Search

This paper describes changes in driving patterns over a five-year period of drivers aged 75 years and older (Year 1: Male = 68.9%; Age = M = 79.5 years, SD = 3.4 years, Range: 75.0–88.0 years) in the Candrive/Ozcandrive cohort study. Participants completed various functional and health assessments and self-reported driving questionnaires. In-vehicle data-loggers, installed in participants’ own vehicles, also monitored spatio-temporal characteristics of participants’ everyday driving trips. Data for a subset of one hundred and ninety-one Ozcandrive participants from Melbourne, Australia were analysed. Reductions in driving trip distance and frequency were observed over the five years. On average, in Year 1, participants drove 1223 (SD = 502) trips, totalling 8993 (SD = 5169) kilometers annually, decreasing significantly to 1028 trips (SD = 559) trips and 6787 (SD = 4624) kilometers in Year 5. On average, in Year 1, participants’ driving trips were around 7.5 km (SD = 3.2), decreasing in distance significantly to 6.9 km (SD 3.9) in Year 5. Log-normal General Estimating Equation (GEE) modelling was conducted for selected driving exposure measures (annual distance driven, annual trip frequency, trip distance, etc.). Reductions in overall annual distance driven were significantly associated with being female, increasing age, withdrawal from the study for health reasons and lower night-time driving comfort scores (marginally significant). Reductions in annual trip frequency were associated with increasing age and withdrawal from the study for health reasons. Results suggest drivers practiced self-regulation, which may reflect adaption to deterioration in health and functional status.

This study used data from the Australian Naturalistic Driving Study to study driver engagement in secondary tasks during every day driving and examine the role that various driver characteristics and driving context variables play in influencing the initiation of secondary tasks. Video from 186 randomly selected trips were viewed to identify a range of secondary tasks and to classify contextual variables at the point of task initiation (e.g. vehicle motion, weather, and light conditions). Results revealed that secondary task engagement when driving is highly prevalent, with drivers spending ∼45% of their driving time engaging in potentially distracting tasks. The results also showed that drivers make a number of strategic decisions regarding when to engage, such as waiting until the vehicle is stationary; however, they do not appear to consider some contextual factors that may impact risks, such as weather and light conditions. The findings will be useful in targeting distraction countermeasures and policies and determining the effectiveness of these in reducing driver distraction.

Using data from the Australian Naturalistic Driving Study (ANDS), this study examined patterns of secondary task engagement (e.g., mobile phone use, manipulating centre stack controls) during everyday driving trips to determine the type and duration of secondary task engaged in. Safety-related incidents associated with secondary task engagement were also examined. Results revealed that driver engagement in secondary tasks was frequent, with drivers engaging in one or more secondary tasks every 96 seconds, on average. However, drivers were more likely to initiate engagement in secondary tasks when the vehicle was stationary, suggesting that drivers do self-regulate the timing of task engagement to a certain degree. There was also evidence that drivers modified their engagement in a way suggestive of limiting their exposure to risk by engaging in some secondary tasks for shorter periods when the vehicle was moving compared to when it was stationary. Despite this, almost six percent of secondary tasks events were associated with a safety-related incident. The findings will be useful in targeting distraction countermeasures and policies and determining the effectiveness of these in managing driver distraction.

Vision is important for safe driving, but there is limited understanding regarding the impact of vision disorders on driving ability and safety. This systematic review evaluated and summarized evidence on the impact of vision disorders and impairment on motor vehicle crash (MVC) risk and on-road driving performance across seven databases, was prospectively registered with PROSPERO (CRD42020180135), and study quality rated using a standard tool. Forty-eight studies met the inclusion criteria for MVC risk (N = 36), on-road performance (N = 9), and both MVC risk and on-road performance (N = 3). Of these studies, less than half were rated as 'good' quality. Due to the small number of studies and often conflicting findings, it was not possible to draw firm conclusions for most vision disorders. However, evidence from several 'good' and 'fair' quality studies suggested increased MVC risk with binocular visual field impairment. There was mixed evidence regarding the impact of cataract, glaucoma, age-related macular degeneration and homonymous field loss on MVC risk and no evidence of increased MVC risk with mild VA impairment. This review highlights the need for well-designed future studies to further explore the impact of vision disorders and impairment on driving outcomes to inform evidence-based policy and fitness to drive guidelines.

