Problem statements have been generated for each High-Priority project. Problem statements give a Title, Problem, Objective/s, Related Work, and Cost for each project.
Problem: NHTSA, in cooperation with the State of Maryland, is currently pilot testing a Model Driver Screening and Evaluation Program (DTNH22-96-C-O5140). This study examines retrospective and prospective relationships between performance on a battery of functional screening measures and indices of driving safety and mobility, for varying samples of older drivers. A volunteer-renewal sample, a residential living community sample, and a medical referral sample were obtained and examined using a NHTSA-developed Gross Impairments (GRIMPS) screening tool, plus other assessment procedures. A preliminary indication of Model Program validity as well as its administrative feasibility in diverse settings will be reported at the project’s conclusion in 2001, and a test plan containing recommendations for replicating components of the model in other states will be produced. A follow-up would allow further testing and refinement.
Objective:
Related Work: Continuation of pilot program initiated in 1996.
Cost: $500K
Problem: Although law enforcement officers routinely encounter drivers whose abilities may be impaired, no standard program or procedure exists to help officers handle the situation. Current procedures are designed to address alcohol- or drug-impairment and do not adequately handle cognitive or physical impairment. In addition, informal cultural pressures discourage referral of drivers when they are not substance-impaired. However, non-substance-impaired drivers can be just as hazardous as drunk or drugged drivers. When policies do address cognitive or physical impairment, they often merely suggest calling for medical assistance (an option which is often used only in acute cases, such as a driver who cannot give his/her name or cannot walk). Law enforcement officers should be provided with a procedure to handle cognitively- and/or physically-impaired drivers.
It is important that input be solicited from the law enforcement community. Procedures and criteria must be usable by law enforcement officers. It is strongly recommended that a current or former law enforcement officer/s be involved at every stage of the development process.
Objective:
Related Work: Law-enforcement officer-based detection programs for alcohol & drug-impaired drivers, Older Driver Cues for Law Enforcement
Cost: $2-300K
Problem: Driver retraining programs (e.g., improvement or refresher courses) are increasing in number and popularity. No definitive evaluation has been made of assessment and/or retraining programs for older or at-risk drivers. It is essential to establish whether or not such programs reduce crash risk.
Objective:
Related Work: Driver retraining programs for accident-involved drivers and frequent offenders, 55ALIVE
Cost: $400K
Problem: If driver re-training proves effective in “Driving Retraining Evaluation” then it is beneficial to define the issues involved in maximizing the effectiveness of training programs and of driver rehabilitation/assessment professionals.
Objective:
Related Work: Driver training program standards
Cost: $100K
Problem: Screening instruments are needed to measure drivers for problems related to crashes. Traditional, one-to-one driving examinations are not financially feasible on a large scale. Therefore, screening instruments are needed to select those individuals who are most likely to have higher crash risk.
Objective:
Related Work: GRIMPS, driver training assessment tools, graduated licensing work
Cost: $300K
Problem: Individuals who interact with older adults (and the older adults themselves) are often concerned about driving abilities. They wish to ensure that the older adult is safe on the road, but have few resources to find out whether this is the case. Screening and assessment instruments are needed for use by people in different roles. Individuals, family members, social workers, physicians, and others would benefit from tools geared toward different users. These tools would allow users to gauge the safety of the older driver and provide objective evidence for discussion and (possibly) intervention. This would allow drivers to continue for as long as safely possible; while assisting in the cessation of drivers for whom safe driving is not possible.
Objective: Develop multiple tiers of assessment for different types of users (e.g.,individuals, family members, social workers, occupational therapists, medical personnel). Include self-assessment. May use results from Screening and Assessment: Development, Evaluation and Validation of Tools as input. Guides (particularly for family members and physicians) should emphasize that age is not the determinant of safety: physical and cognitive abilities are far more important. Tools should be developed with an eye to enhancing interactions with the older adult and improving the safety of all road users.
Related Work: GRIMPS, driver training assessment tools, AAA and New York State materials
Cost: $200K
Problem: Routine screening of all drivers would be impractical. Even the least expensive screening methods will involve some cost, and a blanket screening would be exorbitantly expensive in both dollars and time. If higher-risk populations can be identified for screening, focused screening might be more efficient and more likely (per screening) to expose unsafe drivers. By screening the right populations, safety can be maximized and cost minimized.
Objective:
Related Work: Screening efforts to identify at-risk young drivers and alcohol-impaired drivers
Cost: $200K
Problem: In order to make screening available to at-risk drivers, a referral system must be developed. Current referral systems are slow (often taking 30 days or more) and referral criteria are often not keyed to the wide possible range of cognitive and physical impairments.
Objective:
Related Work: Maryland Model, other assessment/referral efforts to target other at-risk populations
Cost: $100K
Problem: There is very little (accurate) awareness in the general population of the issue of aging and transportation issues. For example, portrayals in the media tend to assume that old age alone creates unsafe driving - that any older driver is a bad driver, and that older people ought not to drive. In addition, popular culture tends to assume that older people do not self-regulate: that is, that their licenses or keys must be “taken away” when they are “too old to drive”.
