Aging and Driving

A special issue of Geriatrics (ISSN 2308-3417). This special issue belongs to the section "Geriatric Neurology".

Deadline for manuscript submissions: closed (31 January 2018) | Viewed by 57687

Special Issue Editors


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Guest Editor
Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
Interests: Alzheimer's disease; driving; functional outcomes; cognitive reserve; biomarkers
Special Issues, Collections and Topics in MDPI journals

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Co-Guest Editor
Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA
Interests: driving; naturalistic methodologies; AD; diverse populations; health disparities; mood disorders; emotion; stress and aging
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Co-Guest Editor
Department of Neurology, Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
Interests: driving; AD; driving cessation; diverse populations; emotion; stress and aging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Driving among older adults is a critical and timely public health issue in society. Driving abilities become increasingly impaired with age, as factors like diseases, multisystem impairments and psychiatric disorders impair physical and mental abilities. Moreover, driving-associated injuries and fatalities increase with older adult age along with annual lifetime costs in the range of billions of dollars. Policies and legislation regarding when to stop driving are often ambiguous at best and typically leave the subjective decision to family members or a third party (e.g., physicians). Additionally, the decision to stop driving is a difficult one for older adults, their families, and their clinicians. Many are optimistic that they will continue to drive into the foreseeable future and rate their driving as great to excellent, though this is not always the case. To prolong driving life expectancy and to protect aging drivers and the driving public, it is very important to classify drivers at risk for decline and safety, develop and test interventions and new technologies and identify transportation alternatives.

This Special Issue on Geriatrics will focus on risk factors of impaired driving in older adults, new methodologies and technologies that identify drivers at risk of driving decline, driving interventions to improve driving skills and transportation alternatives. The Special Issue provides an open access opportunity to publish research articles, reviews, opinions, letters, and case reports related to this important and increasingly noticed field of research. We hope that you and your colleagues will submit for publication in this Special Issue.

Catherine M. Roe, PhD
Ganesh M. Babulal, OTD
Sarah H. Stout, MSW
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Driving
  • Aging
  • Noncognitive outcomes
  • Dementia
  • Driving assessment
  • Biomarkers

Published Papers (12 papers)

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Editorial

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3 pages, 164 KiB  
Editorial
The Importance of Advancing Research on Aging and Driving
by Samantha A. Murphy, Ganesh M. Babulal and Catherine M. Roe
Geriatrics 2021, 6(1), 7; https://doi.org/10.3390/geriatrics6010007 - 14 Jan 2021
Cited by 1 | Viewed by 1661
Abstract
Between 2009 and 2018, the number of older adults (i [...] Full article
(This article belongs to the Special Issue Aging and Driving)

