Abstract
OBJECTIVES: We test the hypothesis that clinical measures of age-related cognitive, visual, and mobility impairments negatively impact older driver speed limit compliance to advance method developments that improve older patient care and screen, identify, and advise at-risk older drivers. DESIGN: Real-world driver behaviors of older adults who had a range of cognitive, visual, and mobility abilities (measured with standardized, clinical tests) were assessed in environmental context (e.g., speed limit, traffic density, roadway type). Older driver speed limit compliance was measured in constant speed limit zones and at transition zones, where speed limits changed. SETTING: A naturalistic driving study of older adults living around Omaha, Nebraska. PARTICIPANTS: Seventy-seven, legally licensed, active, and typically aging older drivers (65-90 years) who had a range of cognitive and visual abilities. MEASUREMENTS: Drivers typical, daily driving was continuously monitored for 3 months using sensor instrumentation installed in their own vehicles. At study start, each participant completed a comprehensive, standardized, clinical assessment of cognitive, visual, and mobility abilities relevant to aging and driving. RESULTS: Older drivers with greater cognitive impairment (P = .10) drove slower than drivers with less cognitive impairment, linking cognitive impairment to speed control. Drivers with greater visual impairment overall complied less with speed limit changes at transition zones (P = .01) and were more likely to comply with speed limit transitions when they occurred concurrently with changes in roadway features (P < .01). CONCLUSION: Results link clinical measures of age-related cognitive and visual impairment to impaired driver safety in real-world contexts. Real-world sensor data coupled with detailed, personalized older driver profiles can inform patients, caregivers, interventions, policy, and the design of supportive in-vehicle technology for at-risk older drivers.