Abstract
BackgroundDecision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult’s health and well-being. Decision aids can enhance the decision-making process by increasing knowledge of the risks and benefits of driving cessation and improve decision quality. The impact of decision aids regarding driving cessation for older adults is unknown.MethodsThe Advancing Understanding of Transportation Options (AUTO) study is a multi-site, two-armed randomized controlled trial that will test the impact of a decision aid on older adults’ decisions about changes in driving behaviors and cessation. AUTO will enroll 300 drivers age ≥ 70 years with a study partner (identified by each driver); the dyads will be randomized into two groups (n = 150/group). The decision aid group will view the web-based decision aid created by Healthwise at baseline and the control group will review information about driving that does not include evidence-based elements on risks and benefits and values clarification about driving decisions. The AUTO trial will compare the effect of the decision aid, versus control, on a) immediate decision quality (measured by the Decisional Conflict Scale; primary outcome); b) longitudinal psychosocial outcomes at 12 and 24 months (secondary outcomes); and c) longitudinal driving behaviors (including reduction or cessation) at 12 and 24 months (secondary outcomes). Planned stratified analyses will examine the effects in subgroups defined by cognitive function, decisional capacity, and readiness to stop driving.DiscussionThe AUTO study is the first large-scale randomized trial of a driving decision aid for older adults. Results from this study will directly inform clinical practice about how best to support older adults in decision-making about driving.Trial registrationClinicalTrials.gov: NCT04141891. Registered on October 28, 2019. Located at https://clinicaltrials.gov/ct2/show/NCT04141891
Highlights
Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence
Fatal crash rates among older drivers increase after age 75 (Cicchino 2015); generally older drivers pose a greater risk to themselves than to the community around them (Braver and Trempel 2004; Tefft 2008)
AUTO study design The Advancing Understanding of Transportation Options (AUTO) study is a randomized, controlled trial being conducted with older primary care patients in three US states that seeks to assess the effects of the Healthwise decision aid among older adults and a study partner (SP)
Summary
Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. The risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult’s health and well-being. Driving is linked to individual well-being and driving cessation can negatively impact older adults independence and mental health (Chihuri et al 2016; Edwards et al 2009; Foley et al 2002; Harmon et al 2018). Identifying ways to support older drivers to stay on the road safely and maintain independence and community involvement is a national priority (Classen et al 2007; NHTSA 2010; NHTSA 1999). Estimation of an individual driver’s risk remains difficult, as on-road testing is costly and not always available (Betz et al 2014) and office-based assessments are impractical (Betz et al 2015) and not routine (Betz et al 2016a)
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