Research

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7 pages, 713 KiB  
Communication
Using the A/T/N Framework to Examine Driving in Preclinical Alzheimer’s Disease
by Catherine M. Roe, Ganesh M. Babulal, Sarah H. Stout, David B. Carr, Monique M. Williams, Tammie L. S. Benzinger, Anne M. Fagan, David M. Holtzman, Beau M. Ances and John C. Morris
Geriatrics 2018, 3(2), 23; https://doi.org/10.3390/geriatrics3020023 - 2 May 2018
Cited by 6 | Viewed by 5462
Abstract
The A/T/N classification system is the foundation of the 2018 NIA-AA Research Framework and is intended to guide the Alzheimer disease (AD) research agenda for the next 5–10 years. Driving is a widespread functional activity that may be particularly useful in investigation of [...] Read more.
The A/T/N classification system is the foundation of the 2018 NIA-AA Research Framework and is intended to guide the Alzheimer disease (AD) research agenda for the next 5–10 years. Driving is a widespread functional activity that may be particularly useful in investigation of functional changes in pathological AD before onset of cognitive symptoms. We examined driving in preclinical AD using the A/T/N framework and found that the onset of driving difficulties is most associated with abnormality of both amyloid and tau pathology, rather than amyloid alone. These results have implications for participant selection into clinical trials and for the application time of interventions aimed at prolonging the time of safe driving among older adults with preclinical AD. Full article
(This article belongs to the Special Issue Aging and Driving)
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14 pages, 1306 KiB  
Article
Altered Functional Brain Connectivity in Mild Cognitive Impairment during a Cognitively Complex Car Following Task
by Megan A. Hird, Nathan W. Churchill, Corinne E. Fischer, Gary Naglie, Simon J. Graham and Tom A. Schweizer
Geriatrics 2018, 3(2), 20; https://doi.org/10.3390/geriatrics3020020 - 19 Apr 2018
Cited by 5 | Viewed by 4450
Abstract
Mild cognitive impairment (MCI) can affect multiple cognitive abilities, leading to difficulty in performing complex, cognitively demanding daily tasks, such as driving. This study combined driving simulation and functional magnetic resonance imaging (fMRI) to investigate brain function in individuals with MCI while they [...] Read more.
Mild cognitive impairment (MCI) can affect multiple cognitive abilities, leading to difficulty in performing complex, cognitively demanding daily tasks, such as driving. This study combined driving simulation and functional magnetic resonance imaging (fMRI) to investigate brain function in individuals with MCI while they performed a car-following task. The behavioral driving performance of 24 patients with MCI and 20 healthy age-matched controls was compared during a simulated car-following task. Functional brain connectivity during driving was analyzed for a separate cohort of 15 patients with MCI and 15 controls. Individuals with MCI had minor difficulty with lane maintenance, exhibiting significantly increased variability in steering compared to controls. Patients with MCI also exhibited reduced connectivity between fronto-parietal regions, as well as between regions involved in cognitive control (medial frontal cortex) and regions important for visual processing (cuneus, angular gyrus, superior occipital cortex, inferior and superior parietal cortex). Greater difficulty in lane maintenance (i.e., increased steering variability and lane deviations) among individuals with MCI was further associated with increased connectivity between the posterior cingulate cortex (PCC) and inferior frontal gyrus, as well as increased intra-cerebellar connectivity. Thus, compared to cognitively healthy controls, patients with MCI showed reduced connectivity between regions involved in visual attention, visual processing, cognitive control, and performance monitoring. Greater difficulty with lane maintenance among patients with MCI may reflect failure to inhibit components of the default-mode network (PCC), leading to interference with task-relevant networks as well as alterations in cerebellum connectivity. Full article
(This article belongs to the Special Issue Aging and Driving)
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13 pages, 241 KiB  
Article
Planning for a Nondriving Future: Behaviors and Beliefs among Middle-Aged and Older Drivers
by Annie C. Harmon, Ganesh M. Babulal, Jonathon M. Vivoda, Brian J. Zikmund-Fisher and David B. Carr
Geriatrics 2018, 3(2), 19; https://doi.org/10.3390/geriatrics3020019 - 13 Apr 2018
Cited by 20 | Viewed by 4532
Abstract
Despite the reality of older adults living many years after driving cessation, few prepare for the eventuality; empirically, planning for a nondriving future has not been directly quantified or explored. The following study quantifies (1) the extent of current drivers’ planning; (2) specific [...] Read more.
Despite the reality of older adults living many years after driving cessation, few prepare for the eventuality; empirically, planning for a nondriving future has not been directly quantified or explored. The following study quantifies (1) the extent of current drivers’ planning; (2) specific planning behaviors; (3) beliefs about benefits of planning; (4) drivers’ intention to plan more for future transportation needs; and (5) group differences associated with planning. In a predominantly female, black, urban sample of current drivers ages 53–92, fewer than half (42.1%) had planned at all for a nondriving future, with correspondingly low levels of planning behaviors reported. However, over 80% believed planning would help them meet their needs post-cessation and transition emotionally to being a nondriver. Most (85%) intended to plan more in the future as well, indicating further potential openness to the topic. Drivers who planned were older, drove less frequently, limited their driving to nearby places, reported less difficulty believing they would become a nondriver, and expected to continue driving three years less than non-planners. These findings suggest that drivers’ perceived nearness to driving cessation impacts planning for future transportation needs, and existing perceived benefits of planning may provide leverage to motivate action. Full article
(This article belongs to the Special Issue Aging and Driving)
10 pages, 786 KiB  
Article
Naturalistic Driving: A Framework and Advances in Using Big Data
by Frank Knoefel, Bruce Wallace, Rafik Goubran and Shawn Marshall
Geriatrics 2018, 3(2), 16; https://doi.org/10.3390/geriatrics3020016 - 29 Mar 2018
Cited by 17 | Viewed by 5028
Abstract
Driving is an activity that facilitates physical, cognitive, and social stimulation in older adults, ultimately leading to better physical and cognitive health. However, aging is associated with declines in vision, physical health, and cognitive health, all of which can affect driving ability. One [...] Read more.