Objective: The aim of this study was to evaluate the consequences of frontal and oblique crashes when positioning a Hybrid III (HIII) 6-year-old child anthropometric test device (ATD) using observed child passenger postures from a naturalistic driving study (NDS). Methods: Five positions for booster-seated children aged 4–7 years were selected, including one reference position according to the FMVSS 213 ATD seating protocol and 4 based on real-world observed child passenger postures from an NDS including 2 user positions with forward tilting torso and 2 that combined both forward and lateral inboard tilting of the torso. Seventeen sled tests were conducted in a mid-sized vehicle body at 64 km/h (European New Car Assessment Programme [Euro NCAP] Offset Deformable Barrier [ODB] pulse), in full frontal and oblique (15°) crash directions. The rear-seated HIII 6-year-old child ATD was restrained on a high-back booster seat. In 10 tests, the booster seat was also attached with a top tether. In the oblique tests, the ATD was positioned on the far side. Three camera views and ATD responses (head, neck, and chest) were analyzed. Results: The shoulder belt slipped off the shoulder in all ATD positions in the oblique test configuration. In full frontal tests, the shoulder belt stayed on the shoulder in 3 out of 9 tests. Head acceleration and neck tension were decreased in the forward leaning positions; however, the total head excursion increased up to 210 mm compared to te reference position, due to belt slip-off and initial forward leaning position. Conclusions: These results suggest that real-world child passenger postures may contribute to shoulder belt slip-off and increased head excursion, thus increasing the risk of head injury. Restraint system development needs to include a wider range of sitting postures that children may choose, in addition to the specified postures of ATDs in seating test protocols, to ensure robust performance across diverse use cases. In addition, these tests revealed that the child ATD is limited in its ability to mimic real-world child passenger postures. There is a need to develop child human body models that may offer greater flexibility for these types of crash evaluations.

Introduction Child occupant safety in motor-vehicle crashes is evaluated using Anthropomorphic Test Devices (ATD) seated in optimal positions. However, child occupants often assume suboptimal positions during real-world driving trips. Head impact to the seat back has been identified as one important injury causation scenario for seat belt restrained, head-injured children ( Bohman et al., 2011 ). There is therefore a need to understand the interaction of children with the Child Restraint System to optimize protection. Method Naturalistic driving studies (NDS) will improve understanding of out-of-position (OOP) trends. To quantify OOP positions, an NDS was conducted. Families used a study vehicle for two weeks during their everyday driving trips. The positions of rear-seated child occupants, representing 22 families, were evaluated. The study vehicle – instrumented with data acquisition systems, including Microsoft Kinect™ V1 – recorded rear seat occupants in 1120 driving 26 trips. Three novel analytical methods were used to analyze data. To assess skeletal tracking accuracy, analysts recorded occurrences where Kinect™ exhibited invalid head recognition among a randomly-selected subset (81 trips). Errors included incorrect target detection (e.g., vehicle headrest) or environmental interference (e.g., sunlight). When head data was present, Kinect™ was correct 41% of the time; two other algorithms – filtering for extreme motion, and background subtraction/head-based depth detection are described in this paper and preliminary results are presented. Accuracy estimates were not possible because of their experimental nature and the difficulty to use a ground truth for this large database. This NDS tested methods to quantify the frequency and magnitude of head positions for rear-seated child occupants utilizing Kinect™ motion-tracking. Results This study's results informed recent ATD sled tests that replicated observed positions (most common and most extreme), and assessed the validity of child occupant protection on these typical CRS uses. Summary Optimal protection in vehicles requires an understanding of how child occupants use the rear seat space. This study explored the feasibility of using Kinect™ to log positions of rear seated child occupants. Initial analysis used the Kinect™ system’s skeleton recognition and two novel analytical algorithms to log head location. Practical applications This research will lead to further analysis leveraging Kinect™ raw data – and other NDS data – to quantify the frequency/magnitude of OOP situations, ATD sled tests that replicate observed positions, and advances in the design and testing of child occupant protection technology.

Objective: Child occupant behavior and head position when travelling in child restraint systems (CRS) may have an effect on injury risk in the event of a motor vehicle crash. The current study aimed to describe the common characteristics and behaviors of child occupants during everyday, real-world motor vehicle travel in a sample of Australian families to identify potential safety implications of observed behaviors and head position within the CRS. Methods: Two instrumented study vehicles were used by 42 families for approximately two weeks. Continuous video and audio data were collected across 1,651 trips (over 600 hours). An online survey provided additional parent, familial and child occupant data. The characteristics and behaviors of 72 child occupants (aged 14 months to 9 years) who travelled in a forward-facing CRS (FFCRS) or a belt-positioning booster seat (BS) were observed and recorded by manual review of a sample of the video/audio recordings. One quarter of all trips (n = 414) was randomly selected for coding/analysis and, within each trip, one child occupant was selected who was travelling in a FFCRS or BS. Child occupant behaviors, head position within the FFCRS or BS, and other relevant information was coded for each trip during nine discrete five second intervals or ‘epochs’ (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip duration). Results: In the majority of epochs (74%), child occupants’ heads were observed to be ‘optimally’ positioned within the FFCRS or BS. For more than half of the epochs, child occupants were observed to be: correctly restrained (58%) and involved in an interaction with another vehicle occupant (59%). Bivariate analyses revealed that children travelling in a FFCRS were significantly more likely to be observed to have optimal head positions than those travelling in a BS (78% vs. 62%), χ2 (1) = 86.00, p < 0.001. Child occupants who were observed to be ‘correctly’ restrained were significantly more likely to be observed to have optimal head positions than those who were observed to be ‘incorrectly’ restrained (80% vs. 20%), χ2 (1) = 10.33, p < 0.01. Conclusions: This is the first naturalistic driving study (NDS) to specifically explore the factors associated with child occupants’ head position when travelling in a CRS. Findings from the current study can be used to inform the positioning of anthropometric test dummies (ATD) in CRS testing, guide improvements to CRS/vehicle design, and develop targeted educational strategies to improve child occupant safety.

Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field‐related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n = 194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self‐referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority's Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.

Developing tools that accurately detect at-risk driving behaviors is a public-health priority. There is a need for a measure that accurately assesses older drivers’ level of competence on familiar roadways. The objective of this presentation is to describe the development of the procedures and scoring of a new approach, the Electronic Driving Observation Schedule (eDOS), to observe everyday driving in the community. The eDOS was used to record and compare the driving environment and performance of older drivers and low-risk younger drivers during their everyday driving. Older (n=160, >74y) and younger (n=60, 35-64y) drivers completed a 20-30-minute drive from their home to destinations of their choice. Older drivers drove on simpler routes with fewer intersections and lane changes. Both groups made few driving errors, which were mostly low-risk. Younger drivers tended to demonstrate poor driving habits (not signaling, speeding, poor lane position) and compliance with road rules. Part of a symposium sponsored by Transportation and Aging Interest Group.

The incorrect use of child car seats is common, with significant negative effects on crash protection for child passengers. There is currently little evidence for effective, practical countermeasures for incorrect use. The provision of clear and comprehensible materials on correct use supplied with restraints at the point of sale could be highly cost-effective and achieve similar benefits to restraint-fitting services or hands-on training; however, routinely supplied instructions in their current form are frequently difficult to understand. We are conducting a randomised controlled trial of the consumer-driven redesign of instructional materials, consisting of an instruction sheet, swing tags and online training videos. This paper presents the protocol that will be used in an innovate process evaluation that will use the primary outcome of overall serious misuse assessed at six months, together with a survey and semi-structured interviews to determine fidelity, dose and outcomes for all intervention participants. The study will assess intervention delivery and external factors that may impact the effectiveness of the intervention, including experience, health literacy, confidence and attitudes. When it has been conducted, this process evaluation will provide enhanced understanding of the mechanisms through which the intervention works or not, aspects of the implementation process key to success of the intervention and insight into how external factors influence the success of the intervention.

Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population.The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk.We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence.Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke.The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.

Objective: To characterise on-road driving performance in individuals with traumatic brain injury who fail on-road driving assessment, compared with both those who pass assessment and healthy controls, and the injury and cognitive factors associated with driving performance. Study design: Cross-sectional. Methods: Forty eight participants with traumatic brain injury (Age M = 40.50 SD = 14.62, 77% male, post-traumatic amnesia days M = 28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures. Results: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills. Conclusions: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs.Implications for rehabilitationClinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries.Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres.Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury.Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury. Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries. Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres. Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury. Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.

Motor vehicle crashes are a major cause of death and injury to children worldwide. Although risk of injury to child passengers can be reduced by using a child restraint, most restraints are incorrectly used. This greatly reduces the restraints’ protective potential; however there is limited research on drivers of correct child restraint use. The aim of this study was to explore perceived barriers and motivators of correct child restraint use in experienced child restraint users, to inform interventions to promote correct use. Motivations and risk perceptions concerning incorrect child restraint use among high and low socioeconomic populations and culturally and linguistically diverse (CALD) child restraint users in Sydney, Australia were qualitatively examined. Six focus groups (N = 44 participants) were facilitated using a semi-structured discussion guide. Transcriptions were deductively analysed using QSR NVivo11 software and the COM-B model of behaviour. Common perceived barriers to correct restraint use were: (a) difficulty interpreting instructions and labels, particularly among CALD participants; (b) remembering and attending to correct use information; (c) lack of information and behavioural feedback on how to correctly install and use a child restraint; and (d) low confidence in ability to install and use a child restraint correctly. The results indicate current child restraint product information is poorly understood, particularly among those whose first language is not English. Interventions to increase correct child restraint use should address access to correct use information, capability to understand and use these, and the influence of motivation, memory and attention in the process.

