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    Hole - Ch8 - The Psychology of Driving

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    Subhajeet Rath

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    © All Rights Reserved
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    THE PsycHoLocy OF DRIVING GRAHAM HOLE Driving a vehicle is something most of us take for granted; however itis one Cee ee een ec cy ee eae ieee ee err ee ccc aed Ce eee a ee ete ee ea rer Ln er rs eee eee oe eee ee ees affect our abilty 10 drive safely? What ate the implications for road safely of technological innovations such as increased vehicle automation and driver uno Serer acres ee a eee eee ey ‘can answer these questions from a knowledge of psychological theories and research, combined with information fram accident statistics. It will be of interest to students taking courses in aprlied psychology and ergonomics, as Ce ee een eee eed Cement BN. 78080 ee ent oa) Peet THE PsycHOoLocy OF DRIVING a | | | i | fh | a. GRAHAM HOLE 8 The Effects of Age on Driving HOW RISKY ARE OLDER DRIVERS? How is driving performance affected by age? A common perception of elderly divers is that they are slow, incompetent and dangerous. Thisstems from youn ger drivers’ exasperation at following an elderly driver along a clear road at 20 mph in a 60 mph limit, bolstered by occasional reports in the news ofan elderly driver driving the wrong way up a highway or having such poor eyesight that he orshe collided with a bus. Fasked to give a reason for the elderly driver’s appar: ent incompetence, most people would probably attribute it ro deteriorating eye- sight. As we shal see, this sketch of the older driver actually does persons over (65 a considerable injustice. Studies of the Effects of Age on Riskiness Itis surprisingly difficult to assess whether or not elderly drivers are significantly more at tisk of an accident. As mentioned in chapter 5, many studies show a U-shaped age pattern in accident or death statistics. The risk of drivingis great est for drivers under 25, decreases during middle age, and then appears to in- ase for the over 65 age group, although even drivers aged 80+ have a fraction of the number of accidents thar the under 25-year-olds have (e.g, Ev ans, 1991; Sjogren, Bjdrnstig, Eriksson, & Ostrm, 1996). Preusser, Williams, Ferguson, Ulmer, and Weinstein (1998) calculated the older drivers’ risk of be- ing involved in a fatal crash, compared to the same tisk for a driver aged 40 to 49. They used data primarily from the Fatality Analysis Reporting System (FARS) of the National Highwey Traffic Safety Administration (NHTSA), which gives details of al faal passenger vehicle accidents in the United States Drivers between the ages of 65 and 69 were found tobe 1.45 times more likely to be involved in a fatal accident than drivers ages 40 to 49. However, the precise magnitude ofthe risk for older drivers depends on how it is measured, and numerous complicating factors need to be taken into ac- count. One problem isthe passiblty of reporting biases. The consequences of accidents tend to be more severe for the elderly. Older people are often more frail, so if they are involved in an accident, they are more likely than younger rivers to be killed or injured (Barr, 1991; Evans, 1988; Mackay, 1983; Sjogren, et al,, 1996). Consequently, accidents involving elderly people may be more likely to come to the attention of the authorities, and thus enter the accident statistics, compared to accidents involving younger drivers. ‘The biggest problems in interpreting the accident data arise from age differ- ences in exposure to the risks of driving, Asa group, older drivers have fewer ac- cidents and commit fewer traffic offenses than younger drivers (Evans, 1988). However, che raw statistics do not take into account the number of drivers in cach age category and the total nileage driven by each group. If there were fewer elderty drivers than young drivers, and ifthe elderly drivers drove much less, then these factors alone might make them appear to be less risky, because the elderly would in effect be limiting their exposure to the hazards of driving. If you don’t drive much, then you are unlikely to have a car accident. In most countries, itis ot known in detail when, where, and for how much time people of different ages drive, but this information is clearly crucial for interpreting ac- cident statistics. Although precise data are lacking, numerous studies suggest thatolder drivers tend to drivelessand that they tend torestrict thei drivingto safer conditions, driving outside of busy periods, in familiar territory, and only during daylight hours. Thus, quite apart from any differences in driving ability between young and old drivers, the latter group might be expected to have fewer accidents simply because they avoid exposing themselves to hazardous driving conditions. Alternatively, elderly drivers are having more accidents despite limiting themselves to relatively safe driving conditions, then this im- plies thae ehey might actually be more risky than the bald statistics suggest There have been vatious attemts to assess the riskiness of elderly drivers, taking into accounc the exposure issue. Evans (1988) used the US. FARS data in conjunction with a Nationwide Transportation Study, to investigate the in- volvement of older drivers in severe and fatal accidents. Sixty-five-year-old 66 Ba Pre: divers had fewer accidents than 20-year-olds. However, when compared to 40-year-olds, the 65-year-cld male drivers had 33% more fatal erashes per unit distance traveled, and 65-rear-old female drivers had 77% more. Thus, when ‘exposure was taken ino account, che accident risk appeared to increase with age, especially for women. Verhaegen (1995) reported the statistics for deaths and serious injuries in Belgium for 1990, in relation to the age ofthe driver. The raw statistics showed a similar pattern to that found in the United States and United Kingdom: the peak number of casualties was for the 20- to 24-year-old group, and with in- creasing age, the numbers rrogressively decreased. In order to compare the risk iness of drivers belonging to different age groups more accurately, Verhaegen used insurance company data about two-car collisions. In most collisions be- tween cars, one driver is considered to be at fault. By collecting arepresencative sample of two-car collisions for each age group, and then dividing the numberof at-fault drivers by the number of blameless drivers, Verhaegen could obtain what he calls an over-involvement ratio for each age group—the numberof coli- sions caused by drivers in that age group, in relation to the numberof collisions suffered. Veshacyert, Toclut, aud Dellehe (1988) exanined 660 reports of two-car crashes that had aot involved personal injury. For most age groups, fdves were outs likely to cause acolsionas roster one; however, driver over