Driving is an activity that facilitates physical, cognitive, and social stimulation in older adults, ultimately leading to better physical and cognitive health. However, aging is associated with declines in vision, physical health, and cognitive health, all of which can affect driving ability. One way of assessing driving ability is with the use of sensors in the older adult’s own vehicle. This paper provides a framework for driving assessment and addresses how naturalistic driving studies can assist in such assessments. The framework includes driving characteristics (how much driving, speed, position, type of road), actions and reactions (lane changes, intersections, passing, merging, traffic lights, pedestrians, other vehicles), destinations (variety and distance, sequencing and route planning), and driving conditions (time of day and season). Data from a subset of Ottawa drivers from the Candrive study is used to illustrate the use of naturalistic driving data. Challenges in using naturalistic driving big data and the changing technology in vehicles are discussed. Full article
(This article belongs to the Special Issue Aging and Driving)
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10 pages, 235 KiB  
Article
Detection of Risky Driving Behaviors in the Naturalistic Environment in Healthy Older Adults and Mild Alzheimer’s Disease
by Jennifer D. Davis, Shuhang Wang, Elena K. Festa, Gang Luo, Mojtaba Moharrer, Justine Bernier and Brian R. Ott
Geriatrics 2018, 3(2), 13; https://doi.org/10.3390/geriatrics3020013 - 21 Mar 2018
Cited by 13 | Viewed by 4480
Abstract
Analyzing naturalistic driving behavior recorded with in-car cameras is an ecologically valid method for measuring driving errors, but it is time intensive and not easily applied on a large scale. This study validated a semi-automated, computerized method using archival naturalistic driving data collected [...] Read more.
Analyzing naturalistic driving behavior recorded with in-car cameras is an ecologically valid method for measuring driving errors, but it is time intensive and not easily applied on a large scale. This study validated a semi-automated, computerized method using archival naturalistic driving data collected for drivers with mild Alzheimer’s disease (AD; n = 44) and age-matched healthy controls (HC; n = 16). The computerized method flagged driving situations where safety concerns are most likely to occur (i.e., rapid stops, lane deviations, turns, and intersections). These driving epochs were manually reviewed and rated for error type and severity, if present. Ratings were made with a standardized scoring system adapted from DriveCam®. The top eight error types were applied as features to train a logistic model tree classifier to predict diagnostic group. The sensitivity and specificity were compared among the event-based method, on-road test, and composite ratings of two weeks of recorded driving. The logistic model derived from the event-based method had the best overall accuracy (91.7%) and sensitivity (97.7%) and high specificity (75.0%) compared to the other methods. Review of driving situations where risk is highest appears to be a sensitive data reduction method for detecting cognitive impairment associated driving behaviors and may be a more cost-effective method for analyzing large volumes of naturalistic data. Full article
(This article belongs to the Special Issue Aging and Driving)
14 pages, 249 KiB  
Article
General Cognitive Impairment as a Risk Factor for Motor Vehicle Collision Involvement: A Prospective Population-Based Study
by Carrie Huisingh, Cynthia Owsley, Virginia G. Wadley, Emily B. Levitan, Marguerite R. Irvin, Paul MacLennan and Gerald McGwin Jr.
Geriatrics 2018, 3(1), 11; https://doi.org/10.3390/geriatrics3010011 - 6 Mar 2018
Cited by 2 | Viewed by 4131
Abstract
This study examined whether cognitive impairment and decline as assessed by a brief mental status screening test is associated with future crash risk in a cohort of older drivers. A three-year prospective study was conducted in a population-based sample of 2000 licensed drivers, [...] Read more.
This study examined whether cognitive impairment and decline as assessed by a brief mental status screening test is associated with future crash risk in a cohort of older drivers. A three-year prospective study was conducted in a population-based sample of 2000 licensed drivers, aged 70 years and older. At the baseline visit, cognitive impairment was defined as <24 on the Mini Mental State Exam (MMSE). Decline was defined as those with a one-year change in MMSE scores in the lowest quartile (largest decrease). Motor vehicle collision involvement was obtained from the Alabama Department of Public Safety. Poisson regression was used to calculate crude and adjusted rate ratios (RR). There were 278 crashes during the follow-up period. Rates of crash involvement were higher for those with cognitive impairment (crude RR = 2.33) compared to those without impairment at baseline; adjustment for potential confounders namely age and visual processing speed attenuated this relationship (adjusted RR = 1.26, 95% confidence interval (CI) 0.65–2.44). Drivers who experienced a pronounced decline in estimated MMSE scores in one year were 1.64 (95% CI 1.04–2.57) times more likely to have a future at-fault crash, as compared to those whose scores did not decline. Evaluation of MMSE over time may provide important insight in an older driver’s future risk of at-fault crash involvement. Full article
(This article belongs to the Special Issue Aging and Driving)
10 pages, 209 KiB  
Article
Relationship between Areas of Cognitive Functioning on the Mini-Mental State Examination and Crash Risk
by Carrie Huisingh, Virginia G. Wadley, Gerald McGwin Jr. and Cynthia Owsley
Geriatrics 2018, 3(1), 10; https://doi.org/10.3390/geriatrics3010010 - 6 Mar 2018
Cited by 7 | Viewed by 4279
Abstract
Previous studies have suggested that the pattern of cognitive impairment in crash-involved older drivers is different from non-crash-involved older drivers. This study assessed the relationship between seven areas of cognitive functioning (orientation to time, orientation to place, registration, attention and calculation, recall, language, [...] Read more.
Previous studies have suggested that the pattern of cognitive impairment in crash-involved older drivers is different from non-crash-involved older drivers. This study assessed the relationship between seven areas of cognitive functioning (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction) on the Mini-Mental State Examination (MMSE) collected at baseline and rates of future crash involvement in a prospective population-based sample of older drivers. Motor vehicle collision (MVC) involvement was obtained from the Alabama Department of Public Safety. Poisson regression was used to calculate crude and adjusted rate ratios (RR). Older drivers having difficulties in place orientation were more than 6 times (95% CI 1.90–19.86) more likely to be involved in a future crash (adjusted RR = 6.14, 95% confidence interval (CI) 1.90–19.86) and at-fault crash (adjusted RR = 6.39, 95% CI 1.51–27.10). Impairment in the other cognitive areas was not associated with higher rates of crash or at-fault crash involvement. The findings were validated in an independent sample of high-risk older drivers and a similar pattern of results was observed. Spatial orientation impairment can help identify older drivers who are more likely to crash in the future. Full article
(This article belongs to the Special Issue Aging and Driving)

