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Cognitive predictors of unsafe driving in older drivers: a meta-analysis

Published online by Cambridge University Press:  01 August 2009

J. L. Mathias*
Affiliation:
School of Psychology, University of Adelaide, South Australia, Australia
L. K. Lucas
Affiliation:
School of Psychology, University of Adelaide, South Australia, Australia
*
Correspondence should be addressed to: Dr J. L. Mathias, School of Psychology, University of Adelaide, Adelaide, South Australia 5005, Australia. Phone: +61 8 83035266; Fax: +61 8 83033770 Email: jane.mathias@adelaide.edu.au.

Abstract

Background: Older drivers are at a higher risk of being involved in a motor vehicle accident. However, on-road assessments of all older drivers are impractical, highlighting the need to screen for potentially unsafe drivers. This study undertook a meta-analysis of research examining the cognitive predictors of driving ability in older drivers in order to provide an evidence-based method for screening drivers.

Methods: Comprehensive searches were undertaken of the PubMed, PsycINFO, CINAHL, and Health-Source Nursing electronic databases between 1980 and 2007 in order to identify studies that examined cognitive differences between drivers aged over 55 years who either passed or failed a driving assessment. Twenty-one studies were eligible for inclusion. Weighted Cohen's d effect sizes, percentage overlap statistics, Fail-safe Ns and 95% CIs were calculated for all cognitive tests.

Results: The best predictors of on-road driving were the Ergovision and Useful Field of View (UFOV) tests, a complex RT task, Paper Folding task, Dot Counting, WMS Visual Reproduction, and Computerized Visual Attention Task. Simulator driving performance was best predicted by the Benton Line Orientation Task, Clock Drawing, a Driver Scanning task, the UFOV, WAIS Picture Arrangement and MMSE. Finally, the Trail Making Test, Stroop, UFOV, WAIS Block Design, and Automated Psychophysical Test were good predictors of driving problems.

Conclusions: There are a variety of tests that appear suitable for screening older drivers, the exact choice of which depends on the “gold standard” for determining driving ability (on-road driving, driving simulator, driving problems) and whether a computerized or paper-and-pencil task is required.

Type
Review Article
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Anstey, K. J., Wood, J., Lord, S. and Walker, J. G. (2005). Cognitive, sensory and physical factors enabling driving safety in older adults. Clinical Psychology Review, 25, 4565.CrossRefGoogle ScholarPubMed
Austroads (2003). Assessing Fitness to Drive: For Commercial and Private Vehicle Drivers. Sydney: Austroads.Google Scholar
Baldock, M. R. J. (2004). Self-regulation of the driving behaviour of older drivers. Available at http://thesis.library.adelaide.edu.au/public/adt-SUA20041221.165852/.Google Scholar
Baldock, M. R. J., Mathias, J. L., Kloeden, C. N. and McLean, A. J. (2002). The effects of age on road crash patterns in South Australia from 1994 to 1998. Road Safety, Research, Policing and Education Conference Proceedings, 4–5 November 2002, Adelaide, South Australia, vol. 1 (pp. 1520). Burnside: Plevin and Associates.Google Scholar
*Baldock, M. R., Mathias, J. L., McLean, A. J. and Berndt, A. (2006). Self-regulation of driving and its relationship to driving ability among older adults. Accident Analysis and Prevention, 38, 10381045.CrossRefGoogle ScholarPubMed
*Ball, K., Owsley, C., Sloane, M. E., Roenker, D. L. and Bruni, J. R. (1993). Visual attention problems as a predictor of vehicle crashes in older drivers. Investigative Ophthalmology and Visual Science, 34, 31103123.Google ScholarPubMed
