The number of older drivers is increasing. Mileage-adjusted crash rates, as well as the risk of injury and death following a crash, are higher for older drivers. However, older persons rely on the automobile for transportation. Limiting or stopping driving can adversely affect independence and mobility, and result in decreased activity levels and increased depressive symptoms. Consequently, identifying factors associated with driving difficulties and developing interventions to correct or compensate for these may enhance safety, independence, and mobility. The primary aims of the study are to determine whether a multicomponent physical conditioning program directed at axial and extremity flexibility, coordination, and reaction time can enhance driving performance and the physical abilities relevant to driving performance. The secondary aims are to determine: 1) if the improvements in driving performance are mediated by changes in physical ability; 2) if the magnitude of treatment effect is moderated by driving confidence and treatment adherence; and 3) if intervention reduces crash and moving violation involvement. To accomplish these aims, 150 consenting drivers age 70 years and older who meet eligibility and screening criteria (absence of severe visual and cognitive impairments; presence of physical impairments associated with driving performance), will undergo a detailed assessment of physical ability and driving performance and be randomized to intervention or control groups. The intervention group will be trained in a graduate physical conditioning program targeted to physical impairments and performed daily at home for 6 months. Adherence will be monitored by a daily check-off sheet that will be reviewed monthly. The control group will receive a series of educational modules in their homes directed at vehicle, home, and environmental safety. Driving performance and physical ability will be reassessed at 6 months by therapists not involved in the intervention and blinded to treatment group. Quaterly phone contacts will be made for two years to ascertain changes in driving patterns, crashes, and moving violatins. This study is an essential step in the process of determining whether driving safety can be enhanced by improving function. The long-term objective is to integrate the findings of this study with interventions directed at visual and cognitive abilities in a multifactorial intervention program in an effort to enhance driving safety and the independence and mobility of older persons.
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