National Academies Press: OpenBook

Improving the Safety of Older Road Users (2005)

Chapter: Chapter Six - Educational Approaches for Improving Older Road User Safety

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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
×
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Suggested Citation:"Chapter Six - Educational Approaches for Improving Older Road User Safety." National Academies of Sciences, Engineering, and Medicine. 2005. Improving the Safety of Older Road Users. Washington, DC: The National Academies Press. doi: 10.17226/13546.
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39 This chapter covers a broad range of programs and materials, all focused on informing and influencing older road users and/or those who might intervene to promote their safety. The four primary audiences for such materials are: • Older road users themselves, • Family members or friends of an older road user, • Intermediaries or those working with or otherwise encountering older adults (physicians, law enforcement personnel, social service providers, driver license agen- cies, etc.), and • The general public. In many cases, the boundaries between these target audi- ences are blurred. For example, an informational booklet on dementia and driving may be written for family members and caregivers, but may also be used by the dementia patient or by social service providers working with patients and their families. Given the large and rapidly growing volume of materials and programs that address older road user safety and mobil- ity concerns, a totally comprehensive accounting is beyond the scope of this report. The programs identified and reviewed in this chapter have either been developed and promoted nationally (by the federal government or by national organi- zations and associations) and/or have been tried at the state or local level and identified as promising. The reader is also referred to a recent UMTRI report that reviews promising approaches for enhancing elderly mobility (Molnar et al. 2003). Table 12 provides a sampling of available programs and materials. Although most have not been formally evaluated and proven effective for reducing crashes, improving driving performance, changing driving habits, or otherwise affecting the safety of older road users, they are generally considered critical components of a comprehensive approach to improv- ing older road user safety and mobility. In addition, many of the individual programs or program components have demon- strated effectiveness in achieving their goals; that is, they may convey important information, increase knowledge and awareness, or provide feedback on functional abilities impor- tant to driving. The table is roughly organized by target audi- ence, beginning with the more specific programs directed toward older road users, then progressing through family members and other intermediaries, and lastly to the general population. FEDERAL GOVERNMENT INITIATIVES NHTSA’s stated mission with respect to older road users is to help them remain safely mobile for as long as possible. To this end, it has teamed with others to develop educational materials and programs for older drivers in general, as well as for specific subpopulations of older adults who may be at increased risk of crashing. The booklet Driving Safely While Aging Gracefully, developed in partnership with the USAA Educational Foundation and AARP, is a good example of the former. The nine Driving When You Have . . . brochures, on the other hand, are each directed at a particular at-risk group, such as drivers with diabetes or cataracts. NHTSA is currently collaborating with a broad range of partners to develop, evaluate, and disseminate educational resources to improve the safety of older road users. Some of these programs and materials target older adults directly; oth- ers target intermediaries, such as physicians, caregivers, licensing authorities, and transportation service providers. Rather than trying to instigate change itself, NHTSA’s gen- eral approach has been to work through national organiza- tions and professional associations to promote “peer to peer” education. For example, it joined with the AMA to develop the Physician’s Guide to Assessing and Counseling Older Drivers. This and many other examples are included in Table 12 and described later in this chapter. OTHER NATIONAL INITIATIVES There have also been a number of nongovernmental key players in recent efforts to improve older road user safety. Some have been active in the field for years, whereas others have more recently joined the effort. Included among these lead organizations and professional associations are: • AARP, • AAA (formerly American Automobile Association), • AAA Foundation for Traffic Safety, • AAMVA, • AMA, CHAPTER SIX EDUCATIONAL APPROACHES FOR IMPROVING OLDER ROAD USER SAFETY

40 ytilibaliavA/ecruoS noitpircseD ecneiduA tegraT epyT/tamroF emaN sesruoC ytefaS revirD revirD PRAA margorP ytefaS moorssalC esruoc redlo lareneG noitalupop revird esruoc rehserfer dna ytefas gnivird ruoh thgiE .stluda redlo rof PRAA gro.praa.www ta elbaliava noitamrofnI gnivirD efaS AAA erutaM rof srotarepO moorssalC esruoc redlo lareneG noitalupop revird ot dengised“ esruoc ytefas gnivird ruoh thgiE dna slliks gnivird yadyreve evorpmi fo stceffe eht ot setaler ti sa egdelwonk tnemevorpmI revirD sʼAAA fo traP ”.gniga .sesruoc fo seires margorP AAA esruoc rof snoitacol dna eludehcS .sbulc AAA lacol morf elbaliava sgnireffo moc.sriaffacilbupaaa.www ees oslA eht gnihcaoC revirD erutaM moorssalC esruoc redlo lareneG noitalupop revird -DC ,margorp moorssalc lanoitidart sedulcnI a dna ,noitcurtsni-fles oediv ro MOR .margorp tnemssessa-fles laitnedifnoc .llI ,acahtI ,licnuoC ytefaS lanoitaN ta etisbew no elbaliava noitamrofnI gro.csn.www slooT tnemssessA-fleS revirD esiwdaoR looT A—weiveR sroineS pleH ot ylefaS evirD regnoL evitcaretnI ,MOR-DC noitcurtsni koob redlo lareneG noitalupop revird tset ot stluda redlo rof erawtfos desab-emoH fo serusaem thgie no ecnamrofrep nwo rieht .ytefas gnivird ot detaler ytiliba lanoitcnuf sbulc AAA lacoL dna lanoitaN AAA 5002 yraunaJ esaeler rof euD moc.sriaffacilbupaaa.www eeS :+55 srevirD nwO ruoY kcehC ecnamrofreP -fleS noitaulave telkoob redlo lareneG noitalupop revird daor redlo pleh ot snoitseuq 51 sniatnoC a htiw gnola ,ssentif gnivird rieht eguag sresu rof snoitadnemmocer dna metsys gnirocs .gnivird gnitcirtser ro gnivorpmi ytefaS ciffarT rof noitadnuoF AAA gro.srevirdroines//:ptth :etisbeW llikS revirD redlO dna tnemssessA ediuG ecruoseR -fleS noitaulave telkoob redlo lareneG noitalupop revird ,emit noitcaer rof stset kciuq sedulcnI n, and vision. Offers tips for saferoitnetta gnippots rof gninnalp segaruocne dna gnivird .gnivird PRAA ta etisbew rieht morf elbaliavA gro.praa.www snoisiceD gnivirD koobkroW -fleS noitaulave telkoob redlo lareneG noitalupop revird -fles ʼsrevird esaercni ot si koobkrow fo laoG tuoba egdelwonk lareneg dna ssenerawa dna ,seitiliba ni senilced detaler-gnivird noitaidemer dna noitasnepmoc dnemmocer .gnivird efas gnidnetxe rof seigetarts noitatropsnarT nagihciM fo ytisrevinU ta elbaliava seipoC .etutitsnI hcraeseR -0002/fdp/yrarbil/ude.hcimu.irtmu.www fdp.41 efaS a I mA ?revirD -fleS noitaulave redlo lareneG noitalupop revird nwo rieht ssessa srevird pleh ot dengiseD gnivird fo ssenerawa-fles esaercni dna slliks .ytefas AMA /bup/1ama/gro.nssa-ama.www//:ptth fdp.revird_efas_a_i_ma/334/mm/daolpu Other Programs and Materials for Older Road Users eno-no-enO tiF raC noitnevretni margorp tluda redlO noitalupop gnivird rac a llew woh fo tnemssessa nim-51–21 A hcaer ot ytiliba yb derusaem ,revird sti ”stif“ ecnatsid ,srorrim fo tnemtsujda reporp ,sladep -nrut“ A .cte ,leehw gnireets eht morf ydob fo morf ecnatsissa htiw detcudnoc margorp ”yek .stsilaiceps noitatilibaher revird deifitrec ,ASA yb yltnioj 5002 ni esaeler rof euD PRAA dna ,AAA :dnuorA gnitteG rof ytiliboM efaS stludA erutaM tnioprewoP ,noitatneserp eruhcorb stluda redlO dna srevird( )snairtsedep lla sessucsid noitatneserp edils tnioprewoP gniknird gnidulcni ,ytefas yawhgih fo stcepsa nairtsedep dna ,esu tleb ytefas ,gnivird dna tuoba snoisiced gnikam htiw gnola ,ytefas yhtlaeh dna gnivird pots ro liatruc ot nehw ,margorp eht secrofnier eruhcorB .gniklaw .enola sdnats osla tub ERAC sesruN ycnegremE Information available on their website at /etutitsni/eracne/gro.ane.www//:ptth psa.tluafed/gniga_yhtlaeh ylefaS gnivirD gnigA elihW yllufecarG redlo lareneG telkooB noitalupop revird lacisyhp ,noisiv ni segnahc woh sebircseD ,ytefas gnivird tceffa nac sexelfer dna ,ssentif eseht gnitcaretnuoc rof spit sreffo dna .segnahc lanoitacudE AASU dna ASTHN noitadnuoF /yrujni/elpoep/vog.tod.asthn.www//:ptth /evirddlo rof gnivirD efaS stludA redlO redlo lareneG eruhcorB noitalupop revird Driving eht no desab eruhcorb roloc-ruoF Safely booklet above. lanoitacudE AASU dna ASTHN noitadnuoF /yrujni/elpoep/vog.tod.asthn.www//:ptth /evirddlo uoY nehW gnivirD . . .evaH stcarataC amocualG .negeD ralucaM ekortS sitirhtrA .siD sʼnosnikraP aenpA peelS setebaiD seruzieS laudividnI seruhcorb redlo lareneG noitalupop revird ksir-ta cificeps dna spuorgbus a no noitamrofni stneserp eruhcorb hcaE gnoma nommoc noitidnoc lacidem cificeps ,ksir hsarc esaercni nac taht snosrep redlo eht fo smotpmys tuoba noitamrofni gnidulcni tceffa nac smotpmys eht woh ,noitidnoc gnisaercni rof spets detseggus ,gnivird dna ,noitidnoc eht htiw decaf fi ytefas gnivird .secruoser elbaliava ASTHN /yrujni/elpoep/vog.tod.asthn.www//:ptth /evirddlo TABLE 12 SELECTED PROGRAMS AND MATERIALS FOR OLDER ROAD USERS AVAILABLE NATIONALLY