As people age into older adulthood, they are more likely to experience events that impact their driving, such as age-related cognitive and functional declines, serious illness, or disability. The ability to demonstrate resilience following such adversity may influence one’s decisions and feelings about driving. This study investigated whether resilience of older drivers changes over time, and if relationships between resilience, gender, and self-reported driving-related abilities, perceptions and practices remain stable or change. Participants were from the Candrive/Ozcandrive study, a prospective cohort study of older drivers from Canada, Australia and New Zealand. Analyses are presented from a subset of Ozcandrive participants (n=125) from Australia who completed a resilience scale at two time points approximately five years apart, as well as measures of driving comfort during the day and night, perceived driving abilities, and driving frequency. Participants were primarily male (67.2%) with a mean age of 81.6 years (SD=3.3, Range=76.0-90.0) at Time 1. Resilience increased significantly from Time 1 to Time 2 (Median=82.0/84.00, z=-2.9, p

This paper describes the development and evaluation of an on-road procedure, the Driving Observation Schedule (DOS), for monitoring individual driving behavior. DOS was developed for use in the Candrive/Ozcandrive five-year prospective study of older drivers. Key features included observations in drivers’ own vehicles, in familiar environments chosen by the driver, with start/end points at their own homes. Participants were 33 drivers aged 75+ years, who drove their selected route with observations recorded during intersection negotiation, lane-changing, merging, low speed maneuvers and maneuver-free driving. Driving behaviors were scored by a specialist occupational therapy driving assessor and another trained observer. Drivers also completed a post-drive survey about the acceptability of DOS. Vehicle position, speed, distance and specific roadways traveled were recorded by an in-vehicle device installed in the participant's vehicle; this device was also used to monitor participants’ driving over several months, allowing comparison of DOS trips with their everyday driving. Inter-rater reliability and DOS feasibility, acceptability and ecological validity are reported here. On average, drivers completed the DOS trip in 30.48 min (SD = 7.99). Inter-rater reliability measures indicated strong agreement between the trained and the expert observers: intra-class correlations (ICC) = 0.905, CI 95% 0.747–0.965, p < 0.0001; Pearson product correlation, r (18) = .83, p < 0.05. Standard error of the measurement (SEM), method error (ME) and coefficient of variation (CV) measures were consistently small (3.0, 2.9 & 3.3%, respectively). Most participants reported being ‘completely at ease’ (82%) with the driving task and ‘highly familiar with the route’ (97%). Vehicle data showed that DOS trips were similar to participants’ everyday driving trips in roads used, roadway speed limits, drivers’ average speed and speed limit compliance. In summary, preliminary findings suggest that DOS can be scored reliably, is of feasible duration, is acceptable to drivers and representative of everyday driving. Pending further research with a larger sample and other observers, DOS holds promise as a means of quantifying and monitoring changes in older drivers’ performance in environments typical of their everyday driving.

INTRODUCTION: Appropriate self-regulation of driving - that is, adjusting one's driving patterns by driving less or avoiding specific situations considered challenging - shows promise as a strategy for extending safe driving. However, results on the extent of self-regulatory practices among older drivers vary considerably across studies. METHOD: The purpose of this study was to develop and test a questionnaire to measure self-regulation at multiple levels of driver performance and decision making, using a sample of older drivers comprised of individuals with clinically-determined functional impairments, as well as older adults recruited from the general population. RESULTS: Results suggest that the questionnaire is a user-friendly instrument for gathering information from older adults about their self-regulatory practices which has good construct validity. Feedback on the questionnaire was positive. Construct validity of the questionnaire was assessed by comparing the recruitment populations along various dimensions on which they might be expected to differ (e.g., self-rated health and functioning, abilities for safe driving, and feelings of driving comfort/safety) and looking for correlations between variables that one would reasonably expect to be correlated. CONCLUSIONS: Overall, participants rated their general health and functioning, and abilities for safe driving quite highly. However, participants from the clinic population rated themselves lower than participants from the general population on several abilities including seeing clearly during the day and night, remembering things, and processing information. While participants reported high levels of driving comfort and safety for most driving situations, the clinic population reported lower levels of comfort and safety for every driving circumstance except driving alone. High correlations were found between comfort and safety and the absolute mean scores were nearly identical for each driving circumstance. Finally, the clinic population was more likely to report trying to avoid driving at night, in unfamiliar areas, and on the expressway, as well as chatting with passengers. IMPACT ON THE INDUSTRY: Results of this pilot work provide insights into the self-regulatory driving process that could eventually inform efforts to extend safe mobility among older adults. Language: en