*Ball, K. K. et al. (2006). Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? Journal of the American Geriatrics Society, 54, 7784.Google Scholar
Bédard, M. and Molloy, D. (1997). Medical screening of older drivers. Journal of the American Geriatrics Society, 45, 388389.CrossRefGoogle ScholarPubMed
Bieliauskas, L. A. (2005). Neuropsychological assessment of geriatric driving competence. Brain Injury, 19, 221226.CrossRefGoogle ScholarPubMed
Bogner, H., Straton, J., Gallo, J., Rebok, G. and Keyl, P. (2004). The role of physicians in assessing older drivers: barriers, opportunities and strategies. Journal of the American Board of Family Practice, 17, 3843.CrossRefGoogle ScholarPubMed
Braver, E. R. (2004). Older drivers and motor vehicle crashes. Hospital Medicine, 65, 599604.CrossRefGoogle ScholarPubMed
Brooks, N. and Hawley, C. A. (2005). Return to driving after traumatic brain injury: a British perspective. Brain Injury, 19, 165175.CrossRefGoogle ScholarPubMed
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155159.CrossRefGoogle ScholarPubMed
Colsher, P. L. and Wallace, R. B. (1993). Geriatric assessment and driver functioning. Clinical Geriatric Medicine, 9, 365375.CrossRefGoogle ScholarPubMed
*Daigneault, G., Joly, P. and Frigon, J. Y. (2002). Executive functions in the evaluation of accident risk of older drivers. Journal of Clinical and Experimental Neuropsychology, 24, 221238.CrossRefGoogle ScholarPubMed
*De Raedt, R. and Ponjaert-Kristoffersen, I. (2000). The relationship between cognitive/neuropsychological factors and car driving performance in older adults. Journal of the American Geriatrics Society, 48, 16641668.CrossRefGoogle ScholarPubMed
De Raedt, R. and Ponjaert-Kristoffersen, I. (2001). Short cognitive/neuropsychological test battery for first-tier fitness-to-drive assessment of older adults. Clinical Neuropsychology, 15, 329336.CrossRefGoogle ScholarPubMed
Dobbs, B. M. (2005). Medical Conditions and Driving: A Review of the Scientific Literature (1960–2000). Technical Report. Washington DC: National Highway and Traffic Safety Administration and the Association for the Advancement of Automotive Medicine Project.Google Scholar
Fox, G. K., Bowden, S. C., Bashford, G. M. and Smith, D. S. (1997). Alzheimer's disease and driving: prediction and assessment of driving performance. Journal of the American Geriatrics Society, 45, 949953.CrossRefGoogle ScholarPubMed
Fox, G., Bowden, S. and Smith, D. (1998). On-road assessment of driving competence after brain impairment: review of current practice and recommendations for a standardized examination. Archives of Physical and Medical Rehabilitation, 79, 12881296.CrossRefGoogle ScholarPubMed
*Freund, B., Colgrove, L. A., Burke, B. L. and McLeod, R. (2005). Self-rated driving performance among elderly drivers referred for driving evaluation. Accident Analysis and Prevention, 37, 613618.CrossRefGoogle ScholarPubMed
Galski, T., Bruno, R. L. and Ehle, H. T. (1992). Driving after cerebral damage: a model with implications for evaluation. American Journal of Occupational Therapy, 46, 324332.CrossRefGoogle Scholar
Galski, T., Ehle, H. T. and Williams, J. B. (1997). Off-road driving evaluations for persons with cerebral injury: a factor analytic study of predriver and simulator testing. American Journal of Occupational Therapy, 51, 352359.CrossRefGoogle ScholarPubMed
Galski, T., Ehle, H., McDonald, M. and Mackevich, J. (2000). Evaluating fitness to drive after cerebral injury: basic issues and recommendations for medical and legal communities. Journal of Head Trauma and Rehabilitation, 15, 895908.CrossRefGoogle ScholarPubMed
