ABSTRACTBackgroundAs the US population continues to age, depression and other mental health issues have become a significant challenge for healthy aging. Few studies, however, have examined the prevalence of depression in community‐dwelling older adults in the United States.MethodsBaseline data from the Longitudinal Research on Aging Drivers study were analyzed to examine the prevalence and correlates of depression in a multisite sample of community‐dwelling adults aged 65–79 years who were enrolled and assessed between July 2015 and March 2017. The Patient‐Reported Outcomes Measurement Information System (PROMIS) depression scale was used to determine the depression status.ResultsOf the 2990 study participants, 186 (6.2%) had depression at the time of assessment. Elevated prevalence of depression was found in those who were 65–69 years of age (7.9%); were women (7.2%); were not married (8.1%); had attained an education of high school or less (8.3%); or had annual household incomes less than $50,000 (10.7%). Older adults with a positive history of depression or chronic medical conditions (e.g., diabetes mellitus and anxiety) had a significantly higher prevalence of depression whereas those engaged in volunteering activities had a significantly lower prevalence of depression. With adjustment for demographic characteristics and comorbidities, volunteering was associated with a 43% reduction in the odds of depression (adjusted odds ratio: 0.57, 95% confidence interval 0.40–0.81).ConclusionsThe point prevalence of depression in this multisite sample of community‐dwelling older adults in the United States was 6.2%, which varied significantly with demographic characteristics and comorbid conditions. Engagement in volunteering activities might help older adults to reduce their risk of depression.

Older adults self-regulate their driving as it becomes more challenging. This study evaluated physical performance and frailty to see their impact on strategic self-regulation in older drivers. The AAA Longitudinal Research on Aging Drivers study was a multisite prospective cohort study. The Fried Frailty Phenotype (FFP) and the National Health and Aging Trends Study (NHATS) Short Physical Performance Battery (SPPB) were administered to 2990 older drivers. Mixed-effects Poisson regression models estimated strategic self-regulation associated with the SPPB and the FFP adjusting for age, sex, visual perception, cognition, miles driven, and urban/rural status. Compared to older drivers with good SPPB scores, strategic self-regulation increased 17% among those with fair scores and 38% among those with poor scores. Compared to older drivers who were not frail, strategic self-regulation increased 6% among pre-frail drivers and 26% among frail drivers. Strategic self-regulation increased in a dose-response relationship with both frailty and physical function.

Diabetes mellitus (DM) can impair driving safety due to hypoglycemia, hyperglycemia, diabetic peripheral neuropathy, and diabetic eye diseases. However, few studies have examined the association between DM and driving safety in older adults based on naturalistic driving data. Data for this study came from a multisite naturalistic driving study of drivers aged 65–79 years at baseline. Driving data for the study participants were recorded by in-vehicle recording devices for up to 44 months. We used multivariable negative binomial modeling to estimate adjusted incidence rate ratios (aIRRs) and 95

Older adults aged 70 and older who drive have higher crash death rates per mile driven compared to middle aged (35-54 years) adults who drive in the US. Prior studies have found that depression and or antidepressant medication use in older adults are associated with an increase in the vehicular crash rate. Using data from the prospective multi-site AAA Longitudinal Research on Aging Drivers Study, this analysis examined the independent and interdependent associations of self-reported depression and antidepressant use with driving behaviors that can increase motor vehicle crash risk such as hard braking, speeding, and night-time driving in adults over age 65. Of the 2951 participants, 6.4% reported having depression and 21.9% were on an antidepressant medication. Correcting for age, race, gender, and education level, participants on an antidepressant had increased hard braking events (1.22 [1.10-1.34]) but self-reported depression alone was not associated with changes in driving behaviors.

