DRIVING SAFE IN YOUR SEVENTIES AND OVER

Driving at the age of seventy and over: challenge or right, skill or hazard? Older persons driving around all over the world are continuously increasing: an important target for industrial marketing, politics and economy. Moving around completely free using your vehicle is a cornerstone for self-confidence and empowerment of older persons. But is really there an “age factor” affecting safety on the road? And how can older driver’s behavior be different from the younger population?

Our study is aimed to answer these questions by analysing old age-linked road accident epidemiological data of the last ten years in Cuneo Province that boasts the sad record of the highest number of fatal road accidents in Italy. 

Very complete and detailed databases were provided by Motorway Police of  the Cuneo Province and Club UNESCO Cuneo and compared with national (ACI-Istat) and international (Red Cross/Crescent) databases. 

Then we asked for advise a qualified multidisciplinary panel of experts in order to settle some comprehensive guidelines about driving safe in old age: public administrators, medical doctors practicing different disciplines (including Forensic Medicine), town-planners, car-designers, psychologists, sociologists etc.

The main subjects treated are the following:

  1. The real over seventy people’s ability to drive, how we can actually evaluate their skills and come up to their expectations, how highway code should be modified to be more respectful of older people’s rights and all the citizens’ safety.
  2. Car-design and ability-design experimental studies and projects, the state of the art of car industry in Turin etc.
  3. How to make our towns and our roads more “older driver-friendly” in a more age-concerned environment as a whole: accessibility and safety-oriented town-planning projects, “intelligent” roads able to interact with vehicles, check their directions, give information and warning messages to the driver etc.
  4. Longlife learning” to promote older persons’ ability to drive, a new mind and a new awareness about driving performance self-evaluation.

The results of our study show that older people  are mostly “weak” road users and when their behavior is dangerous, it is dangerous for themselves far more than for other people. They are not “road killers” crashing into other vehicles or running over other persons, at least in this region of Italy …The present study also shows the need of new medical, forensic medicine and driving performance evaluation guidelines, a higher attention by car-designers to new technological solutions and “intelligent roads”, a wider use of driving rehabilitation training and continuous driving performance evaluation and self-evaluation to ensure both older persons empowerment and road safety.

Key Words:  road accidents; aged drivers; safe driving; elderly empowerment

 

PURPOSE OF THE STUDY

Road accidents are a huge problem in terms of dead/injured people, disability and social costs. In 2008, 1.3 million persons dead in road accidents (about 3,000 every day) and 50 millions were injured! [International Red Cross/Red Crescent, 2009].

At the same time older persons driving around all over the world are continuously increasing, especially in technologically developed countries. By the year 2030, 20% of drivers will be aged 65 or older — some 30 millions in USA only! [US Census Bureau, 2008] – an important target for industrial marketing, politics and economy.

Moving around completely free using your own vehicle is a cornerstone of self-confidence and empowerment of older persons. But vehicles are supposed to be designed and accessory-equipped for an easy and safe drive even when dealing with persons late in their years. On the other hand, also urban environment and roadway system conditions should be modified  to make driving easier and safer for older persons.

Our study is aimed to understand how and how much older drivers are involved in road accidents in Cuneo Province, the most fatal accident-prone region in Italy, and to submit our findings to a multidisciplinary panel of experts in order to settle some comprehensive guidelines on driving safe in your seventies and over.

This will be the first step to experiment new technological solutions in viability and car design: isn’t Turin the capital of Italian car industry? But above all to promote older driver’s awareness about safety and driving skill self-evaluation as well as about their own empowerment and independence.

 

APPROACH AND METHODOLOGY

  1. Epidemiological study

We analyzed a selection of very detailed and complete databases about last ten years road accidents in Cuneo Province that boasts the sad record of road fatal accidents in Italy:

    • Motorway Police of Cuneo Province
    • Club UNESCO Cuneo
    • Provincial Committee on Road Safety of Cuneo
    • Department of Prevention – Agency of Cuneo – N.H.S.
    • We studied 70 years or over drivers/pedestrians’ epidemiological data about:
    • Age and gender
    • Number of accidents
    • Number of fatal accidents
    • Features of accidents (time, day of the week, season, vehicle, dynamics etc)

For all the variables we compared older and younger people’s risks and behaviors in road accidents.

