Road safety education for older drivers: Evaluation of a classroom-based training initiative

Highlights

• 142 drivers aged ≥75 completed a two-hour classroom-based driving course.

• Participants wished to improve their knowledge and confirm or improve driving skills.

• Pre- and post-course confidence and driving ability ratings were unchanged for 60% of drivers.

• Eighty percent said they would definitely or probably change the way they drive.

• Ninety-four percent would recommend the course to others.

Abstract

Around the world, a growing proportion of drivers are aged 70 or over. Although accident rates for older drivers are lower than for young or novice drivers, increased frailty and slowed reactions mean that older drivers are at higher risk of death or serious injury when involved in a road collision. The objectives of this study were to: (a) identify driving knowledge and self-regulatory strategies among a group of older drivers with a view to planning future on-road training; (b) measure driver self-assessments of ability and confidence before and after classroom training delivered by driving instructors; (c) evaluate the utility and acceptability of training courses for older drivers using questionnaires and focus groups; d) examine the characteristics of course participants.

142 drivers aged ≥75 completed a two-hour classroom-based driving course and took part in the evaluation: 94 aged 75–79, 48 aged ≥80, 68% male. Main reasons for taking part were to update knowledge, improve driving and check they were safe to drive. Results showed that females were more likely than males to avoid driving in difficult conditions (at night, in bad weather, unfamiliar roads). More drivers aged 75–79 said they did not restrict their driving (52, 57%) compared to drivers aged ≥80 (19, 43%). Pre-course, males rated their driving confidence and ability significantly higher than females. Post-course, self-ratings of confidence and ability were unchanged for 76 (60%) drivers. However, two-thirds reported improved knowledge and 80% said they would change their driving behaviour as a result of the course. Focus group results suggest that competent drivers are more likely to attend educational courses than unsafe drivers. This study provides preliminary evidence that classroom-based training can initiate behaviour change among older drivers. Future research will examine the effectiveness of on-road training in this age group.

Introduction

Around the developed world, driving is an important part of everyday life for many people. Driving provides independence, mobility, and freedom to travel whenever and wherever the driver chooses. Once a driving test is passed, many drivers wish to continue driving for as long as possible. However, as drivers grow older, they may experience a decline in cognitive, perceptual and physiological functions which can affect their ability to drive (Anstey, Wood, Lord, & Walker, 2005). These impairments may cause driving errors such as failing to yield right of way at road junctions or when merging into moving traffic (AGILE (Aged people integration & safety, 2003). With advancing age there is also an increasing risk of visual and medical conditions which may impair fitness to drive (Tuokko et al., 2007, Whelan et al., 2006).

In many countries, older drivers are required to have a visual or medical assessment to ensure they meet current standards for fitness to drive. For example, in Netherlands, Denmark, Cyprus and Ireland drivers aged 70 are required to have a sight test. In the UK, when drivers reach the age of 70 they must make a self-declaration of their medical and visual fitness in order to renew their driving licence, but there is no formal assessment (Driver and Vehicle Licensing Agency (DVLA), 2015).

In common with many countries, the UK has an ageing population. There are currently 8 million people aged ≥70, with 5.3 million aged ≥75, representing 8% of the UK population (Office for National Statistics (ONS), 2016). Nearly three-quarters (74%) of UK adults hold a valid driving licence, and there are approximately 38.6 million licence holders (Department for Transport, 2016a). The proportion of drivers aged ≥70 holding a driving licence has increased from 15% in 1975 to 64% in 2015 (Department for Transport, 2016b). The ONS estimates that the number of people aged ≥75 will rise to over 9 million by 2035 and will represent 12.5% of the UK population. Consequently, the number of older drivers on the road will continue to rise. Although older drivers are generally safe, the reduction in health and functional ability that comes with advancing age puts them at increased risk of crash involvement (Langford & Koppel, 2006). The accident involvement rate for older drivers begins to increase after the age of 75 (Mitchell, 2013). Similar findings have been reported in the United States (Guohua, Braver, & Hui Chen, 2003). The National Highway Traffic Safety Administration (2009) found that drivers 80 and older were overrepresented in crashes, particularly when negotiating complex situations such as intersections or turning across oncoming traffic. However, access to a car and the ability to drive is important to continuing mobility and quality of life for older drivers (Ragland et al., 2005, Whelan et al., 2006). It is therefore important to ensure that older drivers remain safe on the road.

