A. IDENTIFY OLDER PEOPLE WHO ARE AT HIGH RISK OF CRASHES

1. Epidemiology

(a) Dementia
(b) Cataracts
(c) Diabetes and Associated Conditions
(d) Glaucoma
(e) Foot Abnormalities
(f) Falls
(g) Cardiac (and Cardiopulmonary) Conditions
(h) Feet or Legs Cold on Exposure to Cold
(i) Bursitis
(j) Renal Disease
(k) Seizure Disorders
(l) Back Pain
(m) Overview: Comparative Risk Tables

2. Driving and/or Functional Assessment Outcomes

(a) Physical Performance Deficits
(b) Sensory (Vision) Deficits
(c) Deficits in Visual Attention/Speed of Processing
(d) Perceptual Skills
(e) Memory/Cognition Deficits
(f) Navigation Errors on Road Test
(g) Discriminating Maneuver Errors on Road Test
(h) Decision-Making and Response Selection in Driving Simulators

3. Avoidance of High Risk Situations and Other Compensatory Behaviors

B. DEVELOP MODEL PROGRAM COMPONENTS DESIGNED TO REGULATE AND COUNSEL HIGH-RISK OLDER DRIVERS AND TRANSPORTATION SYSTEM USERS

1. DMV/Licensing Activities

2. Integrated Health, Social Service, and Community-Based Agency Activities

3. Information and Educational Support for Safe Mobility Choices by Public Agencies, Private Professionals/Organizations, and Concerned Individuals

C. DEVELOP TOOLS NEEDED TO IMPLEMENT MODEL PROGRAMS

1. Identification Procedures/Program Intake Mechanisms

(a) Internal (DMV) Identification

i. Direct observation by counter personnel
ii. Responses on license application/renewal form
iii. Contact based on driving record
iv. Contact based on age at renewal (includes random and stratified sampling selection procedures)

(b) External Referral of At-Risk Drivers

i. Family/friend referral
ii. Law enforcement referral
iii Court referral
iv. Occupational/physical therapist referral
v. Referrals from social service providers
vi. Hospital plan of discharge/care plan referral
vii. Assessments performed at special events/wellness fairs
viii Referral from vision specialists
ix. Physician reporting/mandatory
x. Physician referral/voluntary

(c) Problem Identification Through Self-Testing Activities

i. Distribution of self-evaluation materials
ii. Automated testing in public venues (e.g., kiosks)
iii. Outreach by professional associations (AAA, AARP, "Wellness Fair")

2. Test Procedures

(a) First-Tier Functional Screening

i. GRIMPS battery of general physical and mental abilities
ii. Vision screens
iii. Road sign/knowledge test
iv. Supplemental tests specialized for attentional and information processing skills

(b) Second-Tier Functional Screening

i. Clinical assessment of dementia
ii. Psychophysical test batteries
iii. Ophthalmological/optometric examination
iv. Simulator measures of response effectiveness
v. Comprehensive physical examination
vi. Functional abilities and driving evaluations

(c) Design and Methodology For On-Road Evaluations of Driving Competence

i. Standardized exam over a common route
ii. Customized ("home area") exam, tailored to individuals' driving patterns

3. Rehabilitation Procedures

(a) Elderly population without chronic conditions (includes post-trauma recovery)

i. Education
ii. Perceptual skills training
iii. Vehicle modification
iv Fitness and nutrition

(b) Elderly population with chronic conditions -- intervention required

i. Physician and/or occupational therapist review
ii. Physical rehabilitation
iii. Vehicle modification
iv. Functional status review leading to license restriction

4. Alternative Mobility Solutions

(a) Transit/Paratransit/Shared Ride Programs
(b) Volunteer Programs
(c) Private Sector Alternatives

i. Hired drivers
ii. Voucher programs

(d) Electric Golf Carts

5. Alternatives to Transportation

(a) Community/Social Support Activities
(b) Internet Access to Services

D. REFERENCES

II. ANNOTATED RESEARCH COMPENDIUM OF DRIVER ASSESSMENT TECHNIQUES FOR AGE-RELATED FUNCTIONAL IMPAIRMENTS

A. VISION

1. Static Acuity

(a) MultiCAD
(b) Rosenbaum Card
(c) Snellen E Chart
(d) Snellen E (Computerized Presentation)
(e) Snellen Letter Chart (Modified)

2. Dynamic Acuity

(a) MultiCAD
(b) Snellen E (Computerized Presentation)

3. Static Contrast Sensitivity

(a) MultiCAD
(b) Pelli-Robson Test of Low Contrast Acuity
(c) Smith-Kettlewell Low Luminance Card (SKILL)
(d) Vistech Contrast Sensitivity Gratings/Optec 1000

