Americans are concerned about highway traffic safety and what
to do about older people who no longer drive safely. In response
to this concern, the Traffic Safety Plan For Older Persons
was established by the National Highway Traffic Safety
Administration (NHTSA) in 1993 to identify the nature of safety
problems experienced by older persons and develop actionable
solutions to these problems.

Unless there is compelling evidence to the contrary, older
adults should be encouraged to maintain their lifestyle and
activities, including driving. However, we can expect that if a
person lives long enough, at some point, agerelated changes
and declines in health and functional ability may alter the
performance of critical skills needed for driving,

NHTSA has proposed that individuals who have an opportunity to
routinely observe the driving behavior of functionally impaired
drivers may provide referrals for selective review by driver
licensing agencies. This may be preferable to periodic screening
of all older drivers. Individuals in this position include family
members and friends who are frequently concerned about the
driving safety of older individuals.

Project
Objectives

To provide families, friends, healthcare providers, law
enforcement personnel, and community and social services with
information to assist older adults whose capabilities make them
potentially unsafe to drive, NHTSA contracted with Creative
Action Inc., the Beverly Foundation, and the National Mobility
Institute to conduct a series of research tasks.

(1) Review literature and public information materials on
family and friends' involvement with the driving decisions of
older adults.

(2) Identify current state and provincial requirements and
practices regarding identification of high risk older
drivers.

(3) Determine information resource needs among
professionals.

(4) Conduct a series of focus groups to determine the
feasibility of involving family and friends in identifying
and helping atrisk older drivers limit or stop unsafe
driving.

(6) Develop guidelines and materials on what concerned
families need to do to help atrisk older drivers.

Method

All research tasks were conducted with input from a panel of
experts in a wide range of professions related to older driver
issues. The literature review took a broadbased approach
and included related topics of intergenerational linkages,
caregiving, and issues of changing problem behaviors. A mail
survey with telephone followup was carried out with 7
participating states to identify current state regulations and
practices. Professionals attending professional conferences were
asked what resources they need to work with older drivers and
their families. Six focus groups with 50 participants were
conducted among concerned family members, friends and
professionals in St. Louis, MO and Akron, OH. Many basic
questions were answered by this research. Key issues related to
intervention by family and friends have been identified.
Additional quantitative research is needed to develop definitive
guidelines and materials.

Significant
Results

Older drivers most atrisk of engaging in unsafe driving
behavior are males with certain medical conditions, especially
dementia or declining vision, who are not aware of or do not
recognize their disabilities, and who have little contact with
family members or friends. The independence driving provides is
more important to older men than older women who are more willing
to modify or stop driving. Family members and friends most likely
to intervene to help the problem older driver modify or stop
driving are those with strongest concern and caring for the older
driver -- generally the same people who are likely to become
caregivers or decisionmakers for caregiving. Those who
intervene are most likely to be a spouse, or an adult child of an
older driver. Families' ability to function effectively
influences their ability to intervene.

Many family members are able to recognize unsafe driving among
older relatives and think of impairment in functional, rather
than diagnostic terms. They characterize unsafe driving practices
as forgetfulness, confusion, bad judgment, failure to follow the
rules of the road, inability of drivers to see where they are
going, and aggressive driving. Family and friends indicate signs
of unsafe driving situations: crashes, new dents and dings on the
older driver's car, neighbors, friends, police, others calling
family members about the driving problem, and the family members'
observing unsafe driving firsthand.

Some family members try to intervene on their own, often
through persuasion, removing car keys, making the car
impossible to start, or removing the car altogether. Only a few
have the support of the police, the DMV, or a physician. Most
would like the support of these authority figures. At the same
time, professionals who responded to the survey say they want
more information and materials to help them in this supportive
role.

Barriers to intervention include social and cultural norms
that favor individual independence over public safety; national
policies, state regulations and practices including those related
to reporting problem older drivers; lack of support from
authority figures; lack of public education and information about
public health risks; lack of customerfocused alternative
transportation services; and an inability or unwillingness to
recognize the problem and change to driving safely.

Potential
Applications

Families, friends, and professionals in focus group
discussions, and expert panelists recommend a common set of
solutions to involve family members and friends: a social
marketing campaign with materials that indicate signs of unsafe
driving, its consequences, and specific examples of intervention;
federal and state policies and regulations mandating reporting
and retesting; development of functionally appropriate tests with
cutoff scores to identify atrisk drivers of any age;
regional driving assessment clinics; classes to improve driving
skills; establishing insurance providers as gatekeepers; creating
linkages with DMV's and insurance providers; developing
customerfocused alternative transportation; establishing a
more prominent role for authority figures; and providing
transportation planning and counseling at the local level. This
set of solutions should be broadly targeted to the general
public, professionals, and responsible authorities.

Research results indicate use of a 4part model for application in additional
research and development of coordinated intervention programming. Features include:
identification of high risk functional disabilities of the problem older driver;
characterization of families who are likely to intervene; formal community supports;
and informal social networks, within the social and cultural environment.

ACKNOWLEDGMENTS

The authors wish to thank the following individuals for their expertise and
contributions to the text, suggestions for interventions, and thoughtful comments
in the completion of this report:

Other professionals who served on the expert panel and provided detailed,
written commentsLinda Mauger, Kent Milton, Skip Nielsen, Andy Nelson,
and Pete Nunnenkamp. Other professionals who served on the expert panel and
provided verbal commentsArlene Berger and Bonnie Dobbs.