Promoting Older Driver Safety in Missouri: Education - PowerPoint PPT Presentation

Loading...

PPT – Promoting Older Driver Safety in Missouri: Education PowerPoint presentation | free to download - id: 4df694-MWIyM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Promoting Older Driver Safety in Missouri: Education

Description:

Promoting Older Driver Safety in Missouri: Education & Outcomes Jacqueline Rogers, Missouri Department of Transportation Tom Meuser, PhD, University of Missouri ... – PowerPoint PPT presentation

Number of Views:217
Avg rating:3.0/5.0
Slides: 74
Provided by: Drive7
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Promoting Older Driver Safety in Missouri: Education


1
Promoting Older Driver Safety in
Missouri Education Outcomes
  • Jacqueline Rogers, Missouri Department of
    Transportation
  • Tom Meuser, PhD, University of Missouri St.
    Louis
  • David Carr, MD, Washington University School of
    Medicine

2
Agenda
  • MODOT Division of Highway Safety (Rogers)
  • Missouri Statistics
  • Gathering Stakeholders from Five Key Communities
  • Education Blitz
  • Educating Driver Examiners, Troopers, Police
    Officers (Meuser)
  • HB-1536 Evaluation Enhancing DOR Medical Review
  • Older Driver Safety Pamphlet for Missouri (Carr)
  • Clinical Evaluation, Screening, Driver Fitness
  • Questions?

3
Older Drivers Have Fewer Crashes
Crashes per 100,000 drivers
(Source NCSA, 2000)
4
Driver Fatality Rate (per 100 million VMT)
Fatality Rate
Driver Age Group
Source FARS 2001 and NHTSA 2001
5
US Population By Segment (Squaring the U.S.
Population Pyramid 1950-2030)
Age
85
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
1950
1980
2030
2000
(227,658,000)
(150,216,000)
(267,955,000)
(304,807,000)
6
Whats Happening in Missouri?
7
Missouri Traffic Crashes
  • 3,186 disabling injuries involving an older
    driver
  • 42 (1,349) were the older driver
  • 543 fatalities involving an older driver
  • 60 (328) were the older driver
  • 16 of the fatalities involve an older driver

8
Types of Crashes
1. Unsignalized Intersections 34
2. Commercial Motor Vehicle 16
3. Pedestrians 12
4. Signalized Intersections 5. Following Too Close 24 30
9
Develop Statewide Program
  • GOALS
  • Reduce deaths and injuries related to traffic
    crashes involving older drivers
  • Keep people driving safely as long as we can
  • Participate in National Demonstration Project
  • Develop Statewide Network of Partners

10
Model for Older Driver Program Activities
11
National Demonstration Project
  • Focus on Five Communities
  • Columbia, Springfield, Cape Girardeau, St. Louis,
    and KC
  • Implement Five Core Programs
  • DriveWell
  • AMA Physicians Module
  • Roadwise Review
  • CarFit
  • Law Enforcement Module

12
  • Four hour training
  • Discuss issues related to older driver safety and
    community mobility
  • Toolkit that provides resources for local use
  • Trained 95 people

13
Assessing Counseling the Older Driver
  • Washington University provided Training
  • Trained 212 people

14
Roadwise Review
  • Worked with AAA
  • Distributed approximately 125 copies of the
    self-assessment tool statewide
  • Can be accessed on the web at www.aaa.com

15
CarFit Program
  • Community events
  • Fit people to their vehicles
  • Trained 75 people

16
Law Enforcement Module
  • Trained approximately 500 people
  • St. Louis County Municipal Police Academy
  • Law Enforcement Traffic Safety Advisory Councils
    Annual Conference
  • Missouri State Highway Patrol, Driver Examiners
    Training

17
Other Accomplishments
  • Created a display
  • Created print ads
  • Created a brochure
  • Database of over 200 contacts
  • Received a variety of media coverage across the
    state
  • Provided an article in the TRB Newsletter
  • Held statewide older driver workshops
  • MoDOT/FHWA sponsored older driver workshop for
    engineers