Data from Cuneo Province have been also compared with:

  • National database (ACI-Istat annual report: the latest issue — 2008)
  • Wold database (International Red Cross/Red Crescent: latest report – 2008 — and UN Ministerial World Conference on Road Safety, Moscow 19 and 20 November 2009).

 

  1. Experts’ comment and advice

The whole epidemiological information and analysis have been submitted to a panel of experts listed below:

Geriatrics physician — Neurologist  — Cardiologist — Ophthalmologist  — Ear Nose and Throat Specialist — Physiatrist-Rehabilitation Specialist — Forensic Medicine Specialist — Car designer )

Car designer and producers — Motorway Police — Car Insurance brokers — Local political/administrative authorities — Older citizens advocacy associations.

We asked all the experts their suggestion about new solutions and new research frontiers, but also about practical guidelines to ensure both independence for older drivers and safety for all the people on the road.

 

EPIDEMIOLOGICAL RESULTS AND DISCUSSION

In the last ten years (1/1/200031/12/2009), the Cuneo Province showed the highest mortality rate due to road accidents: 2.7% (33.687 accidents and 923 deaths) [Motorway Police – Cuneo Province – database], versus an average national rate of 2.2% (218,963 accidents and 4,731 deaths) [ACI-Istat report 2008].

This sad Cuneo Province’s record holds out although the number of fatal crashes has decreased, in Cuneo Province, faster than Italian average rate, even beyond the EU target of 50% of the fatalities registered in 2000 by the year 2009 (see Fig. 1).

But what is the role of “age factor” in road accidents and how does it affect their consequences?

To ask this question we selected a randomized sample of 7,913 accidents (165 happened to result fatal) from the Motorway Police – Cuneo Province database 20002009. In 611 cases drivers/pedestrians were 70 years old or over (only 7.7%), whereas the whole population in this class of age is 16% (93,155 out of 573,613 inhabitants) [31/12/2006 census]. As showed in Fig. 2, in Cuneo Province, the most accident-prone age (mode) is 22 for both genders, while for age 70 or over the gap between number of inhabitants and number of accidents becomes progressively wider. See moreover the great difference between men and women that persists even in the oldest age.

 

Fig.1: the decrease of fatal accidents in Cuneo Province in the last ten years has been greater than the expected EU target of 50% by the year 2010, whereas the average decrease in Italy has been only 33% in 2008 (less than the expected EU target).

 

Fig. 2: Age class distribution of Cuneo Province population and total road accidents for both genders. The mode (pick) of accidents for men and women is 22 whreas for older people (70 years or over) the gap between accidents and inhabitants is wider, especially for women.

 

Older drivers/pedestrians cause, as a whole, less road accidents than younger people, as confirmed by the main statements of recent scientific literature that disagrees about the old concept of “U-shaped curve” you could obtain if you correct the number of accidents for the smaller amount of miles per year spent driving by older people, because of the important biases that this kind of correction implies [Julien.2008]. But if accidents caused by older persons are les frequent than those caused by younger persons, the fatality rate of people involved is higher: 4.1% if the driver is aged 70 and over versus 2.1% for rivers under 70, maybe just because accidents with an older driver involve a higher average total number of older persons as drivers, passengers or pedestrians. And older people show a worse prognosis after a trauma …

We also studied another randomized sample of 266 fatal road accidents from the Club UNESCO Cuneo database: 663 persons involved and 282 deaths (40%). Taking into account only people aged 70 or over,  the persons involved were 79 and the deaths 63 (80%): this result confirms a higher mortality of older people in some way involved.

Eventually we studied in details a randomized sample of 100 fatal accidents with driver/pedestrian aged 70 or over, from the Club UNESCO Cuneo database, in order to find out specific behaviors or features linked to an older age. Among the tested variables, the following showed an interesting correlation with an age of 70 or over:

Gender78% men and 22% women; for our older generations, driving a vehicle is still “a man job”. From this point  of view, we agree with other Authors describing the important biases that a gender comparison entails: women usually drive less miles, are more often involved in accidents as passengers etc. [Julien.2008]

Time – the top is between 6 and 8 PM; smaller peaks around 910 and 1112 AM; these findings show a “family-oriented” attitude of older drivers (to carry grand-children to school or to practice sports and other leisure activities, to go shopping in the afternoon etc).

