0.02) and time spent driving basis (RR: 1.19, 1.06–1.34, p = 0.03). A similar trend was apparent based on distance travelled but was of borderline statistical significance (RR: 1.11, 0.99–1.25, p = 0.07). Collectively, it can be inferred from these findings that mandatory license re-testing schemes of the type evaluated have no demonstrable road safety benefits overall. Further research to resolve this on-going policy debate is discussed and recommended.

Usefulness of Off-Road Screening Tests to Licensing Authorities When Assessing Older Driver Fitness to Drive

Introduction. There is a growing interest in quick and convenient, off-road tests of fitness to drive to assist licensing authorities in identifying the minority of older drivers at heightened crash risk. Two screening tests have been identified and assessed for their usefulness in a licensing context. Method. The research literature has been examined to identify available evaluation evidence relating to the two tests. In particular, studies that have quantified any association between test results and crash involvement in terms of relative risk have been analyzed for licensing implications. Results. Performance on two tests—UFOV and MaryPODS—has been shown to have a consistent and statistically significant association with crash risk, including at-risk crashes. Overall, poor test performance has been associated with a two times or higher relative risk of crash involvement on both retrospective and prospective bases. This statistical association is seen as a necessary first step in further developing off-road screening tests. It is demonstrated, however, that the tests are presently too inaccurate to be used as a form of age-based assessment on a simple pass/fail basis and would result in large numbers of older drivers being needlessly taken from the road. It is also argued that these tests may hold promise when used for preselected groups of at-risk older drivers and when used to produce a threefold outcome (“pass,” “‘fail,” and “uncertain, requiring further assessment”). Conclusions. At this time, no off-road screening test of fitness to drive currently can be justified if applied on a simple pass/fail basis to all drivers reaching a threshold age, as the sole determinant of licensing status.

TRB Workshop 2007: Licensing authorities' options for managing older driver safety--practical advice from the researchers

JIM LANGFORD,1 KELI BRAITMAN,2 JUDE CHARLTON,3 JOHN EBERHARD,4 DESMOND O’NEILL,5 LOREN STAPLIN,6 and JANE STUTTS7 1Monash University Accident Research Centre (Convenor), Victoria, Australia 2Insurance Institute for Highway Safety, Arlington, Virginia, USA 3Monash University Accident Research Centre, Victoria, Australia 4Seniar Consultant, Howard County Commission on Aging, Colombia, Maryland, USA 5Trinity College, Dublin, Republic of Ireland 6TransAnalytics, LLC, Kulpsville, Pennsylvania, USA 7University of North Carolina Highway Safety Research Center, Chapel Hill, North Carolina, USA

Licence restrictions as an under-used strategy in managing older driver safety

While many older drivers remain unimpaired or otherwise effectively compensate for functional deficits, a minority are currently faced with two main options: either continue to drive with arguably an unacceptable crash risk; or cease driving, perhaps at the instigation of licensing authorities. Licence restrictions represent a possible third option for some older drivers, by better managing crash risk while still allowing acceptable levels of mobility. The present study has explored licence restrictions as applied to Victorian older drivers over a ten-year period. It has identified the types of restrictions and their extent of use in recent years, plus indications of potential safety benefits that may result from restricted licencing practices. Less than 10% of the older driver cohort had a licence restriction and in around 95% of instances, the restriction related to the need to wear corrective lenses; these numbers precluded a conclusive evaluation of safety benefits. However, two important findings emerged. First, the imposition of a licence restriction was usually associated with a reduction in absolute crash rates. Second, three restrictions were identified that most readily form the basis of a graduated driving reduction program.

Reprint of “Driving avoidance by older adults: Is it always self-regulation?” ☆

Self-regulation shows promise as a means by which older adults can continue to drive at some level without having to stop altogether. Self-regulation is generally described as the process of modifying or adjusting ones driving patterns by driving less or intentionally avoiding driving situations considered to be challenging, typically in response to an awareness that driving skills have declined. However, most studies asking older adults whether they avoid certain driving situations or have reduced the amount of driving they do under certain circumstances have not delved deeper into the motivations for such avoidance or driving reduction. There are many reasons for modifying driving that have nothing to do with self-regulation, such as no longer needing to take trips at certain times of day because of changes in preferences or lifestyles. The purpose of this study was to examine self-regulatory practices among older adults at multiple levels of driver performance and decision making, taking into account the specific motivations for avoiding particular driving situations or engaging in other driving practices. Study participants completed a computer-based questionnaire on driving self-regulation. Results suggest that self-regulation is a complex process that cannot be defined simply by the reported driving modifications made by drivers. Understanding the motivations for these behaviors is necessary and the study showed that they are varied and differ considerably across driving situations. Reasons for driving avoidance or other practices were often more closely related to lifestyle or preferences than to self-regulation. Based on these findings, three distinct groups were identified with regard to whether and for what reasons participants modified their driving.

Driving Task: How Older Drivers' On-Road Driving Performance Relates to Abilities, Perceptions, and Restrictions.

