Reducing Crash Risk in Visually-Impaired Older Drivers: Medical-Surgical versus Educational Interventions

OBJECTIVES The aim of this paper is to compare the effectiveness of a medical-surgical intervention and an educational intervention in reducing the rate of crash involvement among visually impaired older drivers. Visual impairment is a common functional problem in older adults. Older drivers with visual processing deficits have an increased crash risk. Interventions that reduce these risks need to be identified in order to enhance driver safety. METHODS We have conducted two studies in an effort to examine two types of interventions to lower crash risk in visually impaired drivers. In a prospective cohort study we focused on 277 older drivers with cataracts, about half of who elected surgery and intraocular lens implantation at baseline, and the other half who declined surgery. They were followed for police-reported crash involvement for four to six years. In a second study, 403 older drivers who were visually impaired (acuity and/or useful field of view deficit) were randomly assigned to an individually administered and tailored educational intervention plus usual care, or to usual-care-only. The educational intervention promoted the use of self-regulatory driving strategies and was based on current models of health behavior change. Usual care was a comprehensive eye exam. In this study, subjects were also followed for police-reported crash involvement. RESULTS With respect to the study evaluating the cataract surgery intervention, patients who underwent cataract surgery had half the rate of crash involvement during follow-up compared with cataract patients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to 0.94; p0.05) CONCLUSIONS Cataract surgery has a previously undocumented benefit for older driver safety. However, an individualized educational intervention to promote safe driving strategies did not enhance driver safety. The most effective public health initiatives for reducing crash risk in older drivers may be to focus on the timely treatment of chronic medical conditions in order to prevent, reverse, or slow functional decline. Evidence that educational programs improve older driver safety remains unavailable

Reducing Crash Risk in Visually-Impaired Older Drivers: Medical-Surgical versus Educational Interventions

OBJECTIVES The aim of this paper is to compare the effectiveness of a medical-surgical intervention and an educational intervention in reducing the rate of crash involvement among visually impaired older drivers. Visual impairment is a common functional problem in older adults. Older drivers with visual processing deficits have an increased crash risk. Interventions that reduce these risks need to be identified in order to enhance driver safety. METHODS We have conducted two studies in an effort to examine two types of interventions to lower crash risk in visually impaired drivers. In a prospective cohort study we focused on 277 older drivers with cataracts, about half of who elected surgery and intraocular lens implantation at baseline, and the other half who declined surgery. They were followed for police-reported crash involvement for four to six years. In a second study, 403 older drivers who were visually impaired (acuity and/or useful field of view deficit) were randomly assigned to an individually administered and tailored educational intervention plus usual care, or to usual-care-only. The educational intervention promoted the use of self-regulatory driving strategies and was based on current models of health behavior change. Usual care was a comprehensive eye exam. In this study, subjects were also followed for police-reported crash involvement. RESULTS With respect to the study evaluating the cataract surgery intervention, patients who underwent cataract surgery had half the rate of crash involvement during follow-up compared with cataract patients who did not undergo surgery (rate ratio [RR] 0.47, 95% confidence interval [CI] 0.23 to 0.94; p0.05) CONCLUSIONS Cataract surgery has a previously undocumented benefit for older driver safety. However, an individualized educational intervention to promote safe driving strategies did not enhance driver safety. The most effective public health initiatives for reducing crash risk in older drivers may be to focus on the timely treatment of chronic medical conditions in order to prevent, reverse, or slow functional decline. Evidence that educational programs improve older driver safety remains unavailable