Season – the top is around Christmas (December-January) with another smaller peak in May, confirming the “family-oriented” use of vehicles by older people whereas for younger drivers the highest peaks are in July, Fridays and week ends.

Vehicle _ car in 42 cases, pedestrians in 25, bicycle in 22, motor-bike in 5, truck or farm tractor in 5 and motor-wheelchair in one. These results show that older persons are very often “weak” road users (pedestrians, bicycle or wheelchair) more than reckless drivers.

Dynamics – tackling crossroads or insertions, pulling out or up in 43 cases, overtaking or changing lane in 13, bumping into in 7, getting run over in 36 and running over other persons only in 1. These findings are coherent with the up to date literature [Levin 2009] and confirm that older people  are mostly “weak” road users and, if their behavior is dangerous, it is dangerous for themselves far more than for other people. They are not “road killers” crashing into other vehicles or running over other persons, at least in this region of Italy …

 

EXPERTS ADVISE

 

  1. 1.   The car insurance broker (Bruno Sillano. Turin)

I can boast a huge experience in examining dossiers of all kind of car crashes and I can say that older drivers/pedestrians show a non intended dangerous behavior a bit more frequently than younger persons, mostly because of sensorial and/or cognitive impairment. But usually their average number of driving hours or miles per year is far smaller and final per capita cost for insurance companies is a bit smaller and fares a bit lower (at least in Italy).

The table in Fig. 3 [ANIA – Associazione Nazionale tra le Imprese Assicuratrici – the Italian national insurance association. 2008] shows the total number of road accidents, for men and women, at different ages. On a national Italian scale, the total number of accidents peaks around 50 year, and not at 22 as in Cuneo Province (see Fig. 2), for both genders, but the trend toward a global reduction after 70 is confirmed.  The table also shows an interesting data about gender distribution of car accidents: whereas young women are far less prone to car crashes than men (only 50% at the age of 20), then they progressively reach the men’s rate around 40 and the risk remains the same thereafter.

 

Age classes

men

women

ratio

1417

0.1

0.1

0.53

1821

0.7

0.9

0.58

2225

2.0

2.7

0.65

2629

4.5

5.7

0.74

3033

7.4

8.9

0.77

3443

22.5

27.6

0.93

4455

27.6

30.3

1.05

5663

15.7

12.6

0.97

6471

10.9

7.0

1.05

72 and over

8.7

4.4

0.97

Total

100.0

100.0

0.96

Fig. 3 – Car crash risk/year % distribution for both genders and women/men ratio in Italy (2007) [ANIA.2009] _ The age classes are not uniform but the average value, inside every class, shows a peak around 45 years in both genders.

 

I examined for you in details a randomized sample of 350 cases of road accidents from the Assimoco database. In 12 cases only persons aged 70 or over were involved: 8 as drivers, one as passenger and 3 as run over pedestrians (actually all the three were crossing the street in a dangerous way…)

These findings stress again the low rate of accidents caused by older drivers but a very high risk for older pedestrians”.

 

  1. 2.   The Forensic Medicine doctor (Maria Francesca Vizzi MDNHS, Ag. TO1, Turin)

Italy is always amazing! Some times ago I discovered an ANIA survey concerning 350 older (60 or over) truck drivers: 30% were driving with some form of heavy visual impairment but without any awareness of their disability! Ordinary renewal of the driving license, in Italy as well as in other counties, is just a formal bureaucratic act, especially if dispatched by private agencies and not public health services. In some counties, like France for instance, the driving license is even granted once and forever without any further evaluation of driving ability.

On the contrary, I think that a thoroughly evaluation should be performed, by a public medical officer (or medical commission), not only in compulsory cases, but also in the following situations: older persons discharged after a hospital admission due to a disease possibly affecting driving ability (newly diagnosed diabetes, stroke, narcolepsy etc), or from a rehabilitation or nursing home; people aged 80 or over even in case of ordinary license renewal; all the citizens applying for disability or blindness pension etc.

The medical evaluation should be performed following well defined and universally accepted guidelines, continuously updated on a scientific base: for instance, visual ability evaluation should include not only sight sharpness but also visual field.

 

  1. 3.   The Geriatrics physician (Sergio Cabodi and Antonino Cotroneo Geriatric District of Turin)

A seventy year old person shouldn’t have any problem driving a car, but we have to remember that driving involves al the five senses, often affected by aging, even when everything is going smoothly …To help an older person’s sensorial ability we can modify the vehicle (display with adjustable light and bigger types, more prehensile drives etc.) and traffic signals (bigger and more visible types, horizontal phosphorescent signals, acoustic signals for traffic lights etc).