RÉSUMÉ: Cette étude a examiné une cohorte de 227 conducteurs âgés et a étudié la relation entre leur performance sur la grille d’observation e-DOS pour manoeuvres de conduite et (1) les caractéristiques des conducteurs; (2) les capacités fonctionnelles; (3) les perceptions des capacités et le confort pendant la conduite, ainsi que (4) les restrictions auto-déclarées de la conduite. Les participants (hommes: 70%; âge: M = 81.53 ans, É-T = 3,37 ans) a achevé une série de mesures de la capacité fonctionnelle et d’écailles sur le confort, les capacités et les restrictions aperçut du Candrive / Ozcandrive protocole d’évaluation Année 2, avec une tâche de conduite e-DOS. Les observations des comportements de conduite des participants au cours de la tâche de conduite ont été enregistrées pour: la négociation au carrefour, le changement de voie, la fusion, les manoeuvres à basse vitesse, et la conduite sans manoeuvres. Les scores de conduite e-DOS étaient élevés (M = 94,74; É-T = 5,70) et étaient liés d’une façon significative aux capacité de conduite perçu des participants, la fréquence rapporté de la conduite dans des situations difficiles, et le nombre de restrictions de la conduite. Les analyses futures exploreront les changements potentiels dans les scores de tâches de conduite au fil du temps. ABSTRACT: This study examined a cohort of 227 older drivers and investigated the relationship between performance on the electronic Driver Observation Schedule (eDOS) driving task and: (1) driver characteristics; (2) functional abilities; (3) perceptions of driving comfort and abilities; and (4) self-reported driving restrictions. Participants (male: 70%; age: M = 81.53 years, SD = 3.37 years) completed a series of functional ability measures and scales on perceived driving comfort, abilities, and driving restrictions from the Year 2 Candrive/Ozcandrive assessment protocol, along with an eDOS driving task. Observations of participants’ driving behaviours during the driving task were recorded for intersection negotiation, lane-changing, merging, low-speed maneuvers, and maneuver-free driving. eDOS driving task scores were high (M = 94.74; SD = 5.70) and significantly related to participants’ perceived driving abilities, reported frequency of driving in challenging situations, and number of driving restrictions. Future analyses will explore potential changes in driving task scores over time.

Road Accidents in Australia

This paper presents an overview of road accidents in Australia, updating earlier studies while also covering the ten-year period from 1998 to 2007. It notes that while road deaths peaked at almost 4,000 deaths in 1970, and fell to below 2,000 by 1993, since 2003 fatality levels have remained stagnant at a little over 1,500 deaths annually. The author sees this leveling trend as a call to once again promote safety improvements from earlier years.

Special issue of traffic injury prevention. Introduction

A quick glance at the contents of any road safety journal will indicate the importance currently being given to managing older driver safety. This emphasis can be readily justified. Older drivers are overrepresented in serious road trauma relative to most other age groups. Even ‘normal’ aging is usually accompanied by physical, cognitive and other forms of functional decline. Aging is also associated with the onset of specific medical conditions with functional consequences which at least intuitively, lead to reduced driving skills. The predicted increase in older driver crashes caused by the aging of the baby boomers has also been extensively documented. There is an indisputable bottom line to the so-called older driver problem: some older drivers should not be driving. This bottom line, albeit in an exaggerated form, seems to have appeal especially to the mass media. Incidents involving older drivers are frequently highlighted, with the media coverage invariably accompanied by widespread calls for tighter assessment of older drivers’ fitness to drive. However research activities around the world have shown that things are not that straightforward. Older drivers’ high injury levels are more likely to be due to physical frailty than to reduced driving skills. The functional declines associated with aging may well impair some driving skills (although there is a far from clear picture in this regard) but many older drivers are able to mange any heightened crash risk by altering both the quality and quantity of their driving. Further, the baby boomers represent a generation that has already dramatically altered social conditions and behaviors and these cohort differences can be expected to persist into their old age, perhaps altering the prevailing crash patterns and levels. If older drivers’ crash risk is a complex issue, the complexities increase when the management options available to licensing authorities are considered. These authorities have a fundamental responsibility to manage the safety of the transport system by developing policies and practices aimed at producing safe road users. On the one hand, can targeting a particular group on the basis of age be justified as part of this responsibility, particularly when the true crash risk remains debated and the assessment methods have at best, limited validity? On the other hand and granting these issues, is it legitimate to overlook a particular group, at least some of whose members are at high risk of death or injury? Furthermore, to repeat a much-voiced proposition, ‘driving is a privilege but mobility is a right’: should licensing authorities’ traditional responsibilities extend beyond safe driving to assist in providing adequate mobility? While researchers have provided at least some answers to at least some of these questions, there is little evidence that the research findings are having an impact on licensing policies. In most jurisdictions, licensing policies and practices have remained essentially unchanged over the past decades. There are of course exceptions. New Zealand licensing authorities recently discontinued mandatory on-road assessment for all older drivers, at least in part because the practice might be discriminatory. In Australia, several jurisdictions are also questioning mandatory assessment and are looking to more effective means to identify older drivers who are unacceptably unfit to drive. In the U.S. the jurisdictions of Maryland and California are also piloting innovative licensing models as an alternative to traditional strategies. The apparent schism between research output and licensing practices prompted the US Transportation Research Board to hold in early 2007, a Human Factors Workshop, “Licensing authorities’ options for managing older driver safety—practical advice from the researchers.” As is implicit in the Workshop title, the main aim was to present key ‘state of the art’ messages from researchers, pointing to the best way forward for licensing authorities. Subsequent to that initial meeting, it was decided to give the issue wider circulation through two communication avenues. In the first instance, the Workshop presentations, along with further invited papers, have been included in this Special Issue of Traffic Injury Prevention. Secondly, many of the papers will form the basis of an Older Driver Symposium to be held on the 5th of October 2008 in San Diego, immediately preceding the Association for the Advancement of Automotive Medicine’s 52nd Annual Scientific Conference (www.aaam.org). I recommend the following papers for your consideration.