BACKGROUND:This study explored factors influencing the acceptance of conditionally automated vehicles among Australian drivers by extending the Technology Acceptance Model with the Technology Readiness Index. METHOD:Data from an online survey of 844 participants were analyzed using partial least squares structural equation modeling (PLS-SEM). RESULTS:Perceived usefulness had the strongest direct effect on behavioral intention (0.469, p < 0.001), followed by attitude (0.318, p < 0.001). Innovativeness positively influenced behavioral intention (0.183, p < 0.001), while insecurity had a negative impact (-0.071, p < 0.01). Optimism and discomfort were not significant. Perceived usefulness also had significant indirect effects through attitude (0.156, p < 0.001) and trust (0.072, p < 0.001). Perceived ease of use indirectly influenced behavioral intention through perceived usefulness (0.306, p < 0.001), attitude (0.102, p < 0.001), trust (0.047, p < 0.001), and their combinations. Trust indirectly affected behavioral intention via attitude (0.130, p < 0.001). Perceived security and privacy risks had indirect negative effects through trust and attitude (-0.035, p < 0.001; -0.005, p < 0.05). CONCLUSION:These results suggest that fostering acceptance among less tech-savvy individuals may help promote positive attitudes, increase conditionally automated vehicle adoption, and potentially enhance road safety. PRACTICAL IMPLICATIONS:These findings suggest a need for targeted programs to enhance perceived usefulness and trust while addressing security and privacy concerns, ultimately contributing to safer road systems through the adoption of conditionally automated vehicles.

Background Trajectories of health-related quality of life (HRQoL) after driving cessation (DC) are thought to decline steeply, but for some, HRQoL may improve after DC. Our objective is to examine trajectories of HRQoL for individuals before and after DC. We hypothesize that for urban drivers, volunteers and those who access alternative transportation participants’ health may remain unchanged or improve. Methods This study uses data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study, a prospective cohort of 2,990 older drivers (ages 65–79 at enrollment). The LongROAD study is a five-year multisite study and data collection ended October 31, 2022. Participants were recruited using a convenience sample from the health centers roster. The number of participants approached were 40,806 with 7.3% enrolling in the study. Sixty-one participants stopped driving permanently by year five and had data before and after DC. The PROMIS®-29 Adult Profile was utilized and includes: 1) Depression, 2) Anxiety, 3) Ability to Participate in Social Roles and Activities, 4) Physical Function, 5) Fatigue, 6) Pain Interference, 7) Sleep Disturbance, and 8) Numeric Pain Rating Scale. Adjusted (age, education and gender) individual growth models with 2989 participants with up to six observations from baseline to year 5 in the models (ranging from n = 15,041 to 15,300) were utilized. Results Ability to participate in social roles and activities after DC improved overall. For those who volunteered, social roles and activities declined not supporting our hypothesis. For those who accessed alternative transportation, fatigue had an initial large increase immediately following DC thus not supporting our hypothesis. Urban residents had worse function and more symptoms after DC compared to rural residents (not supporting our hypothesis) except for social roles and activities that declined steeply (supporting our hypothesis). Conclusions Educating older adults that utilizing alternative transportation may cause initial fatigue after DC is recommended. Accessing alternative transportation to maintain social roles and activities is paramount for rural older adults after DC especially for older adults who like to volunteer.

Introduction One of the most common and serious types of crashes among all motor-vehicle users involves collisions with fixed objects. This type of crash occurs frequently among utility vehicle workers while driving for work. The overarching objective of this research was to improve the safety of electric utility company vehicle operators by determining the circumstances under which utility vehicles are involved in crashes with fixed objects and to provide recommendations to help drivers and utility fleet company management prevent these types of crashes. Methods The study incorporated a mixed methods approach and gathered information from structured interviews with safety managers at electric power companies and an analysis of utility vehicle crashes using data supplied by electric power companies and a statewide database in Michigan. Results Many factors were found to contribute to fixed-object crashes including engagement in secondary tasks and job productivity pressure. Information was organized and evaluated to develop 11 recommendations for countermeasure strategies that are directed at various levels within the system in which the drivers operate. Discussion This study was the first to explore fixed-object crashes among electric utility fleet vehicles. The findings are unique in that they provide insight into the safety practices in an industry that has received limited academic attention and highlight the need to place greater emphasis on road safety practices in the workplace. Practical application Countermeasures generated for this study are applicable to companies in which fleet driver safety is a primary concern.

