[ADAS and automation-a relevant contribution to maintaining mobility of older drivers?] / Fahrerassistenzsysteme und automatisiertes Fahren ­ ein relevanter Beitrag zum Erhalt der Mobilität im Alter?

Driving is the most important and safest form of mobility for the majority of senior citizens. However, physical and mental performance gradually decline with age, which can lead to more problems, critical situations or even accidents. Vehicle technology innovations such as advanced driver assistance systems (ADAS) have the potential to increase the road safety of older people and maintain their individual mobility for as long as possible.This overview article aims to identify ADAS that have the greatest potential to reduce the number of accidents involving older drivers. For this purpose, the accident and damage occurrence as well as the driving behaviour and compensation strategies of older people are examined in more detail. Suitable ADAS should compensate for typical driver errors, reduce information deficiencies and have a high level of acceptance. For older drivers, emergency braking, parking assistance, navigation, intersection assistance and distance speed control systems as well as systems for detecting blind spots and obstacles appear to be particularly suitable.Some of the disadvantages of ADAS are the lack of market penetration, acceptance problems and interface designs that have not yet been optimally adapted to the needs of older users. For older drivers in particular, it appears to be a priority to develop coherent and integrated solutions in the sense of cooperative assistance instead of pushing ahead with high and full automation with many system limits and exceptions, which can place high demands on attention, for example if the vehicle has to be taken over in a critical situation.

[Driving competence in older age: psychological assessment and interventions]. / Fahrkompetenz im Alter: Psychologische Diagnostik und Interventionen.

The article introduces the issue of psychological assessment and training for driving safety, driving competence, and the mobility of older drivers. The psychological methods for assessing driving competence and the training approaches for maintaining mobility in old age are outlined and illustrated with examples. Preserving driving ability in old age remains a task for which development needs and research gaps must be specified. Although periodic mandatory examinations based on age do not yield any relevant improvement in enhancing traffic safety, they do not cause harm and are widely accepted. It is desirable to move away from a theory focusing on deficits of older age and instead develop an assessment of the comprehensive functions, abilities, and resources of elderly drivers to help preserve the mobility and participation of that specific demographic in traffic.

On the road to retirement: Predicting nighttime driving difficulty and cessation using self-reported health factors.

Introduction: Older drivers now expect to drive longer than previous cohorts and will make up about 25% of licensed U.S. drivers by 2050. Identifying early predictors of nighttime driving difficulty, a precursor to driving retirement, can inform screening procedures and timely linkage to interventions supporting driving or transitioning to driving cessation. Methods: We examined self-reported physical and mental health baseline predictors of greater nighttime driving difficulty in five and ten years using weighted multivariate logistic analyses of 2261 drivers, aged 57 to 85, from the National Social Life, Health, and Aging Project (NSHAP). Transition matrix models describe probabilities of having greater, lesser, or the same nighttime driving difficulty after five years based on baseline driving conditions and the significant logistic model factors. We built a transition matrix tool that offers users the ability to calculate expected probabilities of change in nighttime driving difficulty based on the identified salient factors. Results: Five-year predictors of greater nighttime driving difficulty included perceived poor physical health (OR = 3.75), limitations to activities of daily living (ADLs; OR = 1.97), and clinical levels of depressive and anxiety symptoms (OR = 1.63; OR = 1.71). Excellent physical health (OR = 0.52), mental health (OR = 0.60), and any frequency of physical activity compared to 'never' were protective (OR = 0.37-0.51). Physical health, walking pain, and limitations to ADLs were predictive at ten-years. Transition models showed physical health and anxiety were most indicative of greater nighttime driving difficulty at 5-years for those reporting no difficulty at baseline, but limitations to ADLs were more predictive otherwise. Conclusions: Lay practitioners could capitalize on the use of self-report screening measures to identify older adults who may experience near-term nighttime driving difficulty. Earlier identification may better guide long-term driving retirement planning or engagement in appropriate health interventions. The transition matrix modeling tool is freely available to facilitate development and validation of related measures.

Visual Function and Driving Performance Under Different Lighting Conditions in Older Drivers: Preliminary Results From an Observational Study.