*Goode, K. T. et al. (1998). Useful field of view and other neurocognitive indicators of crash risk in older adults. Journal of Clinical Psychology in Medical Settings, 5, 425440.Google Scholar
Grabowski, D. C., Campbell, C. M. and Morrisey, M. A. (2004). Elderly licensure laws and motor vehicle fatalities. JAMA, 291, 28402846.CrossRefGoogle ScholarPubMed
Hedges, L. V. and Cooper, H. E. (1994). The Handbook of Research Synthesis. New York: Russell Sage Foundation.Google Scholar
Hedges, L. V. and Olkin, I. (1985). Statistical Methods for Meta-analysis. Orlando: Academic Press.Google Scholar
Heikkila, V. M. and Kallanranta, T. (2005). Evaluation of the driving ability in disabled persons: a practitioners' view. Disability and Rehabilitation, 27, 10291036.CrossRefGoogle ScholarPubMed
*Hoffman, L., McDowd, J. M., Atchley, P. and Dubinsky, R. (2005). The role of visual attention in predicting driving impairment in older adults. Psychology and Aging, 20, 610622.CrossRefGoogle ScholarPubMed
Huchler, S. et al. (2001). Evaluation of driving simulation. Europa Medicophysica, 37, 283289.Google Scholar
Hunter, J., Schmidt, F. and Jackson, G. (1982). Meta-analysis: Cumulating Research Findings across Studies. Beverly Hills: Sage Publications.Google Scholar
*Janke, M. K. (2001). Assessing older drivers: two studies. Journal of Safety Research, 32, 4374.Google Scholar
*Janke, M. K. and Eberhard, J. W. (1998). Assessing medically impaired older drivers in a licensing agency setting. Accident Analysis and Prevention, 30, 347361.Google Scholar
Kakaiya, R., Tisovec, R. and Fulkerson, P. (2000). Evaluation of fitness to drive: the physician's role in assessing elderly or demented patients. Postgraduate Medicine, 107, 229236.CrossRefGoogle ScholarPubMed
Keall, M. D. and Frith, W. J. (2004). Association between older driver characteristics, on-road driving test performance, and crash liability. Traffic Injury Prevention, 5, 112116.CrossRefGoogle ScholarPubMed
Kippen, R. (2002). The future extent of population ageing in Australia. Journal of Population Research, 19, 151158.Google Scholar
Langford, J., Fitzharris, M., Koppel, S. and Newstead, S. (2004a). Effectiveness of mandatory license testing for older drivers in reducing crash risk among urban older Australian drivers. Traffic Injury Prevention, 5, 326335.CrossRefGoogle ScholarPubMed
Langford, J., Fitzharris, M., Newstead, S. and Koppel, S. (2004b). Some consequences of different older driver licensing procedures in Australia. Accident Analysis and Prevention, 36, 9931001.CrossRefGoogle ScholarPubMed
Lee, H., Drake, V. and Cameron, D. (2002). Identification of appropriate assessment criteria to measure older adults' driving performance in simulated driving. Australian Occupational Therapy Journal, 49, 138145.CrossRefGoogle Scholar
Lee, H. C., Cameron, D. and Lee, A. H. (2003). Assessing the driving performance of older adult drivers: on-road versus simulated driving. Accident Analysis and Prevention, 35, 797803.CrossRefGoogle ScholarPubMed
Levy, D. T., Vernick, J. S. and Howard, K. A. (1995). Relationship between driver's license renewal policies and fatal crashes involving drivers 70 years or older. JAMA, 274, 10261030.CrossRefGoogle ScholarPubMed
Lezak, M., Howieson, D., Loring, D., Hannay, J. and Fisher, J. (2004). Neuropsychological Assessment (4th edn). New York: Oxford University Press.Google Scholar
Lipsey, M. and Wilson, D. (2001). Practical Meta-analysis. California: Sage Publications.Google ScholarPubMed
*Lundberg, C., Hakamies-Blomqvist, L., Almkvist, O. and Johansson, K. (1998). Impairments of some cognitive functions are common in crash-involved older drivers. Accident Analysis and Prevention, 30, 371377.CrossRefGoogle ScholarPubMed