This study introduces and validates a new metric for assessing takeover performance in conditionally automated driving, using Fréchet Distance. Fréchet Distance is a measurement that measures the similarity between two separate curves. Thirty-two participants took part in a simulated driving experiment. Employing a 2 × 2 within-subjects design, the study compared traditional takeover performance metrics, including takeover time, time to collision, and resulting acceleration, with Fréchet Distance. Analysis results revealed similar trends between traditional metrics and Fréchet Distance. These findings suggest that Fréchet Distance can effectively measure takeover performance by integrating spatial and temporal aspects.

Abstract Background Dietary supplement (DS) use is common and increasing among older adults, though much data available on use frequencies are from surveys and performed cross-sectionally. This paper sought to assess the frequency and pattern of dietary supplement use among older adults over time. Methods A secondary analysis of data from the AAA LongROAD study, a longitudinal prospective cohort study of older adult drivers, using data from baseline and the first two years of follow up included a total of 2990 drivers aged 65–79 years recruited at five study sites across the US from July 2015 to March 2017. Participants underwent baseline and annual evaluations, which included a “brown bag” medication review. DS were identified and categorized according to type and key components. Prevalence and pattern of DS use over time and relationship to demographics were measured with frequency and Chi squared analyses. Results 84% of participants took at least one dietary supplement during the 2-year study period, and 55% of participants continually reported use. DS accounted for approximately 30% of the total pharmacologic-pill burden in all years. Participants who were White non-Hispanic, female, 75–79 years of age at baseline, and on more non-supplement medications took significantly more dietary supplements (P < 0.05). Vitamin D, multivitamins, calcium, and omega-3 formulations were the most common supplements, with stable use over time. Use of individual herbal supplements and cannabis products was uncommon (< 1% participants per year). Conclusions DS use among older adults is common and relatively stable over time and contributes to polypharmacy. In clinical settings, providers should consider the influence of DS formulations on polypharmacy, and the associated cost, risk of medication interactions, and effect on medication compliance.

IntroductionFrailty and low physical performance are modifiable factors and, therefore, targets for interventions aimed at delaying driving cessation (DC). The objective was to determine the impact of frailty and physical performance on DC.MethodsMultisite prospective cohort of older drivers. The key inclusion criteria are as follows: active driver age 65–79 years, possessing a valid driver’s license, without significant cognitive impairment, and driving a 1996 car or a newer model car. Of the 2,990 enrolled participants, 2,986 (99.9%) had at least one frailty or Short Physical Performance Battery (SPPB) measure and were included in this study. In total, 42% of participants were aged 65–69 years, 86% were non-Hispanic white, 53% were female, 63% were married, and 41% had a high degree of education. The Fried Frailty Phenotype and the Expanded Short Physical Performance Battery (SPPB) from the National Health and Aging Trends Study were utilized. At each annual visit, DC was assessed by the participant notifying the study team or self-reporting after no driving activity for at least 30 days, verified via GPS. Cox proportional hazard models, including time-varying covariates, were used to examine the impact of the SPPB and frailty scores on time to DC. This assessment included examining interactions by sex.ResultsSeventy-three participants (2.4%) stopped driving by the end of year 5. Among women with a fair SPPB score, the adjusted hazard ratio (HR) of DC was 0.26 (95% confidence interval (CI) 0.10–0.65) compared to those with a poor SPPB score. For those with a good SPPB score, the adjusted HR of DC had a p-value of <0.001. Among men with a fair SPPB score, the adjusted hazard ratio (HR) of DC was 0.45 (95% CI 0.25–0.81) compared to those with a poor SPPB score. For men with a good SPPB score, the adjusted HR of DC was 0.19 (95% CI 0.10–0.36). Sex was not an effect modifier between frailty and DC. For those who were categorized into pre-frail or frail, the adjusted ratio of HR to DC was 6.1 (95% CI 2.7–13.8) compared to those who were not frail.Conclusion and relevanceFrailty and poor physical functioning are major risk factors for driving cessation. Staying physically active may help older adults to extend their driving life expectancy and mobility.