BACKGROUND: Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear. OBJECTIVE: This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare. METHODS: Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions. RESULTS: Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=-0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=-0.24; P=.007), larger SDspeed (r=-0.19; P=.04), greater SDLP (r=-0.22; P=.007), and longer reaction times (r=-0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=-0.32; P<.001), greater SDLP (r=-0.26; P=.001) and longer reaction times (r=-0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions. CONCLUSIONS: Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results.

Hazard warning modalities and timing thresholds for older drivers with impaired vision.

PURPOSE: We examined collision warning systems with different modalities and timing thresholds, assessing their impact on responses to pedestrian hazards by drivers with impaired contrast sensitivity (ICS). METHODS: Seventeen ICS (70-84 y, median CS 1.35 log units) and 17 normal vision (NV: 68-73 y, median CS 1.95) participants completed 6 city drives in a simulator with 3 bimodal warnings: visual-auditory, visual-directional-tactile, and visual-non-directional-tactile. Each modality had one drive with early and one with late warnings, triggered at 3.5 s and 2 s time-to-collision, respectively. RESULTS: ICS participants triggered more early (43 vs 37 %) and late warnings (12 vs 6 %) than NV participants and had more collisions (3 vs 0 %). Early warnings reduced time to fixate hazards (late 1.9 vs early 1.2 s, p < 0.001), brake response times (2.8 vs 1.8 s, p < 0.001) and collision rates (1.2 vs 0.02 %). With late warnings, ICS participants took 0.7 s longer to brake than NV (p < 0.001) and had an 11 % collision rate (vs 0.7 % with early warnings). Non-directional-tactile warnings yielded the lowest collision rates for ICS participants (4 vs auditory 12 vs directional-tactile 15.2 %) in late warning scenarios. All ICS participants preferred early warnings. CONCLUSIONS: While early warnings improved hazard responses and reduced collisions for ICS participants, late warnings did not, resulting in high collision rates. In contrast, both early and late warnings were helpful for NV drivers. Non-directional-tactile warnings were the most effective in reducing collisions. The findings provide insights relevant to the development of hazard warnings tailored for drivers with impaired vision.

Exploring the associations of demographics and scale measures with cognitive driving behavior among older drivers in China.

Age-related changes and frailty are reasons for the high proportion of older drivers in certain types of crashes, such as giving right of way at intersections and turning left. The identified crash causes include the driver's demographics, driving style, cognitive function, and mental workload. This study aimed to explore the associations of demographics and scale measures with cognitive driving behavior. Thirty-nine drivers, consisting of twenty younger drivers (18-60 years old) and nineteen older drivers (above 60 years old), participated in driving simulation experiments after completing scale tests. The selected scale measures included the demographic questionnaire, Multidimensional Driving Style Inventory (MDSI-C), Mini-Mental State Examination (MMSE), Trail Making Test Part A (TMT-A) and Part B (TMT-B), and the National Aeronautics and Space Administration Task Load Index (NASA-TLX) for obtaining subjective information from drivers. Driving scenarios were developed based on the driving characteristics of older adults to investigate age-related driving ability. The driving behavior parameters included reaction time, lateral stability, and driving speed, corresponding to reaction, perception, and execution. Three stepwise regression models showed that NASA-TLX, the interaction between age and driving experience, and the interaction between age and TMT-A significantly explained 53.3 % of reaction time variance; TMT-A, risk driving style, anxiety driving style, and gender significantly explained 53.5 % of lateral stability variance; TMT-A, NASA-TLX, and MMSE significantly explained 60.6 % of driving speed variance. Subsequently, the impact of four age-related predictor variables on driving behavior was further discussed. It is worth noting that a rich driving experience may compensate for driving performance. However cognitive impairment impairs this compensation. Driving behavior is influenced by a combination of various factors. Age, as a physiological indicator, is not sufficient to be a strong predictive factor for lateral stability and driving speed. The results provide a reference for traffic safety management departments to streamline driving suitability test procedures and propose targeted training methods for older drivers.

