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

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

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

REFRESHER COURSES FOR OLDER DRIVERS – A LITERATURE STUDY

Björn Peters, PhD, VTI, Sweden

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DRIVER 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

CHANGES 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

OLD DOGS AND NEW TRICKS

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Use it or lose it!

LITERATURE 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

CLASSIFICATION

General education/trainingGeneral knowledge on aging and trainingPhysical 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/trainingTheoreticalPracticalCombination Theory and Practice 6

TRAINING 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

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EVALUATION 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

REVIEWS 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)

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PROSPECTIVE PARTICIPANTS IN A THEORETICAL COURSE (TUOKKO 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

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GENERAL 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

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GENERAL 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)

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GENERAL TRAINING - COGNITION

Cognitive training (Cassavaugh and Kramer (2009))

Theoretical framework for training of older drivers CBT (attention, memory, and motor control)

1. Tracking task2. 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 performanceTraining outcome could be predicted from initial

resultsRather simple cognitive training can improve

driving performance 13

TRAFFIC SPECIFIC EDUCATION &TRAINING – THEORETICAL 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)

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TRAFFIC SPECIFIC EDUCATION &TRAINING – THEORETICAL COURSE

Theoretical course for older drivers 884 persons (average 75 years)Accident involvement before/afterRandom individually matched control groupsCourse participants more accidents than controlsOlder participants more accidents after Younger males, slightly lower than controlsThree 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)

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TRAFFIC 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

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CONCLUSIONS 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

SAFEMOVE – SWEDISH – FRENCH COLLABORATION

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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

PARTNERS

Questions?