This study sought to investigate the impact of external cue validity on simulated driving performance in 19 Parkinson's disease (PD) patients and 19 healthy age-matched controls. Braking points and distance between deceleration point and braking point were analysed for red traffic signals preceded either by Valid Cues (correctly predicting signal), Invalid Cues (incorrectly predicting signal), and No Cues. Results showed that PD drivers braked significantly later and travelled significantly further between deceleration and braking points compared with controls for Invalid and No-Cue conditions. No significant group differences were observed for driving performance in response to Valid Cues. The benefit of Valid Cues relative to Invalid Cues and No Cues was significantly greater for PD drivers compared with controls. Trail Making Test (B-A) scores correlated with driving performance for PDs only. These results highlight the importance of external cues and higher cognitive functioning for driving performance in mild to moderate PD.

This study aimed to investigate whether older drivers’ driving patterns during an on-road driving task (eDOS) were representative of their real-world driving patterns. Two hundred and eight Ozcandrive participants (Male: 68.80%; Mean age: 81.52 years, SD = 3.37, Range: 76.00 – 96.00 years) completed an on-road driving task which was conducted in their vehicles and the driving route was on roads familiar to/chosen by them. Participants’ real-world driving patterns for a four-month period were collected via an in-car recording device. Participants drove for an average of 4.41km (IQR = 2.83–6.35 km) during their on-road driving task. The on-road driving task driving patterns of 122 participants (59%) fell within the 25th and 75th percentiles, and were therefore representative of real-world driving trips in terms of distance driven. These findings suggest that most older drivers are able to devise an on-road driving route that is representative of their real-world driving.

Objective: We aimed to (a) describe the development and application of an automated approach for processing in-vehicle speech data from a naturalistic driving study (NDS), (b) examine the influence of child passenger presence on driving performance, and (c) model this relationship using in-vehicle speech data. Background: Parent drivers frequently engage in child-related secondary behaviors, but the impact on driving performance is unknown. Applying automated speech-processing techniques to NDS audio data would facilitate the analysis of in-vehicle driver–child interactions and their influence on driving performance. Method: Speech activity detection and speaker diarization algorithms were applied to audio data from a Melbourne-based NDS involving 42 families. Multilevel models were developed to evaluate the effect of speech activity and the presence of child passengers on driving performance. Results: Speech activity was significantly associated with velocity and steering angle variability. Child passenger presence alone was not associated with changes in driving performance. However, speech activity in the presence of two child passengers was associated with the most variability in driving performance. Conclusion: The effects of in-vehicle speech on driving performance in the presence of child passengers appear to be heterogeneous, and multiple factors may need to be considered in evaluating their impact. This goal can potentially be achieved within large-scale NDS through the automated processing of observational data, including speech. Application: Speech-processing algorithms enable new perspectives on driving performance to be gained from existing NDS data, and variables that were once labor-intensive to process can be readily utilized in future research.

PURPOSE OF THE STUDY: The Decisional Balance Scale (DBS) was developed to assess older adults' attitudes related to driving and includes both intrapersonal and interpersonal motivations for driving. This study examined the psychometric properties of the DBS ratings across 3 time points in a sample of 928 older drivers who participated in the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive). DESIGN AND METHODS: Measurement invariance of the DBS was assessed longitudinally and across gender. RESULTS: Confirmatory factor analyses revealed that a two-factor model (positive and negative attitudes) for both driving beliefs related to the self and other provided a good fit to the data at each time point. Measurement invariance was supported across time and gender. Significant associations between the DBS factor scores and other driving measures (e.g., perceived driving ability and self-regulatory driving practices) provided evidence of convergent validity. IMPLICATIONS: The DBS appears to be a robust instrument for measuring attitudes toward driving and is recommended for continued use in future research on driving behaviors with older adults. Language: en

Background : Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. Aim: To systematically evaluate the quality of selected national guidelines about driving with medical illness. Design: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. Methods: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57–0.79). Conclusions: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.

For some time now, it has been recognised that a major shift is occurring in the population age distributions of most motorised countries resulting in a growing number of older persons with an increasing need for mobility. It is expected that the mobility of older persons will become even more reliant on the motor vehicle as European countries in particular undergo transitions towards decentralisation and suburbanisation and because of the well-established longevity factor. This study compares injury outcomes in passenger car crashes for belted occupants of different ages. The study considers drivers and front seat passengers. National accident data in the UK show that whilst older car occupants are less likely to be involved in a car accident than younger occupants, in the event of a crash, older occupants are more likely to be killed or to sustain serious injury. This, in conjunction with the increasing numbers of older licence holder and car users implies that the protection of the inherently frail elderly should become a priority for the future. Analysis of the UK in-depth accident data revealed that the older car occupants were significantly more prone to serious chest injury than their younger counterparts and that these injuries were predominantly due to forces exerted by the restraint system, particularly in frontal impacts. Since by the year 2030 one in four persons will be aged over 65 in most Organisation for Economic Cooperation and Development (OECD) countries, the results suggest a need for intervention through vehicle design including in-vehicle crashworthiness systems that take into account the reduced tolerance to impact that occurs with ageing.