Of course we have to carefully and frequently evaluate their ability to drive. Very often older people suffer from chronic diseases, co-morbility and different degrees of disability that can heavily impair their mobility, sensorial and mental performances and psychological behavior. Often families can’t make grand-father give up driving, even using deception and menacing, in spite of a true Alzheimer disease.

What I could suggest is a more frequent evaluation of driving ability for older persons and a continuous educational effort in order to promote a hiher awareness of dangers they can produce and a new “self-evaluation culture” instead of the present  compulsory, formal and  often useless control system”.

 

  1. 4.   The Physiatrist (Tiziana Jacomussi MD. Maria Vittoria Hospital. Turin)

Analyzing older people’s driving ability from the strict point of view of the physical movement modifications due to age, we should always take into account two components: accessibility and driving. Both can be affected by morphological, anthropometric, joint mobility and muscular strength modifications produced by the aging process. For instance a hand prehensile ability and  movement coordination impairment can affect lock and door opening; main articulations and spine degenerative changes affect getting on and out a vehicle.

As far as driving is concerned, a stiff neck and a reduced shoulder range of motion (ROM), often with joint pain, can jeopardize or even prevent steering-wheel proper use, especially in emergency situations. An impaired neck mobility (cervical arthrosis) can affect head bending and rotation; together with a limitation of visual field (often found in older persons) this limitation can heavily compromise driving ability and safety.

A great effort must be pledged by designers to implement new technical solutions and auxiliary devices tailored to older/disabled persons with this kind of problems because their comfort and everybody’s safety can be extremely improved this way”.

 

  1. 5.   Other medical experts (see panel. Coordinator Ugo Marchisio MD)

Diseases mostly affecting driving ability in older persons are eyes diseases, stroke, diabetes, arthrosis  and cognitive impairment (Alzheimer disease etc.): widely found in older people and often together. Any single driver has to be evaluated specifically as the same diseases can create very different driving risks and disabilities, especially when older persons are taking drugs.

Even temperature and humidity can affect older persons’ driving performance.

Checking to verify if an older person and his/her vehicle fit well together is something as important as a medical checkup. Sometimes they can even need a training by a driver rehabilitation specialist who is also able to evaluate all the possible adaptive features for any kind of vehicle”.

 

  1. 6.   The Motorway Policewoman (Inspector Anna Drai. Cuneo Province)

Cuneo Province is very wide with a roadway network of over 3,500 Km (let alone freeways and main national roads). In the last five years we built more than 300 roundabouts and carried out a pervasive preventive and educational campaign on safe driving, together with widespread police controls on the road. So we achieved a more tan 50% reduction of fatalities in our Province between 2000 and 2009.

In order to secure a safe driving in your seventies and over you have to start educating young people and continue an all life long educational/preventive effort. For older people moreover is of paramount importance to offer ability tests (driving simulation) and behavioral counseling to promote their awareness about dangers and  a positive process of self-limitation”.

 

  1. 7.   The car designer (Giuseppe Varalda. Centro Ricerche Fiat. Turin)

 “How can a car manufacturer contribute to an effective, satisfying and safe mobility of the elderly? When engineers start designing a new car or an updating (restyling) of an already existing model, they always take into account, among other factors, the larger population of users, including the elderly driver. User population is rigorously taken into account by criteria, human models and rules, in the effort to satisfy the needs of the wider driver population. This gives rise to vehicles that, albeit not specifically identified as “for the elderly”, feature characteristics which are appreciated by this special group such as e.g. easy ingress – egress and long-sighted legible displays and indicators. By the way, these features are useful and appreciated also by the general population.

Another important resource comes from research and innovation, where in particular a growing number of assistance and information systems is designed and tested also with the elderly in mind (and in the user testing groups). The benefit of systems such as e.g. blind spot monitoring and T-junction aid systems to the elderly driver has been demonstrated in several international and in-house studies.

 

8.  The town planner (Fabrizio Astrua. Polytechnic of Turin)

All the town planners consider safety first when projecting, especially today that roads are overcrowded than ever and the number of older and disabled drivers is growing up.

