SCREENING AND ASSESSMENT

The most important work on older driver safety that needs to occur in the next five years is on refining screening and assessment tools and getting them into the hands of the users who need them. People who will find the tools useful include medical providers, social services providers, law enforcement personnel, licensing personnel, older drivers, and caregivers.

Screening detects the presence of possible indicators of increased crash risk, such as the presence of slowed walking speed; assessment is the process by which a driver is tested to determine whether a functional limitation influences the person’s ability to drive safely. In the case of the example above, assessment would determine the reasons behind the slow walking speed (e.g., diabetes, arthritis, and muscle weakness) and whether the individual could quickly and accurately move his right foot from an accelerator to a brake pedal.

The state of the art in screening tools is advancing rapidly. A growing body of evidence, first reported in the Model Driver Screening and Evaluation Program from NHTSA and continued by researchers funded by the National Institute on Aging, suggests that divided attention tasks and tasks that require the individual to visualize missing information are the best predictors of prospective crash involvement. These tools focus on cognitive issues.

The understanding and validity of screening tools that detect vision deficits is less clear. Research suggests that screening of contrast sensitivity might be more predictive of crash involvement than screening of visual acuity, though the evidence is mixed. Declines in physical function, absent declines in vision and cognition, can be predictive of increased crash risk, but they are generally amenable to vehicle adaptations and retraining.

There is a great deal of variability in the practice of driver assessment. There is no standard assessment protocol. There appear to be two primary causes for this: client needs and assessor preferences. The category of “client needs” means an assessment can be tailored – and shortened – based on functional deficits the client presents. The “assessor preferences” appear to be based on education and experience, the availability of equipment, and the client’s history with screening tests (the selection of a different test because the client has recently been tested using a particular test, with the goal of eliminating practice effects).

Based on these issues, NHTSA’s efforts will focus on screening and assessment and attempts to standardize within the range and variability of client needs. NHTSA has identified the following steps to take in screening and assessment, and plans to develop a program of research and demonstration projects to address them.

1. Validate Assessment Procedures and Tools
   
   Researchers will work to validate assessment procedures by comparing performance on assessment tests with crashes, at-fault crashes, and other moving violations. The expected result of this research will be the development of an evidence-based assessment tool that shows the most promise in detecting an at-risk driver, leading that driver to be redirected to rehabilitation options. A second result will be guidelines for professionals to use when conducting assessments.
   
   
2. Determine the Outcomes of Using Various Self-Screening Tools
   
   Self-screening tools are appearing in many places in formats ranging from paper and pencil tests to computer-based tests. This project aims to determine whether these tools help older people accurately identify risk factors and whether they implement the recommended actions. Researchers will work to determine what safety benefits and unintended consequences result from the use of various self-screening tools.
   
   
3. Understand Factors That Influence Consumers' Decisions to Continue or Discontinue Driving
   
   This project will present research, program, and outreach activities in how people around older drivers can address transitioning from driving and how to foster demand for assessment, rehabilitation, and other safe-driving services. This project will include market research on drivers considering discontinuing driving and will work to determine what can be done to encourage and foster the use of assessment and rehabilitation in this population.
   
   
4. Increase Capacity to Assess Older Drivers
   
   NHTSA expects research on self-assessment and assessment by licensing and medical professionals to be complete within the next five years. This research will result in refined assessment tests. With this knowledge and the knowledge gained in other program activities, NHTSA will be able to promote driving assessments with our partner organizations, thus making it possible for the public to find assessments in their communities more easily. This national effort will enable more people to perform assessments, and it will help the public to find assessment programs in their areas.