the age of 60 were more than twice as likely to cause a two-car collision than to be the innocent party in one {111989 to 1991, Verhacgen replicated this study witha larger sample, using random selection of 2,400 accident reports. Asin the first scudy, there was an age trend with respect tothe overinvolvement ratios: the chances of being lia- ble in a collision were greater for older drivers (60+) than for 23- to 49-year-olds. However, as Verhaegen points out, older people are not involved inalarge percentage of collisions: in his sample, people aged 50 or more were in volved in 20% of accidents, and were responsible for only 10% of them, Recently researchers have questioned the very existence of a U-shaped rela- tionship between age and accident involvement. Li, Braves, and Chen (2003) looked at the relative contributions of exposure (accidents per mile traveled) and fragility to death rates for different age groups and concluded that fragility \was the major contributor to the elderl’s apparently elevated accident rate; fragility began to increase ftom the age of 65 or so. Hakamies-Blomavist, Raitenan, and O'Neill (2002) have suggested that the apparent increase in ac- cident rates for elderly drivers is largely an artefact of how exposure is caleu- Jared. They claim that elde-ly drivers’ accident ratesare no higher than those of middle-aged drivers ifthe age groups are equated carefully for annual mileage Hakamies-Blomqvist and colleagues claim that, i espective of age, in any com- TSoraGE at 157 a er LTE EEG IOS AGE FEES parison between low- and high-m leage drivers, the former will tend co have an apparently greater risk ofan accident per unit distance traveled. Thisis because calculating accident rates per unit distance traveled ignores the fact that high-mileage deivers do most of their mileage on high-speed roads. These are actually the safest places to drive, despite the high speeds, because everyone is going in the same direction, and there are relatively few intersections at which vehicles can come into conflict. Consequently itis easy for high-mileage drivers to accumulate many safe miles and thus reduce their accident rate per distance traveled. In contrast, low-mileage drivers travel relatively few miles, but these are all on the kinds of roads on which drivers are mote likely to have accidents, However, as noted earlier, elderly drivers tend to restrict their driving to safer conditions (highly familiar roads, during daytime), which must offset this to some extent. Clearly, the exposur issue makes the interpretation of accident statistics fraught with complications. The safest conclusion appeats to be that { the increased! accident risk of the elderly has been somewhat overstated. WHAT TYPES OF ACCIDENT DO ELDERLY DRIVERS HAVE? From the previous section, its apparene that there is surprisingly little frm evie dence thatelderly drivers have mo:e accidents than middle-aged drivers. How- ever, older drivers do seem to have different types of accidents. In a series of review papers, Hakamies-Blomavist (1994, 1996) concludes that compared to younger drivers, elderly drivers are infrequently involved in accidents attribut- able to speed, and they seldom commit major trafic offenses (eg, reckless dri ing or drunk driving). Older drivers tend to be involved in fewer single-vehicle accidents but more two-vehicle accidents (ie, collisions) than young and mid- dle-aged drivers. When they are involved in an accident, the older driver is ‘more likely to have been the guiltyparty, and bis ot her vehicle is more likely to have been the one that was hit. Older drivers are more likely to be involved in, accidents and traffic offenses invo ving failure to attend to road signs, to give ] right of way, or to turn appropriately The elderly appear to be overrepresented in accidents at intersections. Keltner and Johnson (1987) suggest that the types of accident that occur mast often in the elderly are failure to yield right of way (right-of-way violations in- ‘crease in frequency progressively afer the age of 50 of so) and accidents involv ing turns (turning violations increase after the age of 65). The frequency of stop sign violations shows a U-shaped function, decreasing from 20 to 35, and then increasing again from 60 onwards. However, speeding violations markedly decrease with age, ina linear fashion. { s8 A CHAPTERS Subsequent research has confirmed this picture. Hakamies-Blomavist re- ports that in Finland, the proportion of collisions in intersections and similar complex traflic situations inereases from the age of 55 for women and 65 for ‘men; in contrast, the propertion of head-on and rear-end collisions decreases. Elderly Finnish drivers appear to have a particular problem with left turns: in nonfatal intersection accidants, 41% involved let turns and only 6% involved right rurns. Finns drive on ‘he right-hand side of the road, so the difficulty ap- pears to be with turns that require the elderly driver to find a suitable gap in both streams of approaching waffic and then to make the necessary turning Inboth of the studies by Verhaegen mentioned between the frequencies of different types of accidents for different age groups of driver In the 1988 study, Verhaegen compared 49 at-fault older drivers (aged 60+) 10 82 at-faule younger drivers (30 to 39 years old). Compared to younger drivers, the older drivers had a different pattern of accident involvement. Older divers had a higher proportion of accidents involving collision with an oncom- ing ear when turningleft this accounted for 16% ofthe older drivers’ collisions, as ‘opposed to only 1% of the 30- to 39-year-old’. In vontiast, younger divers were mote likely to collide with the cat in front, duc to following too closely (34% of younger drivers, but only 18% of older drivers); more likely to collide wich an- ‘other vehicle while passing (11% of the younger drivers, 0% of the older drivers); and more likely to have a ead-on collision by driving on the wrong side of the road (15% of younger drivers, but only 4% of older drivers). Vethacgen concludes that “accidents for which oder drivers are responsible are related to problems of perception and decision meking, while those of younger drivers are related to in sufficient control of speed and risk taking” (p. 502). In Verhaegen's larger-scale study, the pattern of findings was less clear, There were four types of accident for which younger and older drivers showed different patterns of involvement. [1 the case ofa collision due to following too closely, 18- co 22-year-olds were significantly more likely to cause this type of accident than tobe the victim oft, whereas 30- to 49-yeat-olds were more likely tobe the victim than tobe at fault. For the other age-groups, there was no significant dif- Jieg comparisons were made ference between the number of times that particular age of driver was at fault, and the number of times they were the victim. For