Self-awareness of Driving Performance in Older Adults


Book Description

"Having accurate self-awareness of driving ability may be one important factor to enable older drivers to adopt appropriate self-regulatory behaviors and maintain safe driving performance in their everyday living for as long as possible. Nevertheless, some methodological issues and knowledge gaps related to this topic exist. The overall objective of this thesis was to contribute evidence towards older drivers' self-awareness of their driving ability in a naturalistic driving environment. The first study compared and contrasted how the standard on-road driving evaluation (SODE) and the naturalistic driving observation (NDO) approaches influence older adults' driving performance using a reflective literature review. This study highlighted that, during the SODE, older drivers' performance may be negatively impacted by test anxiety and the unfamiliar environment, but changes in their driving capacity over time can be measured in this structured context. On the contrary, using the NDO approach, older drivers can adjust their driving behavior and environment based on their self-awareness of driving ability and self-regulatory modifications; by reducing the demands of their driving environment, their driving performance could be stable over time despite changes in their driving capacity (Manuscript #1). Based on the previous study, a validated NDO approach, the electronic Driving Observation Schedule (eDOS), was adopted to evaluate older drivers' performance in their everyday driving environment. Some improvements to its scoring system were required and 13 experts in driving rehabilitation were consulted using a two-round on-line survey. A weighted maneuver/environmental complexity score was created to represent the complexity of the driving maneuvers and environment in order to control the fact that the driving environment during each eDOS differs from each other. In addition, a weighted eDOS total score was generated to improve the scoring of older adults' driving performance by accounting for the different risk levels of each driving error type, the maneuver and environment complexity in which they occur (Chapter 4).The next study examined the accuracy of older drivers' self-awareness of driving ability and its associated demographic and clinical factors. The accuracy of self-awareness is defined by the correspondence between one's perceived and actual ability. Perceived driving ability was assessed using the Perceived Driving Ability [PDA] questionnaire, a valid and reliable tool and the weighted eDOS score was used to represent everyday driving performance. By comparing the two scores, 108 older drivers were classified into 3 groups based on the accuracy of estimation of their driving ability: under-estimation (19%); accurate (29%); over-estimation (53%). An ordinal regression model showed that older drivers who over-estimated their driving ability had better visuo-motor processing speed and fewer comorbid conditions (Manuscript #2). A longitudinal study was administered to further examine older drivers' self-awareness of their changes in driving ability over time (n=60). Results indicated that approximately one-third of the older drivers did not detect their declining driving ability over one year. Participants who had worse driving performance at the second session, regardless of their perceived changes in driving ability (Manuscript #3). The findings from this thesis indicate that many older drivers over-estimated their driving ability and did not perceive their declining driving performance over one year. Future studies are needed to examine the relationship between older drivers' accuracy of self-awareness and crash risk, as well as to create intervention programs for enhancing their accuracy of self-awareness of driving ability. " --




Maintaining Safe Mobility in an Aging Society


Book Description

By 2030, 20 percent of the world's drivers, 60 million in all, will be over the age of 65. Consequently, safe and efficient mobility for older adults is a complex and pressing issue. Maintaining Safe Mobility in an Aging Society addresses the complexities surrounding the booming number of aging drivers and practical solutions for sustaining safe tr




The Social Determinants of Mental Health


Book Description

The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.




Communities in Action


Book Description

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.




Assessing the Driving Ability of the Elderly


Book Description

This much-needed book explores the extensive literature on assessing the driving ability of the elderly and provides specific guidelines for practitioners working with the well and the frail older driver. As the number of elderly drivers increases, therapists are being called upon to evaluate drivers who have become physically, cognitively, or otherwise impaired but who wish to continue to drive. Motor vehicle departments are not always equipped to screen out potential hazardous drivers nor are other health professionals with only brief opportunities to assess function. This timely book features preliminary research studies of vital interest to occupational therapists on the driving ability of the elderly. Assessing the Driving Ability of the Elderly provides a general overview of the literature on elderly drivers; reports the results of 21 screening instruments that test older persons visual, motor, and cognitive abilities related to driving; and examines the usefulness of a self-administered driving questionnaire and daily diary as a method of screening individuals for deficits that may affect driving performance. All instruments developed for these studies are included in this groundbreaking book.







Development of Self-Determination Through the Life-Course


Book Description

This volume examines the developmental aspects of the general psychological construct of self-determination. The term refers to self- (vs. other-) caused action—to people acting volitionally—as based on their own will. Research conducted in the fields of psychology and education shows the importance of self-determination to adolescent development and positive adult outcomes. The first part of this volume presents an overview of theories and historical antecedents of the construct. It looks at the role of self-determination in major theories of human agentic behavior and of adolescent development and individuation. The second part of the volume examines the developmental origins and the trajectory of self-determination in childhood, adolescence, and adulthood, and looks as aging aspects. The next part presents studies on the evolutionary aspects, individual differences and healthy psychological development. The last part of the book covers the development of causal and agentic capability.




The Safety of Elderly Drivers


Book Description

By the turn of the century, the elderly will comprise about 20 percent of the population in North" America, and 28 percent of those who drive. Place this percentage in high-powered automobiles, and the need for planning and policy development becomes evident. Most standard research on elderly drivers has not gone beyond gathering data on specific situations or characteristics. This book rises beyond simple statistical presentation. It blends sociological insight with statistical detail to produce an absorbing description of the elderly drivers' daily lives, driving styles, experiences with accident and injury, social relationships, and life aspirations. It also describes areas of neglect: imagined and real health problems, driving exposure and traffic violations, accidents, and loss of self-esteem. It presents in-depth accounts of the trauma of loss of license and the importance of the automobile for sustaining mental, physical, and social well-being. The self-imposed or self-defined rules elderly drivers use to navigate traffic or compensate for physical frailities are described in depth. "The Safety of Elderly Drivers "includes penetrating comments from elderly drivers who have been involved in serious accidents, and from random elderly drivers speaking for their generation of drivers. Integrating statistical findings based on Motor Vehicle Department accident data and survey data with comprehensive interviews and discussions with elderly drivers, the book provides an emperically grounded, in-depth view of the elderly driver today. Rothe summarizes theories and models of aging, along with past research on elderly drivers, projecting what the future may hold if present trends in medicine, housing, politics, migration, and mass transit continue. It closes with a series of recommendations for future traffic planning. This book will be of interest to policymakers concerned with traffic safety, as well as social scientists and others interested in gerontological issues. It is the latest in a series on traffic safety sponsored by the Insurance Corporation of British Columbia in Canada.