41 TABLE 12 (Continued) ytilibaliavA/ecruoS noitpircseD ecneiduA tegraT epyT/tamroF emaN ssentiF ytilibixelF egakcaP gniniarT ,eruhcorB oediv redlo lareneG noitalupop revird ekam elpoep tif yhw sebircsed eruhcorB ot sesicrexe setartsulli dna srevird retteb dna ,kcab ,knurt ,redluohs ,kcen esaercni setartsnomed oediV .ytilibixelf ydob llarevo .sesicrexe eht ,ytefaS ciffarT rof noitadnuoF AAA :etisbew revird roines gro.srevirdroines.www —tuO gnippetS :stludA erutaM ,yhtlaeH eB ylefaS klaW stluda redlO telkooB )snairtsedep( efas wollof ot stluda redlo segaruocnE rof rehtehw ,gniklaw nehw secitcarp .htlaeh gnitomorp rof ro noitatropsnart ASTHN /yrujni/elpoep/vog.tod.asthn.www//:ptth /evirddlo rof klaT thgiartS srevirD erutaM dna srevird redlO seruhcorB ksir-ta cificeps spuorgbus eht gniteem sserdda seruhcorb laudividnI ,noisiv ,gnivird dna gniga fo egnellahc ,sekatsim gnivird nommoc ,snoitacidem gniniatniam dna gniyub dna ,gnivird gnippots .elcihev a eb nac ro seciffo AAA morf elbaliavA ta etisbew rieht morf deredro moc.sriaffacilbupaaa.www Assistance for Family Members and Friends na pleH ot woH revirD redlO srebmem ylimaF telkooB fo sdneirf dna srevird redlo rieht pleh meht pleh ot seilimaf rof ediug A tuoba snoisiced elbisnopser ekam seno devol .noitatropsnart efas rieht rof nalp dna gnivird ytefaS ciffarT rof noitadnuoF AAA gro.revirdroines//:ptth :etisbew When You Are Concerned . . . srebmem ylimaF telkooB fo sdneirf dna srevird redlo fo srebmem ylimaf rof ediug deliated erom A cificeps gnitaroprocni ,revird ksir-ta na tluciffid htiw laed ot woh rof snoitseggus .snoitautis gnigA no eciffO etatS kroY weN ta enilno elbaliavA /gnirac/su.yn.etats.gniga//:ptth mth.xedni/denrecnoc :sdaorssorC eht tA ot ediuG A síremiehzlA ,esaesiD dna ,aitnemeD gnivirD htiw srevird redlO telkooB rieht dna aitnemed seilimaf dna aitnemed htiw snosrep pleh ot dengiseD elihw ecnednepedni ezimixam seilimaf rieht snoitseggus sedivorP .ksir gnivird gniziminim .gnivird gnippots dna g,nitimil ,gnirotinom rof dna ,PRAA ,droftraH ehT fo tcejorp tnioJ ta elbaliavA .baLegA TIM /balega/ude.tim.bew//:ptth ylimaF … klaT ot deeN eW“ ees ,oslA ”.srevirD redlO htiw snoitasrevnoC dna gnivirD tcaF aitnemeD dna teehS noitamrofnI desab-beW slairetam htiw srevird redlO rieht dna aitnemed seilimaf dna gnivird no teehs tcaf a sniatniam etisbeW ,aitnemed dna gnivird no noitamrofni rehto dna erac no tnemetats noitisop a gnidulcni .sthgir ʼstneitap noitaicossA sʼremiehzlA ta etisbew eeS /secruoseR/gro.zla.www//:ptth fdp.IEgnivird/steehStcaF seiraidemretnI rehtO rof slairetaM ediuG s’naicisyhP dna gnissessA ot gnilesnuoC srevirD redlO dna snaicisyhP koobediuG htlaeh rehto slanoisseforp redlo tuoba snaicisyhp etacude ot dengiseD gnissessa ni meht tsissa dna ytefas revird .evird ot ssentif lacidem rof stneitap rieht .secruoser dna noitamrofni ecnerefer sedivorP .3002 .la te gnaW :etisbew AMA morf elbaliavA gro.nssa-ama.www ASTHN no sknil hguorht etacol osla naC setisbew AVMAA dna daoR CDC/ASA gnivirD ot paM ssenlleW tnirP slairetam htlaeh ytinummoC slanoisseforp ”gnoL eviL ,lleW eviL“ esahp-itlum a fo traP slairetam dna seigetarts gnidivorp evitaitini rieht ni esu ot slanoisseforp ytinummoc rof .smargorp noitomorp htlaeh CDC morf troppus htiw ,ASA cdc/gro.gnigasa//:ptth naciremA lanoitapuccO yparehT noitaicossA lanoisseforP noitaicossa lanoitapuccO stsipareht ot secruoser dna noitamrofni sedivorp ATOA ot stsipareht lanoitapucco niart dna egaruocne .noitatilibaher revird ni ytlaiceps a poleved ta etisbew ATOA eeS /revirdredlo/gro.atoa.www//:ptth rof noitaicossA revirD noitatilibaheR stsilaicepS lanoisseforP noitaicossa slanoisseforP revird ni gnikrow gniniart/noitacude elcihev dna snoitacifidom ot troppus dna noitamrofni sedivorp DEDA tnemssessa revird a sreffo dna pihsrebmem sti .margorp noitacifitrec noitatilibaher dna ta etisbew DEDA eeS gro.de-revird//:ptth latnemelppuS noitatropsnarT rof smargorP )sPTS( sroineS ytinummoC tropeR gniga dna slaiciffo ,sredivorp ecivres eht sa llew sa cilbup lareneg erom no noitamrofni deliated sedivorp tropeR nac dna ,yrtnuoc eht ssorca sPTS 004 naht ot gnitnaw esoht rof ecruoser a sa evres .smargorp nwo rieht tnemelpmi no elbaliava troper noitadnuoF ylreveB ta etisbew STF AAA eht .2PTS/fdp/gro.noitadnuofaaa.www//:ptth fpd gro.srevirdroines morf elbaliava oslA ssenerawA ytinummoC gnisaercnI rof smargorP AVMAA revirDdnarG margorP dna aideM tnirp ,srevird redlO ,srebmem ylimaf noitalupop lareneg dna noitamrofni cilbup evisneherpmoC dna VT sedulcni taht ngiapmac noitacude ,stnemecnuonna ecivres cilbup oidar a dna ,seruhcorb ,sda tnirp ,sdraobllib etomorp ot dengiseD .uaerub sʼrekaeps .seussi ytefas revird redlo fo ssenerawa ta elbaliava noitamrofni margorP hguorht ro gro.revirDdnarG.www//:ptth etisbew AVMAA eht ”lleWevirD“ ytinummoC tiklooT rednib gnir-3 tnirp htiw ,slairetam .cte ,oediv ecivres gnigA sredivorp tnioprewop ,oediv a sedulcni tik hcaE seruhcorb dna ,stniop gniklat ,noitatneserp ytinummoc gnisaercni rof slairetam rehto dna .ssenerawa .ASTHN htiw pihsrentrap ni ,ASA .5002 ylrae ytilibaliava detcepxE rof ymedacA lanoitacudE tnempoleveD ytinummoC“ ”snoitasrevnoC ecivres gnigA tnirP dna sredivorp ytinummoc stsivitca gnisaercni rof ngiapmac gnitekram laicos A seussi ytilibom fo ssenerawa ytinummoc ytinummoc a sedulcnI .sroines gnitceffa stniop gniklat ,esaeler sserp elpmas ,yevrus .cte ,smurof ytinummoc rof detcepxE .CDC dna ASA htiw ,DEA eeS .5002 ylrae ytilibaliava dnagnitekraMlaicoS/gro.dea.www//:ptth /egnahCroivahBe eht htiw dednelb eb lliw lairetam sihT .evoba tcejorp ”lleW evirD“

