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SOLUTIONS

 

Focus group discussants and expert panelists suggested a number of guidelines and solutions to consider in removing barriers to intervention and motivating family members and friends to intervene for safe driving decisions. Common themes emerged from both laypersons and professionals. Their recommendations for solutions and interventions are described below.

However, on a cautionary note, one expert panelist, a geriatric physician who has also conducted research on family involvement with older drivers, believed the current state of research knowledge does not yet permit the development of guidelines, materials and legislation. This expert recommends conducting a series of demonstration project to enhance future success in interventions and social marketing campaigns.

 

Solutions and Interventions Offered by Family Members and Friends

Issues and ideas for solution centered on types of interventions at the societal, community, group, and individual levels. It was not always clear who would put the interventions into practice or how one would access them.

Social Marketing Campaign

Develop a social marketing campaign on a state by state basis to achieve an impact on safe driving similar to MADD.

Identify unsafe driving at any age as a public health risk and position driving as a healthcare and safety issue through a media campaign. Use safety and liability as the motivators to change societal norms to make intervention socially acceptable (e.g., “Friends don't let friends drive unsafely”).

Target the campaign to the general public (including the older driver, family and friends) and authority figures in healthcare, law enforcement, DMV's, policy–makers and legislators, and the courts.

Develop multimedia presentations that specify indicators and consequences of unsafe driving, and specific examples of interventions. Initiate widespread education of healthcare providers, police, care providers, and caregivers focused on understanding older driver behavior and the importance of professionals participating in assisting older drivers transition through the stages of driving cessation. Educate family members that age alone is not a predictor of driving ability. Provide information about the signs of unsafe driving and related functional declines. Be aware of some family members' questionable motivations for intervention.

Develop appeals to and intervention strategies for family and friends to help the small proportion of older drivers who cannot or will not recognize their own functional disabilities. Develop methods for family and friends to intervene more successfully on behalf of the highest risk subpopulations such as older male drivers. Adapt interventions now in use for older couples and family members who are experiencing conflict and relationship difficulties for use in driving cessation issues.

Encourage families and friends to seek official assistance from healthcare professionals and DMV's in re–evaluating a driver. Tell family members and friends in each state how to get a reassessment of an older driver. Persuade families, friends, and older drivers who modify unsafe driving on their own volition to look for unsafe driving situations and take refresher courses such as 55 Alive. Encourage the use of alternative transportation prior to the older driver stopping driving completely.

Develop strategies to give the American Association of Motor Vehicle Administrators and the DMV's an active role in distributing social marketing campaign materials. Involve physicians, eye care specialists, podiatrists, and pharmacists. In partnership with NHTSA, disseminate information such as a family-directed quiz or a set of assessment tools through ophthalmologic, optometric, podiatric, pharmaceutical, and other similar societies, as well as national eyeglass and pharmacy chains. In concert with groups such as AARP, NSC, and NHTSA, produce an array of informational materials that organizations can use to illustrate older driver issues and solutions. Involve churches, synagogues, and senior centers as another source to reach and educate family, friends, and older drivers.

Authority Figures

Develop strategies to involve the healthcare community, law enforcement personnel, and the DMV to help them be more responsive to families who need their assistance. Provide them with pamphlets and other reference materials for distribution to family and friends with information about signs of driving impairment, helping older drivers plan for mobility changes, and inform the public about the costs and benefits of driving compared to alternatives to driving.

Position DMV's as the best authority by placing qualified and motivated examiners at licensing sites to conduct appropriate assessments of functional abilities. The examiners should be given sufficient time and budget to effectively test older drivers.

Policies and Laws

Enforce the laws now on the books. Require testing on a regular basis. Revoke the licenses of people who cannot pass the retest or have too many traffic tickets. Get rid of legal loopholes.

Determine how each jurisdiction now handles problems, including graduated licenses, more frequent testing based on age, handling of inquiries about older drivers, and publicizing of alternatives available to older drivers.

Develop federal and state policies and regulations mandating reporting, retesting, and classes in safe driving. Encourage uniform interest in and responses to older driver issues and solutions among all jurisdictions. Develop standardized older driver program strategies, including nationwide, standardized guidelines and tests for medical reporting with physician–recommended restrictions, retesting intervals, and denials for various impairments (i.e., vision, diabetes, episodic disorders, dementia, memory loss, motor coordination, psychiatric disorders, cardiovascular disorders, pulmonary disorders, etc.).

Tests and Assessments

Develop nationwide, standardized skills–testing tailored to age groupings, with skills–appropriate tests for first–time (younger) and experienced (older) drivers that account for differences in driving performance styles. Develop fast, reliable, and scientifically valid tools for DMV examiners to identify, screen, and further test drivers (e.g., paper and pencil, visual cues, and interview tests). Develop scientifically valid and reliable protocols for office–based screening for physicians to predict who may be at–risk of unsafe driving. Develop a quiz with a validated profile form or risk factor index that family members can use to assess their relatives.

Develop Older Driver Evaluation Programs with standardized protocols for national distribution in multiple locations. Involve the physician in the Older Driver Evaluation program. Provide more functional ability testing centers as a first contact or follow-up to DMV skills-testing, a second opinion or appeals center, or as a non–regulatory third party to provide family members with an unbiased evaluation of the older driver's skill level.

Insurance Companies

Establish state codes which designate insurance companies as gatekeepers. Establish interactive computer linkages to DMV's, permitting insurance renewals if licenses are renewed and licensing if insurance is in place. Discount insurance premiums for older drivers who take driving skills improvement classes.