collision with an oncoming car when turning lef, the only significant effects were that 23- to 29-year-olds were less likely to be at fault, whereas drivers over 60 were more likely to be at fault. For collision by failing to give way when coming from a secondaty road, 23, to 29-year-olds and 30- to 49-year-olds were more likely to be the victim than to cause this type of accident. As Verhaegen points out, these few statisti- cally significant differences do not explain the differences with age in the THeerrectsoract = @ 159 overinvolvement ratios. However ifone compares the overinvolvement ratios of the 23-0 49-year-olds to the over 50s, then for nine out often accident types considered in the study, the older drivers have a statistically higher overinvolvement ratio; the older group is significantly moe likely tobe at fault for thac type of accident than to be the blameless party. In all situations, the ‘older group is more frequently lable when an accident occurs ‘The Preusser etal. (1998) study also found that relative risk varied consider- ably for different types of accident. As age increases from 65 onwards, drivers are increasingly more likely to be involved in daytime crashes at intersections, and increasingly likely to beat fault. Driversaged 65 to 69 were 2.26 times more likely to be involved in a crash at an intersection than were drivers in theie for- ties, and 1.29 times more at risk in all other situations. Relative risk increased steadily with age: for drivers age 85 and above, the risks went up to 10.62 and 3.74 respectively. The risk was particularly high for older drivers at uncontrolled and “stop” sign-controlled locations; when traveling straight on ot when just starting to enter the intersection; and when the specific ertot in the crash was failing to give way. Preusser and colleagues looked in detail at the kinds of errors macle by older drivers. Four categories of accidert accounted for most oftheir accidents. The ‘most common type was “ran trafic control.” This involved accidents in whicha driver was requited to stop, remain stopped, or give way but disregarded this re- quirement, and then collided with another vehicle. Itincludes cases where the diver failed to give way to oncoming traffic while executing a left turn. The next category was “ran off road,” which involves a vehicle leaving the traffic lane and hitting another vehicle (including parked vehicles), The third, “straightoncoming," involves vehicles traveling in opposite directions colliding either head-on or ina sideswiping manner. The fourth was “stopped/stopping,” which involves a vehicle that has stopped ori stopping, oris just starting up and is hit from che rear. (Crash-type distributions for drivers aged 65 to 69 and 70 to 74 were similar to those of the 40- to 49-year-old. Over the age of 74, however, the percentage of “ran traffic control” type accidents rose to over 50% of all fatal crashes, and the percentage of “ran off road” and “straight oncoming” crash types declined, Among drivers aged 65 and above, 80% of the fatal “ran traffic control” acci- dents occutted at intersections, and the remainder occurred at other entrances and exits to and from roadways, such as driveways. Ifone considers only inter- section accidents in which the specific error by the driver was a failure to give way, the data paint an even bleaker picture. Sixty-five- co sixty-nine-year-olds were over twice as likely to be involved in this kind of accident than were 40- to 49-year-olds. Drivers over 85 were 33.71 times more likely tobe involved. Only 160% _ciurmns of 194 drivers ages 40 to 49, who were involved in a “ran traffic control crash were judged to be a: fault. However, 88% of the 522 drivers aged 85+ in. volved in this kind of accident were at fault. Fone considers the location of im pactson the vehicle follovinga “ran traffic control” crash, we see asimilar story there is an increasing likelihood that the older driver was driving the vehicle that was hit in the crash, Older drivers were much more likely to have been struck on the left side oftheir vehicles, the side of the vehicle exposed to the most immediate danger when entering most intersections. Preusser’s data suggest that older drivers have particular difficulties in cop- ing with crossing or turing at intersections, or entering or leaving the road at driveways and other locacions. “Ran traffic control” is the most frequent crash type among older drivers, accounting for more than half ofall fatal accidents for drivers aged 75 and abo ‘A.common problem of lderly drivers at intersections involves left cuens (ight ‘ums in the United Kingdom). About 40% of the intersection crashes of drivers aged 75 and above involved left turns, compared with 7% for 40- to 49-year-old. But Preusser and colleagues suggest the biggest problem is starting and going sevaight aciossacjunetion, At hese locations older drivers tend tobe hit feom the lef, the side nearest the most immediate threat when pulling out. Hits from the right appear to occur less often. This may be a consequence of drivers coming from that ditection having alittle more time in which to take evasive action, ot because right-side impacts are les likely to cause fatal driver injury Daigncault, Joly, and Frigon (2002) examined the accident and convietion records of over 426,000 Quebec drivers ages 60 to 80+. Using Reason et al.'s terminology (see chap. 5, this volume), they concluded that crashes due to vio. lations declined with advancing age, whereas crashes due to errors steadily in creased. Compared to younger drivers, elderly drivers appear tobe taking fewer risks, in that they have fewer accidents related to speeding, passing, and loss of| vehicle control. However they are experiencing greater difficulty in situations requiring interactions with other traffic at intersections. Are All Elderly Drivers at Greater Risk of an Accident? The studies described so iar have painted a rather bleak picture of the elderly driver's abilities. Howeve;, there are positive things associated with aging too. Hakamies-Blomqvist (1996) points out that in many accidents, especially coli- sions at intersections, the behavior of both parties affects the chances of an ace dent occurring. The slow, cautious driving style of the elderly may often give other drivers more time torecover from making an errorand thus avoid becom- ing legally responsible foran accident. rucrsor ‘As mentioned earlier older drivers tend to restrict their driving to situations with which they feel they can cope, and avoid difficult driving conditions such as night-time and poor weather (Hakamies-Blomqvist, 1994). The statistics Support the interpretation that they take fewer risks than younger drivers ‘When involved in accidents, chey ate les likely tobe intoxicated than other age groups (Hakamies-Blomgvist, 1994). They also tend to drive more slowly (Chipman, MacGregor, Smiley, & Lee-Gosselin, 1993). ‘Also, as