Sensory Ability and Cognition: Older Drivers

Linking Sensory Ability and Cognition: Older Drivers

• Driving exemplifies how cognitive and sensory systems collaborate
• There are approximately 190 million drivers in the U.S.
• Over 34 million drivers are age 65+ (roughly 18%)
• Older drivers represents the fastest-growing segment of the driving population
• By 2025, it is estimated that 1 in 5 drivers will be over 65 years of age
• Older drivers have relatively few crashes on a per person basis
• However, when considering miles driven, crash risk for drivers 75+ is similar to that of high-risk 16-24 year old drivers
• 90% of crashes involving people over 65 involve multiple vehicles
• In 75% of these cases, the older driver receives the moving violation
• Good driving requires attention
• Age-related declines in attention can impact driving, including the reduction of attentional resources available
• Additionally, older adults demonstrate difficulty switching from task to task
• Age-related declines such as slower reaction time, lower dynamic visual acuity, and slower decision-making speed can create driving challenges
• Some older adults compensate for declining abilities by driving cautiously, slowly, and on familiar routes
• Declining capacities that not recognized may lead to violations and/or accidents

Interventions and Therapy

• Therapies are effective with older adults
• As many as two-thirds of older adults needing help do not receive it
• Reasons for failure to treat older adults include:
  • Stereotypes held by therapists and physicians
  • Economic cost
  • Transportation issues
  • Stigma associated with needing help
• Older adults often consult others before professionals like print materials, friends and family
• Older adults consult health professionals quickly when a symptom is perceived to be medically serious
• Older adults find interactions with health professionals frustrating due to communication problems and perceived social differences
• Older adults usually report only one-third of their symptoms to physicians
• Only 8% of older adults report all problems
• The Health Behavior Model (HBM) explains barriers to treatment

Health Behavior Model (HBM)

• The HBM views help-seeking as a process where people decide whether to seek professional attention for symptoms
• According to the HBM, seeking help depends on four beliefs:
  • Perceived susceptibility or risk
  • Perceived benefits of treatment
  • Perceptions of symptom severity
  • Perceived cost of obtaining treatment
• Individuals and social groups differ in how severe symptoms are perceived
• Older adults often see themselves as more susceptible to disease and are less afraid of being ill compared to younger adults
• Older adults are also more likely to ignore mild symptoms, seeing them as part of normal aging

Prescriptions and Aging

• Prescription medications are available for many health, psychological and behavioral problems
• Over one-third of all Americans and about 84% of older adults take one or more prescriptions monthly
• Approximately 16.5% of all Americans and 47% of those age 65+ reported taking 3 or more prescriptions in the last month
• Medication adherence relies on motivation and cognitive skills
• 90% of outpatients are estimated to take prescribed medications improperly
• 30-50% of prescriptions fail to produce desired effects because they are taken incorrectly
• Reading skills are related to successfully completing health-related tasks, including determining correct dosage
• More than 70% of older adults have significant difficulty reading complex text and completing forms
• Non-adherence in older adults may be as high as 40%

Health Literacy

• Health literacy is the ability to read, understand, and act on health care information and services
• More than 70% of older adults have difficulty reading complex text and completing forms
• Limited health literacy results in:
  • Increased costs
  • Inappropriate consent to medical procedures
  • Missed appointments
  • Medication non-adherence
  • Inability to correctly monitor health outcomes
• The National Assessment of Adult Literacy study in 2003 involved over 19,000 people
• Health care professionals and family members should:
  • Limit health care messages to one or two at a time
  • Use sound teaching techniques, tying new information to past experiences
  • Ask the adult to repeat back the instructions
  • Speak slowly, using concrete and specific examples
  • Demonstrate all procedures
  • Be attentive to clues that a person may have trouble understanding complex information
• Health literacy was assessed by tasks determining high blood pressure, medication dose from a label, and what to drink before a medical test
• Results showed that 36% of adults have limited health literacy
• 59% of older adults had limited health literacy, with 30% showing serious limitations
• More than 77 million U.S. adults have only basic or below basic health literacy skill
• The problem of low health literacy is largely invisible leading to reliance on strategies to navigate the health system, including:
  • Bringing someone who can read to appointments
  • Watching and copying others’ actions
  • Asking for help from medical staff while offering plausible excuses
  • Asking other patients
  • Asking a pharmacist

This lesson explores the relationship between sensory ability, cognition, and driving performance in older adults. It examines how age-related declines in attention, reaction time, and vision can impact driving safety. The lesson also highlights the crash risk factors associated with older drivers and the importance of attentional resources for good driving.