18
  • Tom Meuser, PhD
  • University of Missouri St. Louis

19
Two Older Drivers
A focus on functional health status recognizes
that we age differently on an individual level.
20
Medical Conditions Crash Risk
Many of these conditions are more prevalent in
older adults.
21
Medical Fitness to Drive
  • Medical Fitness to Drive (MFD) is applicable to
    all age groups, but is especially relevant for
    older adults.
  • A number of studies indicate that certain
    age-related medical conditions may impair driving
    ability and thereby elevate crash risk.
  • The management and reporting of MFD concerns is a
    voluntary process in most states.
  • The first responsibility for addressing MFD
    concerns resides with the individual driver. Many
    States require drivers to notify the DMV of
    health conditions that may impair driving safety.
  • Most States allow health professionals, law
    enforcement personnel, and others to report
    potentially unfit drivers for re-testing and
    possible license revocation. A few, such as
    California, mandate such reporting where dementia
    and other conditions are concerned.

22
Driving Mobility Continuum Drawing the Fitness
Line
Mild or Reversible
Serious Permanent
23
St. Louis Team
  • Investigators
  • Tom Meuser, PhD, UM St. Louis (formerly with
    WU)
  • Dave Carr, MD, Washington University
  • Gudmundur Ulfarsson, PhD, University of Iceland
    (formerly with WU)
  • Pat Niewoehner, OTR/L, CDRS, St. Louis VA Medical
    Center
  • Peggy Barco, OTR/L, DRS, Washington University
    Center for Head Injury Services
  • Marla Berg-Weger, PhD, Saint Louis University
  • Past Student Other Assistants
  • Joon-Ki Kim, Washington University
  • Tom Epplin-Zapf, Washington University
  • Matthew Minn, Southern Illinois University
  • Jessica Lester, Washington University
  • Jami Croston, MSOT, Washington University
  • Katie MacLean, MSW, Alzheimers Association, St.
    Louis Chapter
  • Emily Kissel, Washington University
  • Mimi Hilburg Annie Harmon, University of
    Missouri St. Louis
  • Donna Keller, former part-time on-site data
    assistant

And many others
24
Active in Driving Education Research
  • Education
  • Dementia Driving Workshops
  • Highway Patrol Curriculum
  • Missouri Senior Driver Pamplet
  • AMA Older Drivers Project
  • CarFit, DriveWell
  • Mobility Counseling Project
  • Local, Regional National Talks
  • Research
  • Beliefs of Stakeholders
  • Validation of Training Curricula
  • Dementia Driver Fitness
  • Stroke Driver Fitness
  • Older Driver Evaluation Mobility Clinic with
    On-Road Testing

25
Education
26
Health, Functional Status Older Driver Safety
  • A Curriculum for State Highway Patrol Examiners
    Officers

27
Learning Objectives
  • At the end, you will understand
  • Older driver safety statistics in Missouri.
  • How age-related changes in health and functional
    status may impair driving ability and increase
    crash risk.
  • An approach to observing and describing such
    changes in older drivers.
  • How to document such changes in support of a
    citation and the license review process.
  • Complete pre-test questionnaire now, if required,
    and hand it in to the presenter. Thank you!

28
Case Example Traffic Stop
  • Mr. Jim Greene, age 73, was pulled over by State
    Trooper for weaving and driving through a stop
    sign.
  • Mr. Greene has lived in Florissant, Missouri, for
    just the past two years, after moving here from
    Madison, Wisconsin, to live closer to his
    children.
  • He wears glasses, but does not report a vision
    problem.
  • He seems mildly confused, forgetful and rather
    irritated/embarrassed to have been stopped.

29
(No Transcript)
30
Form 4319 (page 1)
31
Form 4319 (page 2)
32
Case Example Driving Skills Test
  • Mrs. Mary Brown, age 74, was cited by the
    Director of Revenue to take a Driver Skills Test.
  • She is a retired factory worker and lifelong
    resident of Florissant, MO.
  • She reports a minor problem with her distance
    vision (I think I need new glasses, but I still
    see OK)
  • She is quite anxious about being tested, but
    tries her best to be cooperative during the
    examination.

