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Research Article  |   March 2010
Seniors’ Perceptions of Vehicle Safety Risks and Needs
Author Affiliations
  • Lynn Shaw, PhD, OT Reg (Ont), is Assistant Professor, School of Occupational Therapy, University of Western Ontario, Elborn College, 1201 Western Road, London, Ontario, Canada N6G 1H1; leshaw@uwo.ca
  • Jan Miller Polgar, PhD, OT Reg (Ont.), FCAOT, is Associate Professor, School of Occupational Therapy, University of Western Ontario, London
  • Brenda Vrkljan, PhD, OT Reg (Ont), is Assistant Professor, School of Occupational Therapy, McMaster University, Hamilton, Ontario
  • Jill Jacobson was Research Assistant, School of Occupational Therapy, University of Western Ontario, London, at the time of the study
Article Information
Community Mobility and Driving / Geriatrics/Productive Aging / Rehabilitation, Participation, and Disability
Research Article   |   March 2010
Seniors’ Perceptions of Vehicle Safety Risks and Needs
American Journal of Occupational Therapy, March/April 2010, Vol. 64, 215-224. doi:10.5014/ajot.64.2.215
American Journal of Occupational Therapy, March/April 2010, Vol. 64, 215-224. doi:10.5014/ajot.64.2.215
Abstract

The investigation of vehicle safety needs for older drivers and passengers is integral for their safe transportation. A program of research on safe transportation for seniors was launched through AUTO21, a Canadian Network of Centres of Excellence. This national research network focuses on a wide range of automotive issues, from materials and design to safety and societal issues. An inductive qualitative inquiry of seniors’ driving experiences, safety feature use, and strategies to prevent injury and manage risks was a first step in this program. We conducted interviews and focus groups with 58 seniors without disabilities and 9 seniors with disabilities. We identified a lack of congruity between the vehicle and safety feature design and seniors’ needs. Seniors described strategies to manage their safety and that of others. Specific aspects of vehicle design, safety features, and action strategies that support safer use and operation of a vehicle by seniors are outlined.

