May/June 2006 · Vol. 69 · No. 6
May/June 2006
Gearing Up for an Aging Population
by Jane Stutts and Ingrid Potts
A new guide aims to improve driving safety for older road users.
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Increasing the safety of older road users, such as this driver and passenger, is the goal of AASHTO's guide for older drivers. |
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
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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.
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California was one of the first States to convene a special task force, shown here, to address traffic safety issues for older adults. The task force released its report, Traffic Safety Among Older Adults: Recommendations for California, in 2002. |
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.
Emphasis Areas in AASHTO's Strategic Highway Safety Plan
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*The total deaths are less than the sum of the numbers since some fatal crashes involve more than one key emphasis area. **Fatal crashes only, not individual fatalities |
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?
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Tyler, TX, has an exceptionally large and growing population of older adults. Advance street name signs, such as the one shown here, are only one of many roadway improvements Tyler officials have undertaken to improve safety for its older drivers. |
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.
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Through its Grand Driver and Elder Road User programs, Florida seeks to lead the way in responding to the needs of older motorists. |
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.
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The final objective in AASHTO's older driver guide is to reduce injuries after a crash occurs, and the best way to do that is to buckle up, as this older driver has done. |
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:
- Education Programs: Educate older drivers on how to assess their own driving skills. Ensure that DOT traffic engineers who are designing safety solutions take into account the differences in the capabilities of older drivers, avoiding standard assumptions about driver capabilities.
- Standards Review: AASHTO, FHWA, and the National Committee on Uniform Traffic Control Devices review all design and traffic control standards for possible modifications to address the increasing numbers of older drivers and the differences between older drivers and other drivers.
- Planning: Encourage States to develop safety action plans to address older driver issues.
- Land Use: When developing residential and commercial property, link the issue of older people's mobility with land use planning to reduce isolation caused by lack of access to transportation.
- Collaboration: Increase communication among State and Federal agencies to ensure that all are aware of tools and programs being developed to address older drivers and senior mobility.
- Technology: Ensure that in-vehicle technology is designed to be clearly visible and thus usable by older people. Develop technology links to the fourth "E," emergency services. [Refers to the classic four elements or "E's"-engineering, enforcement, education, and emergency medical services.]
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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.
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Driver safety classes, such as AARP's recently updated Driver Safety Program, can help older adults learn about age-related changes that can affect their driving and about ways to remain safe behind the wheel. These women are reviewing course materials during one such class. |
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.
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The Minnesota Department of Transportation (Mn/DOT) recently conducted side-by-side comparisons of its current sign sheeting material versus a new product on the market. Drive-by tests were conducted in June 2005 at a closed test track during both daylight and nighttime conditions. As illustrated by these two stop signs photographed at dusk, the researchers determined that the new product (left) proved brighter than MnDOT's existing sheeting (right). As a result, Mn/DOT began specifying the new sheeting material on all new sign placements. |
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."
Next Steps
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.
For more information, contact Jane Stutts at 919-962-8717, jane_stutts@unc.edu or Ingrid Potts at 816-360-5284, ipotts@mriresearch.org.
Other Articles in this issue:
Road Users Can Grow Old Gracefully—With Some Help
The Evolution of Advanced Research
Following the Flow
Acting Now, Building for the Future
The Battle of Its Life
A High-Tech Route for Freight Efficiency
Gearing Up for an Aging Population