Evaluation of assistance systems allowing older drivers to intercept moving inter-vehicular space.

Introduction: The objective of the present study was to test two Advanced Driving Assistance Systems (ADAS) designed to help older drivers to intercept a moving inter-vehicular space. Method: Older and younger drivers were asked to intercept a moving inter-vehicular space within a train of vehicles in a driving simulator. Three ADAS conditions (No-ADAS, Head Down, Head Up) as well as five distinct speed regulation conditions were tested. Vehicle trajectory, gaze behavior and acceptance were analyzed. Results: Our results reveal that the ADAS tested make it possible to perform the interception task but also to reduce the variability of the behavior produced. They also indicate that the location of the augmented information provided by the ADAS directly impacts the information-gathering strategy implemented. Finally, whereas younger divers reported mixed levels of ADAS acceptance, older drivers reported a good level of acceptance. Discussion: All these results could be particularly useful with a view of designing ADAS for older drivers.

Social and Neighborhood Context Moderates the Associations Between Processing Speed and Driving Mobility: A 10-year Analysis of the ACTIVE Study.

Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study (n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility.

Older Adults and Unintentional Injury.

Clinicians play an important role in the prevention of unintentional injuries. Falls and motor vehicle crashes (MVC) have predictable and overlapping antecedents. Systematic screening for and management of vision impairment, frailty, cognitive impairment, polypharmacy, and inappropriate medications will reduce both falls and MVC risks. Fall-prevention measures, such as strength training, need to be more widely prescribed by physicians and implemented by older adults. Technologically tailored approaches are needed to leverage fall-reduction programs at home, as well as education of older adults regarding home hazards.

Medications and traffic accidents involving older drivers: do Spanish primary healthcare physicians know enough?

BACKGROUND: Our aim was to evaluate Spanish family doctors' knowledge about medications that increase the risk of traffic accidents involving older drivers, and to obtain data about the involvement of family doctors in accident prevention activities and the associations between these factors and their demographic and workplace characteristics. METHODS: A cross-sectional study of 1888 family doctors throughout Spain was carried out from 2016 to 2018. Participants completed a previously validated self-administered questionnaire that explored whether family doctors distinguished between medications associated with a high or low risk of involvement in a traffic accident, investigated the appropriateness of advice given to older patients, and physicians' involvement in preventive activities. Multiple regression models were used to estimate the adjusted association of these variables with each other and with characteristics of family doctors in the sample. RESULTS: On a scale of 1 (never or hardly ever) to 4 (always), the indexes constructed to evaluate how often family doctors believed they should oversee the use of high-risk and low-risk medications yielded values of 3.38 for the former and 2.61 for the latter (p < 0.001). Only 24% responded correctly to all three items that inquired about the appropriateness of the advice they gave to older patients. On a scale of 1 to 4, the frequency at which family doctors gave older patients advice about preventive measures was 2.85, and only 43% reported allocating time during appointments to provide this advice. These latter two variables were directly associated with appropriate values for the index used to evaluate physicians' oversight of medications associated with a high risk. The perception of risk associated with medications and involvement in preventive activities were both greater among female participants. CONCLUSIONS: Family doctors correctly identified medications according to their risk of playing a role in traffic accidents, although the recommendations they gave to their patients were not always appropriate. These findings, along with physicians' infrequent involvement in preventive activities, suggest a need to improve family doctors' competencies and increase the resources available to them so that they can provide their older patients with advice on ways to prevent involvement in traffic accidents.

Evaluation of Psychophysical Fitness in Drivers over 65 Years of Age.