• Alzheimer’s Association, • AOTA, • ASA, • ADED, and • N4A. The programs of these groups also appear in Table 12 and are highlighted here. Driver Safety Courses AARP’s Driver Safety Program, perhaps better known to many by its former name of 55 Alive, recently celebrated 25 years in the field. Although the course is now open to drivers of all ages, 85% of its graduates are age 65 or older. A total of 36 states plus the District of Columbia allow insurance companies to offer graduates of the 2-day, 8-h course a dis- count on their auto insurance premiums (Greenberg 2004). The program supports AARP’s goals of promoting both inde- pendent living by seniors and community service. Evalua- tions of the program have generally shown favorable changes in reported behaviors and attitudes among course graduates, along with somewhat lower rates of traffic violations. How- ever, there have been no demonstrated reductions in crashes. Another popular classroom course for older drivers want- ing to refresh their driving knowledge and skills is the Safe Driving for Mature Operators course, which is offered by AAA clubs in most states. As with the AARP course, it is generally taught in two half-day sessions for a total of 8 h of interactive instruction. The course is “designed to improve everyday driving skills and knowledge as it relates to the effects of aging.” A final nationally available driver safety course is Coach- ing the Mature Driver, offered by the NSC. Instructors for the course are trained and certified by NSC. Similar to the two courses above, Coaching the Mature Driver entails roughly 8 h of classroom instruction over 2 days. Course topics include a self-appraisal, safety belts and air bags, physical changes with age, multiple-lane highway driving, city driving, pedes- trian safety, driving on rural roads, special considerations, and a self-appraisal review. Driver Self-Assessment Tools A new self-assessment tool developed by AAA is Roadwise Review—A Tool to Help Seniors Drive Safely Longer. It con- sists of a CD-ROM and instruction booklet that guide the user through a series of computer-based exercises designed to eval- uate visual, mental, and physical abilities important for dri- ving. The tool draws on research carried out for NHTSA’s Model Driver Screening and Evaluation Program (Staplin et al. 2003). The eight areas evaluated are: 42 • Leg strength and general mobility • Head/neck flexibility • High-contrast visual acuity • Low-contrast visual acuity • Working memory • Visualizing missing information • Visual search • Visual information processing speed. Users receive feedback on their performance in each area, along with suggestions for maintaining safe driving skills. Roadwise Review is being made available through state AAA offices at a nominal cost. An earlier AAA product is the booklet Drivers 55+: Check Your Own Performance, which was developed in 1994 and is based on research funded by the AAA Foundation for Traffic Safety. It contains a 15-question self-rating form, followed by suggestions for improvement corresponding to each question. This was one of the first attempts to involve older adults in assessing their own driving strengths and weaknesses, and it remains a popular product on the AAA Foundation for Traf- fic Safety’s seniordrivers.org website. AARP has also developed a self-assessment guide for older adults. The Older Driver Skill Assessment and Resource Guide is a 24-page booklet containing a series of exercises encouraging users to consider whether changes in reaction time, attention, or vision may be increasing their risk of crashing, and suggesting approaches to help compensate for changes. The guide also encourages drivers to place them- selves along a lifetime “Driving Continuum” and begin to think about the possibility that they may some day need to give up their keys. As another example in this area, the UMTRI recently devel- oped the Driving Decisions Workbook, a self-assessment tool that guides users through a series of questions to increase their awareness of declines in abilities that could affect driv- ing performance. The workbook has five sections: on the road, seeing, thinking, getting around, and health. For each area, recommendations (feedback) are offered for compen- sating or remediating identified deficiencies (Eby et al. 2000). A preliminary evaluation of the Workbook demonstrated that scoring was associated with on-road drive-test perfor- mance and with several measures of functional ability that have been shown to predict driving performance (Molnar et al. 2003). A final example of a self-assessment tool is the Am I a Safe Driver? checklist developed by the AMA. This one- page form appears in the Physician’s Guide to Assessing and Counseling Older Drivers and is also available on the AMA website, along with other resource materials for both the patient and his physician.

