1. REFRESHER COURSES FOR OLDER DRIVERS – A LITERATURE STUDY Björn Peters, PhD, VTI, Sweden

2. 2 D RIVER ABILITIES Perception vision hearing touch balance proprioception Motor control size/reach strength endurance stability Driving - a cognitive task of control in a context perceived by our senses, modified by psychomotor actions Neisser’s pragmatic definition of cognition Driving as a cognitive task! Cognition memory attention (execution) mental modells

3. C HANGES DUE TO AGING Declining abilities Traffic change, technology change Perceived problems (intersections, nigh time driving etc.) Defensive driving Self regulation –> driving cessation Vulnerable road user (pedestrian, public transport) Question: Can education/training contribute to sustained safe mobility and independence? 3

4. O LD DOGS AND NEW TRICKS 4 Use it or lose it!

5. L ITERATURE REVIEW  Norwegian Road Administration -> SafeMove  Articles published 1999 – 2009 – update to 2012  Older healthy drivers (no stroke, dementia, etc.)  80 papers identified - 20-25 interesting  Most US, Canada, Australia  Basically nothing from Europe  Mainly theoretical courses  Lack of theory on older driver training! 5

6. CLASSIFICATION  General education/training  General knowledge on aging and training  Physical training (e.g. mobility, strength, reaction)  Perceptual training (mainly visual UFOV)  Cognitive training (e.g. single/dual task, attention (execution), memory training)  Traffic specific education/training  Theoretical  Practical  Combination Theory and Practice 6

7. T RAINING AND EDUCATION METHODS ( TRAFFIC ) Theoretical education  Classroom teaching  Web-based (same as the classroom, but no personal interaction and learner controls the pace yourself)  Interactive CBT (Computer Based Training) to draw more benefit from the possibilities of using computer-based training.  Peer to peer Practical teaching (traffic)  Driving in real traffic  Closed track training  Simulator based training Combination of theory and practice 7

8. E VALUATION OF EFFECTS Safety vs. mobility Transfer effects Knowledge -> behavioural change? Self awareness -> behavioural change? Generic ability training -> behavioural change? Simulator based training -> on the road? Training of specific situations -> other (similar) situations? Durability effects Duration of behavioural change? How to maintain changes (use it or loose it!)? Declining abilities and training durability? 8

9. R EVIEWS OF EVALUATIONS Review 1 ((Kua et al., 2007) (Canada))  review of 8 studies until 2004  education has a positive effect on attention and driving performance (medium)  physical and perceptual training (low)  no safety effects (accidents) Review 2 ((Korner-Bitensky, 2009) (Canada))  Follow-up 2004 – 2008, 4 studies  combination theory and practise positive effect on driver performance (strong) and knowledge (medium)  physical training positive effect on driving performance (medium)  no safety effects (accidents) 9

10. P ROSPECTIVE PARTICIPANTS IN A THEORETICAL COURSE (T UOKKO ET AL., 2007) Willingness and openness to change  86 prospective participants in a theoretical course – most women  most interested in mobility and less safety  men more reluctant to change their behaviour than women  men more frequent drunk driving than women  women believe that the decision to drive is a family business, unlike men who think it is a personal decision 10

11. G ENERAL TRAINING – PHYSICAL TRAINING Physical training (Marottoli et al., 2007)  178 drivers + 70 y physical disabilities - otherwise healthy  Physical training (case)  Theoretical safety education (control)  Before/after driving test on the road  Physical training resulted in improved driving performance, fewer errors, but no difference to control group — 3 months after 11

12. G ENERAL TRAINING – PERCEPTION / COGNITION Driving is a visually demanding task UFOV (useful field of view) scoring  Experimental group UFOV low increased risk (70 drivers) UFOV training – generic Simulator based training + theory – specific  Control group UFOV high low risk (24 drivers) No training Results  Simulator based training improved what was trained  UFOV training not specific improvements but more persistent improvements  18 month follow up confirmed the findings Roenker et al. (2003) UFOV training provided sustained (3 years) mobility improvements Edwards et al (2009) 12

13. G ENERAL TRAINING - COGNITION Cognitive training (Cassavaugh and Kramer (2009))  Theoretical framework for training of older drivers  CBT (attention, memory, and motor control) 1.Tracking task 2.Visual selective attention task (similar to UFOV) 3.Visual–spatial N-back task (working memory task) 4.Dual task (tracking task combined with 2 or 3)  Training resulted in improved driving performance  Training outcome could be predicted from initial results  Rather simple cognitive training can improve driving performance 13

14. T RAFFIC SPECIFIC EDUCATION & TRAINING – T HEORETICAL COURSES o Theoretical courses for older drivers (US and Canada) – most common course!  Class room teaching (4 – 8 h)  Web based alternative  Sometimes combined with practice  Regularly evaluated (questionnaires)  Highly appreciated  Wives persuades their husbands  Improved performance more frequent among females  Older drivers change (subjectively) most  Common changes: check blind spots, distance keeping, entering and leaving motorways, give way  No clear evidence of improved safe mobility  One tentative exception – Norwegian 65+ (Ulleberg) 14

15. T RAFFIC SPECIFIC EDUCATION & TRAINING – T HEORETICAL COURSE  Theoretical course for older drivers 884 persons (average 75 years)  Accident involvement before/after  Random individually matched control groups  Course participants more accidents than controls  Older participants more accidents after  Younger males, slightly lower than controls  Three groups: perfect, pre-crashers, crashers  Crasher remembered less from the course and believed that other road users were causing the accidents not them selves  Education resistant? Or Inappropriate education? Canada - Nasvadi &Vavrik (2007) 15

16. T RAFFIC SPECIFIC TRAINING & EDUCATION – THEORY & PRACTICE  Combination of theory and practice  8 h theory, 2 h driving  Objective to Change behaviour  Before/after case control  Better mobility and safer driving — no accident monitoring  Similar study showed that the improvement in driving performance remained even after 3 months 16

17. C ONCLUSIONS AND FURTHER WORK Can education/training contribute to sustained safe mobility and independence?  Overall Positive effect on performance – specifically subjective No clear effect on safety - methodological problem or course design?  General education/training Cognitive training has a good potential Individually adapted training (needs and abilities)  Traffic specific education/training ”Standard” theoretical courses – limited effect Combination of theory and practice preferable Consider individual differences  Further work Theoretical foundation on aging and learning missing Consider new findings in neuropsychology Evaluation methods and course design need to be further developed 17

18. S AFE M OVE – S WEDISH – F RENCH COLLABORATION 18  Survey of elderly (+70y) license holders (3000 + 1200)  Mobility, personality, health, cognitive ability etc.  On road testing with a smaller sample  Identify over and under estimators of driving performance  Simulator based training  Design and evaluate training based on identified needs and abilities  Aiming to calibrate drivers (i.e. improve safety for over estimators and improve mobility for under estimators)  Driver support systems  Survey on needs and preferences  Develop demonstrators  Perform test with demonstrators

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