BACKGROUND: The deterioration of cognitive and psychophysical ability associated with aging has an effect on road safety, especially in the driving of vehicles. The current study's main objective is to evaluate the psychophysical aptitudes in drivers over 65 years of age in a sample of drivers in Spain. METHODS: The sample was formed of a total of 1663 drivers who attended a Driver Recognition Center. The evaluation of their psychophysical aptitudes was carried out following the Medical-Psychological Exploration Protocol for Driver Recognition Centers, edited by the Ministry of Health and the General Directorate of Traffic. RESULTS: The results show increased restrictions in the evaluation of driving ability with age, which are especially significant after 75 years of age. Regarding sex, 70.1% of women have an approved evaluation, compared to men aged between 65-69, although from 69 onwards, the percentage of approved women decreases significantly. The loss of visual capabilities and poor performance in psycho-technical tests are the main causes associated with an evaluation with restrictions, with the number of restrictive conditions increasing with age. CONCLUSIONS: There is an increase in the number of cases with age-related restrictions, especially in the case of women and ophthalmologic-related problems, although the majority of drivers over 65 years old continue driving, thus continuing with a practice that has been related to the well-being and quality of life of older adults.

The use of driver screening tools to predict self-reported crashes and incidents in older drivers.

There is a clear need to identify older drivers at increased crash risk, without additional burden on the individual or licensing system. Brief off-road screening tools have been used to identify unsafe drivers and drivers at risk of losing their license. The aim of the current study was to evaluate and compare driver screening tools in predicting prospective self-reported crashes and incidents over 24 months in drivers aged 60 years and older. 525 drivers aged 63-96 years participated in the prospective Driving Aging Safety and Health (DASH) study, completing an on-road driving assessment and seven off-road screening tools (Multi-D battery, Useful Field of View, 14-Item Road Law, Drive Safe, Drive Safe Intersection, Maze Test, Hazard Perception Test (HPT)), along with monthly self-report diaries on crashes and incidents over a 24-month period. Over the 24 months, 22% of older drivers reported at least one crash, while 42% reported at least one significant incident (e.g., near miss). As expected, passing the on-road driving assessment was associated with a 55% [IRR 0.45, 95% CI 0.29-0.71] reduction in self-reported crashes adjusting for exposure (crash rate), but was not associated with reduced rate of a significant incident. For the off-road screening tools, poorer performance on the Multi-D test battery was associated with a 22% [IRR 1.22, 95% CI 1.08-1.37] increase in crash rate over 24 months. Meanwhile, all other off-road screening tools were not predictive of rates of crashes or incidents reported prospectively. The finding that only the Multi-D battery was predictive of increased crash rate, highlights the importance of accounting for age-related changes in vision, sensorimotor skills and cognition, as well as driving exposure, in older drivers when using off-road screening tools to assess future crash risk.

15-year incidence of driving cessation and associated risk factors: The Blue Mountains Eye Study.

OBJECTIVES: To report the 15-year incidence of driving cessation and its associated vision-related risk factors in an older Australian population-based cohort. STUDY DESIGN: 15-year data from a sample of 2379 participants who indicated that they were driving at baseline from The Blue Mountains Eye Study was analysed. Questions about driving cessation was asked at all four visits and was recorded as a binary response (Yes/No). Clinical vision examinations were performed at each visit to determine presenting and best-corrected visual acuity and any incident eye diseases (Yes/No). MAIN OUTCOME MEASURES: The cumulative 15-year incidence of driving cessation was calculated using interval-censored data progression-free survival analyses. Age- and sex-adjusted and multivariable-adjusted interval-censored Cox proportional hazard models were used to report the hazard ratios (HRs) for associations of baseline and incident vision status with driving cessation. RESULTS: The 15-year cumulative incidence of driving cessation amongst the 2379 participants was 20.7 %, with women more likely to cease driving than men (p = 0.0005). Cataract (HR 1.98 (95 % confidence interval(Cl) 1.45-2.71)) and age-related macular degeneration (HR 1.85 (95%Cl 1.37-2.50)) were associated with increased risk of driving cessation whilst presenting and best-corrected visual acuity in the better eye were protective against cessation (presenting: HR 0.96 (95%Cl 0.95-0.98); best-corrected: HR 0.93 (95%Cl 0.91-0.95)) in age- and sex-adjusted models, with these factors remaining independently associated in the multivariable-adjusted models. CONCLUSION: Cumulative incidence of driving cessation increased with older age and was higher in females. Cataract and age-related macular degeneration were independently associated with cessation, whilst better visual acuity at baseline helped prolong driving.

