OBM Geriatrics

(ISSN 2638-1311)

OBM Geriatrics is an Open Access journal published quarterly online by LIDSEN Publishing Inc. The journal takes the premise that innovative approaches – including gene therapy, cell therapy, and epigenetic modulation – will result in clinical interventions that alter the fundamental pathology and the clinical course of age-related human diseases. We will give strong preference to papers that emphasize an alteration (or a potential alteration) in the fundamental disease course of Alzheimer’s disease, vascular aging diseases, osteoarthritis, osteoporosis, skin aging, immune senescence, and other age-related diseases.

Geriatric medicine is now entering a unique point in history, where the focus will no longer be on palliative, ameliorative, or social aspects of care for age-related disease, but will be capable of stopping, preventing, and reversing major disease constellations that have heretofore been entirely resistant to interventions based on “small molecular” pharmacological approaches. With the changing emphasis from genetic to epigenetic understandings of pathology (including telomere biology), with the use of gene delivery systems (including viral delivery systems), and with the use of cell-based therapies (including stem cell therapies), a fatalistic view of age-related disease is no longer a reasonable clinical default nor an appropriate clinical research paradigm.

Precedence will be given to papers describing fundamental interventions, including interventions that affect cell senescence, patterns of gene expression, telomere biology, stem cell biology, and other innovative, 21st century interventions, especially if the focus is on clinical applications, ongoing clinical trials, or animal trials preparatory to phase 1 human clinical trials.

Papers must be clear and concise, but detailed data is strongly encouraged. The journal publishes research articles, reviews, communications and technical notes. There is no restriction on the length of the papers and we encourage scientists to publish their results in as much detail as possible.

Indexing: DOAJ-Directory of Open Access Journals.

Archiving: full-text archived in CLOCKSS.

Rapid publication: manuscripts are undertaken in 6 days from acceptance to publication (median values for papers published in this journal in the first half of 2020, 1-2 days of FREE language polishing time is also included in this period). A first decision provided to authors of manuscripts submitted to this journal are approximately 3.3 weeks (median values) after submission.

Current Issue: 2020  Archive: 2019 2018 2017

Special Issue

Driving Skills in Older Adults

Submission Deadline: July 15, 2021 (Open) Submit Now

Guest Editor

Michael Falkenstein

Professor Emeritus, Technical University Dortmund, Dortmund D-44139, Germany; Institute for Working, Learning, and Aging (ALA), Bochum D-44805, Germany
Phone: +49 / 231 1084 277

Website | E-Mail

Research Interests: Neurodegeneration; cognitive neuropsychology; cognitive aging; aging and occupation; aging and driving

About This Topic

The percentage of older people is strongly increasing world-wide. By 2050 the number of people aged 80 and older will most probably triple in the OECD countries. This demographic change also leads to a rising number of older people who want to, or have to, stay mobile. Mobility is an essential requirement for quality of life in older people. The restriction of driving can lead to a decrease in social activities and to an impairment of cognitive fitness and mental health. Moreover the restriction of car driving can lead older people to use less safe modes of mobility (e.g. cycling), which makes them more vulnerable. Hence stopping driving one’s own car should be avoided whenever possible.

Driving requires different sensory, motor and cognitive functions und their interaction. With increasing age declines in most of these functions can be observed in laboratory settings. However, functional changes occur with a large inter-individual differences, since they are influenced by a multitude of environmental and lifestyle factors. Such changes may also have an impact on everyday tasks, in particular under time pressure, such as driving. Indeed, visual and cognitive factors explained most of the age-related variance in the ability to drive safely. 

Since most of traffic-relevant information is taken via the eyes age-related changes of vision are most relevant for driving. Such changes include reductions in visual acuity and contrast sensitivity, increased glare sensitivity, and a reduced field of view. 

