Effects of a Speed-of-Processing Intervention on Driving Performance: The ACCELERATE Study

Useful Field of View performance, as measured by UFOV, is a valid and reliable predictor of crash involvement among older drivers, and UFOV performance improves with Speed of Processing (SOP) training. The ACCELERATE Study is examining the effects of SOP training on other cognitive functions and on everyday mobility among older adults at risk for impaired mobility. To date, 59 participants have been randomly assigned to SOP training and 59 to an Internet training control group (total n = 118). At baseline and post-test, participants are given extensive cognitive, sensory, health, and mobility assessments, as well as driving assessments in either a driving simulator or an instrumented vehicle. Preliminary results indicate that performance on the UFOV improves significantly more in the SOP training group than in the control group. Furthermore, means on most other cognitive variables are in the direction of greater improvement for SOP trainees than controls, with significant transfer of training on select speeded measures. Preliminary analyses of driving indicate that relative to controls, SOP trainees have improved in the speed with which they are able to detect moving targets originating in the periphery and moving toward central vision, but not in the detection of static targets originating in central view. Thus, some driving tasks appear to benefit from SOP training, while others do not. Results suggest that Speed of Processing training may transfer to other cognitive functions as well as to everyday mobility performance, such as driving

Translating Laboratory Measures to Real-World Outcomes: Application of the UFOV® Test in an Insurance Company Setting

Poor performance on the Useful Field of View (UFOV® test) has been linked to negative driving outcomes, such as crashes. The UFOV® test was given to a sample of drivers 75+ years across the state of Alabama (N=2235) as a means of attaining a reduction in insurance rates if successful on the test. Results revealed that retrospectively, participants who failed the assessment were 1.65 times more likely to have an at-fault crash and 1.66 times more likely to have an at-fault insurance claim in the previous five years as compared to participants who passed the assessment. Prospectively, these same participants were 1.85 times more likely to have an at-fault crash and 2.73 times more likely to have an at-fault claim in the subsequent 1.29 years after assessment as compared to participants who passed the assessment. To the authors’ knowledge, this is the first translational study to investigate the impact of offering an insurance discount for passing such an assessment on prospective at-fault crashes and at-fault insurance claims

Can High-risk Older Drivers be Identified in a DMV Setting with a Brief Battery of Functional Tests?

Recent research has indicated that some laboratory measures of functional ability may discriminate between crash-involved and crash-free older adults. However, the ability of these tests to provide the same level of discriminability in a real-world setting such as a Department of Motor Vehicles remains to be established. Therefore, in conjunction with the Maryland Department of Motor Vehicles and the National Highway Traffic Safety Administration, a brief battery of tests was developed and evaluated. The battery contained a number of cognitive tests (e.g., UFOV® subtest 2, the closure subtest of the Motor Free Visual Perception Test [MVPT], Trails A and B, etc.) and physical measures (e.g., Rapid Pace Walk, Head and Neck Rotation, etc.) that prior literature had indicated might be related to crash risk in older adults. Motor Vehicle Administration staff were trained to administer the test battery. Older adults (N=4,173, mean age =69 years) were approached by the staff after license renewal and asked to help evaluate the brief battery. Of the 4,173 older adults approached at the field sites, 2,112 individuals aged 55-96 years of age participated. The primary outcome of interest for this study was the occurrence of an at-fault Motor Vehicle Collision (MVC) following assessment. For members of this sample, the outcome period ranged from 2-3 years. Rate Ratios were determined for each functional variable based upon at-fault crashes adjusted for driving exposure over this period. Univariate analyses revealed that five variables (Age, Walk Time, MVPT, Trails A and UFOV®) were significantly related to crash frequency. These significant variables overlapped with one another to a certain degree, indicating that impaired older drivers score poorly on multiple cognitive assessments. The UFOV® subtest 2 appears to be the most strongly associated within this analysis (RR=3.78, p\u3c .05) and Rapid Pace Walk (RR=1.96, p \u3c .05) remained uniquely related to the frequency of state-reported, at-fault crashes. The role of such a screening battery in field settings such as a DMV will be discussed

Longitudinal Assessment of Older Drivers in a DMV Setting

A brief battery of functional assessments designed to detect crash riskamong older drivers was developed and evaluated initially in 1999 in Marylandmotor vehicle licensing sites following the routine vision screening exam. Thisbattery contained a number of cognitive tests (e.g., UFOV® subtest 2, the closuresubtest of the Motor Free Visual Perception Test (MVPT), Trails A and B, cuedrecall, delayed recall), and several physical measures (e.g., Rapid Pace Walk,Head and Neck Rotation, Foot Tap, Arm Reach). Older adults (N=4,173; meanage = 69 years) were approached by the staff after license renewal and asked tohelp evaluate the brief battery. Of the 4,173 older adults approached at the fieldsites, 2,114 individuals 55-96 years of age participated. Subsequently, the originalsample of 2,114 participants was invited to come in once again, during their fiveyearlicense renewal cycle, and the functional tests were administered once again.To date, 939 individuals have completed the second screening evaluation. Anexamination of the crash data from the interval between assessments for theseindividuals indicates that the same cognitive measures are predictive of at-faultcrashes. Furthermore, approximately 10% of those passing the assessment in 1999are now failing the assessment in 2004. Performance-based cognitive measuresare predictive of future at-fault motor vehicle collisions among older adults.Cognitive performance, in particular, is a salient predictor of subsequent crashinvolvement among older adults. High-risk older drivers can be identified throughbrief, performance-based measures administered in a DMV setting

Predicting Driving Performance in Older Adults with the Useful Field of View Test: A Meta-Analysis

This investigation examines the Useful Field of View (specifically theUFOV® test), as a predictor of objective measures of driving performance.PubMed and PsycInfo databases were searched to retrieve eight independentstudies reporting bivariate relationships between the UFOV® test and drivingmeasures (driving simulator performance, state-recorded crashes, and on-roaddriving). Cumulative meta-analysis techniques were used to examine thepredictive utility of the test, to determine whether the effect size was stable acrossstudies, and to assess whether a sufficient number of studies have been conductedto conclude that the test is an effective predictor of driving competence. Resultsshowed that the study samples could have been drawn from the same population.The weighted mean effect size across all studies revealed a large effect, Cohen’sd=0.945, with poorer UFOV® test performance associated with negative drivingoutcomes. This relationship was robust across multiple indices of drivingperformance and several research laboratories. A concrete measure of sufficiencyrevealed that an additional 513 studies averaging a null result must be conductedto bring the p-value for the cumulative effect size to greater than .05. Thisconvergence of evidence across different points in time and different researchteams confirms the importance of the UFOV® assessment as a valid and reliableindex of driving performance and safety. Corroborating this finding, a recent largefield study in Maryland has further established the UFOV® test as a usefulscreening instrument to identify at-risk older drivers. Taken together, thesefindings could have far-reaching implications for public policy