A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons

A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons

Richard A. Marottoli, MD, MPH1,2,3, Heather Allore, PhD1, Katy L. B. Araujo, MPH1, Lynne P. Iannone, MS1, Denise Acampora, MPH1, Margaret Gottschalk, PT, MS5, Peter Charpentier, MPH1, Stanislav Kasl, PhD6, and Peter Peduzzi, PhD1,4,6

1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 2Geriatrics and Extended Care Section, VA Connecticut Healthcare System, West Haven, CT, USA; 3Cooperative Studies Program Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, USA; 4Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA; 5Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, CT, USA; 6Department 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 movement could improve driving performance among older drivers.

DESIGN: Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules.

PARTICIPANTS: Drivers, 178, age Q 70 years with physical, 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 committed. 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 differences 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 declined during the study period. Having interventions that...