This study investigates the impact of a supportive system on takeover transitions in conditionally automated driving (SAE Level 3). The supportive system is designed to direct drivers’ attention toward potential hazards in the environment when a takeover request occurs. The study comprises two components: (a) identifying various types of potential hazards using naturalistic driving data, and (b) conducting a driving simulator study to develop and assess a gaze guidance system based on the N-SEEV model of visual attention. Results indicate that drivers using a highly salient attention guidance system were less likely to collide with a secondary hazard during takeover transitions. This suggests that gaze guidance support is an effective approach for assisting drivers during takeover transitions.

Background: Polypharmacy (i.e., simultaneous use of two or more medications) poses a serious safety concern for older drivers. This study assesses the association between polypharmacy and hard braking events in older adult drivers. Methods: Data for this study came from a naturalistic driving study of 2990 older adults. Information about medications was collected through the "brown-bag review" method. Primary vehicles of the study participants were instrumented with data recording devices for up to 44 months. Multivariable negative binomial model was used to estimate the adjusted incidence rate ratios (aIRRs) and 95 % confidence intervals (CIs) of hard-braking events (i.e., maneuvers with linear deceleration rates >= 0.4 g) associated with polypharmacy. Results: Of the 2990 participants, 2872 (96.1 %) were eligible for this analysis. At the time of enrollment, 157 (5.5 %) drivers were taking fewer than two medications, 904 (31.5 %) were taking 2-5 medications, 895 (31.2 %) were taking 6-9 medications, 571 (19.9 %) were taking 10-13 medications, and 345 (12.0 %) were taking 14 or more medications. Compared to drivers using fewer than two medications, the risk of hard-braking events increased 8 % (aIRR 1.08, 95 % CI 1.04, 1.13) for users of 2-5 medications, 12 % (aIRR 1.12, 95 % CI 1.08, 1.16) for users of 6-9 medications, 19 % (aIRR 1.19, 95 % CI 1.15, 1.24) for users of 10-13 medications, and 34 % (aIRR 1.34, 95 % CI 1.29, 1.40) for users of 14 or more medications. Conclusions: Polypharmacy in older adult drivers is associated with significantly increased incidence of hardbraking events in a dose-response fashion. Effective interventions to reduce polypharmacy use may help improve driving safety in older adults.

BackgroundMigraine headache is common in older adults, often causing symptoms that may affect driving safety. This study examined associations of migraine with motor vehicle crashes (MVCs) and driving habits in older drivers and assessed modification of associations by medication use.MethodsIn a multi-site, prospective cohort study of active drivers aged 65-79 (53% female), we assessed prevalent migraine (i.e., ever had migraine, reported at enrollment), incident migraine (diagnosis first reported at a follow-up visit), and medications typically used for migraine prophylaxis and treatment. During 2-year follow-up, we recorded self-reported MVCs and measured driving habits using in-vehicle GPS devices. Associations of prevalent migraine with driving outcomes were estimated in multivariable mixed models. Using a matched design, associations of incident migraine with MVCs in the subsequent year were estimated with conditional logistic regression. Interactions between migraine and medications were tested in all models.ResultsOf 2589 drivers, 324 (12.5%) reported prevalent migraine and 34 (1.3%) incident migraine. Interactions between migraine and medications were not statistically significant in any models. Prevalent migraine was not associated with MVCs in the subsequent 2 years (adjusted OR [aOR] = 0.98; 95% CI: 0.72, 1.35), whereas incident migraine significantly increased the odds of having an MVC within 1 year (aOR = 3.27; 1.21, 8.82). Prevalent migraine was associated with small reductions in driving days and trips per month and increases in hard braking events in adjusted models.ConclusionOur results suggest substantially increased likelihood of MVCs in the year after newly diagnosed migraine, indicating a potential need for driving safety interventions in these patients. We found little evidence for MVC risk or substantial changes in driving habits associated with prevalent migraine. Future research should examine timing, frequency, and severity of migraine diagnosis and symptoms, and use of medications specifically prescribed for migraine, in relation to driving outcomes.