Lundqvist, A., Gerdle, B. and Ronnberg, J. (2000). Neuropsychological aspects of driving after a stroke: in the simulator and on the road. Applied Cognitive Psychology, 14, 135142.3.0.CO;2-S>CrossRefGoogle Scholar
*MacGregor, J. M., Freeman, D. H. Jr., and Zhang, D. (2001). A traffic sign recognition test can discriminate between older drivers who have and have not had a motor vehicle crash. Journal of the American Geriatrics Society, 49, 466469.CrossRefGoogle ScholarPubMed
Marottoli, R. A. (1993). Driving safety in elderly individuals. Connecticut Medicine, 57, 277280.Google ScholarPubMed
*Marottoli, R. A. et al. (1998). Development of a test battery to identify older drivers at risk for self-reported adverse driving events. Journal of the American Geriatrics Society, 46, 562568.CrossRefGoogle ScholarPubMed
Mazer, B., Gelinas, I. and Benoit, D. (2004). Evaluating and retraining driving performance in clients with disabilities. Critical Reviews in Physical and Rehabilitation Medicine, 16, 291326.CrossRefGoogle Scholar
McKenna, P. (1998). Fitness to drive: a neuropsychological perspective. Journal of Mental Health, 7, 914.CrossRefGoogle Scholar
McKenna, P., Jefferies, L., Dobson, A. and Frude, N. (2004). The use of a cognitive battery to predict who will fail an on-road driving test. British Journal of Clinical Psychology, 43, 325336.CrossRefGoogle ScholarPubMed
*McKnight, A. J. and McKnight, A. S. (1999). Multivariate analysis of age-related driver ability and performance deficits. Accident Analysis and Prevention, 31, 445454.CrossRefGoogle ScholarPubMed
Meyers, J. E., Volbrecht, M. and Kaster Bundgaard, J. (1999). Driving is more than pedal pushing. Applied Neuropsychology, 6, 154159.CrossRefGoogle ScholarPubMed
Mouloua, M., Smither, J., Hancock, P., Duley, J., Adams, R. and Latorella, K. (2004). Aging and driving. II: Implications of cognitive changes. In Vincenzi, D., Mouloua, M. and Hancock, P. (eds.), Human Performance, Situation Awareness and Automation: Current Trends and Research. New Jersey: Erlbaum Publishers.Google Scholar
OECD (2001). Ageing and Transport: Mobility and Safety Issues. Paris: Organization for Economic Co-operation and Development.Google Scholar
Odenheimer, G. L., Beaudet, M., Jette, A. M., Albert, M. S., Grande, L. and Minaker, K. L. (1994). Performance-based driving evaluation of the elderly driver: safety, reliability, and validity. Journal of Gerontology, 49, 153159.CrossRefGoogle ScholarPubMed
*Owsley, C., Ball, K., Sloane, M. E., Roenker, D. and Bruni, J. R. (1991). Visual/cognitive correlates of vehicle accidents in older drivers. Psychology and Aging, 6, 403415.CrossRefGoogle ScholarPubMed
*Oxley, J. A., Charlton, J. L., Koppel, S. N., Scully, J. and Fildes, B. N. (2005). Crash risk of older female drivers – contributing factors. Annual Proceedings of the Association for the Advancement of Automotive Medicine, 49, 331346.Google ScholarPubMed
*Rebok, G. W., Keyl, P. M., Bylsma, F. W., Blaustein, M. J. and Tune, L. (1994). The effects of Alzheimer disease on driving-related abilities. Alzheimer's Disease and Associated Disorders, 8, 228240.Google ScholarPubMed
*Richardson, E. D. and Marottoli, R. A. (2003). Visual attention and driving behaviors among community-living older persons. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 58, M832836.CrossRefGoogle ScholarPubMed
Rosenthal, M. (1995). Writing meta-analytic reviews. Psychological Bulletin, 118, 183192.CrossRefGoogle Scholar
Rosenthal, R. and DiMatteo, M. R. (2001). Meta-analysis: Recent developments in quantitative methods for literature reviews. Annual Review of Psychology, 52, 5982.CrossRefGoogle ScholarPubMed