Access to a private vehicle, either as a driver or as a passenger, affords considerable independence for seniors when completing their daily activities. Driving an automobile in older adulthood is associated with prolonged health and independence (Marottoli et al., 1997). With the growing number of older people living in society, safe transportation for seniors is becoming a global issue and must include a focus on both drivers and passengers (Shaw & Miller Polgar, 2007) as well as on automobile design and features. Safe transportation involves practices and strategies that minimize the likelihood of personal injury to vehicle occupants, occupants of other vehicles, and pedestrians. Research considering the interaction between vehicle occupants and vehicle design has been conducted in the United States (Steinfeld, Tomita, Mann, & Deglopper, 1999), United Kingdom (Herriotts, 2005), and Canada (Shaw & Miller Polgar, 2007). The research we present in this article recognizes that safe transportation results from the interaction of the person, the vehicle, and the driving environment and that influencing change only at the person level neglects other elements that also affect driving. In particular, we explore seniors’ perception and use of vehicle safety features and the strategies they use to ensure safety for themselves and their passengers.
In 1994, Schieber, a researcher in transportation, along with a panel of experts, identified vehicle design as one of six high-priority research needs for promoting safe transportation for seniors. Despite this call, investigation into safe transportation for seniors has advanced slowly. For instance, in the mid- to late 1990s, some researchers attempted to examine and describe trends in seniors’ driving safety. Investigators focused on seatbelt use (Nelson, Bolen, & Kresnow, 1998; Sahai, Pitblado, Bota, & Rowe, 1998; Uriri & Thatcher-Winger, 1995), vision and cognitive impairments associated with driving (Levy, Vernick, & Howard, 1995; Millar, 1999), and seniors’ daily use of vehicles (Bess, 1999). Shaheen and Niemeier (2001)  reviewed the literature; proposed some anthropometric measures for doorways and modifications for seats, seatbelts, handles, knobs, and steering wheels; and offered some information on antiglare adaptation and auditory considerations. These investigators noted that changes in vehicle design draw, in part, from adaptations recommended for people with physical disabilities. Empirical evidence to support the effectiveness of some of these design changes in enhancing safety of seniors remains lacking.
Herriotts (2005)  used a national survey and focus groups to identify the challenges related to automotive design experienced by older vehicle users in the United Kingdom. To facilitate vehicle use by older adults, Herriotts recommended including optimizing the design of the doorway and seat to facilitate entry and exit, paying attention to the design and depth of the trunk, tailoring interior vehicular architecture to compensate for the reduced neck mobility experienced by many older drivers, and designing radio interfaces that are simple and easy to use. Although this study provided general areas for consideration of vehicle design, strategies that might enable seniors to continue to use vehicle safety features as they experience reduced strength, agility, vision, or cognitive abilities were not specified.
Existing and emerging vehicular technology both facilitate the task of driving and place greater demands on the driver, particularly cognitive demands (Vrkljan & Miller Polgar, 2005). Examples of this technology include navigation systems, Bluetooth access for cellular phones, adaptive cruise control, collision warning systems, lane change aids, parking aids, and telecommunication aids. Much of the relevant research on this technology has focused on its potential influence on older adults’ driving performance (Baldwin, 2002; Caird, Chugh, Wilcox, & Dewar, 1998; Caird, Horrey, & Edwards, 2001; Green, 2001; Liu, 2000; May, Ross, & Bayer, 2003; Verwey, 2000). Recent work has evaluated seniors’ ability to use in-vehicle information systems (IVIS) in both simulated and on-road conditions (Blanco, Biever, Gallagher, & Dingus, 2006; May, Ross, & Osman, 2005; Pauzié, 2002). Collectively, this work has suggested that minimizing the complexity of the task or display (Blanco, Biever, Gallagher, & Dingus, 2006; May, Ross, & Osman, 2005; Pauzié, 2002), providing redundant information (e.g., visual and auditory cues; May et al., 2005), and ensuring the information displayed is both legible and intelligible (Blanco et al., 2006; Pauzié, 2002) are design elements that facilitate older adults’ successful use of IVIS devices.
However, most of the research involving seniors’ use of IVIS devices transpires after technologies are either marketed or integrated into the vehicle. More research efforts are needed to engage seniors’ views about their needs and abilities when using vehicle safety devices as they age (Vrkljan & Miller Polgar, 2005). The project reported in this article is part of a larger program of the automotive research network AUTO21 investigating safe transportation for vulnerable populations. Our purpose in this study was to examine the vehicle safety issues and risk management strategies of seniors and seniors with disabilities (≥55) living in a Canadian context who use light passenger vehicles, such as cars, vans, or light trucks.
Method
Study Design
The aim of this qualitative study was to investigate the perceptions and needs of seniors and seniors with disabilities when using in-vehicle safety features and devices. In designing this study, we considered the assumptions and identified the methods to answer the question “How do seniors (as driver or passenger) use vehicle safety features and strategies to manage their safety when traveling in a vehicle?”