Motor changes due to increasing include a diminishing of muscle strength and movement speed.
This may slow down emergency actions or prolong braking time. Further, neck flexibility, which is essential for looking back during driving, is strongly reduced with age. Finally, motor coordination and dexterity also deteriorate with rising age.
Cognitive problems of older persons are often overlooked despite their high importance for the driving ability of elderly adults. In particular, the so-called executive functions, which control lower-level functions, are highly relevant for driving. Executive functions control attention, which is necessary for visual search and attention switch, the inhibition of irrelevant information and inadequate responses, the management of multiple tasks, and the monitoring of one’s own performance. For example, many studies suggest older adults have a problem inhibiting irrelevant information and inappropriate actions.  In complex traffic situations with multiple distractors, this “filtering” problem of older people can enhance the risk of accidents. Also the distribution, switching and flexible shifting of visual attention across visual space is often impaired in healthy aging. For example, visual search, i.e., the scanning of the visual scene in order to detect a target stimulus is impaired already in people in their sixties. Hence in real traffic important targets and threats are possibly detected later or not at all by older
Cognitive problem increase in mild cognitive impairment (MCI), which is present in many older people and hence also in drivers. People with MCI have clearly enhanced driving problems compared to people without such impairment.  

Safe driving depends not only on skills but also on personality factors like self-rating, overconfidence, risk acceptance, or sensation-seeking. Most of the older drivers are overconfident concerning their driving skills and rate themselves as good or excellent drivers regardless of their actual performance. In particular, those older drivers with poor driving performance usually rate their driving as good to excellent, which may impair their motivation to improve their driving skills.

Despite impaired functions in laboratory tasks, as well as an overestimation of their own driving skills, older people often drive inconspicuously. This is firstly due to the fact that routine traffic situations such as highway driving need only automated processes, which show less age-related decline. Moreover, to cope with such situations to keep driving on a high level and, many older people have developed compensation strategies such as slow driving and the selection of well-known routes. Also covert compensation mechanisms such as a stronger preparation in complex situations are frequent in elderly. However, some of those strategies are not satisfactory since they may encumber other drivers (e.g. slow driving) or the driver itself (e.g. avoidance of certain routes).

Nevertheless, the accident rate of older drivers per distance driven is relatively high and similar to the accident rate of very young drivers. In particular, drivers older than 75 years who drive fewer than 3000 km per year exhibit the highest accident risk. Moreover 75% of drivers aged 75 and above who are involved in an accident are primarily responsible for the accident. A closer look to the accidents show that they occur in specific situations such as giving right of way, turning, driving backwards, and complex crossroads. Accident rates, however, underestimate the problems since in most critical situations accidents can be avoided by the driver himself, or by other traffic participants. More often, near-accidents most probably happen that do not show up in any statistics. They may be only remarked by fellow passengers if present.
These results show that measures are necessary to increase safety and support for older drivers. 

Apart from having problems in certain situations, older drivers are also more vulnerable than younger ones due to their more fragile organism. For example, the bones and ribs are not so flexible in older than in younger persons, which is even aggravated by osteoporosis, a common disease in higher age. Such lower flexibility usually leads to more severe injuries in an accident, and even security belts could cause fatal injuries in old drivers.
Even more vulnerable as in cars are elderly cyclists. To ride a bicycle not only requires the skills of car drivers, i.e. coping with sometimes complex situations and interacting with other drivers, but also the skill of handling the bicycle which is not performed automatically as the handling a car. Many older people have not used a bicycle since years and hence their riding skills are low, which is often not realized by the cyclist. Indeed, accident rates with older cyclists increase steadily, and mainly for e-bikes with their higher weight and speed. 

A further issue with older drivers is fatigue. Many accidents occur because the driver is fatigued. Older drivers have a special problem with poor sleep and may hence be more fatigued than younger drivers. On the other hand, there is some evidence that older people are more resistant against fatigue. The question is about the marginal conditions under which older drivers are more or less vulnerable to fatigue than younger drivers.

With the aim to increase safety, in several countries medical and sometimes also psychological tests are mandatory for older drivers to renew their driving license. However, this does not necessary mean that safety is increased. For example, the number of fatal accidents in Finland, which requires such tests for drivers aged 70 and above is not lower than in Sweden, a country without such tests. In fact, the percentage of fatal accidents with pedestrians aged 70 and above was even higher in Finland than in Sweden. One reason for such failures is the type of tests required. Usually only cursory and short medical tests are used. When cognitive tests are administered in addition, they are often designed for dementia diagnosis, such as the Mini-Mental State Examination (MMSE). Such tests are unsuitable for measuring the physical, sensory, and cognitive skills that are essential for driving.

