PROBLEM STATEMENTS

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.

Title: Maryland Model: Further Testing

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:

  1. Follow-up projects in one or more states should provide more extensive tests of the validity and feasibility of the screening and assessment procedures which appear most promising in the Maryland pilot. Where problems were encountered in the Maryland pilot, corrective approaches should be evaluated. Where the Maryland pilot indicated a need for additional procedures which were beyond the scope of that study, these could be incorporated into follow up projects.
  2. Efforts should be included to disseminate information to the public, including health care and other elder care practitioners; to encourage physician reporting where other interventions have failed; to facilitate the formation or improve the effectiveness of Medical Advisory Boards; to integrate assessment with mobility counseling activities, and to assist with the transition to other transportation options for those who do not continue to drive. 
  3. The final product should be a fully operational program that can be exported to other jurisdictions.

Related Work: Continuation of pilot program initiated in 1996.

Cost: $500K

Title: Law Enforcement Program: Detecting Impaired Drivers

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:

  1. Develop and validate a training curriculum for law enforcement officers to spot impaired drivers and provide a referral for assessment. Criteria for referral must be based on driver behavior, not age or other demographic characteristics. Consider developing a checklist and referral form for officers to keep in car. 
  2. Provide and/or simplify referral avenue.

Related Work: Law-enforcement officer-based detection programs for alcohol & drug-impaired drivers, Older Driver Cues for Law Enforcement

Cost: $2-300K

Title: Driver Retraining Evaluation

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:

  1. Conduct follow-up studies to evaluate the safety outcomes of assessment-and-retraining programs. Include driver remediation programs. 
  2. Examine crash rates (and/or conflicts) to measure safety outcomes. Approach should take into account self-selection bias (i.e., drivers who are concerned with safety may be more likely to enroll in such programs; drivers who fear being told they should cease driving may be less likely to enroll). Approach should also consider the type of retraining program (e.g., those which involve no driving component, those with simulators, etc.) Approaches to be considered might include diary study or survey.

Related Work: Driver retraining programs for accident-involved drivers and frequent offenders, 55ALIVE

Cost: $400K

Title: Driver Retraining Standards: Standardization of Training and Standards of Driver Rehabilitation/Assessment Professionals

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:

  1. Use an expert panel to identify research issues involved in potential standardization of training and standards of driver rehab/assessment professionals. These issues might include the educational background/credentials of the trainer, the format of the training (e.g., written materials, lecture, video, simulator, on-road), the material covered (e.g., visual attention, compensating for reduced abilities, exercises to increase range of motion, self-regulation, defensive driving strategies, when to stop driving, etc.) pre- and post-testing, continuing monitoring of safety outcomes, etc. 
  2. Produce list of potential research issues. Include rationale and possible ramifications of each issue.

Related Work: Driver training program standards

Cost: $100K

Title: Screening and Assessment: Development, Evaluation and Validation of Tools

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:

  1. Develop and evaluate, then implement, screening tests for visual, cognitive and/or physical problems related to crashes. Include higher-order functions (e.g., judgment) and level of expertise, and develop predictive models. 
  2. Develop test training materials for administrators. 
  3. Pilot test comprehensive screening and track crash experience of high-risk drivers vs. others.

Related Work: GRIMPS, driver training assessment tools, graduated licensing work

Cost: $300K

Title: Screening and Assessment: Types/Tiers of Assessments

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

Title: Screening and Assessment: Screening - Routine or Focused?

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:

  1. Evaluate routine screening to determine benefits/drawbacks of routine screening of older drivers (use randomized controlled trials). 
  2. Identify at-risk populations for screening. Define criteria for requiring drivers to complete screening tests. Consider using criteria such as extreme age, medical referral, insurance company referral, crash status, plus other criteria. Use case control methodology.

Related Work: Screening efforts to identify at-risk young drivers and alcohol-impaired drivers

Cost: $200K

Title: Screening and Assessment: Referral Programs

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:

  1. Using an expert panel, develop referral system for at-risk drivers. Assume that referrals will come from diverse sources (e.g., health care providers, law enforcement, family members, etc.) Assume that impairment may be caused by a wide variety of cognitive and/or physical impairment. 
  2. Liaise with insurance companies to explore cooperation in referring at-risk drivers for screening. Consider other possible liaison sources.