43 Other Programs and Materials for Older Adult Audiences Car Fit Program The ASA, AAA, and AARP are together piloting a new approach for reaching out to older drivers that is based on assessing how well older adults “fit” their cars. A 12 to 15 min “car fit exam” protocol has been developed with input from certified driving rehabilitation specialists. Seniors are invited to bring their car to a central location, such as a senior center, where a trained volunteer works with the driver to check for problems getting into and out of the vehicle, ability to reach the pedals and to see over the hood of the car, correct posi- tioning of seat belts, proper alignment, and use of side mirrors, etc. The driver is referred for professional evaluation and assistance if indicated. The Car Fit program is viewed as a “turn key” program that will provide an opportunity to edu- cate participants about other safety resources for older drivers within the community. Car Fit was recently pilot tested in 10 sites and is scheduled for distribution in late 2005. Emergency Nurses CARE Emergency Nurses CARE, or EnCARE, is a program of the Emergency Nurses Association, an organization for nurses, emergency medical technicians, paramedics, and other emer- gency healthcare professionals. The program offers primary injury prevention education to the public and advocates for improved safety legislation. Two programs are offered for older adults: Take CARE I addresses safe medication use and falls prevention, whereas Take CARE II addresses safe driving decisions and pedestrian safety. Each program is presented by a trained volunteer using a PowerPoint slide presentation and includes information on drinking and driving, safety belt use, and pedestrian safety, along with making decisions about when to curtail or stop driving. The program also discusses physical fitness, including healthy walking guidelines. A 14-page pamphlet, Getting Around: Safe Mobil- ity for Mature Adults is designed to accompany the pro- gram. The brochure can also be distributed on its own; for example, in emergency departments or physician office waiting rooms. Other Brochures and Booklets for Older Road Users Table 12 lists a variety of other educational brochures, videos, websites, etc. that target the older road user, includ- ing materials developed by many of the agencies and orga- nizations already noted. The materials are generally readily available and can be used as “stand alone” pieces of infor- mation (e.g., for distribution at driver license offices) or incorporated into larger programs addressing older road user safety. Assistance for Family Members and Friends The AAA Foundation for Traffic Safety’s booklet, How to Help an Older Driver, provides some of the same information as found in its Drivers 55+ guide, but packaged for family members or friends of an older driver. The booklet contains sections on how aging affects driving, medications and driv- ing, ways to assess an older driver’s skills, and approaches for helping an older driver cope with declining skill, including when to decide to retire from driving. How to Help also describes steps that can be taken if an older adult resists advice to stop driving, and provides web links to driver licens- ing and motor vehicle departments in each state. Another resource that was developed by the New York State Office for the Aging, but which has been picked up and used nationally, is the booklet, When You Are Concerned— A Handbook for Families, Friends, and Caregivers Wor- ried About the Safety of an Aging Driver (LePore 2000). This 50-page booklet provides more detailed information about how to help an at-risk driver through the process of stopping driving. Topics covered include keeping track of a loved one’s situation, finding help, initiating a family discussion, coping, and getting around without driving. NHTSA is currently work- ing on two shorter brochures (one for family members and friends and another for the older adult) based on this guide. A number of resources are available for families and friends of drivers with Alzheimer’s disease or other forms of demen- tia. AARP recently collaborated with researchers at the Mass- achusetts Institute of Technology’s AgeLab and The Hartford to produce At the Crossroads: A Guide to Alzheimer’s Dis- ease, Dementia, and Driving. This guide is intended as a tool to help individuals with Alzheimer’s and their caregivers determine when it is time to stop driving. Topics include assessing concerns about driving behavior, monitoring driv- ing, easing the transition from driver to passenger, seeking help from outside sources, understanding how family rela- tionships affect the decision, and advice from caregivers who have made this decision. Quotes from patients and their fam- ilies appear throughout the booklet, offering an immediate connection with the target audience. For example: “Our chil- dren talked to him about possibly not driving. They don’t know it, but he cried that night. Driving is extremely impor- tant to him. I don’t want to strip him of his dignity.” More recently, AgeLab teamed with The Hartford to pro- duce, We Need to Talk . . . Family Conversations with Older Drivers. This 20-page booklet provides answers to a series of questions to help families have more meaningful conversa- tions about older driver safety; questions such as, “Are older drivers at risk?,” “Do family conversations make a differ- ence?,” and “When faced with a discussion about driving abilities, with whom do older adults choose to talk?” Answers to the questions are drawn from a national survey, focus groups with older adults, and interviews with family care- givers of persons with dementia.

Another resource for families and friends of an older driver with Alzheimer’s or other dementia are materials developed by the Alzheimer’s Association. The organization has devel- oped a position statement with regard to driving and dementia and has produced a fact sheet on driving. Materials for Other Intermediaries Physicians The Physicians’ Guide to Assessing and Counseling Older Drivers was a cooperative venture between the AMA and NHTSA (Wang et al. 2003). It contains an overview of the safety of older drivers, provides guidance in formally assess- ing driver function, and identifies the following “red flags” for medically impaired driving: • Acute events (heart attack, stroke or other traumatic brain injury, seizure, etc.). • The patient’s own concern or concern of a family member. • History of chronic medical conditions affecting level of function (cataracts, macular degeneration, glaucoma or other visual disorders; heart disease; dementia, Parkin- son’s, or other neurological disorders; etc.). • Medical conditions with unpredictable and/or episodic events (syncope, angina, seizure, hypoglycemic attack, sleep attack, or cataplexy, etc.). • Medications, both prescription and nonprescription, that can impair driving ability (antidepressants, antihis- tamines, antihypertensives, narcotic analgesics, etc.). • Review of symptoms requiring further workup (fatigue or weakness, shortness of breath, chest pain, muscle weakness, loss of sensation, etc.). • If prescribing a new medication or new course of treatment. The Guide also suggests interventions, discusses the role of driver rehabilitation specialists, and makes suggestions for counseling patients for whom it is no longer safe to drive. Additional chapters in the report provide information about the legal and ethical responsibilities of physicians, state-by- state driver licensing requirements and reporting laws, and listings of medical conditions and medications that may impair driving. To encourage physician use of the Guide, the AMA has developed a Training of Trainers program with support from NHTSA. The program is “designed to educate physicians and other health care professionals on the public health issue of older driver safety and train them on assessing and coun- seling patients for medical fitness to drive.” The AMA web- site maintains a listing of program offerings. 44 Community Health Professionals The ASA, working jointly with the CDC, recently unveiled a new website intended to “enhance the capacity of national, state, and local organizations in serving the health promotion and disease prevention needs of older adults.” The website contains links to five separate health promotion modules, one of which focuses on driving wellness. The modules provide comprehensive background information on older driver safety and wellness, along with guidance for organizing and imple- menting a community awareness and action program. The latter includes detailed outlines for three 2-h courses, links to materials and handouts, and suggestions for integrating driv- ing safety into ongoing programs and activities. Occupational Therapists and Driver Rehabilitation Specialists Occupational therapists assist persons of all ages with dis- abilities or medical conditions that affect their ability to per- form everyday activities of daily living. Currently, however, relatively few are trained to provide driving rehabilitation, including behind-the-wheel instruction and use of adaptive equipment. AOTA recently initiated a major program to encourage and train more occupational therapists to become certified driver rehabilitation specialists. The association’s website provides extensive information and resources, including links to certification programs and continuing edu- cation online course offerings. Its “Toolkit for Professionals” includes information on adaptive equipment, web resources, client education, setting-up referral pathways, driver refresher courses, and brochures and fact sheets. The website also main- tains a directory of driver rehabilitation programs in each state. ADED offers support to professionals from all back- grounds working in the field of driver education and training, including developers and distributors of specialized vehicle equipment. The ADED website contains a description of the Driver Rehabilitation Specialist Certification process, along with a study guide and list of references. It also has links to a series of fact sheets regarding the following: • Driving after a stroke, • Driving and Alzheimer’s/dementia, • Driving after a traumatic brain injury, • Driving after a spinal cord injury, • Driving with rheumatoid arthritis, • Driving with multiple sclerosis, • Driving after a limb amputation, • Aging and driving, • Driving and spina bifida, and • Driving and cerebral palsy. Although geared toward driver rehabilitation specialists, the fact sheets provide useful information for family members, caregivers, and older adults themselves facing such challenges.

