Tài liệu THE ELDERLY AND MOBILITY: A REVIEW OF THE LITERATURE pdf

Preface

Project Manager
Dr. Jennifer Oxley, Senior Research Fellow

Research Team
Mr. Jim Langford, Senior Research Fellow
Ms. Michelle Whelan, Research Assistant
Dr. Sjaanie Koppel, Research Fellow
Dr. Judith Charlton, Senior Research Fellow











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Contents
EXECUTIVE SUMMARY XIII
1 INTRODUCTION 1
1.1 METHOD 2
1.2 STRUCTURE OF THE REVIEW 2
1.3 OLDER PEOPLE’S NEED FOR MOBILITY 3
1.3.1 Findings from the OECD Working Group 3
1.3.2 Findings from the research 4
1.3.2.1 Mobility is more than travel 4
1.3.2.2 Travel needs 5
1.3.2.3 The impact of driving reduction and cessation on QoL 6
1.3.2.4 Older adults in the next two decades 11
1.4 SUMMARY 12
2 ASSESSING AND MANAGING OLDER DRIVER SAFETY: THE FACTS
AND MYTHS 13
2.1 CRASH INVOLVEMENT 13
2.1.1 Findings from the OECD Working Group 13
2.1.2 Findings from the research – the frailty bias 15
2.1.3 Findings from the research – the low mileage bias 17
2.1.3.1 Explaining the low mileage bias 19
2.1.4 Conclusions 20
2.2 VULNERABILITY 20
2.2.1 Findings from the OECD Working Group 20
2.2.2 Findings from the research – older drivers as a crash risk to others 21
2.2.3 Conclusions 23
2.3 MEDICAL CONDITIONS AND FUNCTIONAL DECLINE 23
2.3.1 Findings from the OECD Working Group 23
2.3.2 Findings from the research – the link between ageing and medical
conditions 25
General Condition 26
2.3.3 Findings from the research – the link between ageing and vision 28
2.3.4 Findings from the research – the link between ageing and cognition 29
2.3.5 Findings from the research – the link between ageing, medical conditions,
functional impairments and crash risk 29
2.3.6 Findings from the research – the role of self-regulation in countering
changes in functional performance. 30
2.3.7 Findings from the research – using crash epidemiology to explore unfitness
to drive and crash responsibility. 32
2.3.8 Conclusions 34
2.4 FITNESS TO DRIVE 34
2.4.1 Findings from the OECD Working Group 34
2.4.2 Age-based mandatory assessment programs as part of general licensing
procedures to identify at-risk drivers. 36
2.4.3 Review of the evidence showing the validity of the individual assessment
protocols. 37
2.4.3.1 On-road assessment 37
2.4.3.2 Off-road assessment 38
THE ELDERLY AND MOBILITY: A LITERATURE REVIEW vii
2.4.4 Conclusions 41
2.4.4.1 Age-based mandatory assessment programs 41
2.4.4.2 On-road and off-road assessment 42
2.5 LICENCE REMOVAL 43
2.5.1 Findings from the OECD Working Group 44
2.5.2 Findings from the research: premature cessation of driving 45
2.5.3 Findings from the research – transfer to riskier travel modes 46
2.5.4 Conclusions 46
2.6 IMPACT OF LICENCE REMOVAL 46
2.6.1 Findings from the OECD Working Group 46
2.6.2 Findings from the research – difficulties with different transport modes 47
2.6.3 Findings from the research – impact of cessation of driving 47
2.6.4 Conclusions 48
2.7 THE FUTURE 48
2.7.1 Findings from the OECD Working Group 48
2.7.2 Findings from the research – older driver cohort differences 50
2.7.3 Conclusions 50
2.8 SUMMARY 50
3 METHODS TO INCREASE MOBILITY FOR THE ELDERLY 51
3.1 MEDICAL AND OTHER REHABILITATION 51
3.1.1 Findings from the OECD Working Group 51
3.1.2 Findings from the research 52
3.1.3 Summary 54
3.2 DRIVER EDUCATION AND TRAINING 54
3.2.1 Findings from the OECD Working Group 54
3.2.2 Findings from the research – education and training programs 54
3.2.3 Findings from the research – self-assessment 58
3.2.4 Summary 64
3.3 SAFER VEHICLES 64
3.3.1 Findings from the OECD Working Group 65
3.3.2 Findings from the research – crashworthiness and occupant protection 65
3.3.2.1 Vehicle Mass 67
3.3.3 Findings from the research – vehicle adaptations 68
3.3.4 Findings from the research – crash avoidance strategies 68
3.3.5 Summary 73
3.4 ROAD INFRASTRUCTURE 73
3.4.1 Findings from the OECD Working Group 74
3.4.2 Findings from the research – improved roads for drivers 75
3.4.2.1 At-grade intersections 76
3.4.2.2 Freeway interchanges 77
3.4.2.3 Other road environments 78
3.4.3 Findings from the research – improved roads for pedestrians and cyclists 81
3.4.4 Summary 83
3.5 PUBLIC TRANSPORT AND OTHER TRANSPORT OPTIONS 84
3.5.1 Findings from the OECD Working Group 84
3.5.2 Findings from the research 85
3.5.3 Summary 89
3.6 OPTIONS FOR WALKING, CYCLING AND SMALL MOTORIZED VEHICLES. 89
3.6.1 Findings from the OECD Working Group 89
3.6.2 Findings from the research – walking and cycling 90
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3.6.3 Findings from the research – wheelchairs and motorised scooters 93
3.6.4 Summary 93
3.7 OTHER MEASURES 93
3.7.1 Findings from the OECD Working Group 94
3.7.2 Findings from the research – land-use 95
3.7.3 Findings from the research - use of Internet shopping 96
3.7.4 Summary 98
4 SUMMARY AND RECOMMENDATIONS 99
4.1 RECOMMENDATIONS 99
4.2 CONCLUSIONS 102
5 REFERENCES 103

