Gearing Up for An Aging Population
A new guide aims to improve driving safety for older road users.
According to a June 2002 article in BMJ Publishing Group's Injury Prevention journal, Stephen Lyman and coauthors project that aging baby boomers are expected to have a profound effect on the safety of the Nation's roadways, comprising up to one-fourth of all traffic fatalities by the year 2030. There are a number of reasons for focusing on older drivers, not all of which are readily apparent from a superficial examination of crash statistics.
Based purely on crash rates per licensed driver, older adults are some of the safest drivers on the roadway, and their crash rates have not shown dramatic increases over the past decade. The picture changes, however, when the rates are calculated based on miles driven rather than on licensed drivers. And when the attention also shifts to fatalities rather than crashes or injuries, there is even greater cause for concern. Compared to an overall national average of 1.44 fatalities per 100 million vehicle miles traveled (MVMT), drivers over the age of 75 have a fatality rate of 3.7 deaths per 100 MVMT. And those over the age of 85 have a fatality rate of 8.0 deaths per 100 MVMT, according to Tony Kane, director of engineering and technical services at the American Association of State Highway and Transportation Officials (AASHTO).
Given the national goal—adopted by AASHTO, the U.S. Department of Transportation (USDOT), and others—of lowering the national highway fatality rate from 1.44 to 1.0 per 100 MVMT by the year 2008, Kane says, "These are disturbing numbers, especially when one considers the large projected increase in the number of older drivers on our roadways." He notes that the Nation's population not only is aging but also comprises greater numbers of older adults continuing to drive into their 80s and beyond. These seniors are making more trips and driving more miles.
In the Injury Prevention article cited earlier, Lyman and his coauthors echo Kane's concerns. The authors conclude, "Because older vehicle occupants will comprise a large proportion of future deaths in motor vehicle crashes, public health efforts to reduce their morbidity and mortality should be pursued." Factoring the baby boomer trend into the equation will in all likelihood multiply the challenges to be addressed in reducing the fatality rate.
Debunking Myths About the Older Driver
U.S. adults age 65 and older comprise a rich, diverse, and engaged mix of individuals. Events such as the recently concluded White House Conference on Aging celebrate that diversity and the multifaceted contribution of older adults to their communities. Yet standing in stark contrast to that portrait are various misconceptions about these same people once they get behind the wheel. Continuation of such myths stymies efforts of law enforcement, medical professionals, families, and even older adults themselves to face proactively what in most instances is the eventual transition from driving full time to stopping driving altogether. Consider two examples:
Myth 1: Aging is associated with inevitable functional declines that make most older adults high-risk drivers.
Fact: This myth is the underpinning for calls by some pundits and lawmakers for States to enact mandatory age-based testing of older drivers. Although specific abilities needed to drive safely may decline as a person ages, the rate of change varies greatly among older adults. Many older people do not differ significantly in their driving skills from middle-aged people, who statistically are the safest group on the road. Older drivers have the highest rate of seatbelt use and lowest rate of alcohol-related crashes. In addition, most self-regulate their driving through a variety of actions such as not driving at night. What is less clear is whether they make those changes at the right time and in the right way; many individuals who experience cognitive decline often lack insight into their loss of function.
Myth 2: Older adults can get around using public transportation once they limit or stop driving.
Fact: Many public transportation systems, especially those offering only fixed-route bus service, are poorly equipped to meet the needs of older adults for responsive, convenient transportation. Nationally, less than 3 percent of older adults now look to public transportation for getting around their communities, though in some major metropolitan areas the figure is significantly higher. Still, many older adults have little experience with and confidence in public transportation. Older people are generally more likely to be able to operate their own cars, parked at their homes, than to use fixed-route transit; that is, walking a few or many blocks to the bus stop, waiting for a bus, and making that final big step to get onto the bus. An increasing number of communities are developing transportation choices that are more flexible than traditional fixed-route public systems, offering ondemand, door-to-door or door-through-door service.
Jeff Finn, American Society on Aging
To help State departments of transportation (DOTs) meet the reduction in the national highway fatality rate, the Transportation Research Board's (TRB) National Cooperative Highway Research Program (NCHRP) published a series of guides for improving highway safety called NCHRP Report 500: Guidance for Implementation of the AASHTO Strategic Highway Safety Plan (NCHRP Report 500).One volume of this series is NCHRP Report 500: Volume 9: A Guide for Reducing Collisions Involving Older Drivers (guide). The volume 9 guide recommends planning strategies for improving the roadway and driving environment to better accommodate older drivers, identifying high-risk older drivers and intervening to lower their crash risk, improving the driving competency of older adults in general, and reducing the risk of injury and death to older occupants involved in crashes.
