Graduation Year

2019

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

School of Aging Studies

Major Professor

Jerri D. Edwards, Ph.D.

Co-Major Professor

Victor Molinari, Ph.D.

Committee Member

Lesley A. Ross, Ph.D.

Committee Member

Hongdao Meng, Ph.D.

Committee Member

Brianne Stanback, Ph.D.

Keywords

driving remediation, functional decline, older adults, transportation

Abstract

Increased longevity coupled with age-related declines that compromise driving safety and fragility render older adults as vulnerable road users (Oxley & Whelan, 2008). To address this public health concern, researchers continue to investigate interventions to improve older driver safety. The current dissertation consists of two papers examining: a) the state of the literature on older driver interventions and b) the efficacy of one approach, Useful Field of View cognitive training, to reduce at-fault crash involvement. The first paper sought to identify and quantify the effects of different interventions among older adults on outcomes of crashes, on-road driving performance, self-reported outcomes (errors and crashes), and driving simulator performance in a systematic review and meta-analysis (k = 31). Skill-specific interventions (i.e., physical retraining/exercise, visual-perceptual training) and combined approaches demonstrated medium to large effects on driving performance among those trained across studies, ds = 0.564–1.061, ps < .050. Cognitive training approaches reduced at-fault crashes by almost 30%, OR = 0.729, 95% CI [0.553, 0.962], p = .026. Education and context-specific approaches were not efficacious to improve driving safety outcomes. The second paper examined the longitudinal impact of adaptive Useful Field of View cognitive training on at-fault crash involvement. Results showed that cognitive training did not significantly reduce at-fault crashes per person-year of travel across 10 years as compared to the control group, RR = 0.672, 95% CI [0.326, 1.385], p = .281. However, this paper was limited by inadequate power due to a relatively low base rate of at-fault crashes. Future directions include identifying components within skill-specific and combined training approaches that contribute to improved driving safety and evaluating the durability of adaptive Useful Field of View cognitive training to reduce at-fault crashes among high-risk drivers in an adequately powered study.

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