The relationship between central and mid-peripheral motion perception and the hazard perception test in younger and older adults.

INTRODUCTION: Vision standards for driving are typically based on visual acuity, despite evidence that it is a poor predictor of driving safety and performance. However, visual motion perception is potentially relevant for driving, as the vehicle and surroundings are in motion. This study explored whether tests of central and mid-peripheral motion perception better predict performance on a hazard perception test (HPT), which is related to driving performance and crash risk, than visual acuity. Additionally, we explored whether age influences these associations, as healthy ageing impairs performance on some motion sensitivity tests. METHODS: Sixty-five visually healthy drivers (35 younger, mean age: 25.5; SD 4.3 years; 30 older adults, mean age: 71.0; SD 5.4 years) underwent a computer-based HPT, plus four different motion sensitivity tests both centrally and at 15° eccentricity. Motion tests included minimum displacement to identify motion direction (Dmin ), contrast detection threshold for a drifting Gabor (motion contrast), coherence threshold for a translational global motion stimulus and direction discrimination for a biological motion stimulus in the presence of noise. RESULTS: Overall, HPT reaction times were not significantly different between age groups (p = 0.40) nor were maximum HPT reaction times (p = 0.34). HPT response time was associated with motion contrast and Dmin centrally (r = 0.30, p = 0.02 and r = 0.28, p = 0.02, respectively) and with Dmin peripherally (r = 0.34, p = 0.005); these associations were not affected by age group. There was no significant association between binocular visual acuity and HPT response times (r = 0.02, p = 0.29). CONCLUSIONS: Some measures of motion sensitivity in central and mid-peripheral vision were associated with HPT response times, whereas binocular visual acuity was not. Peripheral testing did not show an advantage over central testing for visually healthy older drivers. Our findings add to the growing body of evidence that the ability to detect small motion changes may have potential to identify unsafe road users.

Safety potential of crash avoidance features, improved headlights, and V2V-enhanced technologies for older drivers.

INTRODUCTION: Age-related changes and frailty are among the reasons that older drivers are overrepresented in certain crash types. Vehicle safety features that address these crash types may therefore deliver greater safety benefits for older drivers than for other age groups even though they are designed for the general population. METHODS: U.S. crash data from 2016-2019 were used to estimate the proportion of crash involvements and fatal and nonfatal driver injuries for older (70 years old and above) and middle-aged (35-54 years old) drivers from crash scenarios to which current crash avoidance features, improved headlights, and forthcoming vehicle-to-vehicle (V2V)-connected intersection-assistance features could be relevant. Risk ratios were then calculated to determine the relative benefits of each technology for older drivers compared with middle-aged drivers. RESULTS: Combined, these technologies were potentially relevant to 65 % of older driver and 72 % of middle-aged driver fatalities during the study period. Intersection assistance features showed the most promise for older drivers. Such features were potentially relevant to 32 % of older driver crash involvements, 38 % of older driver injuries, and 31 % of older driver fatalities. Intersection assistance features were significantly more likely to be relevant to older driver deaths than middle-aged driver fatalities (RR, 3.52; 95 % CI, 3.33-3.71). CONCLUSIONS: Vehicle technologies have the potential to substantially reduce or mitigate crashes and the injuries that they cause for everyone, but the potential safety impact of each technology varies by driver age because different age groups are over- or underrepresented in specific crash scenarios. PRACTICAL APPLICATIONS: With the older driver population growing, these findings underscore the need to bring intersection assistance technologies to the consumer market. At the same time, everyone stands to benefit from currently available crash avoidance features and improved headlights, so their use should be promoted among all drivers.

A systematic review and meta-synthesis of the complex and interconnected factors that influence planning for driving retirement.