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Figures
FIGURE 1: US DRIVER FATALITIES BY AGE, RELATIVE TO LICENSED DRIVERS AND MILEAGE DRIVEN 14
FIGURE 2: INSURANCE CLAIMS PER 100,000 INSURED VEHICLE YEARS AND AGE OF DRIVER 17
FIGURE 3: ANNUAL DRIVING DISTANCES AND CRASH RATES PER 1 MILLION DRIVER-KILOMETRES, BY AGE 18
FIGURE 4: ANNUAL CRASH INVOLVEMENT FOR DIFFERENT DRIVER AGES, CONTROLLING FOR ANNUAL MILEAGE
18
FIGURE 5: PERCENTAGE OF PEOPLE IN GREAT BRITAIN REPORTING MOBILITY DIFFICULTIES OF ANY SORT, 1996
24

FIGURE 6: LIFE EXPECTANCE AND THE ONSET OF DISABILITY IN FOUR EUROPEAN COUNTRIES 25
FIGURE 7: FATALITY RATE PER JOURNEY, GREAT BRITAIN 1998 44
FIGURE 8: NUMBER OF MEDICAL AND VOLUNTARY SURRENDERS OF LICENCE IN QUEENSLAND 45
FIGURE 10: PROJECTED PERCENTAGE OF THE POPULATION AGED 65 YEARS OR OLDER FOR ALL OECD MEMBER
COUNTRIES
, 2000-2050 49
FIGURE 11: CRASHWORTHINESS BY YEAR OF MANUFACTURE (WITH 95% CONFIDENCE LIMITS) 66



Tables
TABLE 1: NUMBER OF DRIVER FATALITIES AND FATALITY RATE PER 100,000 PERSONS BY AGE (US, 1997) 13
TABLE 2: QUANTIFYING THE ROLE OF FRAGILITY IN OLDER DRIVER ROAD DEATHS 16
TABLE 3: OLDER DRIVERS’ CRASH RISK TO OTHERS (1991 DATA) 21
TABLE 4: OLDER DRIVERS’ CRASH RISK TO OTHERS (1992-94 DATA) 22
TABLE 5: MEDICAL CONDITIONS AS ‘RED FLAGS’ REGARDING DRIVING SAFETY 26
TABLE 6: SUMMARY OF MEDICAL CONDITIONS AND ASSOCIATED CRASH RISK 27
TABLE 7: AGE-RELATED IMPAIRMENTS AND DRIVING PROBLEMS 30
TABLE 8: UFOV THRESHOLD SCORE AND CRASH INVOLVEMENT 39
TABLE 9: PROBLEMS USING DIFFERENT TRANSPORT MODES BY DIFFERENT AGE GROUPS, NORWAY, 1997-98.47
TABLE 10: SUMMARY OF OLDER DRIVER EDUCATIONAL, TRAINING AND SELF-ASSESSMENT RESOURCES 62
TABLE 11: AGE-RELATED IMPAIRMENTS, DRIVING PROBLEMS AND IN-VEHICLE INTERVENTIONS OR EQUIPMENT
ASSISTANCE
69
TABLE 12: ASPECTS OF OLDER DRIVER CRASHES AND ITS IMPLICATIONS, AUSTRALIA 70



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EXECUTIVE SUMMARY
The ability to travel is associated with freedom, activity and choice and driving offers an
important mobility option, especially for the elderly. Most people drive to fulfil basic needs
as well as to fulfil social and psychological needs.
While there is a strong emphasis around the world for older people to maintain their
mobility for as long as possible, there is limited understanding and recognition of the
significance of mobility for the elderly, their transportation needs, mobility changes in later
life, and the impact on quality of life of reduced mobility. Moreover, there is little
information about the measures that can be taken to increase, or at least, maintain mobility
in older age.
This report presents the results of a literature review on the issues of older people’s
mobility needs, how reduced mobility impacts on quality of life, health and well-being, and
provides a set of recommendations based on world ‘best-practice’ for managing the
transportation and mobility requirements of this growing road user group.
The next few decades are likely to see a steady growth in the number of older road users as
the population ages. This highlights an urgent need to put into place appropriate
interventions to ensure that the safety and mobility of older road users is not compromised.