No single agency or organization could accomplish the strategies in these areas on its own. Rather, a coordinated effort is needed that involves partnerships across agencies and organizations in both the public and private sectors.
The Older Drivers Guide and AASHTO's Highway Safety Plan
In 1997, the AASHTO Standing Committee on Highway Traffic Safety along with the Federal Highway Administration (FHWA), the National Highway Traffic Safety Administration (NHTSA), and the TRB Committee on Transportation Safety Management convened a meeting of national transportation safety experts to develop a comprehensive highway safety plan for the Nation. The goal was to address not only roadway and infrastructure needs but also drivers and other roadway users, vehicles, emergency medical services, and the traffic safety management process. Its success was to be measured by the number of lives saved.
The AASHTO Strategic Highway Safety Plan (SHSP)—developed by AASHTO, FHWA, NHTSA, and TRB, with the participation of many others—evolved from the meeting and identified 22 emphasis areas where coordinated actions could substantially reduce traffic fatalities and injuries. "Sustaining Proficiency in Older Drivers" was one of the priorities included in the plan.
To assist States in implementing the SHSP recommendations, the NCHRP (a State pooled fund program managed by TRB in cooperation with FHWA) funded a project to develop guides for each of the 22 priorities. Collectively, the guides form NCHRP Report 500. Each guide provides background information and data on the given priority, along with recommended objectives and strategies for addressing the problem. The report indicates that the "development of the volumes of NCHRP Report 500 used the resources and expertise of many professionals from around the country and overseas. Through research, workshops, and actual demonstration of the guides by agencies, the resulting documents represent best practices in each emphasis area."
"We encouraged developers of the guides to identify countermeasures that were practical for States to implement and that had either been formally evaluated and proven effective or had been tried with promising results," says Tim Neuman, overall director for the CH2M Hill team conducting the project. "State and local officials should be able to put these guides to immediate use in reducing crashes and saving lives."
All of the guides in the NCHRP Report 500 follow a similar format. For each of the identified strategies, there is a brief description and rationale for the strategy, followed by a table detailing the technical and organizational attributes needed to implement it. Examples include the strategy's expected effectiveness, keys to success, potential difficulties, appropriate measures and data, and associated needs for support services. Each table also provides information on organizational, institutional, and policy concerns, expected costs, issues affecting implementation time, training and personnel needs, and legislative requirements. Finally, an effort is made to identify agencies or organizations currently implementing the strategy so that others might benefit from their experiences.
To access the NCHRP Report 500 guides, go to http://safety.transportation.org. The Web page versions contain links to relevant programs, resources, and Web sites. "We wanted users of the guides to have ready access to the best available resources, including indepth information that would assist them in implementing a particular strategy," says Neuman.
NCHRP Report 500 guides are comprehensive in scope and target a broad audience of potential users, including State and local transportation officials, safety engineers, planners, law enforcement officials, motor vehicle administrators, and emergency medical services providers. The guides also are part of a broader package of resources available to the States, including an integrated safety management process, a self-assessment tool, and other related documents.
What Does the Older Driver Guide Recommend?
The older drivers guide (Volume 9) includes 5 overarching objectives and 19 specific strategies. Volume 9 focuses on accommodating older drivers on the roadway as well as sustaining their driving proficiencies. The following sections offer highlights from the guidance and strategies.
Objective 1: Plan for an Aging Population. The tenet behind the AASHTO Strategic Highway Safety Plan is that a comprehensive, integrated approach is needed to significantly reduce highway deaths and injuries, especially for improving the safety of older road users. Statistics clearly demonstrate the urgent need for action, which must go beyond the efforts of a single department, agency, or organization. The guide supports the principle that, "like the national plan, these State and local action plans need to reflect the input of a broad consortium of governmental agencies and organizations and interests in the private sector. Although State transportation departments can lead the effort, they need to create partnerships with other departments and agencies at the State, regional, and local levels." Potential collaborators include State offices on aging, area agencies on aging, transportation service providers, social service agencies, and various private sector organizations. Perhaps most important, seniors themselves need to be involved in the planning process.
The guide identifies several States and metropolitan planning organizations that already have addressed the challenge of planning for an aging driving population. These include California, Florida, Iowa, Maryland, Michigan, and Maricopa County in Arizona. The electronic version of the guide includes links to actual planning documents that the States have developed. Patti Yanochko, program coordinator at the Center for Injury Prevention Policy & Practice in San Diego, CA, helped direct efforts in California. She says, "All of our many task force members and consultants worked diligently and with passion to produce recommendations that are meaningful and improve safety and quality of life for older adults."