First, we wanted to understand seniors’ perspectives when using safety features in a vehicle and to give voice to their needs in future research, thus informing our use of a qualitative study (Creswell, 1998). Second, occupational (Law et al., 1996; Law, Polatajko, Baptiste, & Townsend, 2002) and constructivist perspectives (Crotty, 1998) underscored our definitions, procedures, and study methods. Shaw and Miller Polgar, the two primary researchers of this study, are occupational therapists by background and share a common occupational perspective that considers the importance of the interaction of dimensions of the person and the micro environment (the immediate vehicle environment) and macro environment (elements external to the vehicle such as other drivers and weather) to understand what daily occupations people perform and how they perform them (Law et al., 1996; Law, Polatajko, Baptiste, & Townsend, 2002). This perspective informed the importance of capturing the experiences of vehicle occupants (both drivers and passengers) with diverse needs and expertise in using vehicle safety devices, such as seniors with and without disabilities who were ≥55. In addition, it supported our recruitment of seniors who used different vehicles and who lived and traveled in both rural and urban areas of Canada. Finally, a constructivist approach suggests that experiences (views and perceptions) and knowledge are socially constructed through experiences and interactions between people (seniors) and the world or social context in which they live (Crotty, 1998). Thus, in this study we were interested in understanding vehicle occupants’ experiences in using vehicle safety features when traveling with others such as family members and partners and the strategies that seniors used in managing their safety needs. We drew on grounded theory methods (Corbin & Strauss, 2008), consisting of a systematic approach (Strauss & Corbin, 1990) and the constant comparative method, to analyze the data (Corbin & Strauss, 2008; Glaser & Strauss, 1967; Strauss & Corbin, 1990) and to reveal the factors and strategies in the data that shaped or informed seniors’ use or nonuse of safety features and managing safety while traveling in a vehicle.
We consulted three seniors about potential recruitment strategies and methods for collecting data in this study. The senior consultants cautioned that many seniors might be reluctant to respond to advertisements to discuss driving safety because of concerns about losing their license to drive. Thus, recruitment of seniors for participation in this study required personal connections and interactions with groups of seniors. We offered detailed explanations to seniors through one-to-one or group dialogue on the importance of researching safe transportation to promote change in vehicle safety design of devices. We recruited 28 seniors through three seniors’ events (18 at a booth at two seniors’ Jamborees and 10 at a seniors’ social club meeting), 4 at a national conference on aging, 9 through researcher connection with a senior gatekeeper connected to groups of seniors with disabilities, and 27 through snowball techniques (Patton, 2002). Snowball techniques included asking seniors to consider passing along information about the study to other seniors who were acquaintances in different provinces or who lived in rural areas. Seniors were included if they were (1) ≥60 years old (for those without limitations resulting from disability) or ≥55 years old (for those with disabilities), (2) a regular driver or passenger in a private vehicle, and (3) English speaking. Ethics approval was received from the local university’s human subject ethics review board.
Data Collection
The primary research team—Lynn Shaw, Jan Miller Polgar, and Brenda Vrkljan—in consultation with the three seniors, developed a semistructured interview guide. The interview guide included open-ended questions pertaining to seniors’ use of safety features, their transportation needs, and strategies used to promote safe transportation. Both drivers and passengers were asked about how they entered and exited a vehicle and what problems, if any, they encountered when operating vehicle safety features. Finally, seniors were asked to describe their experiences when managing risks, vehicle safety, and safe transportation of others. Interviews were audiorecorded and transcribed verbatim.
Data Analysis and Credibility Strategies
We analyzed data using a grounded theory process. Open and axial coding were used to analyze the transcripts (Corbin & Strauss, 2008; Strauss & Corbin, 1990). First, we did open coding to identify the content or the specific issues that seniors experienced when using a vehicle such as safety risks, concerns, and solutions. Second, we completed axial-level coding that identified the processes or strategies that seniors used to manage their safety needs. All members of the primary research team independently analyzed the data for the first and second levels of coding. They then compared these codes and grouped common factors and strategies that clustered into emergent themes. Relationships among these themes were discussed, and consensus was reached on the key themes.
Credibility strategies used to achieve an accurate interpretation of data included comparing data across subsamples of seniors with disabilities and seniors without disabilities until all data were accounted for. Our interpretations were further verified through a two-phase member-checking process. The first phase involved sharing a written summary of the findings with all participants and eliciting telephone feedback from 20 participants. The second phase involved a focus group with 10 seniors who ranged in age from 67 to 90. Participants in the focus group verified that the findings accurately represented their issues and needs. All qualitative data were uploaded electronically into NVivo 2.0 software (QSR International, Cambridge, MA) and recoded using the themes and categories as a guide for purposes of managing these data.
