A Randomized Trial of a Physical Conditioning Program
to Enhance the Driving Performance of Older Persons
Richard A. Marottoli, MD, MPH
1,2,3
, Heather Allore, PhD
1
, Katy L. B. Araujo, MPH
1
,
Lynne P. Iannone, MS
1
, Denise Acampora, MPH
1
, Margaret Gottschalk, PT, MS
5
,
Peter Charpentier, MPH
1
, Stanislav Kasl, PhD
6
, and Peter Peduzzi, PhD
1,4,6
1
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA;
2
Geriatrics and Extended Care Section, VA
Connecticut Healthcare System, West Haven, CT, USA;
3
Cooperative Studies Program Clinical Epidemiology Research Center, VA
Connecticut Healthcare System, West Haven, CT, USA;
4
Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare
System, West Haven, CT, USA;
5
Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, CT, USA;
6
Department of
Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
BACKGROUND: As the number of older drivers
increases, concern has been raised about the potential
safety implications. Flexibility, coordination, and speed
of movement have been associated with older drivers_
on road performance.
OBJECTIVE: To determine whether a multicomponent
physical conditioning program targeted to axial and
extremity flexibility, coordination, and speed of move-
ment could improve driving performance among older
drivers.
DESIGN: Randomized controlled trial with blinded
assignment and end point assessment. Participants
randomized to intervention underwent graduated exer-
cises; controls received home, environment safety
modules.
PARTICIPANTS: Drivers, 178, age Q 70 years with phys-
ical, but without substantial visual (acuity 20/40 or
better) or cognitive (Mini Mental State Examination
score Q24) impairments were recruited from clinics
and community sources.
MEASUREMENTS: On-road driving performance
assessed by experienced evaluators in dual-brake
equipped vehicle in urban, residential, and highway
traffic. Performance rated three ways: (1) 36-item scale
evaluating driving maneuvers and traffic situations; (2)
evaluator_s overall rating; and (3) critical errors com-
mitted. Driving performance reassessed at 3 months by
evaluator blinded to treatment group.
RESULTS: Least squares mean change in road test
scores at 3 months compared to baseline was 2.43
points higher in intervention than control participants
(P = .03). Intervention drivers committed 37% fewer
critical errors (P = .08); there were no significant differ-
ences in evaluator_s overall ratings (P = .29). No injuries
were reported, and complaints of pain were rare.
CONCLUSIONS: This safe, well-tolerated intervention
maintained driving performance, while controls de-
clined during the study period. Having interventions
that can maintain or enhance driving performance may
allow clinician–patient discussions about driving to
adopt a more positive tone, rather than focusing on
driving limitation or cessation.
KEY WORDS: driving performance; randomized trial; physical
conditioning program.
DOI: 10.1007/s11606-007-0134-3
© 2007 Society of General Internal Medicine 2007;22:590–597
M
aintaining the safety of older drivers is a concern, given
the increasing number of older persons and their
heightened susceptibility to crash injury. In 1990, individuals
age 65 years and older constituted approximately 13% of
licensed drivers (22 million) in the United States, with an
expected 50% increase by 2020.
1,2
Motor vehicle crashes are
the leading cause of injurious and fatal Baccidents^ among
individuals age 65 to 74 years, and the second leading cause
among those age 75 years and older, with two- to fourfold
increases in rates of injury, hospitalization, and death among
individuals 65 years and older compared to younger indivi-
duals in crashes of similar magnitude.
3–6
Increasing evidence supports the importance of driving for
independence and well-being in some countries. Older persons
depend on cars for transportation as driver or passenger.
7,8
Participation in social and productive activities has been
associated with survival and better functional status.
9–13
Conversely, driving cessation has been linked to decreased
participation in out-of-home activities and increased depressive
symptoms.
14–16
There is a need to identify individuals at increased risk for
crashes or poor driving performance and to determine if
driving performance can be enhanced and crash risk lowered,
thereby, maximizing and prolonging safe driving by older
persons. Previous studies indicated that functional impair-
ments (vision, cognition, and physical ability), medical condi-
tions, and medications, rather than age alone, contribute to
crash risk and poor driving performance.
17–34
Received April 20, 2006
Revised September 25, 2006
Accepted January 10, 2007
Published online February 13, 2007
590