Objective 2: Improve the Roadway and Driving Environment. Many of the strategies recommended in the guide address specific roadway design and traffic operation changes that can improve safety for older drivers. The guide makes clear, however, that it is not just older drivers who will reap the benefits, but rather the changes could improve safety for all drivers on the roadway. The 11 strategies under this objective draw heavily from FHWA's Highway Design Handbook for Older Drivers and Pedestrians (FHWA-RD-01-103) first published in 1998 and updated in 2001. In identifying strategies for inclusion in the guide, emphasis was placed on improvements that could be accomplished at relatively low cost and within a reasonable timeframe, effectively answering the question: What will give State and local transportation departments the greatest return on their safety investment?
The recommended strategies identify needs regarding signage, intersection design, traffic control and operations (especially in work zones), and roadway delineation. For example, States are encouraged to increase the size and letter height of roadway signs, and to provide protected left-turn signal phases at high-volume intersections. In many cases the point is made that the needed changes can be accomplished at relatively low cost if States begin now to incorporate them into new projects and scheduled maintenance and reconstruction. "The most important thing," says Tom Welch, Iowa's State transportation safety engineer and a contributor to the guide, "is that engineers realize that the 'design driver' for the 21st century is no longer a 45-year-old male. It's someone in the 65-plus age group, and it may just be their mom."
Objective 3: Identify high-risk older drivers. Four strategies are recommended for identifying older drivers at increased risk of crashing and for intervening to lower that crash risk. State motor vehicle administrators are encouraged to review the role and functioning of their medical advisory boards (MABs), which help to ensure that drivers, regardless of their ages, are medically fit to drive. Currently, not all States have active MABs, and those that do reflect a variety of models. MABs can be expected to play an increasingly important role in the licensing process as the driving population ages.
With or without the help of an MAB, States are encouraged to review and update procedures for assessing medical fitness to drive, including training license examiners (department of motor vehicles personnel responsible for issuing drivers licenses) and working with State medical associations to educate the health community about the important role physicians can play in assessing and counseling older patients who drive. The Model Driver Screening and Evaluation Program recently carried out in Maryland is cited in the guide as a source of information, along with examples.
A related strategy is to encourage physicians and other medical professionals, law enforcement, and family and friends to report potentially unsafe drivers. Again, the guide identifies model programs and materials, such as Oregon's Medically At-Risk Driver Program. In addition to training physicians in how to identify and report medically at-risk drivers, the Oregon DOT's Driver and Motor Vehicles Division (DMV) supports a volunteer reporting program for law enforcement and family or friends, and offers a Web site (www.oregonsafemobility.org) that helps educate the public through a campaign called "Shifting Gears in Later Years." Bill Merrill, manager of Oregon DMV's Driver Control Unit, helped to create the campaign. He says, "Safe mobility begins with awareness of one's own driving abilities and planning for the time that it may not be safe to drive anymore. When safety becomes an issue, family, friends, or a medical professional may need to intervene."
The final strategy in this section of the guide recommends that State DMVs join with the private sector to provide remedial assistance to drivers identified with functional impairments. Although some people can be helped to continue driving by appropriate restrictions on their licenses, others may require special adaptive equipment installed in their vehicles or evaluation and training by an occupational therapist or other specialist. Selma Sauls, a licensing specialist with the Florida Department of Highway Safety & Motor Vehicles, says that "knowing what options exist, and making the right referral, can make all the difference in individuals being able to continue to provide for their own safe mobility."
Objective 4: Improve Driving Competency of Older Adults. Here the guide shifts the focus from at-risk drivers to the general older driver population. After all, the majority of older drivers do not face serious medical conditions or functional limitations that affect their driving and would not come to the attention of licensing authorities. Still, drivers need to be educated about how aging can affect their driving and the steps they can take to compensate. Ultimately, those drivers may need help in relinquishing their licenses and shifting to alternative forms of transportation.
The recommended strategies under this objective include establishing resource centers within communities to promote safe mobility choices and providing educational and training opportunities to older drivers. Ideally, seniors would have access to one-stop shopping for accessing needed information and services. One example cited in the guide is the Older Driver Family Assistance Help Network in Erie County, NY. Under the network, nearly 50 agencies and organizations came together to provide assistance to families, friends, and caregivers concerned about aging loved ones who are driving at risk.