Older drivers are frequently viewed as overly represented in crashes, particularly when crash involvement per distance travelled is considered. This perception has led to a call for tighter licensing conditions for older drivers, a policy which inevitably results in mobility restrictions for at least some drivers. However there is a growing body of research evidence which shows that as a group, older drivers represent no greater road risk than drivers from other age groups once different levels of driving activity are taken into account. This paper has examined aspects of older drivers' fitness to drive based on survey data and off-road and on-road driving performance from a sample of 905 New Zealand older drivers. The results show that policies which target all older drivers and lead to licensing and mobility restrictions cannot be justified from a safety basis.

Hypertension and lipid disorders in type II diabetes contribute to increased coronary risk, but optimal drug therapy has not been defined. We investigated primary care physicians choices of antihypertensive and lipid-lowering therapy for subjects with type II diabetes diagnosed with hypertension. Subjects were registered with 105 UK general practices in the General Practice Research Database and prescribed oral hypoglycaemic drugs for the first time between January 1993 and December 2001. We evaluated prescriptions for antihypertensive drugs in subjects with secondary diagnoses of hypertension in the first year following initiation of oral hypoglycaemic therapy. Data were analysed for 4519 diabetic subjects with diagnosed hypertension. Between 1993 and 2001, the proportion prescribed thiazide diuretics increased from 20 to 30%; angiotensin-converting enzyme (ACE) inhibitors from 35 to 45% and angiotensin receptor blockers from 0 to 8%. The proportion of subjects prescribed lipid-lowering therapy increased from 8% in 1993 to 33% in 2001, with the proportion prescribed statins increasing from 1 to 30%. At different general practices, the proportion prescribed thiazide diuretics ranged from 0 to 52%, beta-blockers from 5 to 60%, ACE inhibitors from 15 to 81%, and statins from 0 to 50%. Variation between practices was not explained by adjusting for age, sex, prevalent coronary heart disease or study year. Trends in drug utilisation were consistent with the evolving evidence base but there were wide variations in drug utilisation between practices. A more consistent approach to drug selection might be associated with improved patient outcomes.

This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17–39 years (young drivers); 515 were 40–64 years (middle-aged), and 137 aged 65–84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p

This paper describes changes in driving patterns for a cohort of older Australians. In-vehicle data-loggers installed in participants’ own vehicles monitored spatio-temporal characteristics of driving trips across three years for 164 participants aged 75+ years (Year 1: Male = 68.9%; Mean Age = 79.5 years, SD = 3.4 years, Range = 75 - 88 years). The majority (60–65%) of trips were within 5km from home across the three years. On average, in Year 1, participants drove 1,276 trips (SD = 479), totalling 9,468km (SD = 5,215) annually, decreasing significnatly to 1,175 trips (SD = 541) and 8,253km (SD = 4,813) annually in Year 3. Generalised Estimating Equations revealed that reduced driving (annual distance, trip frequency, night-time trips, peak-traffic trips) were associated with: increased age, being female, reduced cognitive function, poorer contrast sensitivity, and those that discontinued driving for health reasons. Results are considered in terms of implications for safe mobility.

Objective: This pilot study aimed to investigate physiological responses during an on-road driving task for older and younger drivers.Methods: Five older drivers (Mean age = 74.60 years [2.97]) and five younger drivers (Mean age = 30.00 years [3.08]) completed a series of cognitive assessments (Montreal Cognitive Assessment [MoCA], Mini Mental Status Examination [MMSE]; Trail Making Test [Trails A and Trails B]) and an on-road driving task along a pre-determined, standardized urban route in their own vehicle. Driving performance was observed and scored by a single trained observer using a standardized procedure, where driving behaviors (appropriate and inappropriate) were scored for intersection negotiation, lane changing and merging. During the on-road driving task, participants’ HR was monitored with an unobtrusive physiological monitor.Results: Younger drivers performed significantly better on all cognitive assessments compared to older drivers (MoCA: t(8) = 3.882, p < 0.01; MMSE: t(8) = 2.954, p < 0.05; Trails A: t(8) = -2.499, p < 0.05; Trails B: t(8) = - 3.262, p < 0.05). Analyses of participants’ performance during the on-road driving task revealed a high level of appropriate overall driving behavior (M = 87%, SD = 7.62, Range = 73-95%), including intersection negotiation (M = 89%, SD = 8.37%), lane changing (M = 100%), and merging (M = 53%, SD = 28.28%). The overall proportion of appropriate driving behavior did not significantly differ across age groups (Younger drivers: M = 87.6%, SD = 9.04; Older drivers: M = 87.0%, SD = 6.96; t(8) = .118, p = 0.91).Conclusions: Although older drivers scored lower than younger drivers on the cognitive assessments, there was no indication of ‘cognitive overload’ among older drivers based on HR response to the on-road driving task. The results provide preliminary evidence that mild age-related cognitive impairment may not pose a motor vehicle crash hazard for the wider older driver population. To maintain safe mobility of the aging population, further research into the specific crash risk factors in the older driver population is warranted.