Related Work: Maryland Model, other assessment/referral efforts to target other at-risk populations

Cost: $100K

Title: PI&E: Overall Awareness Level

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:

  1. Promote awareness and education on aging and transportation issues and solutions - include policymakers, consumers, professionals, service providers, health and medical, public community organizations. 
  2. Define desired behavioral outcomes for identified target groups. 
  3. In a demo program, develop overall public information strategy or social marketing plan. 
  4. Evaluate for changes in previously-identified behaviors (e.g., number of requests for mobility information, number of licenses turned in, requests for assessment, etc.)

Related Work: Other NHTSA work re restraint systems, car seats, etc.

Cost: $300K

Title: PI&E: Evaluate PI&E Efforts - new and old

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:

  1. Conduct a community-level evaluation of mobility for non-drivers. Examine materials/strategies for: 
    - appropriateness of messages and delivery system 
    - cultural and geographic appropriateness 
    - financial realities 
  2. Identify successful models for other social issues (e.g., public health) that can be adapted and tested for senior market. 
  3. Identify desired behavioral outcomes. 
  4. Identify new messages. Pilot test program to make older drivers and families aware of options prior to loss of driving privilege and produce a document, “Before You Give Up Your Keys: A Handbook of Options”. Evaluate behavioral outcomes.

Related Work: Other NHTSA/FHWA and DOE efforts to promote bicycling & walking as mobility options

Cost: $200K

Title: Evaluate Mobility Alternatives

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:

  1. Conduct a literature review and identify existing mobility alternative programs. 
  2. Evaluate existing programs. 
  3. Identify successful transportation solutions developed in/by communities/local groups (mobility options). 
  4. Produce a Best Practices report. Conduct an expert panel if needed to produce the report. Cover issues of establishing/ resolving policy issues and creating funding mechanisms for alternative transportation.

Related Work: Evaluation of effect of ADA on increases in mobility/access, NIDR efforts, Beverly Foundation study of unusual mobility programs

Cost: $200K

Title: Mobility Alternatives PI&E

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:

  1. Define behavioral goals (e.g., increased use of mobility services, reduced driving) 
  2. Develop strategies to communicate mobility alternatives 
  3. Develop social marketing to older people so they know that they are eligible for services (and to design services that match their needs) 
  4. In a pilot or demo, measure behavioral change

Related Work: Other PI&E evaluations re seat restraints, car seats, etc. NIDR efforts

Cost: $250K

Title: Alternative Transportation Users: Needs And Capabilities

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

Title: Rate of Impaired Status

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.

  1. Select assessment tool/s and carefully investigate cutoff point or range to define “safe” and “unsafe”. 
  2. Administer assessment tool/s to a sample of the older driving population and to a sample of younger drivers.

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.

Title: Assessment of Medication Effects on Driving

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:

  1. Medication (prescription and over the counter): Conduct an expert panel of physicians and other medication specialists. Define the connections and implications of medicine use for the older driver. Explore interactions and combination effects, where possible. Identify gaps in knowledge about these effects to suggest needed research. 
  2. Develop PI&E materials for effective dissemination of knowledge of medication effects.

Related Work: Alcohol/drug impaired driver research efforts

Cost: $100K

Title: ITS and Implications for At-Risk Drivers

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:

  1. Investigate Older Driver use of ITS systems. Examine instances when ITS might enhance safety, and whether (or when) it might instead complicate the driving task or cause a distraction. 
  2. Study interface issues of ITS displays with an eye to an aging population (e.g., HUD’s, contrast, maps, character size.) 
  3. Determine consequences of use for exposure. Specifically, determine if ITS technology might encourage at-risk drivers to increase their miles drives/trips taken and thereby increase their exposure.

Related Work: FHWA and NHTSA ITS work

Cost: $200K

Title: Media Portrayal of Older Drivers

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.

  1. Define desired behavioral outcomes by media. 
  2. Develop a PI&E effort to give an accurate picture of the safety of Older Drivers. 
  3. In a pilot or demo project, evaluate change in media coverage.