Objective:
Related Work: Other NHTSA work re restraint systems, car seats, etc.
Cost: $300K
Problem: Drivers and non-drivers must be informed about their options. An evaluation of existing messages will enhance the development of new messages and delivery systems.
Objective:
Related Work: Other NHTSA/FHWA and DOE efforts to promote bicycling & walking as mobility options
Cost: $200K
Problem: It is strongly suspected (see Rural Older Drivers, Crashes and Exposure study) that drivers who do not have alternative transportation continue to drive for longer than they know is safe, simply because they feel they have no choice. Conversely, drivers who have alternative methods of transportation may reduce their driving or cease driving earlier than if those alternatives were not in place. Alternative transportation may increase safety by reducing the numbers and exposure of impaired drivers. Mobility alternative programs differ greatly by locality, and much can be learned by examining existing programs.
Objective:
Related Work: Evaluation of effect of ADA on increases in mobility/access, NIDR efforts, Beverly Foundation study of unusual mobility programs
Cost: $200K
Problem: If transitioning or non-drivers are to take advantage of mobility alternatives and reduce exposure to crashes, they must be informed about their options. If transitioning drivers are aware of mobility alternatives, they may choose to drive less; they may also choose to cease driving earlier than they otherwise might. Effective communication of mobility options is needed.
Objective:
Related Work: Other PI&E evaluations re seat restraints, car seats, etc. NIDR efforts
Cost: $250K
Problem: In order to ensure that unsafe drivers do not continue to drive, alternative transportation must fulfill the needs of its potential users. It is necessary to define the needs and capabilities of the target population. If alternative transportation is useful and usable by the target population, drivers may voluntarily reduce their number of trips taken and perhaps be willing to stop driving sooner. Crash risk will then be lowered, through both the reduction in exposure and by the reduction specifically of impaired driving.
Objective: Use a survey to identify the needs and capabilities of alternative transportation users. Include pedestrians. Issues should include physical and cognitive challenges (see Literature Review, Appendix 1 for lists); users’ ability (or inability) to get to a common pick-up point; proximity to public transportation of likely destinations (e.g., medical center, retail stores, senior center, etc.); the need to accommodate devices such as canes, walkers, wheelchairs, etc.
Related Work: FHWA older driver/pedestrian research, NIDR efforts
Cost: $200K
Problem: Older drivers are stereotyped by popular culture as incapable of driving safely. This is inaccurate. Although it is clear that SOME older people can no longer operate a vehicle safely, it is unknown what proportion of the older driving population is unsafe.
Objective: Determine the proportion of Older Drivers who are safe/unsafe.
Special attention must be paid to issues of sampling and self-selection. Sample must be representative of the older driving population regarding such issues as sex, age, visual acuity, medication use, physical limitations (or lack thereof), etc. A younger sample must be included for comparison purposes.
Related Work: Standards development, driver task analyses, Human Resources Research Organization (HumRRO) task analyses and HumRRO efforts to develop links between operator tasks and human performance skills and capabilities
Cost: $250K
Note: The above project is difficult. The selection of a cutoff point or range to define “safe” and “unsafe” is particularly problematic. If assessment scores and crash rates are plotted together, it is extremely unlikely that a neat step function will appear (which would make a cutoff point self-evident). Instead, researchers may find themselves investigating changes in slope, breaks in a curve, or other even more difficult functions. Effort applied to Objective 1 should not be minimized.
Problem: Much of the Older Driver population uses prescription and over-the-counter medications, singly and in combination. In 1988, people over age 65 comprised 12% of the population but accounted for 29% of all prescriptions (Ray, Thapa & Shorr, 1993). 80% of them were taking at least one medication. Approximately 21% of 65-84 year olds were taking a medication that might impair driving (e.g., benzodiazepine, antidepressant, opioid, antihistamine, etc.) It is important that individuals be aware of possible side effects that may impact on the driving task.
Objective:
Related Work: Alcohol/drug impaired driver research efforts
Cost: $100K
Problem: Burgeoning ITS technology has made its way to the user market. Use of ITS instruments may improve performance (especially when users are familiar with the system) or may complicate the driving task. Effects of use on exposure are unknown (e.g., if ITS increases drivers confidence, they might change their trip frequency or length; with vision enhancement systems drivers might increase night trips; and adaptive cruise control users might increase their long-distance driving.) Real-life application may have unintended consequences.
Objective:
Related Work: FHWA and NHTSA ITS work
Cost: $200K
Problem: Older drivers are stereotyped by popular culture as incapable of driving safely. This is incorrect, and hampers the dissemination of accurate information. Popular media portrayals intensify the impression, and serve to foster the stereotype.
Objective: Educate media so they frame the issue without stereotyping - most Older Drivers are safe.