Hakamies-Blomqvist (1996) points ou, age by itselfisa poor predic- torof driving performance. Although the health problems frequently associated with aging (such as visual pathology and dementia) can cause problems for el- derly drivers itis by no means certain that normal aging (i... mere increase in chronological age perse) isassocated witha significant dectease in driving abil- ity. Most older drivers have a crash-free record (Evans, 1991). It seems likely thata subset of impaiced drivers, who are ata greater risk for having a crash, are increasing the average risk for the entire age group (Ball, Owlsey, Stalvey, Roenker, Sloane, & Graves, 1998) One also has to distinguish between age effects and cohort effects (Evans, 1995; Hakamies-Blomqvist, 1995). This isa problem that affects any research that uses cross-sectional design, where different age groupsare examined at a single point in time. Any differences between the groups might be due to their chronological age, or they might be due to the different life experiences that ‘hose groups have had, as a consequence of being born at different times. Sup- pose one finds differences between the driving performance of present-day 70-year-olds and 20-year-olds. It is possible that these differences are due to age-related changes in cognitive functioning. However, they might equally re- flect the fact that the 70-year-olds learned to drive many years ago, at a time when driving conditions—and the standard of driving required to get a license—were somewhat differert from today. Rumar (1986) points out that, considering the performance decrement that ‘occurs due to aging, the increase in accident risk with increased age should be ‘much higher than ic actually s. Presumably the rate is lower than one might ex- ect because elderly drivers are aware of their problems and avoid the critical situations that exacerbate them. However, the accident rate goes up neverthe- less because the elderly driver cannot avoid al such situations all ofthe time. “Older drivershave some advantagesover their younger counterparts. Thesein. clude driving experience, maturity, aneed to drive many fewer miles on average per year as compared wit younger drivers and, often, the flexibility to make their driv. ing trips a times and places that they perceive as being safer. However, beyond the ages of 75 or 80, even these advantages are overwhelmed by the complexity of dy- ‘namie traffic interactions at intersections” (Preusser etal, 1998, p. 158) 162 CHAPTERS Why Are Elderly Drivers More at Risk of an Accident? Ie is one thing to find evidence supporting the notion that elderly drivers are more likely to have certain kinds of accident rather than others. Itis quite an- other to isolate the reasons for this. Following on from Rasmussen's (1983, 1986) hierarchical classification of driving skills, Hakamies-Blomavist (1996) hhas pointed out that elderly drivers might conceivably have problems with any of the component abilities: perception, attention, motor performance, and tac tical skills such as planning one’s maneuvers and anticipating what other road-users are likely to do. With increasing age, changes occur in almost every aspect of our sensory, motos and information-processing abilities. Any ofthese, either singly or in combination, might affect driving performance and hence accident risk Motor Control. Slower motor performance might contribute to the higher level of risk experienced by elderly drivers at intersections. When enter ing the traffic on a main road, a driver has to control the vehicle while simulea- neously making decisions about the traffic situation. If vehicle control takes some time, then the gaps left by other cars in the traffic flow may not be cient to permic the elderly driver to pull out safely. Skilled drivers are able to si multaneously execute various operations involved in car control, for example, ‘maneuvering and changing gear ac the same time. Hakamies-Blomavist (1994) has speculated that elderly drivers might engage in a more serial onganication of car-controlling operations, perhaps in order to reduce processing demands. ‘This might lengthen the time needed for complex actions such as intersection ‘maneuvers well beyond what could be predicted on the basis of aye differences Perceptual (Sensory) Problems. As the average age of drivers increases, poor vision among drivers becomes more commonplace (see chap. 2, this volume). This is due to two things: natural deterioration in eyesight with age, which to a greater or lesser extent i likely co affect everyone as they age; and pathological changes in eyesight, which will affect only those who are un- lucky enough to contract the medical conditions in question. Natural deterio- ration involves neural and retinal changes, and changes in the lens of the eye (see review in Scialfa, 2002). The neural and retinal changes reduce the speed with which the visual system can cope with changes in ambient illumination, and are probably the main factor in elderly drivers’ frequently reported difficul- ties in coping with glare from oncoming headlights, The changes in the lens pri- marily consist of thickening yellowing, and a decrease in its natural elasticity. This reduces the amount ofight reaching the back of the eye, and it also causes 163 IEEEFECTS OF the condition of presbyopia familiar to most people over the age of 45 or so in which focusing on nearby objects becomes increasingly dificult (see chap. 2, this volume). Presbyopia may make it difficult to read a map ot a street index, but it probably int an imporcant factor in everyday driving, since distance vi- sion is unaffected. The width of the visual field (ic. the area over which one can see) also declines somewhat with increasing age. Pathological conditions which may impair vision enough to make driving dangerous, and which are more likely to occur the elderly, include glaucoma, diabetic retinopathy, cataracts, and visual field defects that may occu following stroke. Glaucoma and diabetic resinopathy may lead to losses of peripheral vi- sion. Cataracts defocus the image and hence produce a loss of contrast sensitiv ity and detail vision (ie. high spatial frequencies, see chap. 2, this volute) Visual field defectsias a consequence of strokes may involve an entire halfof the visual field (hemianopia) or blindness in a circumscribed region (a scotoma). The sufferer may be quite unaware that he oF she has a visual field defect, espe- cially iit covers only a relatively small area of the visual fel. ‘There are various ways in which vision can be assessed, and there have been ‘humerous attempts to relate perlormance on these tests t0 accident involve- ment of performance on driving-related tasks. The most obvious measure of eyesight is static acuity, or sharpness of vision as measured by the traditional Snellen eye chatt (see chap. 2, this volume). Davison and Irving (1980) mea sured the Snellen acuities