Alternative Transportation

Develop alternative transportation that meets customers' needs. Develop local partnerships to coordinate local transportation to meet community transportation needs. Develop web-site “Care pools” made up of lists of people who can offer rides to neighbors on a voluntary basis. Encourage older drivers to pool money into a fund that will support a personal transportation service. Encourage the use of alternatives through information materials distributed locally by physicians, community organizations, and other groups.

Transportation Planning and Counseling

Establish and provide an ongoing source of advice, information, and assurance to assist with continuing independence after an elder stops driving. Counsel older adults and caregivers on issues of independence, mobility, and feelings of incompetence surrounding driving cessation. Involve professionals working with older adults and families to plan early for changes in mobility. Encourage social service agencies to establish support groups for older drivers, families, and friends to deal with mobility changes.

Demonstration Projects

Identify signs and indicators of frailty that would alert family members to potential risk of an elder's unsafe driving. Develop materials that might help caregivers to look for those signs of frailty. Train physicians to counsel patients and families about unsafe driving and alternatives to driving. Pilot test these educational materials and trained physicians in physicians' offices.

 

Key Factors Associated with Family and Friends' Involvement for Driving Safety

Family and friends may be in a good position to detect problems and intervene to assist the unsafe older driver to limit or stop driving. Family and friends often look to professionals for help and advice in these matters.

The ability and willingness of concerned family and friends to help older drivers drive more safely or stop driving center on a number of key factors (see Table 1). These include characteristics of older drivers such as their perception of their own driving skills and their readiness to accept intervention; family and friends who are most likely to intervene on behalf of the problem older driver; professionals who may serve as intermediaries and/or advisors; and social norms and policies that must be in place to support these driving modification and cessation efforts.


Table 1: Summary of Findings


 

Problem Older Drivers Most Likely Modify Unsafe Driving Unsafe Driving
Problem Older Drivers Least Likely to Modify to Modify Unsafe Driving Unsafe Driving
Will self–regulate
Will not self–regulate
Recognizes problem driving
Denies problem driving
Female
Male
Not cognitively impaired
Cognitively impaired
Has caregiver/confidant
Has no caregiver/confidant
Has access to alternative transportation
Has no access to alternative transportation
Is ready to change
Is not ready to change

 

Family Members Most Likely to Help Problem Older Drivers
Family Members Least Likely to Help Problem Older Drivers
Sociodemographic/Structural Variables
Close family member
Not close family member
Primary/secondary caregiver
Not primary/secondary caregiver
Spouse or daughter
Son/son–in–law
Mother is care recipient
Father is care recipient
Father is still married to mother
Parents are divorced/separated
Lives within one hour's drive from older driver
Lives more than one hour's drive drive from older driver
Frequent contact with older driver
Infrequent contact with older driver
Not employed
Employed
Euro–American
African–American
Higher income
Lower income
Social/Psychological Variables
Aware of declines
Denies declines
Not stressed
Highly stressed
Helping relationships
Independent relationships
Emotionally close
Emotionally distant

In family unit able to make decisions about elder

In family unit unable to make decisions about elder
Able to provide help and support for elder's change support for elder's change
Unable to provide help and support for elder's change support for elder's change

 

Professionals Most Likely to Help Concerned Family Members and Problem Older Drivers
Professionals Least Likely to Help Concerned Family Members and Problem Older Drivers
Understands issues
Does not understand issues
Sympathetic ethical stance
Unsympathetic ethical stance
Not fearful of lawsuit
Fearful of lawsuit
Risk of problem driving outweighs confidentiality
Risk of problem driving does not outweigh confidentiality
Will report to DMV
Will not report to DMV
Able to give patients and family information
Unable to give patients and family information

 

Social Norms Organized Around Safe Driving by Older Drivers
Social Norms Not Organized Around Safe Driving by Older Drivers
Social norms support driving cessation without stigma
Social norms support continued driving as a marker of independence
State regs support input of family/friends and professionals
State regs do not support input of family/friends and professionals
Public policy supports public or other alternative transportation

Public policy does not support public or other alternative transportation

 

Development of a Model for Research and Social Marketing

These factors may be categorized and analyzed in a four–part model:

  1. The model begins with identification of problem older drivers, the medical conditions and functional disabilities that place the driver in high–risk categories, the meaning driving has for these older individuals, including their emotional attachment to the automobile, driving and consequent independence and autonomy that driving imparts.
  2. The model then proceeds to characterize families that are more likely to regulate or report at–risk older drivers. Particular emphasis should be placed on levels of family functioning and ability to make decisions concerning caregiving, medical intervention, and other issues related to driving.
  3. The model incorporates environmental factors that support or hinder family and friends regulating and reporting unsafe older drivers. Supports include social services, medical and allied health communities, courts and licensing agencies, community agencies, and public transportation services.
  4. Finally, the model recognizes social norms in which these factors and variables operate. Such norms include the values of "freedom" to choose to drive unsafely versus the risk of unsafe driving to public safety. These issues are similar to the change in value of drinking and driving or seat belt usage. The social values of choice and freedom, formerly weighted in favor of the drunk driver and non–user of safety devices, have shifted through social marketing campaigns, to the relative strength of values supporting decreases in risks to public health and safety (See Figure 2).

The model incorporates issues and variables related to unsafe older drivers, their informal networks, family and friends, the formal network of professionals, relevant national, state, and local organizations, as well as the social and cultural milieu. Development of the themes and messages of a social marketing campaign should serve to coordinate components and interventions of each group into an integrated whole.

image chart of formal supports for older drivers

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