Promoting Older Driver Safety: Guide for State Practices (2023)

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2023 BE H AVIORAL TRAFF IC SA FETY COOPERAT IVE RESEARCH PROGRA M BTSCRP RESEARCH REPORT 4 Research sponsored by the Governors Highway Safety Association and National Highway Trafc Safety Administration Subscriber Categories Passenger Transportation • Safety and Human Factors Promoting Older Driver Safety GUIDE FOR STATE PRACTICES Pamela Beer Cambridge Systematics, Inc. Columbia, MD Lorrie Laing Cambridge Systematics, Inc. Columbus, OH Ryan Klitzsch Cambridge Systematics, Inc. Indianapolis, IN Nusrat Sharmin Cambridge Systematics, Inc. Tallahassee, FL Neil Charness John Sobanjo Florida State University Tallahassee, FL Sandi Rosenbloom University of Texas at Austin Austin, TX

BEHAVIORAL TRAFFIC SAFETY COOPERATIVE RESEARCH PROGRAM Since the widespread introduction of motor vehicles more than a century ago, crashes involving their operation remain a significant public health concern. While there have been enormous improvements in highway design and construction, as well as motor vehicle safety, which have been instrumental in lowering the rate of crashes per mil- lion miles in the United States, more than 35,000 people die every year in motor vehicle crashes. In far too many cases, the root causes of the crashes are the unsafe behaviors of motor vehicle operators, cyclists, and pedestrians. Understanding human behaviors and developing effective countermeasures to unsafe ones is difficult and remains a major weakness in our traffic safety efforts. The Behavioral Traffic Safety Cooperative Research Program (BTSCRP) develops practical solutions to save lives, prevent injuries, and reduce costs of road traffic crashes associated with unsafe behav- iors. BTSCRP is a forum for coordinated and collaborative research efforts. It is managed by the Transportation Research Board (TRB) under the direction and oversight of the Governors Highway Safety Association (GHSA) with funding provided by the National Highway Traffic Safety Administration (NHTSA). Funding for the program was originally established in Moving Ahead for Progress in the 21st Century (MAP-21), Subsection 402(c), which created the National Cooperative Research and Evaluation Program (NCREP). Fixing America’s Surface Transportation (FAST) Act continued the program. In 2017, GHSA entered into an agreement with TRB to manage the research activities, with the program name changed to Behavioral Traf- fic Safety Cooperative Research Program. The GHSA Executive Board serves as the governing board for the BTSCRP. The Board consists of officers, representatives of the 10 NHTSA regions, and committee and task force chairs. The Research Committee Chair appoints committee members who recommend projects for funding and provide oversight for the activities of BTSCRP. Its ultimate goal is to oversee a quality research program that is committed to addressing research issues fac- ing State Highway Safety Offices. The Executive Board meets annu- ally to approve research projects. Each selected project is assigned to a panel, appointed by TRB, which provides technical guidance and counsel throughout the life of the project. The majority of panel mem- bers represent the intended users of the research projects and have an important role in helping to implement the results. BTSCRP produces a series of research reports and other products such as guidebooks for practitioners. Primary emphasis is placed on disseminating BTSCRP results to the intended users of the research: State Highway Safety Offices and their constituents. BTSCRP RESEARCH REPORT 4 Project BTS-12 ISSN 2766-5976 (Print) ISSN 2766-5984 (Online) ISBN 978-0-309-69834-4 Library of Congress Control Number 2023932550 © 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and the graphical logo are trade- marks of the National Academy of Sciences. All rights reserved. COPYRIGHT INFORMATION Authors herein are responsible for the authenticity of their materials and for obtaining written permissions from publishers or persons who own the copyright to any previously published or copyrighted material used herein. Cooperative Research Programs (CRP) grants permission to reproduce material in this publication for classroom and not-for-profit purposes. Permission is given with the understanding that none of the material will be used to imply TRB, AASHTO, APTA, FAA, FHWA, FTA, GHSA, or NHTSA endorsement of a particular product, method, or practice. It is expected that those reproducing the material in this document for educational and not-for-profit uses will give appropriate acknowledgment of the source of any reprinted or reproduced material. For other uses of the material, request permission from CRP. Cover photo credit: iStock NOTICE The research report was reviewed by the technical panel and accepted for publication according to procedures established and overseen by the Transportation Research Board and approved by the National Academies of Sciences, Engineering, and Medicine. The opinions and conclusions expressed or implied in this report are those of the researchers who performed the research and are not necessarily those of the Transporta- tion Research Board; the National Academies of Sciences, Engineering, and Medicine; or the program sponsors. The Transportation Research Board does not develop, issue, or publish standards or speci- fications. The Transportation Research Board manages applied research projects which provide the scientific foundation that may be used by Transportation Research Board sponsors, industry associations, or other organizations as the basis for revised practices, procedures, or specifications. The Transportation Research Board; the National Academies of Sciences, Engineering, and Medicine; and the sponsors of the Behavioral Traffic Safety Cooperative Research Program do not endorse products or manufacturers. Trade or manufacturers’ names or logos appear herein solely because they are considered essential to the object of the report. Published research reports of the BEHAVIORAL TRAFFIC SAFETY COOPERATIVE RESEARCH PROGRAM are available from Transportation Research Board Business Office 500 Fifth Street, NW Washington, DC 20001 and can be ordered through the Internet by going to https://www.mytrb.org/MyTRB/Store/default.aspx Printed in the United States of America