Findings
Sixty-seven seniors participated in the study, 58 without disabilities and 9 with disabilities (4 men and 5 women). Table 1 summarizes the participant demographic information, collected and reported by frequency or percentage of use. Demographics included age range, gender, disability, number of drivers and passengers, urban or rural living, daily use of vehicle, top five reasons for using a vehicle, and top five safety devices used while operating a vehicle. Slightly more than half of the participants lived in urban locations; the others lived in a rural location (<25,000 people). Most seniors were from the central region of Canada, including Ontario and Quebec, and two were from the western region.
Table 1.
Participant Demographics and Information (N = 67)
Participant Demographics and Information (N = 67)×
Participant Demographicsn
Age range (n)
 55-594
 60-6928
 70-7926
 80-896
 ≥903
Gender (n)
 Male23
 Female44
Disability (n)
 Without disability58
 With disability9
Drivers and passengers (n)
 Drivers47
 Passengers20
Urban or rural (n)
 Urban35
 Rural32
Daily use of vehicle by participants, n
 ≤1/mo1
 1/wk4
 4/wk8
 6/wk3
 1/day18
 >1/day23
Top 5 reasons for using a vehicleRank order (1-5, where 1 is the top reason)
 Leisure and recreation events1
 Groceries2
 Shopping2
 Running errands3
 Restaurants4
 Social and visiting5
Top 5 vehicle safety features identified by seniorsRank order (1-5, where 1 is the top reason)
 Seat belts1
 Airbags2
 Electronic devices (e.g., mirrors, locks and seat adjusters, mirror electronic devices)3
 Manual seat and steering adjustments4
 Weather-related safety features (e.g., air conditioning, sun visors, climate controls such as defrost)5
Table 1.
Participant Demographics and Information (N = 67)
Participant Demographics and Information (N = 67)×
Participant Demographicsn
Age range (n)
 55-594
 60-6928
 70-7926
 80-896
 ≥903
Gender (n)
 Male23
 Female44
Disability (n)
 Without disability58
 With disability9
Drivers and passengers (n)
 Drivers47
 Passengers20
Urban or rural (n)
 Urban35
 Rural32
Daily use of vehicle by participants, n
 ≤1/mo1
 1/wk4
 4/wk8
 6/wk3
 1/day18
 >1/day23
Top 5 reasons for using a vehicleRank order (1-5, where 1 is the top reason)
 Leisure and recreation events1
 Groceries2
 Shopping2
 Running errands3
 Restaurants4
 Social and visiting5
Top 5 vehicle safety features identified by seniorsRank order (1-5, where 1 is the top reason)
 Seat belts1
 Airbags2
 Electronic devices (e.g., mirrors, locks and seat adjusters, mirror electronic devices)3
 Manual seat and steering adjustments4
 Weather-related safety features (e.g., air conditioning, sun visors, climate controls such as defrost)5
×
The concept of seniors’ perceptions of vehicle safety comprised two main themes: (1) vehicle safety features and their fit with seniors’ abilities and (2) strategies to enhance safety of self and others. The first theme had two subthemes: vehicle features and dimensions and person–vehicle fit. The second theme also had two subthemes: beliefs about safety and managing safety of self and others. Figure 1 provides a representation of the themes and subthemes. We identify and elaborate on common findings and those findings less common yet important for vehicle design consideration in the corresponding subsections of the Vehicle Features and Dimensions section.
Figure 1.
Themes related to seniors’ perceptions of vehicle safety and safety device use.
Figure 1.
Themes related to seniors’ perceptions of vehicle safety and safety device use.
×
Vehicle Features and Dimensions
Entering (Ingress) and Exiting (Egress) the Vehicle.
Seniors identified aspects of physical access to entering and exiting a vehicle, as well as safety issues. Changes in range of motion, flexibility, strength, and balance in the lower extremities affected their ability to maneuver through the door opening and lower the body to or raise it from the seat. Participants expressed concerns related to falling into the vehicle or straining with exertion when attempting to maintain stability while lowering or raising themselves from the vehicle seat. Vehicle design features of door aperture size, doorframe height, height of doorsills, and variable seat heights were all mentioned as contributing to difficulties with vehicle ingress and egress.
Lower seats required the vehicle occupant to “sit down and sort of roll into the seat.” Low door frame heights posed a risk of injury; for example, “The clearance in the car is sort of a problem. If you don’t have your head down, you can hit it [the door frame].” Raised doorsills posed a barrier: “You have to lift your leg over the sill; it’s very awkward and sometimes, if you don’t do that, you fall into the vehicle.”
Opening and closing doors also posed difficulties for seniors when entering and exiting a vehicle. These difficulties were related to physical changes associated with aging similar to those identified in the preceding paragraph. Several participants indicated a fear of falling out of the vehicle when attempting to close the door because of the weight of the door and the reach needed to grasp the interior door handle. One senior explained, “The location of the door handle is awkward. When I try to reach for the door to shut it, I am afraid of losing my balance and falling out of the car.”
Safety issues were also identified relative to entering and exiting the vehicle. Many seniors indicated that interior lighting was a key feature that enhanced their sense of security when entering their vehicle after dark. Keyless entry devices that engaged the interior lights afforded seniors a sense of security. As one senior described,