This study compared a sample of Australian drivers aged 77 years and older to participants from an older driver longitudinal cohort study (Ozcandrive) and examined the relationship between resilience and self-reported driving measures within these samples. Using a survey with a subset of questions from Ozcandrive, data were collected from 237 older drivers throughout Australia. The two samples were analyzed for differences in demographics, health, resilience, and self-reported driving behavior. A series of multiple regression models were fit for each driving outcome measure for both samples. The two samples had both similarities and differences, with the largest difference observed for resilience. Strong and consistent associations were found between resilience and driving comfort, abilities, and frequency for the Australian sample. Across samples, resilience remained a significant variable in seven of 10 regression models, more than any other independent variable.

BACKGROUNDPolypharmacy use among older adults is of increasing concern for driving safety. This study assesses the individual and joint effects of benzodiazepines and prescription opioids on the incidence of hard braking events in older drivers.METHODSData for this study came from the Longitudinal Research on Aging Drivers project-a multisite, prospective cohort study of 2990 drivers aged 65-79 years at enrollment (2015-2017). Adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs) of hard braking events (defined as maneuvers with deceleration rates ≥0.4 g and commonly known as near-crashes) were estimated through multivariable negative binominal modeling.RESULTSOf the 2929 drivers studied, 167 (5.7%) were taking benzodiazepines,  163 (5.6%) prescription opioids, and 23 (0.8%) both drugs at baseline. The incidence rates of hard braking events per 1000 miles driven were 1.14 (95% CI 1.10-1.18) for drivers using neither benzodiazepines nor prescription opioids, 1.25 (95% CI 1.07-1.43) for those using benzodiazepines only, 1.55 (95% CI 1.35-1.76) for those using prescription opioids only, and 1.63 (95% CI 1.11-2.16) for those using both medications. Multivariable modeling revealed that the use of prescription opioids was associated with a 19% increased risk of hard braking events (aIRR 1.19, 95% CI 1.03-1.36). There existed a positive interaction between the two drugs on the additive scale but not on the multiplicative scale.CONCLUSIONConcurrent use of benzodiazepines and prescription opioids by older drivers appears to affect driving safety through increased incidence of hard braking events.

Age-related macular degeneration is a leading cause of blindness worldwide and is one of many limitations to independent driving among old adults. Highly autonomous vehicles present a prospective solution for those who are no longer capable of driving due to low vision. However, accessibility issues must be addressed to create a safe and pleasant experience for this group of users so that it allows them to maintain an appropriate level of situational awareness and a sense of control during driving. In this study, we made use of a human-centered design process consisting of five stages - empathize, define, ideate, prototype, and test. We designed a prototype to aid old adults with age-related macular degeneration to travel with a necessary level of situational awareness and remain in control while riding in a highly or fully autonomous vehicle. The final design prototype includes a voice-activated navigation system with three levels of details to bolster situational awareness, a 360 degree in-vehicle camera to detect both the passenger and objects around the vehicle, a retractable microphone for the passenger to be easily registered in the vehicle while speaking, and a physical button on the console-side of the right and left front seats to manually activate the navigation system.

Background Acute cannabis use is associated with a higher risk of motor vehicle crashes (MVC). This study aimed to determine if self-reported past-year cannabis use is associated with MVC or traffic stops among older drivers.Methods This cross-sectional analysis used data from a multi-center study enrolling active drivers aged 65-79 years. Data regarding cannabis use, MVC, and traffic stops (i.e., being pulled over by police, whether ticketed or not) within the previous 12 months were collected through participant interviews. Log-binomial regression models examined associations of past-year cannabis use with MVC and traffic stops, adjusting for site and sociodemographic and mental health characteristics.Results Of 2,095 participating older drivers, 186 (8.88%) used cannabis in the past year but only 10 (<0.5%) within an hour before driving in the last 30 days; 11.41% reported an MVC and 9.45% reported a traffic stop. Past-year cannabis users had a higher prevalence of MVC (adjusted prevalence ratio [aPR] = 1.38; 95%CI: 0.96, 2.00; p = 0.086) and traffic stops (aPR = 1.58; 1.06, 2.35; p = 0.024).Conclusions Past-year cannabis use was associated with increased traffic stops, which are correlated modestly with increased MVC in past studies and may indicate impaired driving performance. We did not find a statistically significant association of past-year cannabis use with MVC, which may indicate limited sustained effects on driving performance from periodic use among older adults, who report rarely driving immediately after use.