of 1400 drivers. The percentage of drivers who failed to reach the Snellen equivalent of the numberplate test remains reasonably constant until the mid-fortes, and then rises steeply with advancing age. Mean acuity at 20 years of age was 614.2. This increased throughout adulthood, but deteriorated shatply from the early 40s onwards, so that by the age of 70 it had reached a peak of around 6/7.3—nearly double that of the younger drivers, However, less than 5% of drivers had acuity worse than 6/12, even among the older drivers. In most cases of drivers failing to reach the standard required by the rhumberplate test, the cause is simple short- or long-sightedness, correctable with glasses. Interestingly, Davison and Irving (1980) found that only 80% of the younger drivers (under 20 yearsold) who wore glasses or contact lenses “al- ways" wore them for driving, whereas over 90% of the drivers over 50 did so. McCaghrey (1987) found that in a sample of 6,000 drivers, 23% of females re- ported that they wore glasses while driving, whereas only 16% of the men said they did so: this difference betweer. the sexes was present at all ages. Given the importance of visiox for driving, one might expect (healthy) ‘age-related declines in visual acuity to have some consequences for driving per- formance. In fact, there is relatively little evidence that poor vision per seis a 164 cmnreRs major factor in the inereased accident risk ofthe elderly (or for anyone else, for that matter, see chap. 2 for a discussion of cis issue, andi possible explanations for why icmightbe so). Large-scale studies suggest that there is essentially note lationship between various measures of visual performance and driving acct dent rates (Burg, 1967, 1958; Gresser & Meyer, 1994; Hills & Burg, 1977) except for drivers over age 5t, when an extremely weak correlation emerges. As Hills and Burg point out, even this does nor necessarily imply that poor vision causes accidents: the older drivers’ decreased visual performance might simply be linked to age, and the fandamental cause of the enhanced accident rates might be some other age-related factor, such asa deterioration in nonvisual cog nitive processing abilities. Another factor that might attenuate any relationship between age, eyesight, and accident rates is that older drivers with visual im- pairments, such as cataracts, are more likely to drive less and to restrict their driving to daytime conditions (e.g., MeGwin, Chapman, & Owlsey, 2000). Whatever the explanation, itis apparent that measurement of acriver's eye sight is unlikely to provide us with a reliable indication of whether or not the person concerned isa safe driver; it scems we shall have to look elsewhere for the source of the elderly dr-ver's difitculttes. Attention. One pessibility is that elderly drivers don’t have problems with their eyesight, so muck as with allocating theie attention effectively to dif ferent aspects of the drivirg environment. Hakamies-Blomavist (1994) sug- gests that attention/percep‘ion errors seem to be the most important factor in elderly drivers’ accidents. She found that 44% of older drivers had not been aware of any danger before -heir crash occurred, compared to only 26% of mid- dle-aged drivers. ‘Owsley and Ball and their colleagues (e.g, Ball & Owsley, 1993; Owsley, Ball, Sloane, Roenker, & Bruni, 1991) have devised the “Useful Field of View” test (UFOV). The testis based on the idea that driving involves simultaneously processing information from both the center and periphery ofthe visual field; therefore, itassesses driversusinga test that measures the functionally available field of view. Essentially, the UFOV test involves divided attention, where both central and peripheral stimuli maybe present simultaneously. A widely used test (the UFOV Visual Attention Analyser Model 2000) requires the subject to identify a centrally viewed target (a silhouette ofa truck or ear) on a computet screen, while having to loccte a peripherally presented stimulus (a silhouette of acat), which can be at any of 24 locations. The claim is that drivers will be more likely to have an accident their “attentional window” issmall and they cannot adequately divide their attention between central and peripheral tasks, Ball, Owsley, Sloane, Reenker, and Bruni (1995) considered a group of 294 drivers ages 55 1090. “Atfaule” crash frequency (numberof crashes pet year dur- ISOFAGE 165, ing the previous 3 years) was compared with UFOV measurements, static ace ity, contrast sensitivity, and mental status. The UFOV was the best of these tests at idencifying the unsafe drivers inthis sample, but stil relatively poor at distin- guishing between them and perfectly safe drivers. However, this line of research 's promising, as it has produced the strongest correlations yet between a mea- sure of visual performance and accident rates. The findings do suggest that el- derly drivers may not be able to distribute their attention to different stimuli at ‘once as well as younger drivers can, at least not when some of those stimuli are at the center of their visual field and others are in the periphery. Information Processing Difficulties or Cognitive Slow: ing. —Ithasbeen suggested (e.g, Cerella, 1985; Salthouse, 1980, 1991, 1996) thar increased age leads to a decrease in the speed with which many informa- tion-processing operations can be performed, and chat this decrease in process- {ng speed isa fundamental causeo' the elderly's impaired performance on many cognitive tasks—not justin terms ofhow quickly the tasks are carried out, but also in terms of how many errors are made. Why slowing should occur with ad. vancing age is not yet known, bucit could be due to a slower speed of nervous conduction (as the result of loss of myelination of nerve fibers, or because cell death means that transmission has to take increasingly circuitous routes). Salthouse has suggested that there are two main consequences of increased processing speed in the elderly. One is what he cals the limited time mechanism: performance may be impaiced because some ofthe cognitive processes involved in a particular task cannot be successfully completed in the time available. Salthouse likens the limited time mechanism to an assembly lin: ifthe relevant processing operations are not completed within a particular period of ime, then the quality ofthe final product will be impaired because later processing opera- tions will either be les effective or only partially completed. ‘The other consequence is wha: he calls the simultaneity mechanism: some- times performance may be impaired because the products of eatly processingare nolonger available by the time that later processing is completed, Salchouselik- ens the simultaneity mechanism co juggling, a complex activity whose perfor- ‘mance requires the synchronization of constituent tasks: synchronization is easier ifthe relevant subtasks can be executed rapidly. Sometimes