American Journal of Occupational Therapy

The investigation of vehicle safety needs for older drivers and passengers is integral for their safe transportation. A program of research on safe transportation for seniors was launched through AUTO21, a Canadian Network of Centres of Excellence. This national research network focuses on a wide range of automotive issues, from materials and design to safety and societal issues. An inductive qualitative inquiry of seniors’ driving experiences, safety feature use, and strategies to prevent injury and manage risks was a first step in this program. We conducted interviews and focus groups with 58 seniors without disabilities and 9 seniors with disabilities. We identified a lack of congruity between the vehicle and safety feature design and seniors’ needs. Seniors described strategies to manage their safety and that of others. Specific aspects of vehicle design, safety features, and action strategies that support safer use and operation of a vehicle by seniors are outlined.

Researchers of driving and dementia have reported that drivers with early Alzheimer’s disease (AD) may continue to drive for extended periods of time, as long as their driving is evaluated or monitored. The earliest symptoms of AD are known to include loss of recent memory and the inability to recognize familiar environments. In an exploratory study, we examined 207 reports of lost drivers with dementia over 10 yr reported by newspapers and media. Seventy AD drivers were not found, 32 drivers were found dead, and 116 drivers were found alive, although of those found alive, 35 people were found injured. Miles driven and days missing were also reported in some cases, in addition to cause of death (such as drowning or exposure to weather). Becoming lost may have serious consequences. Additional research is needed in this area to more clearly understand the consequences of becoming lost while driving.

Certain driving errors are predictive of crashes, but whether the type of errors evaluated during on-road assessment is similar to traffic violations that are associated with crashes is unknown. Using the crash data of 5,345 older drivers and expert reviewers, we constructed a violation-to-error classification based on rater agreement. We examined the effects of predictor variables on crash-related injuries by risk probability using logistic regression. Drivers’ mean age was 76.08 (standard deviation = 7.10); 45.7% were women. Of drivers, 44.6% sustained crash-related injuries, and female drivers had a higher injury probability (44%) than male drivers (29%). Lane maintenance, yielding, and gap acceptance errors predicted crash-related injuries with almost 50% probability; speed regulation (34%), vehicle positioning (25%), and adjustment-to-stimuli (21%) errors predicted crash-related injuries to a lesser degree. We suggest injury prevention strategies for clinicians and researchers to consider for older drivers, especially older women.

OBJECTIVES. We examined the validity of our on-road driving assessment to quantify its outcomes.

METHOD. Older drivers (N = 127) completed a driving assessment on a standardized road course. Measurements included demographics, driving errors, and driving test outcomes; a categorical global rating score (pass–fail); and the sum of maneuvers (SMS) score (0–273).

RESULTS. There were significant differences in the SMS (F = 29.9, df = 1 p ≤ .001) between drivers who passed the driving test and those who failed. The SMS cutoff value of 230 points was established as the criterion because it yielded the most optimal combination of sensitivity (0.91) and specificity (0.87). The strongest predictors of failure were adjustment to stimuli and lane maintenance errors.

CONCLUSION. The SMS differentiated between passing and failing drivers and can be used to inform clinical decision making.

In this study, we examined confidence and face validity or client acceptability of tests used in a Veterans Affairs Medical Center driving clinic. The clinic used evidence-based off-road tests and adopted the Washington University Road Test (WURT) as a performance-based on-road examination. Forty-three clients consented to participate in the study; most were male with an average age of 78.2 years (standard deviation = 12.6). In general, a trend existed toward higher client acceptability of tests adopted from the Neuropsychological Assessment Battery (Stern & White, 2003) and the WURT than of other off-road measures. Confidence decreased after administration of the psychometric test battery, yet it increased after the on-road evaluations despite a 47% failure rate in the sample. Additional study is needed on test acceptability because it may have the potential to increase understanding, compliance, or both with driving recommendations. Additional research is also needed to examine client confidence levels and their potential impact on performance during the driving evaluation process.

We conducted a series of focus groups to explore the information needs of clinicians and consumers related to arthritis and driving. An open coding analysis identified common themes across both consumer and clinician-based focus groups that underscored the importance of addressing driving-related concerns and the challenges associated with assessing safety. The results revealed that although driving is critical for maintaining independence and community mobility, drivers with arthritis experience several problems that can affect safe operation of a motor vehicle. Findings from this study are part of a broader research initiative that will inform the development of the Arthritis and Driving toolkit. This toolkit outlines strategies to support safe mobility for people with arthritis and will be an important resource in the coming years given the aging population.

OBJECTIVE. To examine whether some drivers with hemianopia or quadrantanopia display safe driving skills on the road compared with drivers with normal visual fields.

METHOD. An occupational therapist evaluated 22 people with hemianopia, 8 with quadrantanopia, and 30 with normal vision for driving skills during naturalistic driving using six rating scales.

RESULTS. Of drivers with normal vision, >90% drove flawlessly or had minor errors. Although drivers with hemianopia were more likely to receive poorer ratings for all skills, 59.1%–81.8% performed with no or minor errors. A skill commonly problematic for them was lane keeping (40.9%). Of 8 drivers with quadrantanopia, 7 (87.5%) exhibited no or minor errors.

CONCLUSION. This study of people with hemianopia or quadrantanopia with no lateral spatial neglect highlights the need to provide individual opportunities for on-road driving evaluation under natural traffic conditions if a person is motivated to return to driving after brain injury.

OBJECTIVES. We sought to determine whether the partial administration of the Cognitive Behavioral Driver’s Inventory (CBDI) has a significant effect on its concurrent validity.

