Older Drivers Reduced Engagement in Distracting Behaviors Over a Six-Year Period: Findings From the Candrive Longitudinal Study.

OBJECTIVES: Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. METHODS: We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g., listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. RESULTS: Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95-0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94-0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03-1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04-1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08-1.19). DISCUSSION: Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation.

Development and Initial Validation of the Transportation Support Scale.

IMPORTANCE: Driving cessation affects older drivers and, possibly, also care partners (most of whom tend to be women). Although tools exist to assess the effects on family and friends of providing informal care to someone who needs assistance, no tool is available to clinicians that specifically focuses on the effects of driving cessation. OBJECTIVE: To develop the Transportation Support Scale (TSS) to measure care partners' responses-both negative and positive-to driving cessation and assuming transportation responsibilities. DESIGN: We developed a list of 98 items to capture the impact on care partners of providing transportation to older adults who have stopped driving. In Phase 1, we pretested the items qualitatively with a small sample of care partners. In Phase 2, we reduced the number of items and examined several psychometric properties of the TSS with a larger sample. SETTING: Community. PARTICIPANTS: Two convenience samples of care partners who provide transportation (Phase 1, n = 11; Phase 2, n = 66). RESULTS: The initial pool of items was reduced from 98 to 22. The final TSS has an internal consistency of .88 (Cronbach's α). Thirty-five percent of care partners' scores fell above the middle possible score; these care partners were likely experiencing a high negative impact related to providing transportation after driving cessation. CONCLUSIONS AND RELEVANCE: The TSS demonstrated adequate preliminary psychometric properties. We need additional research to further evaluate the psychometric properties of the TSS (e.g., test-retest reliability). A fully validated TSS may be useful to clinicians and researchers. What This Article Adds: The TSS has the potential to help clarify the perspective of care partners as well as inform the development and evaluation of services for care partners who are providing transportation to former drivers.

The association between diabetes and safe driving: A systematic search and review of the literature and cross-reference with the current guidelines.

AIMS: We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes. METHODS: The first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross-referenced with the results of the systematic search and review. RESULTS: The systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as 'high', two as 'medium' and 36 as 'low'. Studies with ratings of 'high' or 'medium' were extracted, revealing a body of inconsistent methods and findings. These results, cross-referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations. CONCLUSIONS: The results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence-based guidelines.

Personality Is Associated with Driving Avoidance in the Canadian Longitudinal Study on Aging (CLSA).

As individuals age and become aware of changes in their driving capabilities, they are more likely to self-regulate their driving by avoiding certain driving situations (i.e., night driving, rush hour traffic, etc.). In this paper, we sought to examine the correlates of situational driving avoidance with a particular emphasis on the roles of personality traits, gender, and cognition within a large sample of mid-life and older adults from the Canadian Longitudinal Study on Aging (CLSA). Our findings show that women of older ages tend to report more driving avoidance and that personality traits, specifically extraversion, emotional stability, and openness to experience, may reduce driving avoidance. A negative association was also found between cognition and driving avoidance, such that individuals with higher cognition reported less driving avoidance.

The Association between Psychological Resilience and Driving Behavior among Older Drivers in Australia.

This study compared a sample of Australian drivers aged 77 years and older to participants from an older driver longitudinal cohort study (Ozcandrive) and examined the relationship between resilience and self-reported driving measures within these samples. Using a survey with a subset of questions from Ozcandrive, data were collected from 237 older drivers throughout Australia. The two samples were analyzed for differences in demographics, health, resilience, and self-reported driving behavior. A series of multiple regression models were fit for each driving outcome measure for both samples. The two samples had both similarities and differences, with the largest difference observed for resilience. Strong and consistent associations were found between resilience and driving comfort, abilities, and frequency for the Australian sample. Across samples, resilience remained a significant variable in seven of 10 regression models, more than any other independent variable.

Candrive-Development of a Risk Stratification Tool for Older Drivers.

BACKGROUND: Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. METHODS: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. RESULTS: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81-9.84) compared to the lowest risk group. CONCLUSIONS: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Distraction impairs drivers of all ages: A cross-sectional analysis of fatal crashes in the United States.

Objective: The objective of this study was to examine the association between distracted driving and crash responsibility across the whole age span after adjusting for several driver characteristics and the potential influence of alcohol and drugs.Methods: Using data from the Fatality Analysis Reporting System for the years 2010 to 2019, we estimated the association between distracted driving and crash responsibility in drivers (of passenger-type vehicles) aged 20 and older, with a confirmed blood alcohol concentration of zero, and who tested negative for drugs (n = 33,513). We operationalized crash responsibility as having one or more unsafe driving action (UDA) recorded.Results: In total, slightly under 9% of the drivers examined were coded as distracted. The most common UDA among distracted drivers was a failure to yield right of way (23.4% vs. 14.2% for non-distracted drivers). Driving distracted was associated with higher odds of an UDA for drivers of all ages (overall OR = 1.46, 95% CI = 1.24, 1.73).Conclusions: Distracted driving affects drivers of all ages. Given that distracted driving is highly preventable, we must increase our prevention efforts.