33
(No Transcript)
34
Narrative on Form 232
  • Mrs. Brown was a pleasant, willing participant
    in the driving skills test. She appeared
    moderately anxious, as evidenced by rapid
    breathing, high pitched tone of voice, and many
    comments on her performance.
  • She wore glasses, but appeared to have
    difficulty seeing both near and far objects. For
    example, she misread her driver license number
    and she could not read signs on nearby buildings.
    She reported being at the Hazelwood test
    facility, and she stated her name, address and
    phone number without difficulty. She gave the
    correct date and time.
  • She walked to her vehicle, entered it, and
    fastened her seatbelt properly. She pointed
    correctly to controls named by the Examiner, and
    she named common objects giving incorrect names
    initially, but self-corrected later.
  • During testing, she frequently drove too close
    to the curb and parked cars. She appeared
    confused when asked to parallel park between
    cones, and asked three times to explain what I
    wanted her to do. I discontinued this maneuver
    after a few minutes. At the last intersection on
    the course, she appeared not to see the stop sign
    and continued driving until I instructed her to
    stop. She failed due to excessive points.

35
Missouris Voluntary Reporting Law
  • Passed by the MO Legislature in 1998 following a
    significant lobbying effort by CARD, WU,
    Alzheimers Assoc, other organizations.
  • Not age or disease specific.
  • Intended to promote reporting of impaired drivers
    by health professionals, particularly physicians.
  • Forms allow for a range of health and addiction
    conditions to be reported.
  • Similar to voluntary laws in 45 other states.
  • Has never been formally evaluated.

36
Driver Condition Report Downloadable from
http//dor.mo.gov/mvdl/drivers/forms/
37
Project Details
  • Private University (x2) Private Foundation
    State Government Collaboration
  • Characterize the functional impact and efficacy
    of HB-1536 for the medically impaired older
    driver in Missouri
  • Goal to capture data for all reported
    individuals, aged 50, reported between 2001
    2005.
  • A clear understanding of how the Missouri law
    works and its efficacy will have broad
    implications for state policy, traffic safety,
    public education, and the well-being of medically
    impaired older drivers.
  • Our project will also provide a basis for future
    inter-state comparisons and national policymaking.

38
Missouri Reporting Process
  • Once reported, the older adult must negotiate
    each step (hurdle) in the process to retain a
    valid license.
  • Failure to submit a physician statement (Hurdle
    1) leads to license revocation in all cases.

39
What did we expect coming into this?
  • Most reported drivers would be evaluated by a
    physician.
  • Half or more would be referred on and complete
    on-road testing.
  • A quarter or more would pass and retain a valid
    license to drive.
  • A quarter or so would have a positive crash
    history.
  • A quarter or more would have a positive citation
    history.
  • A substantial number would show evidence of
    ongoing driving subsequent to license revocation.

40
Reporting Trends over Time
Why might reports from license office staff be
going down?
41
Annual Crash Rates
42
Combined Frequency of Medical Conditions (n
4,100 cases from which microfilmed documents
were reviewed)
  • Dementia / Cognitive Impairment 45
  • Vision Condition 31
  • Musculoskeletal / Neuromuscular 28
  • Disorders of Consciousness 16
  • Cardiac / Cardiovascular 12
  • Brain Insult, Tumor or Stroke 10
  • Psychiatric Condition 8
  • Alcohol / Drug Abuse 3

43
Summary of Outcomes
44
MODOT-Funded Project 2008-2009
  • Follow-up project with the Missouri DOR to apply
    findings from the HB-1536 evaluation effort to
    improve current forms and system.
  • Single Form for Reporting from All Stakeholders
  • Incorporate best practices from other States
    into a new Physicians Statement (Form 1528)
  • Enhance education provided to License Office
    Staffers

45
Issues
  • States rely significantly on physician input in
    deciding questions of medical fitness to drive
    and whether someone should have license
    restrictions or be de-licensed (permanently or
    temporarily).
  • Few physicians are trained to make such
    determinations, however, and many do not view
    driving as within their medical purview.
  • Some States, such as California, provide
    significant guidance to physicians concerning the
    medical review process, whereas others provide
    very little.
  • The quality of physician input in Missouri has
    been mixed at best.