45 Driver rehabilitation programs can be housed in a variety of settings, including hospitals or other medical facilities, uni- versities, and independent, community-based businesses. Not all programs employ the services of a certified driver rehabil- itation specialist, although those based at medical facilities generally do. The AOTA website maintains a searchable data- base of driver rehabilitation programs and specialists in vehi- cle adaptation. Some exemplary programs that have served as models for others are described later in this chapter. A key consideration in promoting driving assessment pro- grams is their cost, because Medicare or other insurance gen- erally does not cover the cost of an assessment unless it is pre- scribed by a physician (e.g., for evaluation following a stroke, head injury, or other acute medical event). For a comprehen- sive evaluation, including both clinical and on-road compo- nents, costs typically will run several hundred dollars. As an alternative, and in locations where no formal driving assess- ment programs are available, local driving schools will some- times provide these services, either on their own or in collab- oration with a local physician (Stutts and Wilkins 2003). Supplemental Transportation Programs Supplemental Transportation Programs, or STPs, are com- munity-based transportation programs that complement or supplement exiting transportation services (Beverly Founda- tion 2004). These programs fill a gap between public transit systems that are nonexistent in many rural or suburban areas, and paratransit systems that are costly to provide and for which many seniors do not qualify. As such, STPs are especially beneficial for the nondriving older adult. Although techni- cally beyond the scope of the current synthesis effort, STPs are a key resource for keeping older adults safely mobile. A recently updated report available on the AAA Foundation for Traffic Safety website catalogs more than 400 community- based transportation programs available to seniors, providing information on their hours of operation, rider fees, availability of escorts, vehicle type used, etc. (Beverly Foundation 2004). Programs for Increasing Community Awareness AAMVA GrandDriver: Getting Around Safe and Sound The GrandDriver program was developed by the AAMVA in response to requests by its membership. The comprehensive social marketing campaign was designed to educate the pub- lic, especially older drivers and their adult children, about the effects of aging on driving ability and the importance of fam- ilies discussing driving. It was piloted in Washington, D.C., over a 6-month period from April 1 to September 30, 2003. During this time, campaign messages received extensive pub- licity through paid television and radio advertisements, print advertisements, billboards, brochures, and an active speakers’ bureau. Robert Butler, founding director of the National Insti- tute on Aging, served as honorary spokesperson for the cam- paign. Results of pre- and post-campaign surveys showed an increase in awareness of the “GrandDriver” name, as well as of skills needed for safe driving. One unique aspect of the program, which proved highly effective, was training older adults to use the District of Columbia’s MetroRail (rapid transit) system. Based on these positive results, AAMVA has packaged GrandDriver for broader distribution and plans to support other DMVs in implementing the program. Informa- tion on the program is available on the GrandDriver website or through the AAMVA website. Other partners in the pro- gram included NHTSA, Administration on Aging, AARP Driver Safety Program, AAA, Washington Metro Area Tran- sit Authority, and the National Association of Area Agencies on Aging (Figure 8). DriveWell Toolkit NHTSA has partnered with the ASA to develop the Drive- Well Community Toolkit for promoting older road user safety and mobility at the community level. DriveWell is directed toward aging service providers to use as a teaching tool in public forums. It contains background information, talking points, a PowerPoint presentation, video, brochures, and other supporting materials. To disseminate the Toolkit, NHTSA recruited volunteers to serve on a speaker’s bureau in each of its 10 regions. The national rollout of the program was scheduled for early 2005. Academy for Educational Development Community Conversations A partner project to the DriveWell Toolkit described previ- ously is the Older Driver Safety Mobility Project, also referred to as “Community Conversations.” This project was a joint undertaking by the Academy for Educational Development, ASA, and CDC. Recently pilot-tested in five communities, the program uses a pre-survey of older community residents, followed by a public discussion of the survey results and a post-survey to gauge changes in attitudes and behaviors. It is intended to be a social marketing tool for motivating com- munities to begin addressing the transportation safety and FIGURE 8 The GrandDriver campaign was developed by AAMVA to provide information to the public about aging and driving.

mobility of older residents, especially with regard to provid- ing alternatives to driving. Current plans are to fold this pro- gram into the DriveWell program. As a final example activity, the N4A announced competi- tion in the fall of 2003 for 10 to 12 mini-grants ranging from $2,000 to $3,000. The one-year grants are being awarded to member Area Agencies on Aging to “initiate, enhance, or evaluate an older driver safety program/training/activity in which their agency participates.” STATE AND LOCAL INITIATIVES This section highlights selected state and local initiatives with regard to driver assessment and information and education programs for improving older road user safety. Again, a com- prehensive listing of such activities is beyond the scope of this report. Rather, the intent is to provide examples of a range of program types and offerings, with the goal of stimulating additional such programs and activities in other states and communities. The programs have been offered by state health departments, state and Area Agencies on Aging, hospitals, traffic safety groups, and various public and private partner- ships (programs housed in state driver license offices were dis- cussed in chapter five). Driver Evaluation and Training Programs Mature Driver Retraining Workshop (Michigan Traffic Improvement Association) The Michigan Traffic Improvement Association (TIA) offers seniors a 21⁄2-day, 10-h driver safety program that includes the standard classroom instruction, but in addition tests partici- pants’ visual acuity, peripheral vision, depth perception, glare recovery, reaction time, and useful field of view. A unique feature of the program is an optional behind-the-wheel driv- ing assessment conducted in the participant’s own vehicle. The assessments were originally offered on a trial basis, but owing to positive feedback from participants as well as instructors they have become a standard feature of the course. Approximately 25 courses are offered each year, reaching some 500 to 550 older Michigan drivers. The paid instructors are trained and certified by TIA. Because of strong financial support from a variety of public and private agencies and organizations, TIA is able to offer the course at a cost to par- ticipants of only $20 (actual per-student cost is $100 to $125) (Rich 2004; F. P. Cardimen, Jr., personal communication, Sept. 2004). Older Driver Evaluation Program (Ohio State University) The Ohio State University Medical Center offers a compre- hensive, individualized driving evaluation. The program was one of the first to actively promote itself to older adult driv- 46 ers, and it has reached out to local hospitals, driving schools, law enforcement, licensing agencies, and others to encourage referrals of at-risk drivers who might benefit from its services. It also maintains a comprehensive transportation resource guide to assist seniors in accessing alternative transportation in the area. In addition to the comprehensive driving evalua- tion, components of the Ohio State University Medical Cen- ter program include: • Medical history review • Driving history review • Cognitive screening • Vision screening • Assessment of functional status • Analysis of medications • Review of alcohol use • Review of sleep habits • Reaction time analysis • Assessment of threat recognition • Driving simulator experience • On-the-road driving test • Alternative transportation information • Educational opportunities • Remediation opportunities. Information and Education Programs and Materials Mature Driver Improvement Course (California) The California DMV encourages state drivers ages 55 and older to participate in a 7-h (minimum 400-min) driving safety course offered by approved driver improvement schools and instructors. The course covers California motor vehicle laws; defensive driving; and the effects of medication, fatigue, alco- hol, and visual or auditory limitations on driving ability. The maximum fee for the course is $20, and with successful com- pletion participants receive a certificate that qualifies them for reductions in their car insurance premiums for 3 years. You Decide Senior Driving Awareness Program (Michigan) Seniors living in a six-county area in Michigan are able to par- ticipate in the You Decide Senior Driving Program, offered by Area Agency on Aging 1-B. The program was begun in 1997 and has spread to senior centers throughout a five-county region. Its goal is to empower seniors to make their own responsible mobility decisions. A series of monthly programs is offered at local senior centers, with invited speakers to lead discussions on topics chosen by the seniors themselves (e.g., medications and driving, using the public transportation sys- tem, vision and driving, and licensing and insurance). The sec- ond half of the program allows seniors time to discuss issues among themselves and/or to receive additional one-on-one support and guidance. The program reaches approximately