these limita tions ean be overcome by the use of experience or by the use of acquired knowledge, but this may not be possible for many tasks. Salthouse (1996) provides a variety of evidence for his theory. One tech. nique involves using statistical techniques to remove the effects of processing speed from data obtained on a cognitive cask. When this is done, the remaining effects of age on performance are cften greatly reduced. imnlvine that nrocess- 166% cunrrers ing speed was the main cause of the age differences in the first place. Measures of processing speed that involve perceptual or cognitive operations such as sub- stitution, transformation, ae comparison are more effective in this respect than ‘measures involving merely copying or line drawing; Salthouse interprets thes results as clemonstrating that it is the speed of cognitive operations that is ina- ortant, tather than merely the speed of sensory or motor processes. Salthouse claims that “an average of 75% or more of the age-related variance in a wide range of memory and cognitive variables is shared with measures of processing speed” (p.420), and that thisis true across a wide range of tests including those requiting reasoning, spatialand memory abilities, and with self-paced, as well as timed, measures. ‘The idea that a unitary deficit in processing speed produces age-related cog- nitive impairments is not universally accepted: other researchers have sug- gested that there might be more than one type of cognitive slowing, depending fon the task requitements. For example, Verhaegen, Cerella, Semenec, Leo, Bopp, and Steitz (2002) propose that there are three types of processing mode, which vary in the extent to which they are affected by age, although it may be notable rhar the worst affected was that reflected in performance on complex visuospatial scarch tasks. Alko, finding age differences in processing speed in the laboratory is one thing, Whether or not these differences arc large enough to have a significant effect an driving ability remains to be determined. McKnight and McKnight (1999) measured the performance ofa large sam- ple of elderly drivers on a wide variety of psychological rests, as well as examin- ing their driving ability on the road, Four hundred seven drivers aged 62 and above were involved: 253 cf these had been referred to licensing agencies be- cause they had been seen driving unsafely, and many of these instances of unsafe driving had resulted in an accident. The remaining 154 were accident-free vol- uunteers. The average age ofthe unsafe drivers was 81, and that of the safe driv- ers was 75. The psychological tests fll into five diferent classes: sensory (e.g static and dynamic acuity), attentional (measuring the range of attention, as wellas testing selective attention and divided attention), perceptual (including perceptual speed, motion perception, and field dependence), cognitive (con- sisting of various matchirg tasks and tests of short-term memory), and psychomotor (including simple and choice reaction time).The road test was a highly seructured test that involved a variety of road types as well as tasks likely to give elderly drivers problems, such as estimating the adequacy of gaps in the traffic before pulling out fiom a side street; distributing attention between driving and reading street ames; and remembering a set of ditections. McKnight and McKnight report various correlations between “unsafe driv- ing incidents” and the various psychological test measures. Allof these cortel e167 tions were statistically significant (meaning that they were unlikely to have occurred by chance), bur all were very small in absolute terms. Tis implies there isan extremely weak relationstip between the abilities measured by these tests and driving performance. Most of the individual tests had correlations with unsafe driving of about 0.2 to C.3. This means that an individual driver's test score is of little practical use in deciding whether or not he or she hasa high oc low ‘unsafe driving incident” sco-e. The correlations between road tester rorsand unsafe driving incidents were even lower, and often nonsignificant. On. the bosis of substantial intercorrehitions between the various ability tests, McKnight and McKnight suggest that “an age-related deficit appears to per- vade all aspects of ability to some extent ... With such high intercorrelation, there is no way of knowing which ability declines [sic] are actually contributing roaccidents” (p. 453). ‘An interesting study thae points indirectly to information-processing diff- culties in the elderly was performed by Wood and Troutbeck (1995). They in- vestigated the effects of simulaced visual impairment on the driving performance of 14 young and 10 ol! subjects, on a closed road circuit. They ised yoxules 1 sinulate the effect of cataracts, vioul field reetrction, and ‘monocular vision. Wood and Troutbeck measured peripheral awareness, ma- nneuvering, reversing, reaction time, speed estimation, road position, and driv- ing time. Visual impairment significantly reduced performance on all these measures, except speed estimation. Simulated cataract proxhced the greatest decrease in driving performance, followed by visual field restriction—even though all drivers would satisfy the legal requirements for driving while wearing the goggles. Monoculatity did not significantly impait performance on any task. Wood and Troutbeck found that older drivers were affected much more by these manipulations than were the younger drivers. In other words, if one ‘equates young and old drivers for vsual performance (by impairing it for both groups equally, in ways that are commonly associated with advancing age), older drivers still perform worse than younger drivers. This implies that the problems of the elderly driver cannot be attributable solely to visual impait- ment. Wood and Troutheck speculate that the differences were due toa slowing of reaction times and information processingin the older driver, which increases the detrimental effect of any given level of visual impairment for them, as compared to the younger driver, ‘Together with the attentional problems, generalized cognitive slowing seems 1 promising candidate for explaining the pattern of problems encountered by the elderly driver, especially a intersections. As mentioned earlier, one can en visage driving as involving a variety of activities, which can be categorized loosely according to whether they are operational, tactical, or strateyic. Opera 168 CHAPTERS tional activities include the various low-level actions required to operate the vehicle—things such as steering, braking, and accelerating. These are highly over-learned through years of practice, and are likely to be affected only mildly by cognitive slowing as they are largely automatic and unconscious. Strategic activities, uch as deciding whether or not tomake ajourney, and which route to take, can mostly be