Older drivers have been shown to have a higher incidence of crashes per mile driven than all but the youngest drivers, and these crashes are asspciated with greater morbidity and mortality. However, cessation or restriction of driving for many elderly individuals represents not only a major loss of independence but is associated with substantial decline in activity levels and increase in depressive symptoms. Thus, interventions that can decrease the risk for adverse driving events and postpone or prevent loss of independence related to driving would contribute to the public health and quality of life for many older Americans. The proposed study is a randomized controled trial of the effectiveness of a cognitive intervention with older drivers in improving visual attention and spatial cognition, factors shown to be related to increased risk for crashes/moving violations. The primary hypothesis is that the cognitive intervention will improve visual attention and spatial cognition. Secondary hypotheses are that (a) the intervention will improve driving performance, (b) improvements in driving performance will be mediated by changes in visual attention and spatial cognition, and (c) the magnitude of the treatment effect will be moderated by participant-based characteristics, including sociodemographic (education), psychological (driving confidence), and treatment adherence variables. To test these hypotheses, 142 eligible consenting persons 65 years of age or older who meet screening criteria for """"""""driving risk,"""""""" defined by visual attention/spatial cognition impairments, will undergo baseline assessment of cognitive function and on-road driving performance, and be randomly assigned to a treatment or a control group. Participants will then engage in an 8 week (2 sessions per week) multicontext cognitive intervention involving (a) training on computerized tasks, (b) education in didactic sessions, and (c) participation in home-based assignments. The treatment group will receive training and didactics that are targeted at visual attention and spatial cognition, whereas the control group will receive training and didactics that are targeted at general health areas unrelated to driving ability. Participants will undergo post-intervention re-evaluation of cognitive function and on-road driving performance. Outcomes will be assessed by research staff not involved in theintervention, and blinded to group assignment. ANCOVAs will be conducted to compare the post-treatment performances of the two groups, controlling for pretreatment performances. The study was designed to ensure adequate power (greater than or equal to 80 percent) to detect a medium effect size of treatment. The proposed study represents a critical step in determining whether clinically meaningful changes in driving risk can be accomplished through improvements in function. The long-term goal is to develop a multifactorial intervention program that targets several domains of function, including cognition, physical function, and vision, for the purpose of reducing driving risk and promoting independence in older drivers.
Showing the most recent 10 out of 86 publications