47 700 to 800 seniors per year. The Area Agency on Aging that developed the program has prepared a manual to facilitate implementation by other Area Agencies on Aging (You Decide: Senior Driving Program Manual, undated). It also conducted an evaluation that showed that the program was meeting its primary goals (You Decide: Senior Driving Awareness Program—Evaluation). Choices—Not Chances Initiative (Iowa) The Iowa DOT has developed a video and a series of book- lets based on the Resources for Wise Choices document that resulted from its state and regional forums. The booklets include: • Older Drivers and Risk—Why Be Concerned About Safe Mobility? • Driver License Renewal in Iowa • Senior Drivers Workbook—Practical Driving Tips and a Self-Quiz • Driving with Diminished Skills—Normal Aging Changes and Dementia or Alzheimer’s Disease • Driving Retirement—Planning and Making it Work. The Choice Not Chances video addresses all of these top- ics in a friendly way and is used by local driver license exam- iners when speaking before groups. SafeRiders Program for Older Adults and “On the Road in Texas” Public Service Announcements (Texas) From 1993 to 2002, the Texas Highway Safety Office joined with the Texas Department of Health to provide statewide educational training, presentations, and materials to older adults. Traffic safety messages addressed occupant protec- tion, airbags, walking mobility and safety, bicycle safety and bicycle helmet use, and recreational vehicles. For the past several years, the state’s On the Road in Texas initiative has provided prerecorded messages to more than 247 radio sta- tions across the state. Life-saving traffic safety topics, tips, and laws, in English and Spanish, reach 2 million listeners each week in an entertaining and informative way. The radio messages are timely, seasonal, and address current events and issues, including those aimed at older drivers, passen- gers, and pedestrians. Driving Decisions in Later Life (Pacific Northwest Extension Agency) The Oregon State University Extension, Washington State University Extension, and University of Idaho Cooperative Extension System, which together form the Pacific North- west Extension office, developed Driving Decisions in Later Life (Schmall et al. 2003). The 22-page booklet provides guidance to family members faced with helping an older adult make responsible decisions about driving. First produced in 1998, it was updated in 2003 to incorporate recent resource and reference material, including the Physician’s Guide to Assessing and Counseling Older Drivers (Wang et al. 2003). Except for reference to an Oregon DOT program and Pacific Northwest Extension publications, the guide presents a uni- versal message and could be easily adapted for use by other states. Circuit Court of Cook County Mature Driver Programs (Illinois) The Circuit Court of Cook County, Illinois, the largest court system in the country, developed the Drive Wise, Stay Alive traffic safety awareness campaign under a grant from the Illi- nois DOT Division of Traffic Safety. In 2001, a new compo- nent was added to the program with the goal of raising aware- ness about changes in physical health that can affect the ability to drive safely. Senior citizen groups were invited to contact the Court’s Community Safety Initiative group to schedule participation in the program. A speaker was then arranged to address the gathering. Under a 2003 grant, the court developed a video and accompanying booklet, Keeping the Keys: Mobility, Freedom, Choice (2002). The new mate- rials emphasize the physical changes that occur with aging and encourage readers to take charge of their medications. The material also incorporates a 15-question self-assessment taken from the Australian Capital Territory Older Drivers Handbook. Although funding for the program ended in 2003, the court has been able to continue offering the program at no cost to local senior centers. Each program is specially tai- lored to the needs of the site, with past speakers including occupational therapists, nurses, adaptive vehicle equipment distributors, and transportation providers. Super Seniors Program (Illinois) Illinois also offers seniors the opportunity to participate in its Super Seniors program. Under this program, seniors can attend a free, 2-h Rules of the Road Review course to update their knowledge and give them confidence to obtain or renew their driver’s license. The course includes a review of safe driving techniques and Illinois driving laws, along with a practice exam. Participants also have the option of taking the vision screening test required to obtain a license, which is valid for up to 90 days for license renewal. At some sites they are even able to renew their license. The programs are sponsored by local organizations and are offered more than 3,000 times annually at about 600 locations statewide (see http://www.sos. state.il.us/departments/seniors/supersenior.html).