INTRODUCTION: With an aging population there are more older drivers than ever before. To reduce unnecessary road accidents and assist older drivers to successfully transition to non-driving, a better understanding of the factors that influence planning for driving retirement is required. This review explores documented factors that may influence older adults in planning for driving retirement, thus providing new understandings that can inform future preventative road safety measures, interventions, and policies. METHOD: A systematic search was performed using four databases to locate qualitative studies on the factors that influenced older drivers to plan for driving retirement. To identify factors influencing planning for driving retirement, a thematic synthesis approach was utilized. Identified themes were categorized in relation to elements of the Social Ecological Model theoretical framework. RESULTS: The systematic search resulted in 12 included studies from 4 countries. Four major themes and 11 subthemes were identified regarding planning driver retirement. Each subtheme denotes a factor that may facilitate and/or impede older drivers planning for driving retirement. CONCLUSION: These results indicate that it is vitally important to encourage older drivers to plan for driving retirement as early as possible. Stakeholders involved in the safety of older drivers (including family, clinicians, road authorities, and policy makers) should work together on interventions and policies that empower older drivers to successfully plan for driving retirement in order to improve road safety and quality of life. PRACTICAL APPLICATIONS: Introducing conversations about driving retirement via medical appointments, family, media, and peer-support groups could facilitate planning for driving retirement. Community-based ride-sharing systems and subsidized private transport options are needed to ensure continued mobility of older adults, especially in rural and regional areas that lack alternate transport services. When devising urban and rural planning, transport, license renewal, and medical testing rules, policy makers should consider older drivers' safety, mobility, and quality of life after driving retirement.

What triggers road traffic fatalities among older adult drivers? An investigation based on the Swedish register for in-depth studies of fatal crashes.

INTRODUCTION: Road traffic fatalities among drivers result not only from erroneous driving manoeuvres. They can also be triggered by poor mental or physical health like suicidal acts and acute disease attacks, the latter being more frequent with age. There are few studies comprising all the different triggers of fatal crashes among older drivers and on how these triggers evolve over time. This Swedish national study aims to investigate this, considering drivers 50+ years. METHOD: For the period 2010-2019, data on non-commercial car drivers aged 50 and older were extracted from the Swedish Transport Administration's in-depth studies of fatal crashes, compiled in a register encompassing all road traffic fatalities. The crash triggers reported were classified as suicide, acute disease, own manoeuvre (single or other type of crash), external, and undetermined. Total and annual frequencies were presented by crash trigger, overall and stratified by sex and age groups. RESULTS: In total, 762 fatalities were identified and with 709 of them, it was possible to classify the crash trigger: 12% resulting from suicide; 29% from acute disease; 49% from the driver's own manoeuvre; and 10% from an external crash trigger. Suicides increased from 9% in average 2010-2014 to 15% in 2015-2019 while acute disease decreased (from 32% to 27%). The overall male-to-female ratio was 4.5, and as high as 8.7 for acute disease. The relative importance of each trigger varied with age with, for instance, acute disease being more frequent in the two younger age groups; 31% for 50-64 and 52% for 65-79 years old drivers, while own manoeuvre was more prominent for drivers aged 80 and older (23%). CONCLUSION: The distribution of the four different triggers of road traffic fatalities varies only slightly over time and, a majority are triggered by the driver's own manoeuvre. However, a substantial proportion, about four out of ten,are triggered by a health condition, of which some are suicide but the major part an acute disease, mainly cardiovascular. In some instances, such crashes can be harmful to other road users. Having in mind the need for safety and mobility of older drivers and the protection of all road users, there is a need for the promotion of road safety policies that encompass a wider range of measures to help reducing the likelihood of fatal and severe crashes to happen e.g., targeting incapacitated drivers.

Overestimation of on-road driving performance is associated with reduced driving safety in older drivers.

OBJECTIVES: Older drivers often show less precise self-ratings with a tendency to overestimate themselves. It is unclear, however, how overestimators differ from underestimators or drivers with adequate self-ratings. METHODS: 59 healthy older drivers participated in this on-road study. Besides standardized on-road driving assessment, the study protocol included the collection of neuropsychological and driving-related data as well as different self-ratings. Statistical analyses involved correlations between different subjective and objective ratings as well as statistical comparisons between drivers who overestimated and drivers who adequately rated their on-road driving performance (no drivers underestimated their performance). RESULTS: Despite positive correlations between different self- and expert ratings, our results revealed that 25 % of the participants overestimated their on-road driving skills. Among other things, overestimators showed poorer on-road driving performances, more prospective near and minor at-fault accidents, poorer cognitive performances in specific driving-related domains and reduced annual mileage. DISCUSSION: Our results suggest that older drivers who overestimate their driving skills show poorer performances within a broad range of skills that directly reflect or are closely related to driving safety. Against the background that an adequate self-assessment is required by German traffic regulations, our findings suggest that overestimators represent a risk group among the population of older drivers.