Evaluation of the AARP Driver Safety Program in Florida

OBJECTIVES Older drivers are the fastest growing group of drivers on the road in the United States, both in terms of the number of drivers and annual mileage; also, per-mile-driven, this group has a crash rate nearly equivalent to that of younger drivers. One approach to reducing crash risk in this population has been educational programs aimed at improving driving skills and/or changing driving behaviors. This retrospective cohort study describes the impact of the AARP Driver Safety Program (DSP) in Florida on motor vehicle collisions and violations. METHODS Information on individuals who participated in the AARP DSP in the state of Florida in 2001 and 2002 was provided by the AARP. The Florida Department of Highway Safety and Motor Vehicles (FDHSMV) provided licensure information on all licensed drivers who were aged 60 and older as of January 1, 2001. With respect to violations and collisions, information dating from the mid-1990s to early 2005 was provided. A total of 232,192 unique records for DSP participants were available; however, of these, 38,321 records were excluded because they contained out-of-state, erroneous or missing driver’s license numbers and therefore could not be matched to the data provided by the FDHSMV. Of the remaining 193,871 records with legitimate Florida driver’s license numbers, a total of 140,282 (72.4%) could be linked to the data provided by the FDHSMV. Two separate analyses were conducted. The first analysis compared violation and collision rates for DSP participants before and after DSP participation. The second analysis compared violation and collision rates between DSP participants and DSP non-participants. RESULTS Overall, DSP participants experienced a 7% statistically significant decrease in collisions (rate ratio [RR] 0.93, 95% confidence interval [CI] 0.89-0.97); a similar decrease was observed for injury-related collisions (RR 0.92, 95% CI 0.88-0.98) but not for fatal collisions (RR 1.20, 95% CI 0.74-1.94). The decline in the overall collision rate can be attributed to a decline in not-at-fault collisions (RR 0.85, 95% CI 0.80-0.91); there was no change in at-fault collisions (RR 1.00, 95% CI 0.94-1.07). Following DSP participation, violation rates significantly decreased 15% (RR 0.85, 95% CI 0.83-0.87). This decrease was observed for all types of violations with the exception of failure to yield, improper turning and improper lane changing, all of which showed no change, and careless driving, which showed a statistically significant 11% increase (RR 1.11, 95% CI 1.03- 1.20). Prior to DSP participation, those who participated in the DSP had a significantly higher collision rate (RR 1.11, 95% CI 1.07-1.14) compared to DSP non-participants, independent of age, gender, and race. This significantly elevated rate was consistent across all types of collisions. Following DSP participation, the overall collision rate for DSP participants was higher than that of non-participants (RR 1.21, 95% CI 1.17-1.25), though there was no difference for injurious or fatal collisions. The RR for not-at-fault and at-fault collisions indicated a lower collision rate for participants compared to non-participants. With respect to violations, prior to DSP participation, those who ultimately took part in the DSP had a lower violation rate (RR 0.96, 95% CI 0.95-0.98), however, this was mostly attributable to seat belt usage (RR 0.64, 95% CI 0.61-0.68). For all other types of violations, DSP participants had higher rates than the rest of the population. After DSP participation, participants had a higher violation rate compared to non-participants (RR 1.09, 95% CI 1.08-1.11), as well as elevated rates for most types of violations. There was no difference for failure to obey traffic signals, careless/improper driving, or improper backing. DSP participants had a lower rate of seat belt violations. CONCLUSIONS The results of this analysis suggest that though individuals who participated in the DSP had an overall reduction in collision rates, this reduction was attributable to not-at-fault collisions. This likely indicates that DSP participants modified their driving habits following the program (e.g., reduced their exposure) and did not necessarily improve their driving skills. There was also a reduction is some types of collisions, as well as an increase in careless driving-related offenses. These reductions may reflect a greater adherence to traffic laws or may simply reflect a reduction in driving brought about by changes in driving habits. Compared to similarly aged Florida drivers who did not participate in the DSP, participants had higher collision rates prior to the DSP. After DSP participation, the observed differences between participants and non-participants were either diminished or inverted such that participants had lower rates compared to non-participants. Participants had an overall lower violation rate prior to the DSP but for the most common types of violations they had elevated rates. Following participation, DSP participants had a higher crash rate compared to the rest of the population. For specific types of violations the elevated rates persisted but were diminished in magnitude

Assessing Driving Performance with Moderate Visual Field Loss

The minimum binocular horizontal field extent for driver licensingvaries widely between states in the USA. We examined the relationship betweenvisual field extent and open-road driving performance using a scoring method thatmeasured the quality of specific skills for a range of general driving maneuvers,as well as maneuvers that we expected to be difficult for people with restrictedfields. Twenty-eight current drivers with mild to moderate peripheral visual fieldrestrictions (123 ± 20°, V4e target) drove the 14-mile route. While most subjectswere scored as safe drivers, those with more restricted horizontal and verticalbinocular field extents showed significantly poorer skills in maneuvers for whicha wide field of vision is likely to be important (p ≤ 0.05): speed matching whenchanging lanes, and maintaining lane position and keeping to the path of the curvewhen driving around curves. Further studies using similar assessment methodswith drivers with more restricted fields are necessary to determine the minimumfield extent for safe driving

Impact of aging and age-related maculopathy on inactivation of the a-wave of the rod-mediated electroretinogram

AbstractThis study examined the impact of aging and age-related maculopathy (ARM) on the inactivation of phototransduction in rod photoreceptors by measuring the recovery of the a-wave using a paired flash electroretinogram technique. Measurements were made on 32 older adults in normal retinal health, 25 with early ARM, 7 with late ARM, and 20 young adults for comparison purposes. ARM presence and severity were defined by the Wisconsin Age-Related Maculopathy Grading System based on grading of fundus photographs. The inactivation of rod phototransduction exhibited an aging-related slowing. Those with early ARM did not exhibit inactivation slowing over and above what would be expected based on normal retinal aging. Persons in the late stages of ARM exhibited dramatic slowing in inactivation kinetics

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

Preliminary Evaluation of the InCHARGE Program Among Older African Americans in Rural Alabama

Objective: Blindness rates among older African Americans are two times higher than for older whites. Our purpose was to understand attitudes about eye care and perceived barriers to care among older African Americans living in rural Alabama and to determine whether an educational program reduced perceived barriers to care. InCHARGE, an eye health education program for older African Americans, promotes eye disease prevention by conveying the personal benefits of annual dilated comprehensive eye care and by teaching strategies to minimize barriers to eye care. Design and Participants: InCHARGE was presented in five senior centers to 111 individuals. Using a questionnaire before and three months after InCHARGE, we evaluated what impact InCHARGE had on attitudes and knowledge about prevention and strategies for reducing barriers. Results: Before InCHARGE, 52.3% reported receiving an eye examination in the past year. Almost all indicated that they felt finding, getting to, and communicating with a doctor were not problems yet about one-quarter indicated that the cost of an examination and/or eyeglasses were problems. After InCHARGE the percentage saying that cost was a problem increased to almost half. Conclusions: Older African Americans in rural Alabama have positive attitudes about comprehensive eye care, yet only about half reported receiving an exam by an eye care provider in the past year. The cost of care is a barrier for many, a problem that was not mitigated by InCHARGE. In order to improve eye health in this population, eye health education initiatives are not enough; economic strategies must be implemented to address the cost barrier

Formaldehyde Exposure and Asthma in Children: A Systematic Review

Obj e c t i v e: Despite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship. Data s o u r c e s: After a comprehensive literature search, we identified seven peer-reviewed studies providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma (e.g., self-report, physician diagnosis). Most of the studies were cross-sectional