METHOD. Data were extracted from charts of clients with cerebrovascular accident or traumatic brain injury from three centers. The CBDI was administered either completely or partially (right and left perimetry or Wechsler Adult Intelligence Scale–Revised (WAIS–R; Wechsler, 1982; Picture Completion and Digit Symbol tests were not completed). Concurrent validity indicators were calculated for the CBDI and three different scenarios of partial administration of the CBDI.

RESULTS. Only 52% of the road test failures were predicted correctly by the completely administered CBDI. Nonadministration of the WAIS–R rarely modified the CBDI results. Omission of perimetry scores tended to increase the sensitivity and decrease the specificity (not significantly).

CONCLUSION. The CBDI should be used as a complement, not a substitution, for a road test. Partially administrating the CBDI, specifically excluding perimetry measures, can affect its concurrent validity.

We examined whether participants who failed to complete a simulated drive because of simulator sickness (dropouts) differed from those who completed the simulation (completers). Thirteen healthy older adult dropouts (mean age = 74.8 yr) and 12 comparable completers were compared on the following variables: on-road driving performance, the Useful Field of View® test, the Attention Network Test, and the Trail Making Test Part A. Results showed that completers scored more demerit points during the on-road drive than did dropouts. In addition, only 1 of 13 comparisons based on participants’ cognition was statistically significant. These results suggest that in healthy senior drivers, simulator sickness does not prevent examination of those who need it most (i.e., those with the poorest on-road driving performance) and that cognitive differences are not associated with dropping out because of simulator sickness.

OBJECTIVE. We report on item development and validity testing of a self-report older adult safe driving behaviors measure (SDBM).

METHOD. On the basis of theoretical frameworks (Precede–Proceed Model of Health Promotion, Haddon’s matrix, and Michon’s model), existing driving measures, and previous research and guided by measurement theory, we developed items capturing safe driving behavior. Item development was further informed by focus groups. We established face validity using peer reviewers and content validity using expert raters.

RESULTS. Peer review indicated acceptable face validity. Initial expert rater review yielded a scale content validity index (CVI) rating of 0.78, with 44 of 60 items rated ≥0.75. Sixteen unacceptable items (≤0.5) required major revision or deletion. The next CVI scale average was 0.84, indicating acceptable content validity.

CONCLUSION. The SDBM has relevance as a self-report to rate older drivers. Future pilot testing of the SDBM comparing results with on-road testing will define criterion validity.

OBJECTIVE. The number of functionally impaired drivers being assessed is increasing the urgency to develop a standardized off-road driver assessment battery. We examined the validity of the Road Law and Road Craft Test (RLRCT) and a version of the Melbourne Slide Test to determine whether they should be included in the Occupational Therapy Driver Off-Road Assessment (OT–DORA) battery, which is under development.

METHOD. We conducted a file audit of 118 data sets with individual item scores for the RLRCT and Melbourne Slide Test.

RESULTS. The RLRCT test with one item removed provides clinicians with a valid indication of clients’ off-road driving skills. The Melbourne Slide Test added no new information over that provided by the RLRCT and can be excluded from the battery.

CONCLUSION. The revised 14-item RLRCT should be included in the OT–DORA battery. Further research is required to develop the OT–DORA battery as a valid and reliable measure of off-road driver skill.

BACKGROUND. Older driver safety is a growing concern. We identified capacity-building needs of occupational therapists related to older driver screening, assessment, and intervention.

METHOD. A Canadawide survey was undertaken involving 133 occupational therapists working with an older clientele. A standardized questionnaire elicited information regarding (1) actual practices related to older driver screening, assessment, and intervention; (2) perceived competence; and (3) need for continuing education.

RESULTS. Occupational therapists were twice as likely to use screening tools rather than in-depth assessments (n = 79 vs. n = 37). Only 25 occupational therapists offered on-road assessment, and even fewer offered retraining (n = 11). Occupational therapists more often felt very competent in domains related to screening as opposed to assessment, and most were interested in continuing education.

CONCLUSION. Driving services offered were primarily related to screening compared with assessment or intervention. Occupational therapists would benefit from driving-related professional training aimed at enhancing professional capacity in this arena.

OBJECTIVE. We collected practitioner opinions to improve the validity and reliability of the on-road driver assessment procedures used in Australia.

METHOD. We used focus groups to document the views of experienced occupational therapy driver assessors using a purposive sampling method.

RESULTS. Eight focus groups were conducted with 55 clinicians practicing in urban and rural regions. There was strong support for greater standardization of procedures for all tests. For drivers seeking unrestricted (open) licenses, use of standard routes with predetermined assessment points was important where practicable. Where use of a nonstandard route for this purpose was unavoidable, it was important to specify a minimum set of requirements related to route characteristics and assessment items.

CONCLUSION. Australian occupational therapy driver assessors support greater standardization of test routes and procedures to improve reliability and validity. However, the extent to which standardization can be achieved is limited by variable road traffic environments where assessments are conducted.

We examined the validity and reproducibility of simulator-based driving evaluations. In Study 1, we examined correlations among Trails A and B, demerit points for simulated drives, and simulator-recorded errors. With one exception, correlations ranged from .44 (p = .103) to .83 (p = .001). In Study 2, we examined correlations among Trail Making Test Part A, Useful Field of View, and demerit points for simulated drives; correlations ranged from .50 to .82 (all ps < .001). The correlation between demerit points for on-road and simulated drives was .74 (p = .035). We examined reproducibility of simulator assessments using the playback function; intraclass correlation coefficients ranged from .73 to .87 (all ps < .001). These results suggest that simulators could be used to facilitate the evaluation of fitness to drive.