Schanke, A. and Sundet, K. (2000). Comprehensive driving assessment: neuropsychological testing and on-road evaluation of brain injured patients. Scandinavian Journal of Psychology, 41, 113121.CrossRefGoogle ScholarPubMed
Smither, J., Mouloua, M., Hancock, P., Duley, J., Adams, R., and Latorella, K. (2004). Aging and driving. I: Implications of perceptual and physical changes. In Vincenzi, D., Mouloua, M. and Hancock, P. (eds.), Human Performance, Situation Awareness and Automation: Current Research and Trends. New Jersey: Erlbaum Publishers.Google Scholar
Sommer, S., Falkmer, T., Bekiaris, E. and Panou, M. (2004). Toward a client-centred approach to fitness-to-drive assessment of elderly drivers. Scandanavian Journal of Occupational Therapy, 11, 6269.CrossRefGoogle Scholar
Strauss, E., Sherman, E. and Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms and Commentary (3rd edn). New York: Oxford University Press.Google Scholar
*Stutts, J. C., Stewart, J. R. and Martell, C. (1998). Cognitive test performance and crash risk in an older driver population. Accident Analysis and Prevention, 30, 337346.CrossRefGoogle Scholar
Stutts, J. C. and Wilkins, J. W. (2003). On-road driving evaluations: a potential tool for helping older adults drive safely longer. Journal of Safety Research, 34, 431439.CrossRefGoogle ScholarPubMed
Szlyk, J., Myers, L., Zhang, Y., Wetzel, L. and Shapiro, R. (2002). Development and assessment of a neuropsychological battery to aid in predicting driving performance. Journal of Rehabilitation Research and Development, 39, 483495.Google ScholarPubMed
Tamietto, M., Torrini, G., Adenzato, M., Pietrapiana, P., Rago, R. and Perino, C. (2006). To drive or not to drive (after TBI)? A review of the literature and its implications for rehabilitation and future research. Neuro Rehabilitation, 21, 8192.Google ScholarPubMed
*Tarawheh, M. and McCoy, P. (1993). Factors associated with driving performance of older drivers. Transport Research Record, 1405, 6471.Google Scholar
Unsworth, C., Lovell, R., Terrington, N. and Thomas, S. (2005). Review of tests contributing to the occupational therapy off-road driver assessment. Australian Occupational Therapy Journal, 52, 5774.CrossRefGoogle Scholar
Vaa, T. (2003). Impairment, Diseases, Age and their Relative Risks of Accident Involvement: Results from Meta-analysis, TØI Report 690. Oslo: Institute of Transport Economics.Google Scholar
Waller, P. F. (1991). The older driver. Human Factors, 33, 499505.CrossRefGoogle ScholarPubMed
*Whelihan, W., DiCarlo, M. and Paul, R. (2005). The relationship of neuropsychological functioning to driving competence. Archives of Clinical Neuropsychology, 20, 217228.CrossRefGoogle ScholarPubMed
White, H. (1994). Scientific communication and literature retrieval. In Cooper, H. and Hedges, L. (eds.), The Handbook of Research Synthesis. New York: Russell Sage Foundation.Google Scholar
White, S. and O'Neill, D. (2000). Health and relicensing policies for older drivers in the European Union. Gerontology, 46, 146152.CrossRefGoogle ScholarPubMed
Withaar, F. K., Brouwer, W. H. and van Zomeren, A. H. (2000). Fitness to drive in older drivers with cognitive impairment. Journal of the International Neuropsychological Society, 6, 480490.CrossRefGoogle ScholarPubMed
Zakzanis, K. (2001). Statistics to tell the truth, the whole truth, and nothing but the truth. Formulae, illustrative examples and heuristic interpretation of effect size analyses for neuropsychological researchers. Archives of Clinical Neuropsychology, 16, 653667.CrossRefGoogle ScholarPubMed
Zakzanis, K. K., Leach, L. and Kaplan, E. (1999). Neuropsychological Differential Diagnosis. Lisse: Swets & Zeitlinger.Google Scholar