e National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, non- governmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. e National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. e National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. e three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. e National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. e Transportation Research Board is one of seven major programs of the National Academies of Sciences, Engineering, and Medicine. e mission of the Transportation Research Board is to provide leadership in transportation improvements and innovation through trusted, timely, impartial, and evidence-based information exchange, research, and advice regarding all modes of transportation. e Board’s varied activities annually engage about 8,000 engineers, scientists, and other transportation researchers and practitioners from the public and private sectors and academia, all of whom contribute their expertise in the public interest. e program is supported by state transportation departments, federal agencies including the component administrations of the U.S. Department of Transportation, and other organizations and individuals interested in the development of transportation. Learn more about the Transportation Research Board at www.TRB.org.

AUTHOR ACKNOWLEDGMENTS The research conducted for this project was performed under BTSCRP Project 12, “State Practices Promoting Older Driver Safety” by Cambridge Systematics, Dr. Sandra Rosenbloom, and Florida State University. Cambridge Systematics was the prime contractor for this project with Dr. Rosenbloom and Florida State University serving as sub-contractors. Special thanks and recognition are given to Lorrie Laing, Ryan Klitzsch, and Nusrat Sharmin with Cambridge Systematics; Dr. Sandra Rosenbloom with the University of Texas, and Dr. Neil Charness and Dr. John Sobanjo with Florida State University. C O O P E R A T I V E R E S E A R C H P R O G R A M S CRP STAFF FOR BTSCRP RESEARCH REPORT 4 Christopher J. Hedges, Director, Cooperative Research Programs Waseem Dekelbab, Deputy Director, Cooperative Research Programs Richard A. Retting, Senior Program Officer Dajaih Bias-Johnson, Senior Program Assistant Natalie Barnes, Director of Publications Heather DiAngelis, Associate Director of Publications Margaret B. Hagood, Senior Editor BTSCRP PROJECT BTS-12 PANEL Susan B. Herbel, SBH Consult, Fort Meyers, FL (Chair) Matthew R. Baldock, University of Adelaide, Adelaide, SA Bayliss J. Camp, California Department of Motor Vehicles, Sacramento, CA Carol P. Gould, Colorado Department of Transportation, Denver, CO Laura Krol, Pennsylvania Department of Transportation, Harrisburg, PA John Saunders, Virginia Department of Motor Vehicles, Fredericksburg, VA Nanette M. Schieke, Maryland Department of Transportation, Glen Burnie, MD James I. Taylor, University of Notre Dame, Notre Dame, IN Terecia W. Wilson, Clemson University, Prosperity, SC Norraine Madeline Wingfield, Traffic Safety Consultant, Lecompton, KS Kathy J. Sifrit, NHTSA Liaison Bernardo B. Kleiner, TRB Liaison

