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) in 1993 to identify the nature of safety problems experienced by older persons and develop actionable solutions to these problems.
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 health and functional ability may alter the performance of critical skills needed for driving,
NHTSA has proposed that individuals who have an opportunity to routinely observe the driving behavior of functionally impaired drivers may provide referrals for selective review by driver licensing agencies. This may be preferable to periodic screening of all older drivers. Individuals in this position include family members and friends who are frequently concerned about the driving safety of older individuals.
To provide families, friends, healthcare providers, law enforcement personnel, and community and social services with information to assist older adults whose capabilities make them potentially unsafe to drive, NHTSA contracted with Creative Action Inc., the Beverly Foundation, and the National Mobility Institute to conduct a series of research tasks.
(1) Review literature and public information materials on family and friends' involvement with the driving decisions of older adults.
(2) Identify current state and provincial requirements and practices regarding identification of high risk older drivers.
(3) Determine information resource needs among professionals.
(4) Conduct a series of focus groups to determine the feasibility of involving family and friends in identifying and helping atrisk older drivers limit or stop unsafe driving.
(5) Convene an expert panel to provide additional input, insight, and suggestions for interventions.
(6) Develop guidelines and materials on what concerned families need to do to help atrisk older drivers.
All research tasks were conducted with input from a panel of experts in a wide range of professions related to older driver issues. The literature review took a broadbased approach and included related topics of intergenerational linkages, caregiving, and issues of changing problem behaviors. A mail survey with telephone followup was carried out with 7 participating states to identify current state regulations and practices. Professionals attending professional conferences were asked what resources they need to work with older drivers and their families. Six focus groups with 50 participants were conducted among concerned family members, friends and professionals in St. Louis, MO and Akron, OH. Many basic questions were answered by this research. Key issues related to intervention by family and friends have been identified. Additional quantitative research is needed to develop definitive guidelines and materials.
Older drivers most atrisk of engaging in unsafe driving behavior are males with certain medical conditions, especially dementia or declining vision, who are not aware of or do not recognize their disabilities, and who have little contact with family members or friends. The independence driving provides is more important to older men than older women who are more willing to modify or stop driving. Family members and friends most likely to intervene to help the problem older driver modify or stop driving are those with strongest concern and caring for the older driver -- generally the same people who are likely to become caregivers or decisionmakers for caregiving. Those who intervene are most likely to be a spouse, or an adult child of an older driver. Families' ability to function effectively influences their ability to intervene.
Many family members are able to recognize unsafe driving among older relatives and think of impairment in functional, rather than diagnostic terms. They characterize unsafe driving practices as forgetfulness, confusion, bad judgment, failure to follow the rules of the road, inability of drivers to see where they are going, and aggressive driving. Family and friends indicate signs of unsafe driving situations: crashes, new dents and dings on the older driver's car, neighbors, friends, police, others calling family members about the driving problem, and the family members' observing unsafe driving firsthand.
Some family members try to intervene on their own, often through persuasion, removing car keys, making the car impossible to start, or removing the car altogether. Only a few have the support of the police, the DMV, or a physician. Most would like the support of these authority figures. At the same time, professionals who responded to the survey say they want more information and materials to help them in this supportive role.
Barriers to intervention include social and cultural norms that favor individual independence over public safety; national policies, state regulations and practices including those related to reporting problem older drivers; lack of support from authority figures; lack of public education and information about public health risks; lack of customerfocused alternative transportation services; and an inability or unwillingness to recognize the problem and change to driving safely.
Families, friends, and professionals in focus group discussions, and expert panelists recommend a common set of solutions to involve family members and friends: a social marketing campaign with materials that indicate signs of unsafe driving, its consequences, and specific examples of intervention; federal and state policies and regulations mandating reporting and retesting; development of functionally appropriate tests with cutoff scores to identify atrisk drivers of any age; regional driving assessment clinics; classes to improve driving skills; establishing insurance providers as gatekeepers; creating linkages with DMV's and insurance providers; developing customerfocused alternative transportation; establishing a more prominent role for authority figures; and providing transportation planning and counseling at the local level. This set of solutions should be broadly targeted to the general public, professionals, and responsible authorities.
Research results indicate use of a 4part model for application in additional research and development of coordinated intervention programming. Features include: identification of high risk functional disabilities of the problem older driver; characterization of families who are likely to intervene; formal community supports; and informal social networks, within the social and cultural environment.
The authors wish to thank the following individuals for their expertise and contributions to the text, suggestions for interventions, and thoughtful comments in the completion of this report:
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