Some older drivers experience difficulties wayfinding whilst driving in unfamiliar areas. A navigation system (GPS) may be an effective strategy to help improve older adults’ driving performance whilst wayfinding, however little is known about the use or potential safety and mobility benefits/disadvantages of these technologies by older drivers. This paper examined older Australian drivers’ attitudes about potential acceptability (before use) and acceptance (following use) of navigation systems, and whether these attitudes affected intention to use. Two complementary studies were conducted; (i) a survey of 434 older adults who had not previously used navigation systems; and (ii) a pre-post study of usability and acceptance of a contemporary navigation system among a convenience sample of 20 older adults with limited or no previous experience with navigation systems. Drivers who reported wayfinding difficulties were more likely to report willingness to use a navigation system in the future, while other demographic characteristics, such as age, gender and educational level were not predictive. Some drivers indicated that they were satisfied with their current wayfinding methods and did not see a need to use navigation systems. Other barriers to acceptability and acceptance included concerns about how well a navigation system would perform and whether it would be distracting. In contrast, concerns about usability and learnability were less important for acceptance.

Background Correct use of an age-appropriate restraint reduces the risk of death and injury among child passengers. While rates of age-appropriate restraint continue to rise in most developed countries, misuse of restraints remains a significant problem. Measures that target the individual are effective in reducing misuse. Carers identify instructions supplied by manufacturers as a common source of information yet there is no evidence base for developing effective instructions for targeting misuse. We aim to develop enhanced product information for child restraints through expert consensus supplemented by consumer input and testing. Methods A modified consensus method will be used. The consensus panel consists of experts in child safety and health literacy and industry professionals. A report synthesising health literacy, and human factors design principles combined with qualitative results from consumer focus groups will be used to construct a prototype of product information ( Round 1 ). This prototype will be sent to panel members for review and results are synthesised ( Round 2 ). The results are redistributed and panel members re-rank preferences in light of results ( Round 3 ). Round three is repeated until consensus is reached, at which stage the prototype is finalised and tested using consumer installation and comprehension trials ( Consumer input ). Consumer feedback will inform the next consensus cycle. Results The final enhanced product information will be presented at the conference with an evaluation of the modified consensus method in developing safety information for preventing misuse. Conclusions Child restraint product information is perhaps the most widely used and underutilised channel of communication for the correct use of child restraints. Product information that is developed using a consensus method involving consumers, child safety experts and industry professionals will ensure that the information is targeted and effective at preventing misuse.

The Candrive II/Ozcandrive study, a multicentre prospective cohort study examining the predictive validity of tools for assessing fitness to drive, aims to develop an in-office screening tool that will help clinicians identify older drivers who may be unsafe to drive. This paper describes the study protocol. We are following a cohort of drivers aged ≥70 years for up to 4 years. Starting in 2009, 928 participants have been recruited in seven cities in four Canadian provinces, as well as 302 participants in two sites in Melbourne, Australia and Wellington, New Zealand. Participants underwent a comprehensive assessment at baseline and repeat the assessment yearly thereafter, as well as a brief follow-up assessment at 4 and 8 months each year. A recording device is installed in participants' vehicles to assess driving patterns, and driving records are obtained from licensing authorities to determine the outcomes: at-fault crashes per kilometre driven and violations. To date, the protocol has been generally well adhered to, with 1230 participants, and barriers and challenges are being addressed, as necessary. The Candrive II/Ozcandrive study is unique owing to its size, duration, partnerships with Canadian, Australian and New Zealand stakeholders, and international research collaboration.