Educational opportunities for older drivers can range from simple brochures and other print materials to self-assessment tools; refresher classes; or one-on-one, behind-the-wheel evaluation and training. The guide contains electronic links to many of the materials or information on how to order them. State DMVs and drivers license offices can make resources available on their Web sites and at local licensing offices, as well as to organizations serving older adults.
Objective 5: Reduce Risk of Injury and Death to Crash-Involved Older Drivers and Passengers. The last objective shifts focus from avoiding crashes to protecting older occupants of vehicles once a crash occurs. Older bodies are more fragile than younger bodies, and older car occupants are much more likely to die from a car crash. Seatbelts save lives for everyone but are especially beneficial to older drivers and passengers. A 2002 National Highway Traffic Safety Administration study, covered in an article by E.K. Wagner and C. Gotschall in the Transportation Research Record (#1818), indicated that unbelted older people are five times more likely to be killed than belted older people and concluded that "potential improvements to occupant protection within the vehicle, although important, may have less to offer older people than the simple use of seatbelts."
Promoting the AASHTO Plan
AASHTO, NCHRP, USDOT, and the Governors Highway Safety Association are providing extensive outreach efforts to help in implementing the plan. The four organizations are encouraging senior officials in State and local agencies to make highway safety a top priority and to focus on emerging older driver issues.
For example, at the 2005 Safety Leadership Forum II in Galloway, NJ, former Michigan Department of Transportation Director Gloria Jeff led a session of State DOT chief executive officers who explored ways of improving mobility and safety for senior citizens. Several recommendations emerged from the session:
Demonstrating the Guide's Usefulness
As shown in examples found throughout the guide, some States already are actively engaged in improving safety for older drivers. But many States still lack a comprehensive, coordinated approach for achieving progress in this area. The final section of each of the guides in TRB's NCHRP Report 500 outlines an 11-step model for implementing the program of strategies presented.
Minnesota and Texas were invited to demonstrate the applicability of the older driver guide. Working over a period of approximately 6 months, the two States recruited team members, reviewed crash data, and used the guide to help identify and develop strategies for addressing a given priority.
The Minnesota team, led by State Traffic Safety Engineer Loren Hill, included representation from the Department of Public Safety's Driver and Vehicle Services team and Office of Traffic Safety. It also included a specialist in geriatric research from the Geriatric Research Education and Clinical Center at the Minneapolis Veterans Administration Medical Center. Team members shared information throughout the course of the project and plan to continue to serve as resources for one another. "We see this as a very positive outcome of the project," says Hill, "and one that will facilitate future efforts to form a broad-based coalition in the State for addressing older adult transportation safety and mobility issues."
In Texas, activity was focused at the local level, specifically the neighboring communities of Tyler and Atlanta, TX, in the far eastern part of the State. In Tyler, planned roadway and signage improvements were supplemented by efforts to engage a broader sector of the community in addressing other problems facing older adults, such as accessing a senior center from a bus stop located across from a highway. According to Texas Department of Transportation (TxDOT) engineer Peter Eng, who led the program in Tyler, "Efforts such as these are complementary to our engineering efforts to improve the safety of older drivers in the county." In nearby Atlanta, TX, examination of local crash data revealed a high concentration of left-turn angle collisions at unsignalized intersections and run-off-road collisions involving drivers aged 65 and older along two highway corridors.
Drawing from the recommendations included in the guide, a number of countermeasure alternatives were identified. Carlos Ibarra, TxDOT's director of transportation operations for the Atlanta district, reports, "funding is already allocated for improvements to these roadways."
In the coming years, improving safety for older road users will be critical to helping the Nation achieve its goal of no more than 1 traffic fatality per 100 MVMT by 2008. Strategic highway safety plans, best practices, and A Guide for Reducing Collisions Involving Older Drivers will help State and local practitioners and advocates put the plan into action. Successfully meeting this national goal will require the efforts of organizations at the Federal, State, and local levels.
Jane Stutts, Ph.D., is associate director for social and behavioral research at the University of North Carolina (UNC) Highway Safety Research Center. During her 30-year career at the center, she has managed projects in a wide variety of highway safety areas and has written more than 100 articles and technical reports. She received her undergraduate degree in psychology from Wake Forest University and a Ph.D. in epidemiology from UNC-Chapel Hill.
Ingrid Potts, P.E., is a senior traffic engineer at the Midwest Research Institute (MRI), where she has spent nearly 10 years conducting research in highway safety, geometric design, and traffic operations. Before joining MRI, she worked as a highway design engineer at HNTB Corp. She received her undergraduate degree in physics from North Park College and a master's degree in civil engineering from Texas A&M University.