46
Physician Statement
47
Best Practices Project
  • We are in the process of collecting medical
    review forms and supporting documents from all US
    States, Canadian Provinces, and from other
    countries (UK, Australia).
  • We need to develop a means to rate these forms in
    terms of the guidance they provide to physicians,
    their comprehensiveness, ease of use, etc.

48
We will also be improving training provided to
license office clerks
In Missouri, DMV clerks are encouraged to be on
the lookout for impaired drivers and to report
those they consider to be a safety risk.
49
  • David Carr, MD
  • Washington University
  • School of Medicine

50
Disclosures Carr
  • Funding Support (Past Year)
  • National Institute on Aging (NIA)
  • AAA Foundation Traffic Safety
  • Missouri Department of Transportation
  • LongerLife Foundation
  • Consulting Relationships
  • American Medical Association (AMA)
  • ADEPT
  • SeniorSMART
  • AAA Foundation Traffic Safety
  • Speakers Bureau
  • St. Louis Alzheimers Association
  • Drug Industry Sponsored Trials
  • Elan
  • Investment/Stock/Equity None

51
Transportation Safety Handout for Older Adults
  • Final Report Submitted to
  • Missouri Department of Transportation
  • Highway Safety Division Oct 23, 2007
  • Dr. Gudmundur Freyr Ulfarsson
  • Assistant Professor of Civil Engineering
  • Washington University
  • School of Engineering and Applied Science
  • Dr. David B. Carr
  • Associate Professor of Medicine and Neurology
  • Washington University School of Medicine

52
AGING DEMOGRAPHICS
  • Older Adults
  • 2007
  • 36 Million Older Adults over age 65 yrs (12 US)
  • 28 Million Licensed Drivers over 65 yrs (15 US)
  • 2050
  • 86 Million Older Adults over age 65 yrs (21 US)
  • 66 Million Licensed Drivers over age 65 (25 US)
  • Chronic Disease
  • General Population
  • 25 million people or about 1/10 citizens
  • 1.7 million die each year
  • Older adults
  • 50 affected over age 65 years
  • 37 report disease is severe
  • 16 require assistance

53
OBJECTIVES
  • To develop a transportation safety pamphlet
  • -for older drivers
  • -based on crash statistics in Missouri
  • -based on common medical conditions
  • The booklet
  • - reviews the risk factors for injury
  • -enhances knowledge of vehicular/environmental
    risk factors
  • -enables older adults to take steps to address
    impairments
  • -provides materials in a format that was easy to
    understand

54
METHODOLOGY
  • Pre-pamphlet Focus Groups
  • Little insight
  • The Missouri Crash Statistics
  • Focus on Older Drivers
  • Medical Literature
  • Focus on conditions that are associated with risk
  • Draft Pamphlet Design
  • Based on Literature
  • Pre and Post Focus Groups
  • Further modification
  • MoDOT input and Graphic Design Team

55
CONTENT CRASHES
  • Behavioral Suggestions
  • Vehicle adjustments and service
  • Avoid alcohol or drowsy driving
  • Use seatbelt and avoid cellphones!
  • Environmental Suggestions
  • Weather
  • Intersections
  • Parking/Driveways
  • Turning

56
CONTENT MEDICAL INFO
  • Conditions
  • Vision
  • Cognition
  • Motor
  • Areas
  • Common medical conditions
  • Symptoms related to common diseases

57
Fitness-to-Drive in Older Adults with Dementia
  • Investigators
  • Washington University at St. Louis
  • David B. Carr, MD
  • Associate Professor of Medicine/Neurology
  • Clinical Director, Division of Geriatrics and
  • Nutritional Science, ADRC
  • Peggy Barco, MS, OTR/L, BSW
  • Instructor
  • Program of Occupational Therapy
  • Funded by MoDOT
  • Division of Highway Safety
  • Report due Oct 30, 2008
  • Collaborators
  • Washington University at St. Louis
  • Annie Johnson, Project Coordinator
  • Holly Hollingsworth, PhD Statistician
  • Jami Croston, OT Graduate Student
  • The Rehabilitation Institute of St. Louis
  • Kathy Dolan, OTR/L
  • Pat Storie, COTA
  • Independent Drivers, LLC
  • Steve Ice, OTR/L
  • Jefferson Barracks, VA
  • Pat Niewoehner, OTR/L