A most important issue is the identification of unfit older drivers. An obvious and direct method is an on-road driving assessment, usually conducted by a driving instructor, which is sometimes accompanied by a traffic psychologist. Meanwhile there are standardized and even PC-based driving protocols which aim at more objectivity. However, such on-road assessments are costly and require appropriate equipment and time resources. In addition the real traffic is not always challenging, which depends on time and location of the assessment ride, and of course on the competence and experience of the driving instructor. Hence elderly may show no problems even though there are some. An alternative is driving in a driving simulator which has the advantage of objectivity and allows administering sufficiently difficult scenarios, which can be repeated. As with driving tests in real traffic, this methodology requires adequate equipment and skilled experts to yield reliable results. Also the feeling of being in real traffic is absent in simulators, while there is often simulator sickness with older persons.  A third and promising alternative is to administer off-road tests of cognitive but also visual and motor functions that are important for driving. This reminds of the periodic car inspection in which functions of the car but not its behavior in real traffic is checked.
The crucial issue with testing  is the selection of the most appropriate tests for predicting driving fitness and accident rate as closely as possible. Single and ill-chosen tests have no predictive power. Meanwhile however, carefully compiled test batteries that include tests of the most important functions relevant for driving appear to have a high predictive power. Moreover such off-road assessments should include interviews that ask for risk factors such as avoidance behavior, relatives‘ reports of unsafe driving, the number of (minor) accidents in the past years, and reduced driving practice. 

All those assessment methods are only meaningful if there are accompanied and followed by measures to support older drivers, and in particular those who have driving problems. Otherwise assessments are likely avoided if voluntary, and dreaded if mandatory. Such measures could either be information and guidance campaigns, the design of age-friendly traffic and car environments, or training measures that are aimed at improving the individual driving skill of an older driver.

Information campaigns address the older public, giving information about factors that influence driving fitness (e.g. certain diseases and drugs), about strategies how to cope with certain driving situations, and about training possibilities to increase driving performance. They are relatively easy to organize. However, the success of such campaigns depends on whether they are accompanied by practical courses in groups.

Since certain traffic situations, such as turning left at complex crossroads, are particularly difficult for older drivers, it appears straightforward to decrease those problems by an age-friendly street design. For example, left turns should be protected by traffic lights or by well-visible guidelines. Also at crossroads or roundabouts distracting and traffic-irrelevant information such as advertisements should be minimized. Complex areas should be clearly structured and traffic routing distinctly marked by coloring. Also, well-designed car technology such as high doors and seats and a broad circumferential visibility and can help elderly drivers.  Moreover, route guidance systems are highly important for the elderly since they reduce visual search. However, to be helpful and not distracting, such systems have to meet certain requirements.

The third measure is individual training for older drivers. The most straightforward training is to take driving lessons in real traffic. Such lessons require well-trained driving instructors which both know the problems of older drivers, as well as the locations where sufficiently difficult driving scenarios usually occur.  If properly conducted, such driving lessons can strongly improve driving fitness in older drivers, and mainly so for poor drivers.
An off-road variant is the training of specific skills (such as visual search) or the coping with difficult driving scenarios with the help of programs running on a personal computer or a driving simulator. The PC has the advantage of being cheap and everywhere available, so it might be possible to conduct such a training even at home.
A further possibility is the direct training of functions that are necessary for driving. While visual functions can be hardly trained, motor and cognitive functions are trainable. For example, head movements and strength can well be trained and result in improvements of the trained functions.
In the cognitive domain, the division of spatial attention can be trained which results not only in an improvement of the trained function but also in better and longer driving. Also physical training is known to improve not only motor but also cognitive functions. There are, however, only very few studies which show improvements of driving fitness due to such trainings. Since such trainings are very easy to conduct, and often even at home, further studies on this topic are warranted.

The present special issue aims at addressing most of the mentioned issues, and any other issue concerning older drivers and how to help them keep driving as long as possible.