Driving Safely As You Get Older (Pennsylvania) The Pennsylvania DOT incorporated portions of the AARP Self-Assessment and Resource Guide and other tests of physi- cal function into Driving Safely As You Get Older: A Personal Guide. The booklet is distributed at driver license offices statewide. Along with testing abilities related to driving, the guide offers suggestions for addressing any identified limita- tions and gives tips on using the new safety features in cars. Older Adult and Family Assistance Programs Erie County Help Networks In Erie County, New York, more than 30 agencies and orga- nizations have joined to form the Erie County Older Driver Family Assistance Help Network. The network supplies information about available services, helps caregivers with problem-solving, works to remove barriers to services, and helps caregivers to assist an at-risk driver to either drive safely or step away from the wheel. Its stated goal is safe mobility for all Erie County residents. The network draws inspiration from the When You Are Concerned booklet developed by the New York State Office for the Aging (LePore 2000). The Help Network website contains a wealth of information and is a model for any community based program seeking to address the many and various needs of older road users. Driving Decisions for Seniors (Oregon) In Oregon, a single individual, Ethel Villeneuve, led a grass- roots effort to assist seniors in making appropriate trans- portation choices. Her program relies heavily on volunteers and is currently funded solely through donations. Volunteers are trained to facilitate bimonthly support groups, where older adults can meet and discuss issues related to driving and meet- ing transportation needs through means other than driving. A signature activity of the program is group rehearsals, in which participants gain experience in using alternative means of transportation in a friendly and supportive environment. For example, they may gather at a designated bus stop for a com- munal ride to a favorite shopping destination. A recent eval- uation of the program showed that it helped seniors to com- petently manage their own mobility decisions (Molnar et al. 2003). Comprehensive Programs Senior Safety Resource Centers (Florida) Florida’s Senior Safety Resource Centers, serving the Tampa Bay region of the state, seek to provide “one-stop” services for helping older adults remain safely mobile. Key compo- nents of the centers include: • State-certified, community-based nonprofit status; • Mobile outreach; 48 • Training, educational programs, and services to aging drivers, at-risk drivers, and their families; • Tiered driver skill assessments; • Mobility counseling; and • Referrals to other diagnostic or intervention services. The centers rely heavily on community partnerships to achieve their goals. The Getting in Gear program was an ini- tial testing of the concept. Led by the Tampa Bay Area Agency on Aging, the program offers tiered screening of driver func- tional abilities in conjunction with case management services that includes counseling, rehabilitation, referrals, medical care, and information on adaptive equipment. The program also offers mobility management services to help participants with functional losses develop a plan for meeting their trans- portation and mobility needs. Although fees are charged for some of the more comprehensive screenings and evaluations, most of these services are made available at no cost to area residents. HIGHWAY SAFETY OFFICE AND STATE UNIT ON AGING SURVEY RESULTS Both the State Highway Safety Office (HSO) and the State Unit on Aging (SUA) surveys primarily addressed efforts to educate and inform older road users and related audiences (family members, physicians, social service agencies, etc.). The HSO survey was sent to all state offices of highway safety using a mailing list provided by the GHSA. Responses were received from 22 states, the District of Columbia, and Puerto Rico. A copy of the survey can be found in Appendix F, and a state-by-state summary of survey results in Appendix G. The brief SUA survey (see Appendix H) was distributed using a mailing list provided by N4A. A total of 18 states responded to this survey, whose results are summarized in Appendix I. N4A is a national nonprofit membership organization representing the 57 state and territorial government agen- cies on aging. The SUA administers, manages, designs, and advocates for benefits, programs, and services for the elderly and their families and, in many states, for adults with physical disabilities. The term “State Unit on Aging” is a general term: the specific title and organization of the unit varies from state to state. State units, in turn, oversee Area Agencies on Aging, which have primary responsibility for administering programs within communities or regions. N4A conducted a survey of all Area Agencies on Aging in early 2004 to gather information on transportation programs and services offered. This survey, however, focused entirely on alternative transportation. Ideally, the current synthesis report on older road user safety and mobility programs would have surveyed all Area Agencies on Aging, because it is at

49 the local level that such programs are typically carried out. However, such a large survey was beyond the scope of the project. As a compromise, a brief survey was developed and distributed to just the 50 SUAs. Summaries of results from both surveys follow. HSO Survey Collaboration with Other Agencies and Organizations Survey results with respect to safety planning (Question 1) were presented in chapter three. Results with respect to col- laborations with other agencies and with public- or private- sector organizations on older road user safety issues are summarized in Table 13. One-half (12) of the 24 responding jurisdictions reported that their offices collaborated with other state agencies on older road user safety issues. Agen- cies named included the DMV, DOT, Highway Patrol/State Police, Office of Public Safety/Traffic Safety, Department of Aging/Elder Affairs, Office of Health/Human Services Department, and governor’s office. Some of the activities described were development of educational materials, par- ticipation on working groups, communication across agen- cies, strategic planning, and promoting safer walking and bicycling. One-half (12) of the responding states also indicated that they collaborated with public- or private-sector organizations. Those named included AARP, AAA (auto club), insurance companies, universities, AMA, and Citizens for Safety. Nine (38%) indicated that they had established a liaison with their state office on aging, with two of these (Michigan and Puerto Rico), described as formal liaisons. Finally, nine state respondents (38%) indicated that some type of coalition or task force had been formed in their state to address safe mobility for older citizens in a more compre- hensive way. In Iowa and Michigan, comprehensive plans are being developed with extensive HSO involvement. In Nevada, activity is primarily occurring at the community level through the formation of Community Partnership Orga- nizations, and in New Jersey, the Ocean County Community Traffic Safety Program has established a Senior Safety Task Force. In South Dakota, efforts have been led by the Road- way Safety Committee that is coordinated by the Office of Highway Safety. The Department of Aging is leading a coali- tion in Idaho, whereas AARP and AAA have assumed lead- ership in Tennessee. Ohio’s HSO has worked through its strong Safe Communities network, whereas in Washington State the DMV formed a coalition primarily to address issues of mandatory retesting. Program Support Information gathered with respect to programmatic activities is summarized in Table 14. Fourteen states (58%) indicated that their HSO had engaged in public information and edu- cation activities addressing some aspect of older road user safety. Sample activities included development and distribu- State Collaboration with Other State Agencies Collaboration with Public/Private Organizations Liaison with State Office on Aging State Coalition(s) Alabama No No No No Arkansas No No No No Dist. of Columbia Yes No No No Georgia No Yes No No Idaho No No No Yes Illinois No — Yes No Iowa Yes Yes Yes Yes Kentucky No No No No Massachusetts No No No No Michigan Yes Yes Yes Yes Nevada Yes Yes Yes Yes New Jersey No No No Yes New Mexico No Yes Yes No Ohio Yes No Yes Yes Oklahoma Yes Yes Yes No South Carolina Yes Yes No No South Dakota Yes Yes No Yes Tennessee No No No Yes Texas Yes Yes No No Vermont No No No No Utah Yes Yes Yes No Washington Yes Yes No Yes West Virginia No No No No Puerto Rico Yes Yes Yes No TABLE 13 STATE HIGHWAY SAFETY OFFICE COLLABORATIONS TO ADDRESS OLDER ROAD USER SAFETY ISSUES

tion of brochures and other educational materials, participa- tion in conferences, development of a driving decision guide and video (Iowa), radio public service announcements (New Jersey and Texas), and pedestrian safety campaigns (Puerto Rico). In addition, the District of Columbia noted its recent participation in the GrandDriver Program, described earlier in this chapter. Fifteen responding states (63%) had also provided finan- cial support in the past 5 years to local programs or activities addressing older road user safety and mobility issues. Exam- ples of the types of activities supported include: • The GrandDriver Program (District of Columbia). • Driving simulators taken to homes and activity centers that cater to older road users (Georgia). • An educational program offered through the court sys- tem (Cook County, Illinois). • A 2-day Senior Mobility Forum (Iowa). • Statewide distribution of Walk Safely Senior Kits (New Jersey). • Purchasing vans for transporting elderly and disabled adults (New Mexico). • High-visibility signage on roadways (Ohio). • Support for aging conferences, staff attendance at work- shops (Oklahoma, Puerto Rico). • Training for AARP instructors (South Dakota). • Safe Riders Program, Older Driver Tool Kit (Texas). • Support for AARP/driver safety programs and individ- ual class attendance (Washington, West Virginia). 50 In addition, Michigan noted a broad range of activities, which were described earlier in this chapter. Finally, seven respondents indicated that they had engaged in activities with law enforcement personnel. These activities will be highlighted in chapter seven. Barriers to Increased Attention to Older Road Users A final question on the survey asked respondents what, in their opinion, is the greatest barrier to increased attention to older road users by the highway safety community. The two most frequently cited barriers were a lack of funds and con- flicting priorities (e.g., seat belts, alcohol, and young drivers). Mention was also made of the general lack of awareness of and interest in older driver safety. Several respondents noted that young drivers, drunk drivers, and unbelted drivers accounted for the greatest share of their highway fatalities. Sample quotes included: • “Lack of funding to directly address the concern . . . Still need to focus on 16–34 year-olds who are biggest problem.” (Illinois) • “Limited funds that are committed to seat belt and impaired driving.” (Arkansas) • “Other programs loom as larger safety problems. Perhaps we need more awareness of the problem. We realized we had a senior pedestrian problem . . . [but] haven’t put State Older Road User PI&E Activities Law Enforcement Activities Support to Local Programs Alabama No No No Arkansas No No No Dist. of Columbia Yes No Yes Georgia Yes No Yes Idaho No No No Illinois Yes No Yes Iowa Yes Yes Yes Kentucky No Yes No Massachusetts No No No Michigan Yes Yes Yes Nevada Yes No Yes New Jersey Yes No Yes New Mexico No No Yes Ohio Yes Yes Yes Oklahoma Yes No Yes South Carolina Yes No No South Dakota Yes Yes Yes Tennessee No No No Texas Yes Yes Yes Vermont No No No Utah Yes No No Washington No No Yes West Virginia No No Yes Puerto Rico Yes Yes Yes Note: PI&E = public information and education. TABLE 14 STATE HIGHWAY SAFETY OFFICE PROGRAM ACTIVITIES RELATED TO OLDER ROAD USERS