The City of Turin has realized the PUT (Piano Urbanistico del Traffico –Traffic Town Plan); thanks to PUT a lot of roundabouts have been built as well as cycle tracks, pedestrian zones, limited traffic areas (ZTL), protected railways etc. To stimulate greater attention by citizens a lot of acoustic traffic lights have been installed as well as TV cameras and other road signals. Moreover town planners hope to be realized a modern system of traffic light synchronization, able to direct the traffic following its intensity, and a unified European road signal system.

 

9.  The elderly advocacy associations (Cesare Palenzona. Consiglio dei Seniores. Turin)

Driving a car means mobility and independence: two very important benefits for older persons. Driving in town is very different then on country roads: a lot of heavy accidents happen in town.

The Municipality of Turin hosts the Consiglio dei Seniores (Senior Council), about 300.000 aged people (from about 50 Elderly Associations) living in Turin area.

Senior Council is prepared to make a survey on “Driving safe in your seventies and over”, involving UGAF (Fiat retired persons association– member of Senior Council) with some 80,000 affiliates: a very suitable sample of older persons to be studied with driving simulator tests.

A continuous updating of older drivers ability through tests (especially self-tests) and medical check-up, could contribute to ameliorate safety and independence.

 

 

CONCLUSIONS

Older persons are not, as a whole, a major road danger: as drivers they are responsible for car crashes less often than younger people, even in Cuneo Province that boasts, in Italy, the sad record of the highest number of fatal road accidents. Probably an impaired sensorial and/or cognitive ability is counterbalanced by a reduced number of hours (or miles) spent driving so that the number of accidents caused per year is eventually smaller. As a matter of fact insurance companies, at least in Italy, offer lower fares to people aged 70 or over.

As far as gender is concerned, whereas the Italian national data show no risk difference for older people (from 50 year of age on), our study in the Cuneo Province shows a great gap (men > women) even at 70 and over, probably due to a very wide country roadway network, with a lot of little villages and only a few little towns.

On the other hand, accidents caused by older drivers/pedestrians show a higher fatality rate due to a worse dynamics: for instance a completely absent driver’s reaction facing a dangerous situation because of an impaired vision or a syncope.

Moreover older persons involved in road accidents (as drivers, passengers or pedestrians) show a higher risk of dying in major road accidents, mostly just because an advanced age and pre-existing co-pathologies make the prognosis of any kind of trauma worse. Accident risk and fatality rate rise tremendously when the older persons involved are “weak” road users (pedestrians, bicycle or wheelchair users), as they often happen to be.

Analysis of time, day of the week and season shows a “family-oriented” distribution of accidents for older drives/pedestrians, in Cuneo Province at least.

The analysis of dynamics  shows that older persons cause fatal accidents mostly when facing new or unexpected situations and that they are “weak” road users far more often then reckless drivers bumping into or running over other people. These results are explained by the well proved theory that older people, with a mild cognitive impairment or even with completely normal mental tests, show an impaired sustained, selective and divided attention. Procedural and working memory, mainly involved in driving ability, are also impaired so that executive function can be seriously jeopardized with a reduction of flexibility and inhibition, especially when facing double task and task switching.  No doubt cognitive impairment is also deeply connected with personality and personality changes due to aging (locus of control, coping strategies etc): a matter that still deserves more attention and further investigation [Julien.2008].

The panel of experts we sought for advise gave us a lot of precious pieces of suggestion you can see in the “discussion” chapter above.

It is of paramount importance to face this issue by putting together all the competences needed for a 360° effort to promote both older persons ‘ empowerment and everybody’s safety on the road. Control by Motorway Police and elderly advocacy, technological design and car industry, public health and roadway system should be absolutely brought up to date together.

The right question is not “Why older drivers are at higher risk of road accidents?”, that is not true (or at least not proved) and politically incorrect, but “Which older drivers are more at risk than others?” [Julien.2008].

For this reason Ce.R.R.Co. is going to organize a great congress in Turin , next year, and to invite Regional Authorities , car firms, technology researchers from the Polytechnic of Turin, medical, Psychology and Sociology experts, insurance brokers and elderly advocacy associations.

Ce.R.R.Co. will also produce a practical handbook to help older persons and caregivers to optimize comfort and safety when driving around in your seventies and over: education and long-life learning remain the cornerstones of older people empowerment.

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