All ETDs from UAB

Advisory Committee Chair

Gerald McGwin

Advisory Committee Members

Marguerite R Irvin

Emily B Levitan

Paul Maclennan

Cynthia Owsley

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Motor vehicle collisions are a major public health problem for older adults in the United States. In 2013, there were 5,671 older adults killed and an estimated 222,000 injured in motor vehicle crashes. After adjusting for miles driven, the risk of crashing increases rapidly after age 70, nearly equal to that of younger drivers whose crash rate is the highest among all age groups. Driving is a highly complex task that relies on a variety of visual and cognitive functions. A large body of work has demonstrated that drivers with visual sensory impairments and/or higher-order visual-cognitive processing deficits, those who engage in secondary tasks, and those with cognitive impairment are at increased risk for collision involvement. To date, the majority of population-based research studies have utilized accident reports from police agencies. While accident reports provide a wealth of information on the circumstances of the crash, they are limited on the availability and scope of on-road data from actual driving situations. Therefore, the goal of this dissertation was to make use of an innovative approach to study risk factors for driving safety using naturalistic driving data from the Strategic Highway Research Program 2. In addition, the Mini-Mental Status Exam is widely regarded as a valid and reliable screener for general cognitive impairment, is very brief, and has been used successfully with diverse populations. However, results from prior studies are inconsistent with respect to whether MMSE scores are associated with crash involvement. Using naturalistic driving data, we observed higher rates of crash involvement among those with contrast sensitivity impairment compared to those without impairment. We also found that secondary task involvement was not associated with a higher risk of crash involvement among older drivers. Finally, in a population-based sample of licensed drivers, we found that general cognitive impairment status was not associated with future crash involvement; however, a 1-year decline in cognitive function was a significant risk factor for at-fault crash involvement. In conclusion, this dissertation highlights the importance of visual and cognitive functioning as well as behavioral characteristics of older drivers as risk factors for crash involvement.

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