planned in advance, and can therefore be performed atarel- atively leisurely pace. Itistactical activities that are likely tobe affected most by cognitive slowing—things such as responding to other road-user's actions, ‘maneuvering around parked cars ahead, changing lanes, and so fore Because of cognitive slowing, subjectively things may happen faster to el- derly drivers since they need more time than younger drivers fr each cognitive ‘operation that they perform, Irisalmostasif things are speeded up, compared to how they are subjectively experienced by a younger person. To some extent, cognitive slowing can be zompensated for at the tactical level, by driving more slowly, cautiously and defensively. Driving is a self-paced activity so elderly drivers can cope with the rapidly changing situations of normal driving reason ably well by exposing themselves to these situations at a slower rate. In many respects, this works well, saul as akatnies-Dhonuqist Its pointed cout, it makes the average elderly drivera comparatively safe driver. However, in- tersections and junctions are another story—these are the one situation in which the pace at which things happens is outside of the control of the driver. ‘There sa “window of opportunity” of a few seconds for emerging at a moder- ately busy junetion (see Fig. 8.1). Because of cognitive slowing, pethaps this window of opportunity i effectively shorter for the elderly driver: whereas a «given number of cognitive operations takes a certain amountof time in a young, driver, nan elderly driver the same number of operations may take considerably elderly driver's processing time: LooK ‘Look DECIDE TO] CONTROL sence objective time: LOOK Look | ey: | DECIDE TO] contROL LEFT RIGHT EMERGE | VEHICLE younger driver’s processing time: FIG. 8.1. The window of opportunity for emersing ta jameson TTHEERTECTSOFAGE a 169 longer Inshort, the effective amoun: of time that adriver has at an intersection becomes shorter with increasing age. Couple this with attentional problemsand exacerbate those attentional problens by the fact that stress and anxiety pro- duce a narrowing of the effective fie of view, and one can see why elderly driv crs might cause collisions at intersections. This account is speculative bue plausible, and it fits most of the data we have so fat. Clearly more research is needed in this area How Can the AtRisk Elderly Driver Be Identified? From the above discussion, it seems likely that age-related increases in accident risk are not due to age per se, but due to age-related impairment ina minority of elderly drivers. Mdentifying these dr-vers is obviously an important issue. Ifel- derly drivers are at greater riskofan accident, and we lackas yetany reliable test todifferentiate the safe divers from the dangerousones, can we rely on selfeg- ulation? As we have seen, many elderly drivers appear to have some insight into theie difficulties and try to restrict their driving to conditions with which they feel they can cope. However, there is at least one group of elderly drivers for whom this may not always be true—those in the early stages of dementia. Al- though some studies suggest that most elderly people are willing to give up driv- ing once diagnosed with dementia te, Foley, Masaki, Ross, & White, 2000), there is evidence to suggest that many will continue to drive, despite diagnosis, license revocation, and family pressure. For example, O'Neill, Neubauer, Boyle, Gerrard, Surmon, and Wilcock (1992) found that nearly 20% of 329 patients with dementia attending a memory linic persisted in driving after the onset of dementia, even though in most cases their driving was impaired. Other studies estimate that as many as 30 to 45% cf people diagnosed with dementia continue to drive (e.g, Carr, Jackson, & Algsite, 1990; Logsdon, Teri, & Larson, 1992 Lucas-Blaustein, Filipp, Dungan, & Tune, 1988). ‘One approach to identifying at-isk elderly drivers has been to compile a list ofillnesses and drugs that would make an older driver unsafe. The problem with this is that an individual driver may be suffering from a number of medical con- ditions and drug treatments, each of which individually may not cause them too ‘many problems, but in interaction make driving difficult. Another approach as, been coadministera test of mental competence: the most widely used of these is the "Mini Mental Status Examinaton (MMSE)" devised by Folstein, Folstein, and McHugh (1975). Although periormance on this test correlates with driving performance, retrospective studies have found virtually no difference between dementia patient groups that were crash free and groups that have been in- volved in at leastone crash (Lucas-Blaustein et al, 1988; O'Neill etal, 1992) 170% _ charters a ee nz rSEIE/esEEEIIESSEPESISUSESPESIESSOUEET Dobls, Heller and Schopflocher (1998) devised a driving test that was in tended to emphasize the driving maneuvers that have been reported to be espe- cially troublesome for older drivers, such as turns, lane changes, and merging with other traffic. Dobbs and colleagues were concerned to tty to identify driv {ngimpairment due to cognitive decline, as opposed to poor performance due to the bad habits picked up 2 experienced drivers. They therefore tested three groups of drivers: young, “normal” drivers (30 to 40 years of age), “normal” el- derly drivers (ages 65 and over), and a group of similarly aged elderly drivers who had been referred to the Clinical Driving Consult of the Northern Alberta Regional Geriattic Program. The latter were mostly probably suffering from the early stages of Alzheimer’sdisease. Sixty-eight percent ofthe demented drivers, 25% of the “normal” elderly drivers and only 3% of the younger “normal” rivers failed the test. Dobbs also looked in more depth at the kinds of errors made by each group. ‘This revealed chat the derrented group made many more hazardous etrors than did the other two groups, who in tum did not differ from each other. Fifty per- cent of the hazardous errors were made while changing lanes, merging with other trafic or approaching intersections. Twenty-one percent of hazarchous et- rors occurred during left turns, and 15% involved failing to stop at an intersec- tion. The remaining errors occurred in right turns (6%) and in stopping maneuvers (8%). The demented drivers also differed from the other two groups {in the number of tum positioning errors, minor positioning errors, and the extent to which they were over-cautious Overall, the data suggest that the decline in driving performance due to age per se is relatively small; in contrast, the impairment of eldetly drivers in the early stages of dementia is considerable. The results of Dobbs' formal testing of driving performance are in ine with a numberof retrospective studies that have shown that dementia sufferers are very much at risk of an accident (Cooper, Tallman, Tuokko, & Beatte, 1993; Friedland et al, 1988; Gilley et