"This one-on-one program was the Cadillac version of an education program. It was tailored to each individual's needs," said Dr. Owsley. "We don't know how we could improve the program, because it was so comprehensive--nonetheless, it showed no effect on collision rates for this population." Dr. Owsley spoke today at an American Medical Association media briefing on patient communication and adherence in New York City.
Many organizations have created educational programs that aim to increase the safety of older drivers. However, only two of these programs have been evaluated for their effectiveness; neither one reduced collision rates. Dr. Owsley and her co-authors reported on a program that they hoped would show some success through a one-on-one intervention that not only addressed safety issues and strategies to increase safety, but also included a focus on awareness of limitations caused by the driver's visual deficits.
The educational curriculum, Knowledge Enhances Your Safety (KEYS), was motivated by models of health behavior change and health promotion. It was administered one-on-one in two sessions in an eye clinic conference room. The first session was individually tailored to the participant's own driving needs, lifestyle and visual problems. The participant discussed how their visual impairment interfered with safe driving, caused driving performance difficulties/ and elevated crash risk.
The discussion focused on maneuvers and settings that the individual participant found challenging or frustrating and then moved to strategies that the participant could implement to avoid those driving situations. Such strategies included driving during daylight and not at night, driving in less busy routes, not driving at rush hour, postponing trips in bad weather, and seeking out routes in which three right turns could substitute for one left turn. Drivers were encouraged to identify strategies that could realistically be incorporated into their own routine driving. Before the session ended participants set goals in a personal written contract that listed ways they would try to modify their driving behavior.
The drivers that participated in the program reported better avoidance of challenging driving maneuvers and reported regulating their behavior to avoid challenging or unsafe driving situations. Dr. Owsley speculates that the kinds of behavior changes that the participants instituted may not be reflected in a reduced crash rate because crashes are uncommon events. "Crashes are rare when you look at the millions of miles we drive. Crashes have many causes, including not only driver error, but other factors such as weather conditions, erratic behavior of other drivers and road conditions. Therefore, it is difficult to measure the impact that some of these subtle behavioral changes may have on collision rates."
When measured on a per-mile-driven basis, licensed drivers 60 year and over have a collision rate equivalent to younger drivers aged 25 years, whose crash rate is highest among all age groups. It may be possible, however, it might be possible to teach an older driver who wants to remain behind the wheel about their functional deficits that affect driving skills and to facilitate strategies for self regulation. "Results of study suggest that, on average, older drivers do embrace these new behaviors," said Dr. Owsley.
"If we are going to offer these programs, we need the participants to know that there is a high probability that the program will have limited or no effect on crash risk," said Dr. Owsley. "There's no evidence that these programs make participants safer drivers."
"I would not recommend stopping driving just because an older adult has a chronic disease that causes functional impairments since it can have such negative consequences on older adults," said Dr. Owsley. "They need to make sure they get the best medical care to reduce the impact that their functional problems have on their driving. They may want to go to a driving fitness clinic where a certified driving rehabilitation specialist can evaluate their potential risk and safety on the road. Driving cessation should be seriously considered if the functional impairments are serious and irreversible."
Driving cessation is associated with increased depressive symptoms and reduced quality of life, Dr. Owsley explained, and the feeling that they now have to depend more on other people. Older drivers often say "I can't imagine what my life would be like without driving." Therefore, counseling older drivers to stop driving should not be taken lightly.
To contact Cynthia Owsley, M.S.P.H., Ph.D., call Bob Shepard at 205-934-8934 or 800-UAB-9091 or bshep@uab.edu. On the day of the briefing, call the AMA's Science News Department at 312-464-2410.
Journal
American Journal of Preventive Medicine