Examining the contribution of psychological resilience on self-reported and naturalistic driving behavior of older adults.

INTRODUCTION: This study examined the contribution of psychological resilience on self-reported driving comfort, abilities, and restrictions, and on naturalistic driving (ND) behavior of older adults at two time points, five years apart (N = 111; Male: 65.8%, Mean age = 86.1 years). METHOD: Participants from the Ozcandrive older driver cohort study completed a demographic questionnaire, functional assessments, psychosocial driving questionnaires, and a resilience scale. Participants' vehicles were equipped with a recording device to monitor driving behavior throughout the study. Over 1.7 million kilometers of ND data were analyzed. RESULTS: There was a significant increase in resilience over time, and both self-reported and ND measures revealed reduced driving across five years. Hierarchical regression analyses using age, sex, driving exposure, functional measures, and resilience showed that adding resilience into the models at the final step resulted in statistically significant increases in the amount of variance explained for driving comfort during the day and night, perceived driving abilities, number of trips, trip distance, and proportion of night trips. CONCLUSIONS: This research leveraged the longitudinal nature of the Ozcandrive study to provide the first insights into the role of resilience and ND. The observed patterns of reduced driving, captured by both subjective and objective measures, are suggestive of increased levels of self-regulation. As resilience is associated with adaptive coping skills, older adults with higher resilience may be able to more effectively engage in appropriate coping behaviors with regard to driving behavior, safety, and mobility. PRACTICAL APPLICATIONS: Effective methods of increasing resilience in the context of driving is worthy of future research as it will provide valuable information about how older drivers navigate the process of aging as it relates to driving and may assist stakeholders in developing suitable measures to support older driver safety.

Perceived Community Age-friendliness is Associated With Quality of Life Among Older Adults.

We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77-96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendliness (Age-Friendly Survey [AFS]), and quality of life (WHO Quality of Life). Hierarchical regression models including age, gender, driving status, finances, health, social participation, and AFS scores explained 8 to 21 per cent of the variance in quality of life scores. Community age-friendliness was a statistically significant variable in all models, accounting for three to six and a half per cent of additional variance in quality of life scores. Although the proportion of variance explained by age-friendliness was small, our findings suggest that it is worthwhile to further investigate whether focused, age-friendly policies, interventions, and communities could play a role towards successful and healthy aging.

The efficacy of mindfulness-based cognitive therapy to improve depression symptoms and quality of life in individuals with memory difficulties and caregivers: A short report.

INTRODUCTION: Depression symptoms are common for older adults with memory difficulties and their caregivers. Mindfulness-based cognitive therapy (MBCT) reduces the risk of relapse in recurrent depression and improves depression symptoms. We explored recruitment and retention success and preliminary effect sizes of MBCT on depression and anxiety symptoms, as well as mindfulness facets, in individuals with memory difficulties and their caregivers. METHODS: A difficulty with memory group (DG) and caregiver group (CG) were randomized into either the MBCT intervention or waitlist control. After serving as controls, participants received the intervention. Mean pre-post changes by group were compared and effect sizes computed. Correlations between mindfulness facets and depression symptoms are also presented. RESULTS: Only 47% of the initial participants completed the study. The intervention did not have an effect on the outcome variables examined. However, improvements in non-judgmental scores were associated with reductions in the number of depression symptoms reported by DG participants (r = -0.90, 95% confidence interval [CI]: -0.98, -0.52) and CG participants (r = -0.76, 95% CI: -0.95, -0.19). Furthermore, improvements in awareness scores (r = -0.69, 95% CI: -0.93, -0.05) and level of burden (r = 0.87, 95% CI: 0.49, 0.97) also significantly correlated with reduced depression symptoms in the CG group. CONCLUSIONS: By determining preliminary MBCT effect sizes in individuals with memory difficulties and their caregivers, research with larger, controlled samples is now justified to determine the true effects of MBCT in these populations.

Women's Spiritual Intelligence is Associated With Fewer Depression Symptoms: Exploratory Results From a Canadian Sample.