al., 1991; Lucas-Blaustein, Filipp, Dungan, & Tune, 1988; Stutts, Stewart, & Martell, 1998), Ball, Owlsey, Stalvey, Roenker, Sloane, and Graves (1998) examined in some detail the issue of self-regulation among older drivers. A. group of 257 active olderdriversaged 55 or above (average age 70) were given various tests of visual and cognitive performance including Ball's own Useful Field of View (UFOV) test and the Mattis Organic Mental Status Syndrome Examination (MOMSSE), a battery of tests specifically designed to assess the elderly'scogni- tive performance. They also completed a questionnaire on driving habits that focused on how frequently :hey avoided challenging driving situations. In line with previous studies Ball and colleagues found that many older drivers avoid IEERFECTSOFAGE BECP PR Sec ee eeeeC eee eee et exposing themselves to driving situations that they generally believe are more difficult (e.g, rain, night, heavy traffic, rush hour). Older drivers with visual and/or attentional impairments reported more avoidance than those free of im- pairments. Those with che most impairment reported avoiding moze types of situations than other less impaired ornonimpaired drivers. Older drivers with a history of at-faule crashes in the prev.ous 5 years (as determined from state re cords) reported more avoidance than those who had crash-free records. It should be noted, however, that almost all of the correlations between visual measures and measures obtained from the driving questionnaire ace very low, even ifthey are often statistically sign ficant. Thisisall the more worrying, given that over 100 separate correlations ate reported in this study: purely by chance, 5 in 100 of these would be expected to appear statistically significant anyway, at the significance level chosen by the experimenters. Marottoli and Richardson (1998) provide some data that point to the oppo- site conclusion—at least some elderly drivers may lack an accurate perception of their own abilities. Marottoli and Richardson investigated the relationship between driving performance and se f-ratings of confidence and driving ability ina group of 125 diiveis age 77 and above, For moot of the drivers, driving per formance was measured in terms oftheir accident and violation history for the previous 5 years; forsome of the drivers, an on-road driving test was also carried cout. In terms of their self ratings of driving abiliy, none of the drivers rated themselves as being worse than other drivers of their own age. Forty-four per- cent rated themselves as being “a little bit better than” other drivers, 32% rated themselves as being “the same as," end 24% rated themselves as being “much better than” other drivers of their age. In fact, there was 0 relationship be- tween self-rated driving ability and nistory of accidents and violations. Of the 50 drivers who had a history of accifents or violations, 68% (34) rated them- selves as being better than or much better than other drivers of their own ‘ge—a proportion identical to participants who had no such history. Similarly, among those who participated in the driving test, self-rating of driving perfor- ‘mance was not associated with driving performance. Furthermore, nine indi- viduals who were independently rated as having moderate or severe difficulties on the test rated their awn driving ability as being atleast as good as that oftheir peers. Three of them rated their abil ty as being better or much better chan their peers. Self-ratings of confidence were not associated with either a history of accidents of violations, or on-road driving performance. Marottoli and Richardson conclude that confidence in one’s own driving abil- ity and selératings of driving ability, are related to each other and to driving fre- quency, but not to objective measuresof driving performance in termsofadriving testor the person's history of accidents and violations. "Despite the fact that 40% m_% _cwrrers of the cohort reported a history of adverse events, and 27% of those participating in the driving performancesub-study were rated by the driving therapist asexhib- iting moderate or major difficulties, all drivers rated themselves as being average twabove average drivers Similarly, drivers were confident irespective of on-road performance and/or event history. Thus, objective evidence of driving ability (performance or event history) did not appear to impact on a driver's confidence or self-rating of abilities among this sample of older persons” (p. 334) Beginning with Svenson (1981), numerous researchers have shown that younger drivers over-estimate their driving skills relative to their peers. Itseems that this bias persists large y unchanged into late adulthood, and is resistant to being changed by experiences that should provide the elderly river witha more aceurate impression of his ar her abilities (Groeger & Brown, 1989; Holland S. Rabbitt, 1993; McCormick, Walkey, & Green, 1986) CONCLUSION Although it has frequentlv been asserted that older drivers as a group are at greater risk ofan accident than younger diiveis, tte auitude of the “problem” of older drivers may have been overstated (Hakamies-Blomavist, Johansson, & Lundberg, 2002). There de seem to be age-related changes in the types of acci- dents in which drivers are involved, with older drivers being more likely to col- lide with other road-users a junctions. However, the precise nature of the older driver's problems remains ancertain, Although eyesight does tend to deterio- rate with age, it seems clear that visual impairment per se does not seem to be the main factor in the eldetly driver’ increased accident risk. The correlations between eyesight measures and accident rates are very weak, whether one ex- amines them in the wider population of drivers or confines one's attention to the elderly. Although there have been experimental demonstrations of cogni- tive slowing in the elderly, these are small in absolute terms, and they may be rel- atively insignificant in evervday life. Also the observed effects might arise partly because old people are less familiar with performing formal experiments than the young undergraduates «0 whom they are often compared. Mostimportane, itis byno means clear that impairmentis an inevitable conse- ‘quence of aging: the problems associated with aging may often be more accurately conceptualized as being prcblems associated with the il-health that frequently accompanies aging, There is some evidence that dementia and impaired visual fields (due to eye pathology ot stroke) inerease the risk of an accident, but iis clear that many elderly drivers remain competent and safe. One certainly cannot judge the quality ofa person's driving merely by knowing their age. Asin other ar- eas of research, conclusions that are made about the performance of a group are THEEFFECTSOFAGE 173 generalizations that seldom apply to

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