A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons
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As the number of older drivers increases, concern has been raised about the potential safety implications. Flexibility, coordination, and speed of movement have been associated with older drivers’ on road performance.
To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility, coordination, and speed of movement could improve driving performance among older drivers.
Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules.
Drivers, 178, age ≥ 70 years with physical, but without substantial visual (acuity 20/40 or better) or cognitive (Mini Mental State Examination score ≥24) impairments were recruited from clinics and community sources.
On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban, residential, and highway traffic. Performance rated three ways: (1) 36-item scale evaluating driving maneuvers and traffic situations; (2) evaluator’s overall rating; and (3) critical errors committed. Driving performance reassessed at 3 months by evaluator blinded to treatment group.
Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants (P = .03). Intervention drivers committed 37% fewer critical errors (P = .08); there were no significant differences in evaluator’s overall ratings (P = .29). No injuries were reported, and complaints of pain were rare.
This safe, well-tolerated intervention maintained driving performance, while controls declined during the study period. Having interventions that can maintain or enhance driving performance may allow clinician–patient discussions about driving to adopt a more positive tone, rather than focusing on driving limitation or cessation.
KEY WORDSdriving performance randomized trial physical conditioning program
The authors thank Robbin Bonanno for her assistance in preparing this manuscript.
Claude D. Pepper Older Americans Independence Center at Yale Intervention Development Study (P60-AG10469- NIA); Dr. Marottoli was supported by a VA Health Services Research and Development Career Development Award, a Beeson Physician Faculty Scholars in Aging Research Award, and a Donaghue Foundation Investigator Award.
Potential Financial Conflicts of Interests
- 6.Evans L. Older driver involvement in fatal and severe traffic crashes. J Gerontol: Soc Sci. 1988;43:S186–93.Google Scholar
- 9.Bygren LO, Konlaan BB, Johansson SE. Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions. Br Med J. 1996;313:1577–80.Google Scholar
- 10.Glass TA, Mendes de Leon C, Marottoli RA, Berkman LF. Population based study of social and productive activities as predictors of survival among elderly Americans. Br Med J. 1999;319:478–83.Google Scholar
- 14.Marottoli RA, Mendes de Leon CF, Glass TA, et al. Consequences of driving cessation: decreased out of home activity levels. J Gerontol: Soc Sci. 2000;55B:S334–40.Google Scholar
- 15.Fonda SJ, Wallace RB, Herzog AR. Changes in driving patterns and worsening depressive symptoms among older adults. J Gerontol: Soc Sci. 2001;56B:S343–51.Google Scholar
- 25.Legh-Smith J, Wade DT, Langton Hewer R. Driving after a stroke. J Royal Soc Med. 1986;79:200–3.Google Scholar
- 32.Margolis KL, Kerani RP, McGovern P, et al. Study of osteoporotic fractures research group. Risk factors for motor vehicle crashes in older women. J Gerontol: Med Sci. 2002;57A:M186–91.Google Scholar
- 36.Richardson ED, Marottoli RA. Visual attention and driving behavior among community-living older persons. J Gerontol: Med Sci. 2003;58:832–6.Google Scholar
- 37.Allison LD. Logistic Regression Using the SAS® System: Theory and Application. Cary, NC: SAS Institute, Inc; 1999.Google Scholar
- 39.Wang CC, Kosinkski CJ, Schwartzberg JG, Shanklin AV. Physicians Guide to Assessing and Counseling Older Drivers. Washington, DC: National Highway Traffic Safety Administration; 2003.Google Scholar
- 40.Ageing and Transport: Mobility Needs and Safety Issues. Paris, France: Organisation for Economic Cooperation and Development; 2001.Google Scholar