Importance:Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as inattentiveness and impulsivity, could affect daily functioning and driving performance throughout the life span. Previous research on ADHD and driving safety is largely limited to adolescents and young adults.Objective:To examine the prevalence of ADHD and the association between ADHD and crash risk among older adult drivers.Design, Setting, and Participants:This prospective cohort study collected data from primary care clinics and residential communities in 5 US sites (Ann Arbor, Michigan; Baltimore, Maryland; Cooperstown, New York; Denver, Colorado; and San Diego, California) between July 6, 2015, and March 31, 2019. Participants were active drivers aged 65 to 79 years at baseline enrolled in the Longitudinal Research on Aging Drivers project who were studied for up to 44 months through in-vehicle data recording devices and annual assessments. The data analysis was performed between July 15, 2022, and August 14, 2023.Exposure:Lifetime ADHD based on an affirmative response to the question of whether the participant had ever had ADHD or had ever been told by a physician or other health professional that he or she had ADHD.Main Outcomes and Measures:The main outcomes were hard-braking events defined as maneuvers with deceleration rates of 0.4g or greater, self-reported traffic ticket events, and self-reported vehicular crashes. Multivariable negative binomial modeling was used to estimate adjusted incidence rate ratios (aIRRs) and 95% CIs of outcomes according to exposure status.Results:Of the 2832 drivers studied, 1500 (53.0%) were women and 1332 (47.0%) were men with a mean (SD) age of 71 (4) years. The lifetime prevalence of ADHD in the study sample was 2.6%. Older adult drivers with ADHD had significantly higher incidence rates of hard-braking events per 1000 miles than those without ADHD (1.35 [95% CI, 1.30-1.41] vs 1.15 [95% CI, 1.14-1.16]), as well as self-reported traffic ticket events per 1 million miles (22.47 [95% CI, 16.06-31.45] vs 9.74 [95% CI, 8.99-10.55]) and self-reported vehicular crashes per 1 million miles (27.10 [95% CI, 19.95-36.80] vs 13.50 [95% CI, 12.61-14.46]). With adjustment for baseline characteristics, ADHD was associated with a significant 7% increased risk of hard-braking events (aIRR, 1.07; 95% CI, 1.02-1.12), a 102% increased risk of self-reported traffic ticket events (aIRR, 2.02; 95% CI, 1.42-2.88), and a 74% increased risk of self-reported vehicular crashes (aIRR, 1.74; 95% CI, 1.26-2.40).Conclusions and Relevance:As observed in this prospective cohort study, older adult drivers with ADHD may be at a significantly elevated crash risk compared with their counterparts without ADHD. These findings suggest that effective interventions to improve the diagnosis and clinical management of ADHD among older adults are warranted to promote safe mobility and healthy aging.

Abstract Level 1 and 2 Advanced Driver Assistance System (ADAS) technologies (e.g., adaptive cruise control, blind spot warning, lane keep assist) are predicted to be available in approximately three-fourths of all vehicles worldwide by 2025. To realize the potential of these systems in extending safe mobility for aging adults, it is critical that the driver understands the functionality of the technology and uses the system appropriately. The current study examined demographic and vehicle technology questionnaire data from the Longitudinal Research on Aging Drivers (LongROAD) cohort study which concluded in December 2022. A total of 1,417 participants changed their vehicle throughout the study. There were statistically significant increases in the prevalence of all 15 ADAS technologies examined. Despite increases in prevalence, frequency of using the technologies remained unchanged across 5 years. Frequency of use also varied by functionality of the technology whereby participants reported higher frequency of using technologies that provide alerts, such as blind spot warning, than technologies that take action to assist drivers with vehicle operations, such as adaptive cruise control. Results showed differences in prevalence and use of technologies by income and education, suggesting disparities in access to vehicles with technologies that could help to create a safer driving experience. In consideration of the rapid proliferation of ADAS into the vehicle fleet, increased research into how older drivers learn about and use ADAS technologies will assist in efforts to develop tailored and accessible programs for training older adults to properly utilize ADAS available in their own vehicles.