Results from Pre- Conference Survey of Participants*

1. Results from Pre- Conference Survey of Participants* International Older Driver Consensus Conference Arlington, VA December 1 – 2, 2003 For additional information contact: Burt Stephens, University of Florida, Seniors’ Institute for Transportation and Communications E-mail: Bstephen@hp.ufl.edu * N = 22

2. How to Identity “at-risk drivers How to Identify “At-Risk” Drivers?

3. Average Ratings of Effectiveness of Methods for Identifying At-Risk Drivers (N=16 - 22; Scale ranges from 4 – Very Effective to 1 – Not At All Effective)

4. Experience of Conference Participants

5. DRIVER ASSESSMENTS

6. REMEDIATION

7. REMEDIATION (Cont)

8. COUNSELING

9. Assess By Components or Holistically?

10. Changes Associated With Aging

11. Importance of Sensory and Perceptual Changes * Should have been included in the listing, but inadvertently omitted.

12. Importance of Cognitive Changes * Insufficient number of responses

13. Importance of Other Changes

14. DRIVER SCREENING AND ASSESSMENT

15. Protocols forSCREENING/EVALUATION • 11 PROCEDURES RATED • VALIDITY (Correlation between scores from the procedure and crash records) • USABILITY (Level of difficulty in implementing the procedure) • SUFFICIENCY (Can thisprocedure stand alone or must it be carried out in conjunction with other procedures?) • COST-EFFECTIVENESS (Takes into account all of the proceeding characteristics and the cost of administration of the procedure)

16. RATING SCREENING OR EVALUATION PROTOCOLS * Includes SafeDrive sim, DriVR Fargos, Doron, STI-SIM/STI-SIM Drive, Atari/AGC/TWI/AMOS/VISTA Doron Precision Drive Square driVR Illusion Technologies/RealDrive I-SIM and other specialized systems

17. RATING SCREENING OR EVALUATION PROTOCOLS (Cont)

18. RATING SCREENING OR EVALUATION PROTOCOLS (Cont)

19. Other Driver Screening or Evaluation Procedures Recommended • Visual acuity Contrast sensitivity visual field assessment • MVPT (not 3, because it takes 50 minutes to administer) • Trail Making B only (not A) • DPT driver performance training video • Chart based contrast sensitivity testing • Structured Observations for obvious physical impairment • Behind the wheel evaluation • Driver Performance Measurement (DPM) • Situation awareness fitness for duty

20. REMEDIATION

21. Procedures Used to Remediate Inadequate Driver Capabilities • Treatment of visual impairment to see if it is reversible or can be remediated • In-vehicle training with CDRS • Counseling on self-regulation of driving • Education about how impairment impacts driving skills • Use of AAA handouts on flexibility, changing your route, driver safety course • Training behind the wheel & determining whether clients can adequately follow through and recall the remediations • Prescribe limiting area of driving • Use O.T. skills to perform activity analysis & knowledge- base to improve the various skills

22. RISK MANAGEMENT PAYOFFS FOR APPLYING METHODS N = 9 participants; 1 = Highest possible Ranking

23. MEDICATION SIDE EFFECTS EXPERIENCED That can affect driving N = 9 Participants

24. COUNSELING AND TRANSPORATION ALTERATIVES

25. HOW CLIENTS GET INTO TRANSPORTATION COUNSELING

26. Basis of Counseling Process Used • Personal and professional experience – 4 • Specific courses or training to develop the process – 0 • Use a standardized protocol – 2

27. Specific Advice Provided to Clients or Their Caregivers * N = 6

28. Constraints Experienced In Counseling on Transportation Alternatives • Client’s unwillingness to accept that he/she is no longer able to drive safely • Lack of reliable, affordable transportation • Lack of transportation options and knowledge as to how the options work • Lack of on-time reliable public or paratransit transportation • Lack of transportation resources in communities

29. INFORMATION AVAILABLE AND NEEDED

30. Publications with the Most Definitive Statements on the Safety of Older Drivers • NHTSA Reports and Manuals • TRB Special Report 218 and Update Soon to be Published. • Holland, C.A. (2001) Older Drivers: A review. DLTR, • (http://www.roads.dft.gov.uk/roadsafety/research25) • AOTA journals and publications • AARP Publications • ADED Publications • DOT-HS-808-853, NHTSA Safe Mobility for Older People Notebook. • DOT-HS-809-582, Model Driver Screening and Evaluation Program • "Highway Research to Enhance the Safety and Mobility of Older • Road Users, " Draft dated June 21, 2000, F. Schieber for TRB • FHWA Older Driver Handbook • AMA Guide for Physicians

31. INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS, & NEEDED TECHNOLOGY - 1 • Affordable, reliable transportation for persons no longer capable of driving • Removal of social stigma to using alternative transportation systems • Lack of sidewalks and street lighting • Funding of new initiatives and their evaluation • Fear that older adult voters will not support initiatives that potentially threaten mobility • Lack of funding (by Medicare) for the screening and mobility counseling process

32. INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS, & NEEDED TECHNOLOGY - 2 • Lack of short & comprehensive screening instruments that are highly sensitive and specific for tier 1 screening • Expectation that automobiles ought to cost money, but alternative transportation ought to be cheap or free • Need for predictive clinical tests: “people often test well in the clinical setting, but do very poorly behind the wheel” • Training Courses for OT's • Physician training

33. INFORMATION NEEDED, SOCIO-POLITICAL CONSTRAINTS, & NEEDED TECHNOLOGY - 3 • Need champions to gain wide support • Criterion problem: “There is no essential agreement about what makes a "safe" driver”. • Unspoken "competition" between practitioners to create the "gold standard" • Different requirements by motor vehicle agencies for retesting and relicensing • Need to develop and implement a testing methodology that overcomes current limitations

34. RESEARCH NEEDS

35. Most Critical Research Needed - 1 Develop improved vehicle and road design to facilitate better use of diminished senses Establish the role of in-car training Evaluate interventions, rather than adopting what "experts" call "best practices" and "model programs“ Develop short, easy-to-administer, and comprehensive screening instruments with high sensitivity and specificity ratings Develop effective alternative transportation and transportation planning process Empirically determine relationships between the following: Types of driving relevant functional impairment Types of constraints on adequate compensation Types of critical driving errors Types of crashes

36. Most Critical Research Needed - 2 • Develop more effective retraining and route planning techniques • Develop a self-assessment tool that assures confidentiality for older persons • Research to identify when older drivers become unfit to drive - the physical, mental or functional cues • Define qualities of elderly who are still successful drivers --test their cognitive & physical ie reaction time & correlate to those that are not able to drive safely • Develop physician screening tools • Development of physician communication and training programs

37. Most Critical Research Needed - 3 • Develop a consensus criterion, including acceptable levels of performance and capability that can be correlated with reverse graduated driving privileges. • Research that can lead to broadly accepted screening protocols, with high reliability and validity, and are cost-effective to administer, and, ultimately, acceptable to AAMVA (et al) • Detailed task analyses of critical driving tasks across a variety of conditions • Develop a systematic way to find and create transportation alternatives

38. This is a start! An opportunity to obtain agreement on what we can do now to improve safe mobility of older persons and to lay out a course for the future at this International Older Driver Consensus Conference.