Review

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15 pages, 842 KiB  
Review
Challenges for Older Drivers in Urban, Suburban, and Rural Settings
by Rashmi P. Payyanadan, John D. Lee and Lorelie C. Grepo
Geriatrics 2018, 3(2), 14; https://doi.org/10.3390/geriatrics3020014 - 22 Mar 2018
Cited by 21 | Viewed by 6111
Abstract
Along with age-related factors, geographical settings—urban, suburban, and rural areas—also contribute to the differences in fatal crashes among older drivers. These differences in crash outcomes might be attributed to the various driving challenges faced by older drivers residing in different locations. To understand [...] Read more.
Along with age-related factors, geographical settings—urban, suburban, and rural areas—also contribute to the differences in fatal crashes among older drivers. These differences in crash outcomes might be attributed to the various driving challenges faced by older drivers residing in different locations. To understand these challenges from the perspective of the older driver, a focus group study was conducted with drivers 65 and older from urban, suburban, and rural settings. Guided-group interviews were used to assess driving challenges, mobility options, opportunities for driver support systems (DSS), and alternate transportation needs. Content analysis of the interview responses resulted in four categories representing common challenges faced by older drivers across the settings: behavior of other drivers on the road, placement of road signs, reduced visibility of road signs due to age-related decline, and difficulties using in-vehicle technologies. Six categories involved location-specific challenges such as heavy traffic situations for urban and suburban drivers, and multi-destination trips for rural drivers. Countermeasures implemented by older drivers to address these challenges primarily involved route selection and avoidance. Technological advances of DSS systems provide a unique opportunity to support the information needs for route selection and avoidance preferences of drivers. Using the content analysis results, a framework was built to determine additional and modified DSS features to meet the specific challenges of older drivers in urban, suburban, and rural settings. These findings suggest that there is heterogeneity in the driving challenges and preferences of older drivers based on their location. Consequently, DSS technologies and vehicle automation need to be tailored to not only meet the driving safety and mobility needs of older drivers as a population, but also to their driving environment. Full article
(This article belongs to the Special Issue Aging and Driving)
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11 pages, 458 KiB  
Review
Driving Outcomes among Older Adults: A Systematic Review on Racial and Ethnic Differences over 20 Years
by Ganesh M. Babulal, Monique M. Williams, Sarah H. Stout and Catherine M. Roe
Geriatrics 2018, 3(1), 12; https://doi.org/10.3390/geriatrics3010012 - 20 Mar 2018
Cited by 18 | Viewed by 4841
Abstract
The population of older adults (aged 65 years and older) in the United States will become more racially and ethnically diverse in the next three decades. Additionally, the growth of the aging population will come with an expansion in the number of older [...] Read more.
The population of older adults (aged 65 years and older) in the United States will become more racially and ethnically diverse in the next three decades. Additionally, the growth of the aging population will come with an expansion in the number of older drivers and an increased prevalence of chronic neurological conditions. A major gap in the aging literature is an almost exclusive focus on homogenous, non-Hispanic white samples of older adults. It is unclear if this extends to the driving literature. A systematic review of SCOPUS, PubMed, CINAHL Plus, and Web of Science examined articles on driving and racial/ethnic differences among older adults. Eighteen studies met inclusion criteria and their results indicate that racial and ethnic minorities face a greater risk for driving reduction, mobility restriction, and driving cessation. The majority of studies compared African Americans to non-Hispanic whites but only examined race as a covariate. Only four studies explicitly examined racial/ethnic differences. Future research in aging and driving research needs to be more inclusive and actively involve different racial/ethnic groups in study design and analysis. Full article
(This article belongs to the Special Issue Aging and Driving)
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Other