In recognition of the importance of driving into later life, road safety for older drivers has been the focus of considerable research during the twenty-first century. In Canada, and latterly Australia and New Zealand, the Candrive, Candrive II and OzCandrive longitudinal projects have prospectively recruited over a thousand drivers aged 70 and over with the aim of keeping older drivers safely on the road by studying driving behaviour, assessments, medical fitness to drive and screening tools (Langford et al., 2013, Marshall, Man-Son-Hing, Bédard, et al., 2013, Marshall, Man-Son-Hing, Charlton, et al., 2013). These projects and others have provided insights into the behaviour of older drivers and how it may be modified to improve road safety.

An important concept is that of self-awareness of driving abilities. Older drivers often regulate their driving and take fewer risks than younger drivers (Lang, Parkes, & Fernandez Medina, 2013). Gwyther and Holland (2012) found that self-regulation increased with age, and that women were significantly more likely than men to regulate their driving. Driving self-regulation is the driver’s behavioural adaptation to maintain safe driving despite the decline in functioning with advancing age (Donorfio, D'Ambrosio, Coughlin, & Mohyde, 2008). Some older drivers use compensatory strategies such as avoiding difficult situations (e.g. driving at night, in bad weather, or during rush hours), or by increasing safety distances or reducing speed (Baldock et al., 2006, Ball et al., 1998, Donorfio et al., 2009, Gabaude et al., 2010, Holland and Rabbitt, 1992, Molnar and Eby, 2008). However, driving adaptation to a specific situation depends on the self-awareness of abilities and limitations (Anstey et al., 2005).

The provision of specialised training can give drivers insights into their abilities and limitations, and there is evidence that training and refresher courses help older people to continue driving safely for longer. Jones et al. (2012) examined in-class training for drivers aged 60 and over, comparing an intensive taught course to a lower-resource self-guided course, following-up attendees six months later by questionnaire. They found the intensive programme to be most effective, concluding that driving safety programmes which focus on behaviours to self-evaluate driving abilities help older drivers to remain safe on the road. Owsley et al., 2003, Owsley et al., 2004 examined the effectiveness of an educational programme for visually impaired drivers aged 60 and over. They concluded that although it did not alter crash risk, the training improved self-regulation and avoidance of challenging driving situations. In a review of eighteen older driver refresher programmes in Canada, Korner-Bitensky, Menon, Von Zweck, and Van Benthem (2010) found that both classroom-based and on-road training courses improve driver performance, but concluded that there is a need for better evaluation of their effectiveness.

Nasvadi and Vavrik (2007) reported a self-selection bias among drivers attending a mature driver education programme for drivers aged 55 and over in Canada. However, they found that male volunteers aged 75 and over had an increased post-course crash risk compared to women and men aged 55–74. They concluded that understanding the behaviour and characteristics of those who attend mature driver training is essential for the design and delivery of effective courses on road safety.

In view of the above evidence, we designed a training course for older drivers which would educate them in self-evaluation, self-regulation and how to cope with or avoid difficult driving situations. The course would also update their knowledge of driving rules as this has been linked to driving performance (Wolming & Wiberg, 2004). A novel aspect of our course is that it was tailored to drivers aged 75 and over, as this is the group most at risk of crash involvement (Mitchell, 2013), and drivers aged ≥75 have been found to be more likely to fail an on-road test (Classen et al., 2013). Studies of mature driver courses included in recent literature reviews were aimed at drivers aged 60 or 70 plus, with none specific to drivers aged 75 plus (Korner-Bitensky et al., 2009, Kua et al., 2007).

The Dorset Road Safe Partnership created a driver training course specifically aimed at older drivers, called Dorset Driver Gold (DDG). It was initially offered free to older residents pending evaluation of the course. The objectives of the DDG course were to update older drivers regarding their knowledge and awareness of road safety issues and improve driving skills and confidence. The aims of the evaluation were to measure the acceptability of the course to older drivers and demonstrate the effectiveness and utility of the DDG initiative. We also sought to study the behaviour and characteristics of those who attended the course.

The objectives of the study were to:

• identify driving knowledge (road safety and rules of the road), reasons for driving, and self-regulatory strategies among a group of older drivers with a view to planning future on-road training.

• measure self-assessments of driving ability and confidence as a driver before and after classroom training delivered by driving instructors.

• evaluate the utility and acceptability of classroom training courses for older drivers using questionnaires and focus groups.

• examine the characteristics of course participants, including comparison of differences between male and female and youngest-old and oldest-old drivers.