title: Effects of a Safe Transportation Educational Program for Older Drivers on Driving Exposure and Community Participation: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To ascertain whether a safe-transportation program can change driving exposure while maintaining community participation of older drivers.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Northwest Sydney.
  
  
  METHODS
  Drivers aged 75 and older (mean 80 ± 4) (n = 380).
  
  
  METHODS
  Intervention group participated in an individualized, one-on-one safe-transportation program adapted from the Knowledge Enhances Your Safety curriculum. A registered occupational therapist delivered the intervention in two sessions held approximately 1 month apart.
  
  
  METHODS
  An in-vehicle monitoring device hardwired into participants' vehicles measured driving exposure. Community participation was measured using the Keele Assessment of Participation. A staging algorithm based on the Precaution Adoption Process Model measured behavior change toward increased and sustained driving self-regulation. Main outcomes were distance driven per week over 12 months and community participation. Secondary outcomes were behavior change, depressive symptoms, and alternate transportation use. Generalized estimating equations were used to model effect on driving exposure, adjusting for weekly measures, and ordinal regression was used to analyze differences in behavior change profiles between groups using an intention-to-treat approach.
  
  
  RESULTS
  Participants were randomized after baseline assessment-190 each to the intervention and control groups. One hundred eighty-three of 190 completed the intervention and 366 of 380 completed the study. On average, participants drove 140 ± 167 km/wk. Although there was no significant difference between the groups in distance driven per week over 12 months (between-group difference -5.5 km, 95% confidence interval (CI) = -24.5-13.5 km, p = .57), intervention group participants showed greater readiness to engage in self-regulatory driving practices, such as reporting avoiding driving at night or at rush hours, than control group participants (odds ratio (OR) = 1.6, 95% CI = 1.1-2.3, P = .02). At 12 months, use of alternate transportation was similar (between-group difference 0.1, 95% CI = -1.4-1.6, P = .90). Although there was no difference in community participation (between-group difference -0.1, 95% CI = -0.6-0.3, P = .59), older drivers with low function in the intervention group were 3.1 times as likely to report depressive symptoms (95% CI = 1.04-9.2, P = .04) than those with low function in the control group.
  
  
  CONCLUSIONS
  An individualized safe-transportation program can promote behavior change but did not translate to significant differences in weekly mileage after 12 months. Longer follow-up may detect changes over time.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.|School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia.
authors.forename: Kristy
authors.initials: K
authors.lastname: Coxon
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Chevalier
authors.affiliation: Neuroscience Research Australia and School of Medical Science, University of New South Wales, Randwick, New South Wales, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Brown
authors.affiliation: Kolling Institute, Sydney Medical School, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Clarke
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Laurent
authors.initials: L
authors.lastname: Billot
authors.affiliation: Transport and Road Safety Research, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Soufiane
authors.initials: S
authors.lastname: Boufous
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Keay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001334:Automobile Driving / Q000706:statistics & numerical data*; D003256:Community Participation; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D012449:Safety; D000068356:Self-Control; D014186:Transportation / Q000706:statistics & numerical data
keywords: aging; automobile driving; community participation; education; safety