Sjaanie Narelle Koppel

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.

Older drivers, crashes and injuries

Objective: This article aimed to identify the main features of older driver casualty crashes, including detailed descriptions of injury outcomes. Methods: Data were obtained from the Transport Accident Commission insurance claims database for 2 groups of drivers: aged 41 to 55 years (middle-aged drivers) and aged 65 years and older (older drivers). Results: In terms of crash circumstances, the majority of crashes involved a collision with another vehicle (70.0% of middle-aged drivers and 68.7% of older drivers). The 2 main maneuvers at the time of crash were driving straight ahead (44.6% of middle-aged drivers and 42.8% of older drivers) and turning right (equivalent of left turn in North America; 15.2% of middle-aged drivers and 17.6% of older drivers). In terms of injury outcomes, older drivers sustained a significantly higher proportion of injuries to the thorax (30.9% compared to 18.5% of middle-aged drivers). Conversely, a significantly higher proportion of middle-aged drivers sustained some form of injury to the neck (30.6% compared to 12.1% of older drivers). Conclusion: These findings highlight the situations that are particularly risky for older drivers and provide important insights for developing solutions to reduce older driver crash and injury risk.

Child restraint system misuse and/or inappropriate use in Australia

Objective: Motor vehicle crashes are one of the leading causes of child death and acquired disability. Child restraint systems (CRS) for vehicles are designed to provide specialized protection for child occupants in the event of a crash. However, the effectiveness of a CRS is critically dependent on: correct installation of the CRS in the vehicle, the correct harnessing of the child in the CRS, and use of an appropriate CRS. The current study aimed to investigate the incidence misuse and/or inappropriate use of CRS through a CRS inspection program in the Australian states of New South Wales (NSW), Victoria (VIC), Queensland (QLD), South Australia (SA), Western Australia (WA), and Tasmania (TAS). Methods: Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, the CRS fitting specialist inspected and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use if the child restraint(s) and or system(s). Results: The following results are based on the inspection of 1386 vehicles, in which there were 1995 restraints. Of all the restraints inspected, the majority (79%) were reported as having at least one instance of misuse. The most common forms of misuse included harness strap errors such as the straps being adjusted, faulty, twisted, and/or incorrectly positioned (38%); seat belt errors such as the seatbelt being incorrectly routed, twisted, and/or incorrectly adjusted (32%); missing or incorrect fitting of gated buckle/locking clip (23%); the need for a missing sash guide (8%); tether errors such as the tether being incorrectly routed and/or adjusted (7%); inappropriate use of a CRS for the size of the child (6%); anchor errors such as the anchor was fitted incorrectly or not the correct type (5%); and the H Harness 1 being used incorrectly (5%). In addition, there were significant differences across restraint types in terms of the proportion of restraints with CRS misuse or fitment errors, χ2 (2) = 51.42, p < 0.001. The rate of misuse was highest for the forward-facing CRS (88%), compared to infant seats (67%) and booster seats or cushions (63%). 1 An H harness is an additional device that is designed for use with or without booster seats for children weighing up to 32 kg. The harness is attached to the vehicle at the same point as a CRS top tether, with the lap belt of the vehicle threaded through the harness. Discussion: The results show that CRS misuse and fitment errors are widespread in Australia. Based on the findings of this study, it is recommended that educational and awareness materials and programs that provide information on the safety benefits associated with correct CRS use (as well as the injury risk associated with CRS misuse) be developed for both parents and children.

Older female drivers: An emerging transport safety and mobility issue in Australia

This paper describes an investigation of safety, mobility and travel patterns in a sample of older women drivers and former drivers aged 60 years and over. Participants provided information on general health and functional abilities, travel and driving patterns, driving experiences and confidence, difficulty with and avoidance of driving situations, self-assessment of driving ability, crash and infringement history, the process and experiences leading up to stopping driving, and satisfaction with current mobility. The sample was a fairly active group, travelling frequently and substantial distances, and generally satisfied with their level of mobility. Current drivers were strongly interested in keeping driving for as long as possible, expressed strong concerns about the prospect of stopping driving and reported little evidence of self-regulation. In contrast, former drivers were less negative about driving cessation and mostly reported successful retirement from driving with few negative mobility consequences. Further, a number of relationships between crash involvement and driving experience, confidence of being a safe driver, and problems in driving situations were found. These findings have added to our understanding of the issues concerning the safety and mobility of older women. Implications for the promotion of safe driving practices are discussed.

Factors associated with the premature graduation of children into seatbelts

This study investigated the factors associated with the premature graduation into seatbelts for Australian children aged 4-11 years. From 699 child restraint use questionnaires, 195 children were identified as meeting the booster seat height-weight criteria (height: 100-145 cm and weight: 14-26 kg). Of these children, 44% were correctly traveling in a booster seat, while 56% had been moved prematurely into a seatbelt. A multivariable logistic regression model showed that there were a number of key predictors associated with the premature graduation to seatbelts. For example, children who were moved prematurely into a seatbelt were more likely to be older, have other children travelling in the vehicle and have younger parents compared to children appropriately restrained in a booster seat. In addition, there was a significant interaction between vehicle type and parents household income. Based on the findings of this study, a number of recommendations are made for strategies to enhance appropriate restraint use for this age group, as well as for future research.

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.

An Australasian model license reassessment procedure for identifying potentially unsafe drivers

Most licensing jurisdictions in Australia currently employ age-based assessment programs as a means to manage older driver safety, yet available evidence suggests that these programs have no safety benefits. This paper describes a community referral-based model license re assessment procedure for identifying and assessing potentially unsafe drivers. While the model was primarily developed for assessing older driver fitness to drive, it could be applicable to other forms of driver impairment associated with increased crash risk. It includes a three-tier process of assessment, involving the use of validated and relevant assessment instruments. A case is argued that this process is a more systematic, transparent and effective process for managing older driver safety and thus more likely to be widely acceptable to the target community and licensing authorities than age-based practices.