Statement of the Problem
Americans are concerned about highway traffic safety and what to do about older people who no longer drive safely. In response to this concern, the Traffic Safety Plan For Older Persons was established by the National Highway Traffic Safety Administration (NHTSA) to identify the nature of safety problems experienced by older persons and articulate actionable solutions to these problems.
This investigation was initiated to determine if individuals who have the opportunity to routinely observe the driving behavior of functionally impaired drivers are able to identify the unsafe older driver and intervene on that driver's behalf to help limit or stop unsafe driving. The study was also initiated to determine if family and friends may be a better trigger for more extensive testing than periodic screening of all older drivers. People in this position include family members and friends who are frequently concerned about the driving safety of older relatives and peers. NHTSAsponsored research (McKnight and Urquijo, 1992) and the Illinois Retired Teachers Association, Inc. (1990) survey have shown that family members and friends rarely report driving difficulties to regulatory authorities. The ability of families to deal with changes in older adults' functioning has a lot to do with how the family deals with problem situations (Aizenberg and Treas, 1985; Sterns, Weis, and Perkins, 1984).
To ensure that high risk older drivers are identified before they are involved in an injury or crash, the public has begun to pressure state licensing agencies to test older drivers more extensively and more frequently. The use of testing for older adults may be reasonable, if it can be shown that potential impairment is related to higher risk of crashes, and tests can detect the capabilities known to be associated with driving risks (Hunt, 1994; U.S. Department of Transportation National Highway Traffic Safety Administration, 1992). Currently, increased testing is problematic because it is imprecise, expensive, time consuming, and is perceived by many people to be unfair and discriminatory. A blanket driving licensing requirement based on age alone would be difficult to defend as chronological age, per se, does not lead to an increased risk of crashes (Marotolli, Cooney, Wagner, Doucette, and Tenneti, 1994; Marotilli, Ostfield, Merril, Perlman, Foley, and Cooney, 1993).
Unless there is compelling evidence to the contrary, older adults should be encouraged to maintain their lifestyle and activities, including driving. However, we can expect that if a person lives long enough, at some point, agerelated changes and declines in functional ability due to disease may alter the performance level of critical skills needed to drive.
Given their responsibilities for the diagnosis and treatment of health problems, health professionals are also in a critical position to detect functional and medical conditions that may compromise driving. They also have the responsibility of advising clients about the level of appropriate activities, including driving, in relation to their physical condition and medications involved in treatment. The degree to which medical professionals are aware of their responsibility to assist individuals in enhancing their driving, limit when or whether they should drive, or report older adults who should not be driving has not been systematically researched. (Indeed, the nature of reporting responsibility is debated among medical professionals themselves). Health professionals need explicit guidelines and assessment tools to identify and report patients with medical impairments that jeopardize safe driving (Marotolli, 1993; Rueben, 1993).
Families, friends, physicians, law enforcement, and social and community services should be provided with information to assist older adults whose capabilities make them potentially atrisk for unsafe driving. To determine the surest course of action, NHTSA contracted with CREATIVE ACTION INC. the Beverly Foundation, and the National Mobility Institute to conduct a series of research studies:
Review the literature and public information materials on family and friends' involvement with driving decisions of older adults;
Identify current state and provincial requirements and practices regarding identification of high risk older drivers;
Determine information resource needs among professionals interested in issues concerning older drivers;
Conduct a series of focus groups to determine the feasibility of involving family and friends in identifying and helping atrisk older drivers;
Convene an expert panel to provide additional input, insight, and suggestions for interventions, and
Develop guidelines and materials on what concerned families need to do to help atrisk older drivers.
This report summarizes the results of these research activities.
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