Local Advisory Panel Tom Meuser, PhD, Marla
Berg-Weger, PhD External Advisory Panel Linda
Hunt, PhD, Loren Staplin PhD, Dr. G. Ulfarrson
58
Why Alzheimers Disease?
4 Million AD Cases Today Over 14 Million
Projected Within a Generation
16
14.3
14
11.3
12
10
8.7
Millions
8
6.8
5.8
6
4
4
2
0
Year
59
Driving and non-DAT Dementia
Alzheimers Disease
Temporal profile laboratory results
Behavior, Language
EPS, Visual Hallucinations
Stroke, Focal Signs
Frontotemporal dementias
Rapidly evolving dementias
Lewy body dementia
Vascular dementia
60
WHAT IS THE PROBLEM?
  • We currently have no brief, simple, office-based
    instrument that would predict the ability to pass
    a performance-based road test in medically
    impaired drivers, particularly those with
    cognitive impairment.
  • Often, the final "arbiter" in the decision to
    drive is whether the impaired driver can pass an
    on road test.
  • Road tests are expensive, time consuming, and
    may need to be repeated over time in individuals
    with progressive conditions.
  • There is also the safety concern for the driving
    instructors (OT's/SHP officers) and the welfare
    of the public when administrating these tests.

61
BACKGROUND
  • Medical Fitness-to-Drive (MFD) study in Missouri
    indicates dementia an issue
  • 20 of drivers over age 80 demonstrated
    significant cognitive impairment at license
    renewal in one study
  • Larger population-based studies that are able to
    identify cognitively impaired drivers by brief
    cognitive screens have found modest increases in
    crash rates
  • At higher levels of cognitive impairment,
    previous studies from our Center have indicated
    that many older adults are unable to pass a road
    test.

62
BACKGROUND cont.
  • Current Approaches
  • Heterogeneous vs. Homogenous Groups
  • One test vs. Multiple tests
  • Various Outcome Measures
  • Candidate Tests
  • Vision Tests
  • Traffic Sign Tests
  • Knowledge Tests
  • Road Tests

63
OBJECTIVES
  • Develop a first tier screen for fitness-to- drive
    testing in older adults with dementia (Year 1)
  • Primary goal is to reduce the number of road
    tests performed by the highway patrol
  • Secondary goal is to develop screening tools for
    caregivers and for health professionals
  • Study different types of dementia (Year 2)
  • Build a database that can be adopted by others
  • Recommend further validation with prospective
    studies examining at-fault crash data

64
PRELIMINARY RESULTS
  • Each participant was screened via telephone.
  • As of Oct 22nd, 2008 86 participants were
    screened.
  • 27 were excluded for the following reasons
  • 9 informants stated they were not interested or
    refused
  • 4 specifically stated concerns about being
    reported to the DMV
  • 3 had driving evaluations in the past year
  • 2 did not have an active license
  • 2 did not meet criteria for a dementing illness
  • 2 did not have a physician diagnosis of dementia
  • 2 participants refused
  • 1 participant had state testing
  • 1 participant admitted to the nursing home
  • 1 raised concern for a lawsuit

65
DEMOGRAPHICS
  • 59 driving evaluations of participants with a
    diagnosis of dementia have been studied to date.
  • The demographic characteristics of this sample
    are as follows 74.310.3 age in years, 54 Male,
    18 African American, 14.62.9 years of
    education, have averaged 56.210.8 years of
    driving, and drive an average of 5.2 1.9 days
    per week.
  • Informants that provided information on the
    participants included spouses (61), adult
    children (32) and friends/relatives (7).
  • GOAL 200 participants with dementia from
    TRISL/VA sites

