title: Comparison of a Virtual Older Driver Assessment with an On-Road Driving Test.
abstract: To design a low-cost simulator-based driving assessment for older adults and to compare its validity with that of an on-road driving assessment and other measures of older driver risk.
  
  
  
  Cross-sectional observational study.
  
  
  
  Canberra, Australia.
  
  
  
  Older adult drivers (N = 47; aged 65-88, mean age 75.2).
  
  
  
  Error rate on a simulated drive with environment and scoring procedure matched to those of an on-road test. Other measures included participant age, simulator sickness severity, neuropsychological measures, and driver screening measures. Outcome variables included occupational therapist (OT)-rated on-road errors, on-road safety rating, and safety category.
  
  
  
  Participants' error rate on the simulated drive was significantly correlated with their OT-rated driving safety (correlation coefficient (r) = -0.398, P = .006), even after adjustment for age and simulator sickness (P = .009). The simulator error rate was a significant predictor of categorization as unsafe on the road (P = .02, sensitivity 69.2%, specificity 100%), with 13 (27%) drivers assessed as unsafe. Simulator error was also associated with other older driver safety screening measures such as useful field of view (r = 0.341, P = .02), DriveSafe (r = -0.455, P < .01), and visual motion sensitivity (r = 0.368, P = .01) but was not associated with memory (delayed word recall) or global cognition (Mini-Mental State Examination). Drivers made twice as many errors on the simulated assessment as during the on-road assessment (P < .001), with significant differences in the rate and type of errors between the two mediums.
  
  
  
  A low-cost simulator-based assessment is valid as a screening instrument for identifying at-risk older drivers but not as an alternative to on-road evaluation when accurate data on competence or pattern of impairment is required for licensing decisions and training programs.
authors: Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Ranmalee
authors: R
authors: Eramudugolla
authors: Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Jasmine
authors: J
authors: Price
authors: Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Sidhant
authors: S
authors: Chopra
authors: Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Xiaolan
authors: X
authors: Li
authors: Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia.
authors: Kaarin J
authors: KJ
authors: Anstey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001333:Automobile Driver Examination; D001334:Automobile Driving; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male
keywords: driving; injury prevention; on-road assessment; simulator