9 pages, 563 KiB  
Commentary
Driving Decisions: Distinguishing Evaluations, Providers and Outcomes
by Anne Dickerson, Elin Schold Davis and David B. Carr
Geriatrics 2018, 3(2), 25; https://doi.org/10.3390/geriatrics3020025 - 11 May 2018
Cited by 5 | Viewed by 5956
Abstract
Driving is a highly valued instrumental activity of daily living on which many older adults depend for access to their community. The demand to address driving is changing as older adults experience increasing longevity while facing medical conditions that often affect their fitness [...] Read more.
Driving is a highly valued instrumental activity of daily living on which many older adults depend for access to their community. The demand to address driving is changing as older adults experience increasing longevity while facing medical conditions that often affect their fitness to drive. As one of the most complex of daily tasks, driving is a multifaceted issue that involves the older driver, family members, state licensing and health care practitioners. This commentary discusses potential options and strategies for making evidence-based fitness to drive decisions by differentiating between driving skills and driving capacities, and how these differences are manifested on the road. Typical service options are described using an algorithm format that suggests decision points with options and referrals for service based on the individual’s experiences and/or needs. Full article
(This article belongs to the Special Issue Aging and Driving)
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6 pages, 169 KiB  
Case Report
Teaching a Person with Memory Impairment Smartphone Use for Emergencies during Outdoors Walking: Case Report
by Jennifer H. Maze and Linda A. Hunt
Geriatrics 2018, 3(1), 8; https://doi.org/10.3390/geriatrics3010008 - 20 Feb 2018
Cited by 2 | Viewed by 5981
Abstract
Safety issues arise during the performance of activities as dementia advances. Occupational therapists collaborate with dementia clients and their caregivers to find solutions and strategies to prolong safe activity participation. Additionally, occupational therapists teach through demonstration showing engagement in specific activities may no [...] Read more.
Safety issues arise during the performance of activities as dementia advances. Occupational therapists collaborate with dementia clients and their caregivers to find solutions and strategies to prolong safe activity participation. Additionally, occupational therapists teach through demonstration showing engagement in specific activities may no longer be safe. We present the case of a 70-year-old male with mild dementia. His caregiver believes he needs to use a smartphone for safety during outdoors walking; the client’s enjoyed and valued occupation. This case report illustrates smartphone use may be difficult to learn for a person with mild dementia. It highlights the need for the caregiver and person with dementia to receive education together for best understanding. New technologies for community mobility such as outdoors walking are considered. Full article
(This article belongs to the Special Issue Aging and Driving)
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