Abstract
BACKGROUND: Decisions about driving cessation can be stressful for older adults. We tested effects of a driving decision aid (DDA) on psychosocial outcomes among older drivers during two-year follow-up. METHODS: Multisite randomized controlled trial of licensed drivers ages ≥70 with at least one diagnosis associated with increased likelihood of driving cessation, without significant cognitive impairment. The intervention was the online Healthwise® DDA, addressing "Is it time to stop driving?"; controls received National Institute on Aging web-based information for older drivers. Outcomes were assessed at baseline, 6, 12, 18, and 24 months. Primary outcomes were the Decision Regret Scale, Decisional Conflict Scale (assessing decisional ambivalence or uncertainty), and PROMIS Depression (4a) Scale. Self-reported Life-Space Assessment (assessing community mobility), crashes and driving outcomes were also assessed. Using intention-to-treat analyses, we tested whether DDA (vs. control) effects on each outcome differed during follow-up using a study group by time interaction. Longitudinal outcomes were modeled using generalized linear mixed models, accounting for repeated measures, age, site, and baseline visit before vs. during COVID. RESULTS: We enrolled 301 participants (age at enrollment: mean 77.1 (range 70-92) years; 51% identifying as female). During follow-up, the DDA group had less decisional conflict (p(interaction) = 0.010) and decision regret (p(interaction) = 0.012). The DDA had its greatest effect on decisional conflict immediately post-intervention (adjusted mean ratio [aMR] = 0.87; 95%CI: 0.79, 0.97) and on decision regret at 12-month follow-up (aMR = 0.45; 95%CI: 0.27, 0.72). Odds of depression were similar between groups during follow-up (p(interaction) = 0.237). The intervention did not negatively affect life space, crashes, or other driving outcomes. CONCLUSIONS: In older drivers, the Healthwise® DDA reduced uncertainty and regret about driving decisions during longitudinal follow-up, without adversely affecting community mobility or crash risk. Use of DDAs in clinical and other settings may reduce the distress older adults often experience when making decisions about driving cessation.