4. Static Contrast Sensitivty/Glare

(a) Berkeley Glare Tester

5. Dynamic Contrast Sensitivity

(a) MultiCAD

6. Peripheral Visual Fields

(a) Goldman Perimeter
(b) Manually Operated Perimeter

7. Eye Disease

(a) Cataracts
(b) Diabetic Retinopathy
(c) Glaucoma

8. Multiple Visual Capabilities

(a) Keystone Telebinocular Testing Device
(b) Sight Screener II

B. ATTENTION/PERCEPTION/COGNITION

1. Angular Motion Sensitivity

(a) MultiCAD

2. Attentional Search and Sequencing

(a) AARP Reaction Time Test
(b) Auto-Trails
(c) Trail-Making Test
(d) WayPoint

3. Attention Switching

(a) Digit Symbol Subscale of WAIS
(b) Washington University Attention Switching Task

4. Attentional Visual Field

(a) Smith-Kettlewell Modified Synemen Perimeter
(b) Visual Attention Analyzer (UFOV)

5. Divided Attention

(a) MultiCAD

6. Driving Knowledge

(a) Rules of the Road
(b) Traffic Sign Recognition

7. Immediate/Delayed Recall

(a) Logical Memory Subscale of Wechsler Memory Scale

8. Language Abilities/Naming Behavior

(a) Boston Naming Test

9. Mental Status

(a) Mattis Organic Mental Status Syndrome Examination (MOMSSE)
( b) Mini-Mental State Evaluation (MMSE)
(c) Short Blessed Cognitive Screen

10. Perceptual Speed

(a) Cue Recognition (Doron Driver Analyzer)

11. Selective Attention

(a) Auditory Selective Attention Test

12. Sustained Attention

(a) Continuous Performance Task

13. Visual Perception

(a) Benton Visual Retention Test
(b) Motor-Free Visual Perception Test
(c) WAIS-R Picture Completion

14. Multiple Capabilities

(a) Cognitive Behavioral Driver's Inventory (CBDI)
(b) Cognitive Screen (DrivAble Testing, Ltd.)
(c) Driving Advisement System (DAS)
(d) Easy Driver
(e) Elemental Driving Simulator (EDS)
(f) University of Iowa/Atari Interactive Driving Simulator
(g) University of Nevada, Las Vegas (UNLV) Subtests
(h) Washington University Visual Attention Tests

C. PHYSICAL CAPABILITIES

1. Balance

(a) Tandem Stand

2. Gross Mobility

(a) Number of Blocks Walked
(b) Number of Foot Abnormalities

(c) Rapid Pace Walk
(d) Usual Pace Walk

3. Range of Motion

(a) Left-Knee Flexion
(b) Neck Flexibility
(c) Multiple Measures (Trunk, Neck, Shoulder)

4. Reaction Time

(a) Brake Reaction Time (Doron)

D. MULTIPLE FACTORS

1. Self-Reports

(a) Driving Habits Survey
(b) Panel Data Set (medical and functional limitations, demographics)

2. Number of Observed Problems

3. Test Batteries

(a) Automated Psychophysical Test (APT)
(b) Johns Hopkins University
(c) Salisbury Eye Evaluation
(d) University of Alabama at Birmingham (UAB)
(e) University of Helsinki
(f) University of Iowa
(g) Yale University

4. Literature Review- Medical Conditions

E. ON-ROAD MEASURES OF SAFE DRIVING PERFORMANCE

1. California Modified Driving Performance Evaluation (MDPE)

2. California Area Driving Performance Evaluation (ADPE)

3. Washington University Road Test (WURT)

References for Section II

Footnotes:

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1. Decina, Staplin, and Spiegel (1990) provide a review of vision screeners commercially available as of July 1988. They stated that at that time, Stereo Optical Company, Titmus Optical Company, and Keystone/Mast have provided most of the screeners to driver licensing agencies. Because vision screeners have many similarities, only a subset are presented here.

2. The Driver Performance Evaluation (DPE) is based on Ray Engel's driver performance measurement model. A 4-stage project was undertaken to develop an improved competency-based drive test for possible state-wide implementation in California (Romanowicz and Hagge, 1995). It was piloted in 30 CALDMV field offices. The results provide strong evidence that the DPE is a valid test. Inexperienced drivers and drivers with mental or physical conditions that affect their driving tended to perform worse than did experienced drivers with no known driving-related debility. Novice original, limited term renewals, and 3-crash reexamination driver groups had significantly higher/worse mean scores than did out-of-state originals, congratulations renewal (good drivers not required to take knowledge test), and written test renewal groups.

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