66
TOOLS FOR HIGHWAY PATROL (N59)
  • To date, our participants have been able to name
    correctly 7.4 3.0 road signs (out of 12),
    provide the correct meaning of the sign on
    average 7.42.2, and obtain an average score of
    9.4 2.8 out of 13 questions on our written
    examination.
  • This data will be compared to on-road performance
    as our sample size increases.
  • These tests have been easy to administer, take
    minimal time by the examiner, have some face
    validity and may be potentially acceptable to the
    older adult and family as a proxy for safe
    driving.
  • Continue to modify scoring rules

67
TOOLS FOR CAREGIVERS (N59)
  • The Functional Activity Questionnaire (FAQ)
  • Scores range from 0-30, each of ten items scored
    0-3.
  • It has been well validated in the geriatric
    literature.
  • It assesses performance of IADL
  • The FAQ was completed by mail.
  • Informants 6.86.8
  • Participants 2.53.1
  • Driving Behaviors
  • A checklist was provided by mail
  • Informants 2.53.1
  • Participants .91.4

68
TOOLS FOR OTs DRIVING CLINICS TRISL (N59)
  • Contrast Sensitivity (1.6.2 LogMARs)
  • Reaction time right foot (.82.7 secs)
  • Rapid Pace Walk (7.71.9 secs)
  • Short Blessed Test (8.97)
  • Trails A (61.140.8 secs)
  • Trails B (195.389.9 secs)
  • Clock Drawing Task (5.12.4)
  • Maze Test (46.225.7)
  • UFOV (334.5159.6 msec)

69
DRIVING CLINICS VAMC (N61)
70
Driving Outcomes
  • Crashes
  • (4 Crash rate per year)
  • Road Tests
  • (56 failure rate)
  • Simulators
  • Questionnaire
  • Cessation
  • Others

71
Statistical Methods
  • Independent variables continuous, categorical
  • Dependent variables continuous, categorical
  • Use t-tests for continuous, chi-square for
    categorical
  • Inter-rater and intra-rater reliability and
    perhaps measures of test stability
  • Determine unadjusted correlations with pass/fail
  • Stepwise logistic regression for those variables
    that were significant, along with important
    demographics
  • Models will be created to determine the
    combinations of independent variables that best
    predict road test failure
  • ROC curves to be created with the AUC to reflect
    graphically and quantitatively the ability of the
    model to discriminate those that fail from those
    that pass

72
Expanded Fitness-to-Drive Study
  • Create a set of standards for driving evaluations
    (OTs)
  • History (DHQ, Destinations, etc)
  • Physical Exam (DHI, Muscle Strength, etc)
  • On-the-road performance testing (WURT, DMV, etc)
  • Recruit DMV/Driving Clinics across the state
  • Urban
  • Rural
  • Create a common data base shared by sites
  • Desktop
  • Web-based
  • Develop disease specific fitness-to-drive models
  • Diseases Dementia, CVA, other
  • Outcomes Road Test, Cessation, Crashes, At-fault
    Crashes

Pre-proposal sent into AAAFTS and pending 11/08
73
Acknowledgments
  • AAA
  • Michael Wright
  • CARD
  • Shel Suroff
  • Alzheimers Association
  • Katie McLean
  • MoDOT/Highway Safety
  • Leanna Depue
  • Jackie Rogers
  • Highway Patrol
  • Captain Gary Moore
  • Ron Beck
  • External Advisors/Collaborators
  • Linda Hunt
  • Pacific University
  • Loren Staplin
  • Transanalytics
  • Gudmundur Ulfarsson
  • University of Iceland
  • WUSM
  • Participants and their families
  • Peggy Barco
  • JoAnn Wilson
  • Ann Johnson
  • Jami Croston
  • Holly Hollingsworth
  • ADRC and MDC staff
  • UMSL
  • Tom Meuser
  • Jefferson Barracks VAMC
  • Pat Niewoehner
  • Independent Drivers
  • Steve Ice
  • TRISL
  • Kathy Dolan
  • Patricia Storie
  • SLU
  • Marla Berg-Weger
About PowerShow.com