Older Drivers: An Evidence-Basis for Licensure Standards

描述（由申请人提供）：驾驶个人车辆是美国老年人的主要和首选旅行方式。老年人驾驶不仅能满足至关重要的“出行”或移动功能，还能深刻影响健康状况，因此具有直接的公共卫生相关性。成为一名司机与提高生活质量，减少抑郁和社会孤立的可能性以及增加医疗保健的可及性有关。因此，界定适用于老年人口的执照视力标准的政策必须是合理的，即，循证本研究旨在通过利用亚拉巴马的独特机会和资源，采取关键步骤建立这一证据基础。亚拉巴马州是一个在获得初始许可后没有视力重新筛查的州。这种情况是一个机会，进行一项研究，将克服方法上的问题，早期的研究，旨在探讨视力和碰撞参与之间的关系和视力重新筛选的高级司机的安全效益。在对亚拉巴马有执照的驾驶员进行的一项研究中，视力值的分布将不限于视力良好的驾驶员，因为视力受损的驾驶员不会像大多数其他州那样被重新筛选法律检测到并从道路上移除。为此，将对年龄≥ 70岁的老年驾驶员进行前瞻性研究，在基线时进行某些视觉和认知功能筛查测试，然后跟踪样本在随后三年的碰撞数据。这项研究计划是翻译的，因为它涉及到翻译的基本研究结果，什么因素提高了老年驾驶员碰撞参与的风险，这些已知的风险因素如何可以指导筛选在这个人群中的再许可证的实际问题。需要解决的实际问题是，当老年驾驶员在续证时，机动车牌照办公室应该使用什么样的筛选测试和分界点，以优化老年驾驶员在随后几年的安全性？利用这项前瞻性研究的数据，我们将能够确定在基线时实施各种取消许可证的筛选标准的情况下，本可以预防的队列故障碰撞的数量。这将使我们能够描述老年司机执照的各种替代筛选标准的公共安全利益，这些信息将有助于国家机构设计司机重新筛选政策，以优化公共安全。

DESCRIPTION (provided by applicant): Driving of the personal vehicle is the primary and preferred mode of travel for older adults in the US. More than fulfilling the critically important "getting around" or mobility function, driving in older adults profoundly impacts health status and thus has direct public health relevance. Being a driver has been linked to increased quality of life, reduced likelihood of depression and social isolation, and increased accessibility to healthcare. Therefore policies defining the vision standards for licensure as applied to the elderly population must be rational, i.e., evidence-based. This research is designed to take critical steps toward establishing this evidence-basis by making use of unique opportunities and resources available in Alabama. Alabama is a state with no visual acuity re-screening after initial licensure. Such a situation represents an opportunity to conduct a study would overcome methodological problems of earlier studies purporting to examine the association between visual acuity and crash involvement and the safety benefit of visual acuity re-screening of senior drivers. The distribution of visual acuity values in a study carried out on drivers licensed in Alabama will not be limited to those with good visual acuity, since drivers with visual acuity impairment are not detected and removed from the road by a re-screening law as they would be in most other states. Toward this end, a prospective study on older drivers ages = 70 years will be carried out, where certain visual and cognitive functional screening tests will be administered at baseline, followed by tracking of the samples' crash data for the subsequent three years. This research program is translational in that it involves the translation of basic research findings on what factors elevate the risk of older driver crash involvement to the practical issue of how these known risk factors can guide screening for re-licensure in this population. The practical question to be addressed is what screening tests and cutpoints should motor vehicle licensing offices be using when older drivers present for license renewal in order to optimize older driver safety in the subsequent years? Using the data from this prospective study, we will be able to determine the number of at-fault crashes for the cohort that would have been prevented had various screening criteria for license removal been implemented at baseline. This will allow us to characterize the public safety benefit of the various, alternative screening criteria for licensure of older drivers, information that will be useful to state agencies in designing driver re-screening policies to optimize public safety.