The evidence is clear that, for older adults who cease driving, quality of life is reduced, and
that poor mobility places a substantial impact on the individual, their family, the
community and the society in which they live. Furthermore, the evidence suggests that
there are subgroups of the elderly who are more likely to suffer more pronounced mobility
consequences including women and financially disadvantaged groups.
The review discusses a number of facts and myths about the ‘older driver problem’ in an
attempt to dispel some of the misconceptions regarding the risks that older drivers pose on
the road and how their safe mobility should be managed. Over the last few decades, many
measures have been proposed to address the issues surrounding the safe mobility of older
drivers. For example, there has been much focus on re-licensing procedures for older
drivers, with many countries and jurisdictions imposing age-based license renewal
procedures, with a range of screening tests to determine fitness to drive. However, there is
much debate regarding the identification of those older drivers who are most at risk.
Moreover, many of the procedures currently in place have been called into question
regarding their efficacy in reducing crash risk and implications of reduced mobility.
It is argued that, in general, the great majority of older drivers are at least as safe as drivers
of other age groups, and that only a small proportion of older drivers are unfit to drive.
This has major implications for the management of ‘at-risk’ older drivers. The evidence
strongly suggests that age-based mandatory assessment programs are ineffective in
identifying and managing these drivers. Most importantly, while it is difficult to find any
safety benefits of such programs, they can compromise the mobility of some older drivers
(through the tendency of premature cessation) and possibly result in a safety disbenefit
(those who cease driving are likely to undertake more trips as pedestrians – a much more
riskier form of transport).
Driving is the safest and easiest form of transport and many older adults experience
difficulty using other forms of transport, particularly walking. Continued mobility means
access to a private vehicle for as long as possible as it is safe to drive, or as a passenger.
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Managing the safe mobility of older adults requires policies and initiatives that achieve an
acceptable balance between safety and access to critical services and amenities.
The evidence suggests that provision of safe travel options that allow easy access to
services and amenities is a vital factor in maintaining mobility amongst older road users,
and it is argued that, unless there is a fundamental reconsideration of the traffic and
transport systems to ensure that the mobility and safety needs of these road user groups are
met, the problems and risks associated with ageing will worsen in the coming decades.
It is recommended that a co-ordinated approach is required that encompasses co-operation
between government policy, local government initiatives and community programs to
manage the mobility of older road users. ‘Best-practice’ measures were identified in four
broad categories. These were: safer road users; safer vehicles; safer roads and
infrastructure; and, provision of new and innovative alternative transport options that are
specifically tailored to older adults. The recommendations are as follows:
Strategies addressing safer road users should focus around improved licence re-assessment
procedures, medical and other rehabilitation and educational and training programs. To
improve road user behaviour, it is recommended that:
• It be recognised that most older drivers manage adequately their own safety as
drivers;
• These older drivers be treated no differently than other age groups by licensing
authorities;
• For the small proportion of older drivers who represent an unacceptable crash risk
and who cannot manage their own safety as drivers, rehabilitation and/or training
strategies should, where possible, aim to restore functional performance;
• In the management of these at-risk sub-groups, consideration is given to the
introduction of more valid and acceptable licence re-assessment systems that are
not age-based but based on functional ability, involve only those suspected of being
‘at risk’, and use valid assessment instruments to determine fitness to drive.
• Educational and training programs be developed to raise awareness of changing
abilities and to promote safe driving, walking and cycling practices. Such programs
should acknowledge that the elderly are a heterogeneous group and need to be
designed accordingly.
Strategies addressing safe vehicles should focus on improved crashworthiness and
occupant protection, development of Intelligent Transport System (ITS) technologies that
are designed to avoid crashes and simplify the driving task, and improved frontal structure
design to improve the safety of pedestrians. To improve vehicle design, it is recommended
that:
• Strategies addressing the purchase and use of vehicles with high crashworthiness
and occupant protection standards be developed.
• Improvements to vehicle crashworthiness be further encouraged, particularly with
regard to testing programs that include a component specifically addressing older
driver safety.
• Continued development of ITS technologies that may improve the safe mobility of
older drivers, be undertaken. Such technologies should ensure that they are optimal
for targeted users and may include (but are not limited to) force-limiting seat belts,
supplementary airbags, vehicle adaptations to make driving more comfortable and
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