BTSCRP Research Report 4: Promoting Older Driver Safety: Guide for State Practices provides guidance for state highway safety offices (SHSOs) to enhance older driver safety. The research team conducted a survey of SHSOs to determine the degree to which states have implemented NHTSA Highway Safety Program Guideline No. 13, Older Driver Safety; conducted a literature search to identify challenges and effective approaches in the areas of program management, roadway design, driver licensing, communications and outreach, and problem/countermeasure identification; and developed a guide for SHSOs to enhance older driver safety based on Highway Safety Program Guideline No. 13. The guide will be of interest to SHSOs and other stakeholders concerned with improving older driver safety. By 2060, the number of people age 65 and older in the United States is projected to more than double, which will represent nearly one in four people. While older adults tend to practice safe driving behaviors, the effects of aging may impact their driving ability. What makes it difficult for highway safety countermeasures is that there is no specific age when any of these effects occur and to what degree someone can be affected. Aging impacts people differently, but the fact remains that older adults accounted for 18 percent of all fatalities in 2017. In 2014, NHTSA recognized the issue and released Highway Safety Program Guideline No. 13, Older Driver Safety. It stated that states should have a program to reduce older driver crashes, fatalities, and injuries. Each state older driver safety program should address driver licensing and medical review of at-risk drivers, medical and law enforcement education, roadway design, and collaboration with social services and transportation services providers. It is unclear to what extent state highway safety offices are addressing this guideline or preparing to meet the increased challenges of the older driver population in the future. In BTSCRP Project BTS-12, Cambridge Systematics was asked to (1) conduct a survey of SHSOs to determine the degree to which states have implemented Highway Safety Pro- gram Guideline No. 13, Older Driver Safety; (2) conduct a literature search to identify challenges and effective approaches in the areas of program management, roadway design, driver licensing, communications and outreach, and problem/countermeasure identifica- tion; and (3) develop a Guide for SHSOs to enhance older driver safety based on Highway Safety Program Guideline No. 13. F O R E W O R D By Richard A. Retting Staff Officer Transportation Research Board

Note: Photographs, figures, and tables in this report may have been converted from color to grayscale for printing. The electronic version of the report (posted on the web at nap.nationalacademies.org) retains the color versions. 1 Chapter 1 Background 1 1.1 Problem Statement 1 1.2 Research Approach 3 Chapter 2 Elements of Highway Safety Program Guideline No. 13: Older Driver Safety 3 2.1 SHSOs Practicing Guideline No. 13 Elements 7 Chapter 3 Research Findings 7 3.1 Program Management 9 3.2 Roadway Design 9 3.3 Driver Licensing 13 3.4 Medical Providers 15 3.5 Law Enforcement 16 3.6 Social and Aging Services Providers 18 3.7 Communications Programs 19 3.8 Program Evaluation and Data 21 Chapter 4 Challenges, Successes, and Resource Allocation 21 4.1 Challenges in Implementing the Guidelines 23 4.2 Successful Approaches 28 4.3 Resource Allocation 30 Chapter 5 Samples of Effective Messages, Materials 30 5.1 Safety Behavior Messages 32 5.2 Educational Materials 42 Chapter 6 How to Evaluate an Older Driver Safety Program 43 6.1 Conclusion 46 Chapter 7 Resources 46 7.1 Safety Programs/Projects 54 Chapter 8 Conclusion 56 References C O N T E N T S