Near-term impact of COVID-19 pandemic on seniors' crash size and severity.

Recent research revealed that COVID-19 pandemic was associated with noticeable changes in travel demand, traffic volumes, and traffic safety measures. Despite the reduction of traffic volumes across the US, several recent studies indicated that crash rates increased across different states during COVID-19 pandemic. Although some recent studies have focused on examining the changes in traffic conditions and crash rates before and during the pandemic, not enough research has been conducted to identify risk factors to crash severity. Even the limited research addressing the contributing factors to crash severity were focused on the pool category of drivers and no insight is available regarding older drivers, one of the most vulnerable groups to traffic collision and coronavirus. Moreover, these studies investigated the early impact of the COVID-19 pandemic mostly using up to three months of data. However, near-term and long-term effects of the COVID-19 pandemic are still unknown on traffic collisions. Therefore, this study aims to contribute to the literature by studying the near-term impact of the COVID-19 pandemic on crash size and severity among older drivers. To this end, a relatively large sample of crash data with senior drivers at fault was obtained and analyzed. To identify the main contributing factors affecting crash outcomes, Exploratory Factor Analysis was conducted on a high-dimension data set to identify potential latent factors which were validated through Confirmatory Factor Analysis. After that, Structural Equation Modeling technique was performed to examine the associations among the identified independent latent factors and the dependent variable. Additionally, SEM model identified the impact of the COVID-19 pandemic on seniors' crash severity. The findings reveal that several latent variables were the significant predictors of crash severity of older drivers including "Driving maneuver & crash location", "Road features and traffic control devices", "Driver condition & behavior", "Road geometric characteristics", "Crash time and lighting", and "Road class" latent factors. The binary variable of "Pandemic" was found to be as highly significant as the last four latent factors mentioned above. This means not only were older drivers more likely to be involved in higher crash size with higher severity level during the pandemic period, but also "Pandemic" was a risk factor to seniors as much as "Driver condition & behavior", "Road geometric characteristics", "Crash time & lighting", and "Road class" factors. The results of this study provide useful insights that may improve road safety among senior drivers during pandemic periods like COVID-19.

Associations of cannabis use with motor vehicle crashes and traffic stops among older drivers: AAA LongROAD study.

BACKGROUND: Acute cannabis use is associated with a higher risk of motor vehicle crashes (MVC). This study aimed to determine if self-reported past-year cannabis use is associated with MVC or traffic stops among older drivers. METHODS: This cross-sectional analysis used data from a multi-center study enrolling active drivers aged 65-79 years. Data regarding cannabis use, MVC, and traffic stops (i.e., being pulled over by police, whether ticketed or not) within the previous 12 months were collected through participant interviews. Log-binomial regression models examined associations of past-year cannabis use with MVC and traffic stops, adjusting for site and sociodemographic and mental health characteristics. RESULTS: Of 2,095 participating older drivers, 186 (8.88%) used cannabis in the past year but only 10 (<0.5%) within an hour before driving in the last 30 days; 11.41% reported an MVC and 9.45% reported a traffic stop. Past-year cannabis users had a higher prevalence of MVC (adjusted prevalence ratio [aPR] = 1.38; 95%CI: 0.96, 2.00; p = 0.086) and traffic stops (aPR = 1.58; 1.06, 2.35; p = 0.024). CONCLUSIONS: Past-year cannabis use was associated with increased traffic stops, which are correlated modestly with increased MVC in past studies and may indicate impaired driving performance. We did not find a statistically significant association of past-year cannabis use with MVC, which may indicate limited sustained effects on driving performance from periodic use among older adults, who report rarely driving immediately after use.