While some evidence suggests a relationship between spiritual intelligence and depression, overall, research has yielded inconclusive results. We set out to expand the literature by further exploring this relationship in a Canadian sample. We also aimed to investigate the moderating effect of gender, shedding additional light on an interaction mostly overlooked in the current research. A clinical sample of 39 participants (66.7% female) completed measures of SI and depression before receiving treatment for depression in an outpatient mental health clinic. Results indicated that overall, there was a negative relationship between SI and depression symptoms (r(39) = - 0.55, p < .001); our findings illustrate that this beneficial relationship was driven by women. Future research of interventions aimed at improving spirituality as a means of reducing depression symptoms is warranted.

Adolescent exposure to cannabis marketing following recreational cannabis legalization in Canada: A pilot study using ecological momentary assessment.

OBJECTIVE: The goal of this pilot study was to assess the feasibility of a 9-day, smartphone-based ecological momentary assessment (EMA) protocol for tracking the frequency of Canadian adolescents' exposures to cannabis marketing, their reactions to such exposures, and the context in which exposures occur in the real-world and in real-time. METHOD: Participants were n = 18 adolescents between the ages of 14 and 18 years of age. They used an EMA application to capture and describe cannabis marketing exposures through photographs and brief questionnaires assessing marketing channel and context. Participants also rated their reactions to each exposure in real-time. RESULTS: Results showed that participants were generally compliant with the protocol. Participants recorded 40 total exposures to cannabis marketing, representing an average of 2.2 (SD 2.3) exposures per participant during the 9-day study. Exposures tended to occur in the afternoon (45.0%) or evening (37.5%), and while participants were at home (70%) and alone (52.5%). Most exposures occurred through promotion by public figures (27.5%) or explicitly marked internet ads (27.5%). CONCLUSION: This is the first study to demonstrate the feasibility and utility of EMA to capture adolescent exposures to cannabis marketing as it occurs in participants' natural environments. Our research offers an early look at the predictable wave of cannabis advertising targeting youth and a promising approach for studying its impacts in a post-legalization context, as well as a strategy for assessing policies, such as advertising restrictions, intending to mitigate the harms of early cannabis use among youth.

Canadian Older Adults' Perceptions of Transitioning from Driver to Non-Driver.

Ceasing driving is associated with many negative outcomes. We examined the perceived impact of driving cessation among current older drivers. Transcripts from 92 interviews with participants from several locations across Canada were analyzed using inductive thematic analysis. We identified five themes: planning for mobility change, mobility supports and neighborhoods, financial security, fearing loss of control and independence, and coping and acceptance as a part of aging. Findings highlight diverse attitudes toward driving cessation, ranging from avoidance to acceptance, and emphasize the importance of tailored resources for drivers at various stages of behavior change.

Psychological Resources and Driving Status: A Study of Current and Former Drivers 55 Years of Age and Older.

Psychological resources can help individuals adjust to changes associated with aging. In this study, we examined the effect of demographic, health, and psychological resource variables in explaining driving status among adults 55 years and older. A convenience sample of 222 adults between the ages of 55 and 91 years (mean = 72.20 years) completed questionnaires that included measures of driving status, self-rated health, and psychological resources (e.g., life control, life purpose, and locus of control). Multiple logistic regression models that controlled for confounders were constructed with driver status (i.e., current driver or former driver) as the outcome. Former drivers were older, reported being in poorer health, and reported more depression symptoms. After controlling for age and health, current drivers reported higher levels of life control and life purpose and a more internal locus of control. Results highlight the importance of considering psychological resources when examining driving cessation.

The SIMARD-MD is not an Effective Driver Screening Tool for Determining Fitness-To-Drive.

BACKGROUND: Studies have reported poor sensitivity and specificity of the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a modification of the DemTech (SIMARD-MD) to screen for drivers with cognitive impairment. The purpose of this study was to determine whether the SIMARD-MD can accurately predict pass/fail on a road test in drivers with cognitive impairment (CI) and healthy drivers. METHODS: Data from drivers with CI were collected from two comprehensive driving assessment centres (n=86) and compared with healthy drivers (n=30). All participants completed demographic measures, clinical measures, and a road rest (pass/fail). Analyses consisted of correlations between the SIMARD-MD and the other clinical measures, and a receiver-operating-characteristic (ROC) curve to determine the predictive ability of the SIMARD-MD. RESULTS: All healthy drivers passed the road test compared with 44.2% of the CI sample. On the SIMARD-MD, the CI sample scored significantly worse than healthy drivers (p < .001). The ROC curve showed the SIMARD-MD, regardless of any cut-point, misclassified a large number of CI individuals (AUC=.692; 95% CI = 0.578, 0.806). CONCLUSIONS: Given the high level of misclassification, the SIMARD-MD should not be used with either healthy drivers or those with cognitive impairment for making decisions about driving.

The Validity of Three New Driving Simulator Scenarios: Detecting Differences in Driving Performance by Difficulty and Driver Gender and Age.