Related Work: PI&E effort by ATA, BMCS and AMA (American Motorcycle Association) to improve image
Cost: $100K
Problem: The NPTS survey addresses many important issues, but does not investigate issues of aging in detail. The identification of additional data elements for the NPTS survey would be beneficial to the state of knowledge regarding older individuals’ transportation, and to NHTSA’s research efforts on at-risk drivers. In addition, the sample size of drivers over 85 needs to increase to a level that would allow generalizability.
Objective:
Related Work: Previous NPTS work, efforts to improve NPTS coverage of pedestrian/bicycling activities
Cost: $25K
Problem: There can be resistance to seeking driver assessment, both from individual drivers and from those who might refer them for assessment (e.g., physicians). Individuals may fear the loss of the driving privilege, and those surrounding them recognize the difficulty of this transition. This can prevent assessment efforts from being effective.
Objective:
Related Work: Efforts to overcome resistance to screening for medical conditions (e.g., breast & prostate cancer)
Cost: $100K
Problem: Many of those diagnosed with early stage dementia continue to drive. Although the diagnosis itself does not necessarily indicate hazardous driving, the short- and long-term consequences are unclear. The resistance of later-stage dementia patients to driving cessation is especially troubling.
Objective:
Related Work: Work by NIMH, NIH
Cost: $400K
Problem: The Indiana Tri-Level studies were in-depth investigations of specific crashes. The study included on-site data collection (skid marks, coefficients of friction, surface characteristics) as well as detailed psychological analyses/profiling of the crash-involved. An update including all age groups would be invaluable and would shed light on many crash-related questions, such as those involving medication use, vulnerability to distraction, speed differentials, visual acuity, cognitive and physical limitations, etc. Although many of these are believed to have safety-related outcomes, some relationships are hard to establish (or disprove) based on current data. In-depth investigations would provide the power and breadth of data necessary to directly establish (or disprove) relationships between many age-related issues and crashes.
Objective:
Related Work: In-depth investigations on pedestrian injury causation parameters by NHTSA, original Indiana Tri-Level
Cost: $1M
Problem: Some medical conditions (e.g., dementia, sleep apnea, hypoglycemic episodes or insulin reactions, some medications) harm judgement and self-perception. Because judgement and self-perception are critical for self-regulation, self-regulation may be less effective. That is, the same condition that creates a hazardous driving state prevents the driver from recognizing the danger.
Objective:
Related Work: NIMH, NIH work
Cost: $400K
Problem: Rural Older Drivers have few alternative transportation solutions upon driving cessation. Older Drivers may continue to drive for longer than their urban counterparts. If so, this may be because of lack of alternative transportation methods and/or a lack of nearby services. If Older Drivers do drive longer, crash rates may be affected. Because rural driving involves less traffic and fewer complex driving situations, crash rates might be lower or the same as for urban drivers. Conversely, rural driving often involves greater distances and higher speeds, so crash rates might be higher than for urban counterparts.
Objective:
Related Work: ITS work targeting rural areas/driving
Cost: $200K
Problem: Older Pedestrians are strongly represented in pedestrian fatalities, particularly at intersections. However, their level of exposure is unknown, so any estimated rate is pure speculation. That is, it is unknown whether older pedestrians make up a greater proportion of the pedestrian population (which would increase their representation in crashes), or if they do more walking than younger pedestrians (which would also increase their representation in crashes) or if older pedestrians are more at risk when walking than are younger pedestrians.
Specific issues involving older pedestrian crashes are also in need of study and might be addressed. For example, older pedestrians appear to be overinvolved at intersections, but older pedestrians might be more likely to cross at the intersection than younger pedestrians, thereby inflating exposure to intersections relative to younger pedestrians. Additionally, intersection crashes might exist disproportionately at complex intersections. Older Pedestrians might be overrepresented in right turn on red (RTOR) crashes. It has long been believed that short pedestrian “WALK” signals might be related to fatalities in older pedestrians, but this has not been directly demonstrated. Investigate length of “WALK” signals to see if the “older-pedestrian-trapped-by-the-light” issue is verifiable.
Objective: Determine whether Older Pedestrians are overrepresented in pedestrian crashes in the U. S.
Related Work: FHWA pedestrian exposure studies, NHTSA pedestrian exposure methodological efforts
Cost: $200K
A Problem statement has been generated for a medium-priority project.
Problem: Some data indicates a Gender X Age interaction for crash rates of drivers (Smiley, MacGregor, Chipman, Taylor & Kawaja, 1997; Smiley, Lee-Gosselin, Chipman & MacGregor, 1991). That is, Older female drivers may have a higher crash rate (per million driver kilometers per year) than Older male drivers, while no such effect is found in younger ages. This may be a cohort effect (i.e., specific to the current Older generation and not applicable to aging baby boomers), or might be a unique effect of aging on females that impacts the driving task, or might be caused by some other factor.
Objective: Investigate Gender X Age interaction.
Related Work: Crash research on over-involved young male drivers/cohort effects
Cost: $125K
Note: NHTSA might explore the possibility of supplying data to the TRB Committee on Women’s Issues in Transportation for investigation of this issue.