Preface: Driving and the Promotion of Safe Mobility in Older Populations

Abstract

IN the present issue of the Journal, we present a fine article by Richard Marottoli and colleagues reporting the results of a randomized trial of a multicomponent education program to improve driving knowledge and performance of older at-risk drivers, together with an excellent guest editorial by William Satariano. As noted by both, safe driving is an ascendant public policy issue in an aging society built around automobiles. Professor Satariano mentions several ways in which safe driving might be achieved. The public—and public policy— are likely to understand ‘‘save driving’’ in terms of agespecific crash rates and widely-reported, egregious incidents involving older drivers, rather than the more esoteric terms of crashes per miles driven. Interventions affecting safe driving fall into two categories: those that result in curtailment in driving in the at-risk (either self-initiated or via the kinds of state actions Satariano describes, the effect of which may reduce the opportunity for crashes), and those that improve the driving performance of the at-risk older drivers. Marottoli’s educational program is of the latter sort. This well-designed trial demonstrated significant results at 8 weeks, specifically, improved road-test performance and improved knowledge test scores. Based on unpublished data from a prior study, he estimates that the observed improvement would translate into a 9.5% decrease in crash risk, surely an important reduction if true and sustained. A problem for programs attempting to improve safe driving of older drivers through knowledge, skills, and performance enhancements is the fact that they may, over time, encourage older drivers to drive more frequently, longer distances, or longer before quitting or reducing the activity. The extent, then, to which performance enhancement impacts crash rates per driver age-group per time-unit seems to be an open question, as suggested by Marottoli’s review of the sparse literature. Ultimately, there will be a special burden on programs aiming to improve driving skills of at-risk older drivers to demonstrate not only proximal knowledge and road-test gains, but effects of training on driving frequency, behavior, and crashes ‘‘down the road.’’ There is an interesting parallel between this kind of intervention and physical activity and related programs targeted to older people at risk of falls, which result not in fewer falls but more walking. The special problem of driving is that the consequences of crashes impact not only on the older driver, but on other drivers, passengers, and pedestrians. We encourage readers to write the Journal offering comments on this and related research, and suggestions concerning next steps.