OBJECTIVE: We explored the convergent and discriminant validity of three driving simulation scenarios by comparing behaviors across gender and age groups, considering what we know about on-road driving. BACKGROUND: Driving simulators offer a number of benefits, yet their use in real-world driver assessment is rare. More evidence is needed to support their use. METHOD: A total of 104 participants completed a series of increasingly difficult driving simulation scenarios. Linear mixed models were estimated to determine if behaviors changed with increasing difficulty and whether outcomes varied by age and gender, thereby demonstrating convergent and discriminant validity, respectively. RESULTS: Drivers adapted velocity, steering, acceleration, and gap acceptance according to difficulty, and the degree of adaptation differed by gender and age for some outcomes. For example, in a construction zone scenario, drivers reduced their mean velocities as congestion increased; males drove an average of 2.30 km/hr faster than females, and older participants drove more slowly than young (5.26 km/hr) and middle-aged drivers (6.59 km/hr). There was also an interaction between age and difficulty; older drivers did not reduce their velocities with increased difficulty. CONCLUSION: This study provides further support for the ability of driving simulators to elicit behaviors similar to those seen in on-road driving and to differentiate between groups, suggesting that simulators could serve a supportive role in fitness-to-drive evaluations. APPLICATION: Simulators have the potential to support driver assessment. However, this depends on the development of valid scenarios to benchmark safe driving behavior, and thereby identify deviations from safe driving behavior. The information gained through simulation may supplement other forms of assessment and possibly eliminate the need for on-road testing in some situations.

Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment.

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.

Age and engine displacement are associated with unsafe motorcycle rider actions.

BACKGROUND: Our goal was to examine the relationship between age and engine displacement in cubic centimeters (CCs) and crash responsibility. METHODS: Male motorcyclists, aged 16-94, involved in a fatal crash in the United States (1987-2015) who tested negative for both drugs and alcohol were included. Employing a case control design, cases had committed one or more Unsafe Motorcyclist Actions (UMAs), the proxy measure of responsibility; controls had no UMAs recorded. Odds ratios were computed via multinomial regression examining the effect of motorcyclists' age and motorcycle displacement (up to 1500 CCs, in 250 CC increments) on crash responsibility by any UMA and top three individual UMAs committed. RESULTS: A total of 19,166 motorcyclists met our inclusion criteria. Increased displacement was observed in older motorcyclists and in more recent crashes. Fifty-six percent of motorcyclists committed one or more UMAs (n = 10,743). The top three individual UMAs were: Speeding (35%, n = 6,728), Weaving (24%, n = 3,269), and Erratic Operation (6%, n = 1,162). Odds ratios for committing any UMA were the greatest for riders on 750 CC motorcycles, followed closely by 500 and 1000 CC motorcycles. By 1250 CCs the effect of displacement on rider crash responsibility (any UMA) was no longer statistically significant. Typically, younger ages (e.g., 20-30) on motorcycles with 500-1000 CCs were associated with the highest odds of either speeding, weaving, or erratic riding compared to similar aged riders on 250 CC motorcycles. Exceptions were observed, for example riders at 70 years of age on 1500 CCs having higher odds of speeding than younger riders on equivalent CC motorcycles. CONCLUSION: Education and legislative measures should be considered. Educationally, the development of training interventions focusing on control, stability, and breaking differences with more powerful motorcycles (750 to 1250 CCs) is needed. Legislatively, licensing tiers could be employed based on displacement and educational requirements. Education and legislative measures could help to curb the trend seen between high-powered motorcycles and crash responsibility.

Speeding and Speed Modification of Older Drivers: Does Vehicle Type Make a Difference?

The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.

Measuring the impact of driving status: The Centre for Research on Safe Driving-Impact of Driving Status on Quality of Life (CRSD-IDSQoL) tool.

BACKGROUND.: Driving an automobile is often considered an activity of daily living and is crucial to quality of life for many individuals. Following driving cessation, quality of life may become compromised. PURPOSE.: The Centre for Research on Safe Driving-Impact of Driving Status on Quality of Life (CRSD-IDSQoL) was designed to measure various elements of quality of life and how those elements are affected by driving status. METHOD.: The CRSD-IDSQoL was cross-sectionally administered to a convenience sample of 114 individuals (mean age 65.8 years). Exploratory factor analysis was used to examine the factor structure. FINDINGS.: The results supported three factors. Following adjustments for conceptual fit, Cronbach's alphas for the Community Mobility, Emotional, and Resources and Safety domains were .82, .84, and .74, respectively. Community Mobility was positively associated with distance driven per week. IMPLICATIONS.: The CRSD-IDSQoL may be a useful tool to study quality-of-life impacts of driving cessation. Further evaluation of the tool is warranted.