Objectives
To design a low-cost simulator-based driving assessment for older adults and to compare its validity with that of an on-road driving assessment and other measures of older driver risk.
Design
Cross-sectional observational study.
Setting
Canberra, Australia.
Participants
Older adult drivers (N = 47; aged 65–88, mean age 75.2).
Measurements
Error rate on a simulated drive with environment and scoring procedure matched to those of an on-road test. Other measures included participant age, simulator sickness severity, neuropsychological measures, and driver screening measures. Outcome variables included occupational therapist (OT)-rated on-road errors, on-road safety rating, and safety category.
Results
Participants’ error rate on the simulated drive was significantly correlated with their OT-rated driving safety (correlation coefficient (r) = −0.398, P = .006), even after adjustment for age and simulator sickness (P = .009). The simulator error rate was a significant predictor of categorization as unsafe on the road (P = .02, sensitivity 69.2%, specificity 100%), with 13 (27%) drivers assessed as unsafe. Simulator error was also associated with other older driver safety screening measures such as useful field of view (r = 0.341, P = .02), DriveSafe (r = −0.455, P < .01), and visual motion sensitivity (r = 0.368, P = .01) but was not associated with memory (delayed word recall) or global cognition (Mini-Mental State Examination). Drivers made twice as many errors on the simulated assessment as during the on-road assessment (P < .001), with significant differences in the rate and type of errors between the two mediums.
Conclusion
A low-cost simulator-based assessment is valid as a screening instrument for identifying at-risk older drivers but not as an alternative to on-road evaluation when accurate data on competence or pattern of impairment is required for licensing decisions and training programs.
from Journal of the American Geriatrics Society http://ift.tt/2eu9nWK
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