Related Work: PI&E effort by ATA, BMCS and AMA (American Motorcycle Association) to improve image

Cost: $100K

Title: National Personal Transportation Survey (NPTS) - Analysis

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:

  1. Use an expert panel to identify data elements to add to NPTS survey for an older population sample. Useful elements might include indicators of health and cognitive/physical function; day and night driving; frequency of driving; modifications being taken; crashes, violations, near misses, getting lost or difficulty navigating; use of alternate transportation; desire to stop driving. 
  2. Request increase in sample size of older drivers, particularly 85+ age group.

Related Work: Previous NPTS work, efforts to improve NPTS coverage of pedestrian/bicycling activities

Cost: $25K

Title: Overcoming Barriers to Driver Assessment

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:

  1. Use a survey, focus groups, and/or an expert panel to define barriers to seeking assessment. Study both self-referrals and other referrals (e.g., physician). 
  2. Make recommendations regarding solutions to barriers.

Related Work: Efforts to overcome resistance to screening for medical conditions (e.g., breast & prostate cancer)

Cost: $100K

Title: Early-Stage Dementia Driving Behavior Research

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:

  1. Conduct a longitudinal observational study of early stage dementia patients.
  2. Measure the proportion of patients with early stage dementia who keep driving. 
  3. Measure exposure and crash rates and/or near misses.

Related Work: Work by NIMH, NIH

Cost: $400K

Title: Indiana Tri-Level, Update

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:

  1. Conduct additional in-depth investigations with all age groups, including Older Drivers. 
  2. Analyze crashes, using hard-copy crash reports and site visits. Use caution when attributing “fault”, avoiding age bias. Investigations should include (but not be limited to) medication use, vulnerability to distraction, speed differentials, visual acuity, cognitive and physical limitations, etc. 
  3. Use case control approach to determine overinvolvement associated with factors such as medication use and/or cognitive and physical limitations. Otherwise, the study might simply measure prevalence of that factor in the population and would not show impact on crash risk.

Related Work: In-depth investigations on pedestrian injury causation parameters by NHTSA, original Indiana Tri-Level

Cost: $1M

Title: Medical Conditions: Do They Impede Insight for Self-Regulation?

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:

  1. Target specific medical conditions which may affect judgement and self-perception, thereby potentially interfering in self-regulation. Consider studying dementia, sleep apnea, hypoglycemic reactions (e.g., in diabetes), some medications (e.g., antihistamines). 
  2. Design method to evaluate subjects and conduct survey to determine whether the targeted medical conditions impede self-regulation.

Related Work: NIMH, NIH work

Cost: $400K

Title: Rural Older Drivers, Crashes, and Exposure

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:

  1. Define rural drivers as those whose residence is outside a Standard Metropolitan Statistical Area (SMSA). 
  2. Compare rural drivers to urban drivers. Do not include suburban drivers in either sample, as suburbs vary greatly in their characteristics (e.g., access to mass transit or other alternative transportation, distance to necessary services, traffic density, etc.) 
  3. Conduct a survey (or diary study) and crash analysis to determine exposure and crash rate of rural older drivers compared to urban. Investigate relationship to crashes. Measured variables should include (but not be limited to) number and distance of trips taken, alternative transportation methods, self-perceived driving efficacy, and other necessary information.

Related Work: ITS work targeting rural areas/driving

Cost: $200K

Title: Crashes Involving Older Pedestrians

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.

  1. Collect pedestrian exposure data. Possible methods might include diaries, videotapes, surveys, telephone surveys, site observation, etc. 
  2. Consider investigating specific crash types (e.g., intersection issues including RTOR, length of “WALK” signals, etc.) In-depth crash case studies might be necessary to investigate types of crashes.

Related Work: FHWA pedestrian exposure studies, NHTSA pedestrian exposure methodological efforts

Cost: $200K 

A Problem statement has been generated for a medium-priority project.

Title: Crash Rates of Older Females: Cohort Effect?

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.

  1. Identify possible crash predictors. Consider many possible influences such as years of driving experience, change in type of driving (e.g., changing from local, residential driving to limited-access highways), an increase in responsibilities that may cause fatigue (e.g., caring for infirm spouse), etc.
  2. Measure relationship of predictors to crash rates. Use caution to ensure an adequate sample size.

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.