51 nearly enough resources into senior safety programs.” (New Jersey) • “Lack of dedicated funds. This population doesn’t con- tribute significantly to the total fatals we see [compared to DUI (driving under the influence), lack of seatbelt, etc.].” (Washington State) SUA Survey Ten of the 18 states responding to the SUA survey indicated some level of involvement in safety programs for older road users, and several others indicated indirect involvement through their local Area Agencies on Aging. Most frequently mentioned were providing information or brochures, making referrals to appropriate agencies, promoting AARP and other driver safety programs, participation in conferences, and involvement on committees or task forces. Some of the more notable activities included: • Seeking DOT and other funding for pilot studies to use signage and other safety measures to improve inter- section and roadway safety in three communities/Area Agencies on Aging. (Illinois) • Participation in the state Older Driver Coalition. (New Hampshire) • Participation in the At-Risk Driver Work Group. (Oregon) • Development of a report for the Commission on Aging on Elder Driver Safety. (Rhode Island) • Charter member of the ROADS (Reassessment of Aging Drivers Skills) Consortium. (West Virginia) Several of these activities were described earlier in this or other chapters. Collaborating partners often cited were AARP, DOT, and DMV, as well as Area Agencies on Aging and other state and community agencies and services organiza- tions. In West Virginia, the SUA had also collaborated with a geriatric center, the Alzheimer’s Association, the Older Americans Assistance Program, and the State Police. Nine SUAs were aware of older driver programs in which Area Agencies on Aging in their state had been involved; two additional states (Delaware and Rhode Island) do not have Area Agencies on Aging. Partnering with AARP to promote driver safety classes at senior centers and community centers was again frequently cited. In addition • The Missouri Department of Health and Senior Services described a number of programs in which its Area Agencies on Aging were involved. They include lobby- ing to improve edge markings on secondary roadways (by The Silver Haired Legislative Delegates), hosting a presentation by someone well known in the area on Older Drivers and Their Independence, educating trans- portation planning staff about senior driving issues, and production of a video (now rather dated) titled Driving and Dementia Don’t Mix that had aired on local cable network and had been used by Alzheimer’s Association chapters across the country. • In Washington State, the Pierce County Area Agency on Aging catalogs and provides information to others about nationwide best practices in safe driving for older road users, and publicizes driving safety activities in its senior’s newspaper. Asked specifically if their (state) office made information on driving safety available to older adults or to their family members and friends, 11 of the 18 states (61%) responded that they did. A noteworthy example here is the Pennsylvania Department of Aging, which had partnered with the Pennsyl- vania DOT to produce the booklet, Talking with Older Driv- ers: A Guide for Family and Friends. Four states (Delaware, Illinois, New Hampshire, and Pennsylvania) also reported making information on safe walking available. The New Hampshire aging unit is participating in a statewide coalition initiative promoting liveable, walkable communities. Nine state offices (38%) indicated that they provide assis- tance to family members or friends concerned about an older adult’s safety behind the wheel. For most, this involved pro- viding information and/or making a referral (e.g., to Easter Seals, AARP or other driver safety course, or a geriatric assessment clinic). Often a case manager is involved in the process. Illinois noted that it used a number of resources available from the Administration on Aging website. The following four SUAs indicated that their websites addressed older road user safety: Illinois—http://www.state.il.us/aging/ (follow links). Kansas—http://www.agingkansas.org/kdoa. Ohio—http://goldenbuckeye.com. Pennsylvania—http://www.aging.state.ps.us. SUMMARY This chapter provides examples of many evaluation, educa- tion, and training and support programs and resources at the national, state, and local levels that have as their general goal improving safety and mobility for older road users. As noted at the outset of the chapter, relatively few have undergone rigorous evaluation; nevertheless, they are core components of many states’ efforts to promote lifelong safe mobility. The programs and materials described in this chapter were devel- oped and implemented by a broad range of agencies and organizations in both the public and private sectors. Many have also involved active collaborations between and among these agencies and organizations. Included in the program descriptions in this chapter are driver safety courses and driver assessment programs, materi- als for self-assessment of driving capabilities, as well as more general programs and materials to educate drivers and their

families about changes that occur with aging and steps that can be taken to extend safe driving. Target audiences include older drivers themselves; family members and friends of older driv- ers; physicians, health care professionals, and other “interme- diaries”; and the community at-large. Although some of the programs and materials, such as AARP’s Driver Safety pro- gram, the former 55-Alive, have been around for some time, many more are relatively new ventures, developed in response to the growing number of older drivers traveling on the nation’s streets and highways and being injured and killed in traffic crashes. Useful Web Resources American Society on Aging [Online]. Available: http://www. asaging.org. American Medical Association [Online]. Available: http:// ama-assn.org. 52 Alzheimer’s Association [Online]. Available: http://www. alz.org. AAA Foundation for Traffic Safety [Online]. Available: http:// www.seniordriver.org. American Occupational Therapy Association [Online]. Avail- able: http://www.aota.org/olderdriver. Association for Driver Rehabilitation Specialists [Online]. Available: http://www.driver-ed.org. NHTSA older driver information [Online]. Available: http:// www.nhtsa.dot.gov/people/injury/olddrive. Florida Getting in Gear Program [Online]. Available: http:// www.agingcarefl.org/services/programs/gear. Erie County, N.Y. Help Networks [Online]. Available http:// www.erie.gov/depts/seniorservices/older_driver/. MIT AgeLab [Online]. Available: http://web.mit.edu/agelab/. See Table 12—Source/availability for selected education and evaluation programs and materials for older road users. Also of general interest: Pedestrian and Bicycle Information Clearinghouse [Online]. Available: http://walkinginfo.org and http://bicyclinginfo.org.

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TRB's National Cooperative Highway Research Program (NCHRP) Synthesis 348: Improving the Safety of Older Road Users examines programs and policies in place across the country to improve the safety and mobility of older road users. The report documents a range of strategies and related programs under way in roadway engineering, driver licensing, public information and education, and enforcement and adjudication.

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