Previous research has found that only older drivers with low annual driving mileages had a heightened crash risk relative to other age groups. These drivers tend to drive mainly in urban areas, where the prevalence of complex traffic situations increases crash risk. However it might also be that some drivers may have reduced their driving due to perceived or actual declines in driving fitness. This paper uses Canadian and Australian data from the Candrive/Ozcandrive older driver study to investigate the association between annual driving distances and a set of driving-related factors, including fitness to drive. All drivers in the Candrive/Ozcandrive older driver cohort study were allocated to one of three groups according to their self-reported annual driving distances:5001km;5000 and15,000km; and 15,000km or greater. Relationships between these driving-distance categories and: (a) self-reported crash data; (b) various Year 1 'fitness to drive' performance measures; and (c) self-perceptions of driving ability and of comfort while driving, were determined. Results confirmed the previously reported association between low mileage and heightened crash risk. Further, low mileage drivers performed relatively poorly on a wide range of performance measures, perceived their own driving ability as lower, and reported lower comfort levels when driving in challenging situations, compared to the higher mileage drivers. In most instances, these differences were statistically significant. The paper provides further evidence that the so-called 'older driver problem' is most pertinent to low mileage drivers, and that this is due in part to low mileage drivers tending to have reduced fitness to drive. This higher risk group represented a fairly small proportion of the sample in this study.

INTRODUCTION: Internal driver events such as emotional arousal do not consistently elicit observable behaviors. However, heart rate (HR) offers promise as a surrogate measure for predicting these states in drivers. Imaging photoplethysmography (IPPG) can measure HR from face video recorded in static, indoor settings, but has yet to be examined in an in-vehicle driving environment. METHODS: Participants (N=10) completed an on-road driving task whilst wearing a commercial, chest-strap style heart rate monitor ("baseline"). IPPG was applied to driver face video to estimate HR and the two measures of HR were compared. RESULTS: For 4 of 10 participants, IPPG produced a valid HR signal (±5BPM of baseline) between 48 and 75% of trip duration. For the remaining participants, IPPG accuracy was poor (CONCLUSIONS: In-vehicle IPPG is achievable, but significant challenges remain. PRACTICAL APPLICATIONS: The relationship between IPPG accuracy and various confounding factors was quantified for future refinement. Language: en

This article reviews recent scientific literature relating to vehicle design and the safety of older road users. The review describes the protection offered by recent technologies and features as well as future vehicle design recommendations. Recent research has identified that many older people are not well informed about vehicle safety issues and do not consider safety as a high priority when purchasing vehicles. Crash statistics suggest that older drivers are not involved in a large number of crashes, but when figures are adjusted for their shorter travel distances, it is clear that they are over-represented in serious injury and fatal crashes compared with younger drivers. Much of this risk can be attributed to their vulnerability or lower injury tolerance once involved in a crash. Compared with younger occupants, older vehicle occupants who sustain injuries, particularly to the chest, are likely to experience more serious consequences and require longer recovery times. The review highlights the need for better vehicle safety design to protect older occupants and better promotion of the benefits of vehicle safety amongst older road users.

Licensing requirements in Australasia vary across jurisdictions with little evidence of any safety benefit for any existing procedure. In 1998, Austroads (a collaboration of State Traffic Authorities in Australia and New Zealand) commissioned the Monash University Accident Research Centre to develop and trial a model licence re-assessment program for older drivers in Australasia. The procedure was developed in 1999 and involved input from a number of key experts in Australia and New Zealand. A pilot study was undertaken in Tasmania early in 2000 to evaluate the procedural aspects of the model. A study of four off-road screening tests also commenced in 2001 to validate these instruments against a range of driving performance measures. This paper reports preliminary findings from these studies. For the covering abstract see ITRD E113119.

This study involved a survey of self-regulatory driving practices of 656 drivers aged 55 years and older. Types and prevalence of self-regulatory behaviours were described and several key characteristics of self-regulators were identified. Those who drove less than 100 kilometres per week were more likely to be female, 75+ years, retired, with arthritis, good/fair/poor ratings for decision-making, not the principal driver and not married. Those who avoided specific driving situations were also more likely to be female, 75+ years and not the principal driver. Avoidance was also associated with vision problems, lower confidence in driving situations and crash-involvement. Implications for promotion of safe driving practices are discussed.

Anxiety and traumatic stress symptoms are common post-crash. This study documents generalised anxiety responses post-crash, and examines the association between Acute Stress Disorder and Post-Traumatic Stress Disorder (PTSD) with personality and coping styles. Sixty-two patients aged 18–60 admitted to hospital were interviewed prior to discharge, at 2-months and at 6–8 months post-crash. Anxiety symptoms were common, with 55% of participants experiencing moderate-severe levels prior to discharge, with this decreasing to 11% and 6.5% at 2-months and 6–8 months post-discharge. Females reported significantly higher levels of anxiety and acute distress. Neuroticism and generalised coping styles were associated with acute stress responses but not PTSD. These results have important theoretical and practical implications, and indicate that females are at risk of poorer acute anxiety outcomes following injury.