At night, when you open the door with the remote, it has an interior light and the lights come on. You can see if there’s anybody hiding in the back seat of the car, so I know it is safe to get in.

Seat Belt Use.
Seat belts were one of the features most frequently commented on by participants. Seniors expressed concerns about the physical aspects of fastening and unfastening seat belts and the assistance they provided to others to use these devices, and they had divergent beliefs regarding the seat belts’ potential to keep them safe in a crash. Seniors reported differences in physical capacity and characteristics that influenced seat belt use, such as reduced grip strength, decreased finger dexterity, decreased range of motion for reach, and decreased ability to exert force, all of which posed difficulties when fastening and unfastening seat belts. These issues were present for both drivers and passengers, and in some instances, seniors reported assisting their passengers with fastening their seat belts. One participant, age 70, said,

My mother [age 90] couldn’t turn her head to see the seat belt, nor did she have the strength to insert the buckle into the clasp, so she would hold onto the seat belt, instead of asking for help. I would have to put it on for her.

When this cohort began driving, seat belt technology was not available, and it was not available for much of their driving careers. Consequently, they held mixed views on whether it was effective in enhancing safety. Those beliefs contributed to whether they used seat belts. Most participants reported that they fastened seat belts before driving and refused to transport others unless they also fastened their seat belt.
Person–Vehicle Fit Dimension
Vision.
Age-related visual changes resulted in increased sensitivity to glare, reduced contrast sensitivity, lower acuity, and slower visual scanning. These changes posed particular difficulty when retrieving information quickly from the instrument panel. Participants identified problems with the size of numbers and color contrast used. One participant said,

There are complications that make it difficult to use features in your car, like a lack of larger digits in terms of numbers on the radio for seniors. If you have larger digits, it would really help. Sometimes, you have to wear bifocals to see something with our vision. They should consider things like dials in the vehicles and the white and black backgrounds. It’s easier to read them in the daytime if the digits are black and white; it’s very important to be able to see and read clearly.

Another senior commented on how changes in acuity became problematic in poor driving conditions: “Ordinary things become troublesome as you become older. If it is snowing and the snow is coming at us, it is difficult to see.”
Some seniors indicated that the changes in location of certain elements on the instrument panel facilitated their use. One participant indicated,

Years ago, the [turn signal] indicator lights were down low and the location wasn’t great. The location of the indicator lights being at the top of the panel is a good thing. Now you know if you have left them on or not.

Location of Device Controls.
The location of vehicle device controls affects the force required to activate them and the range of motion needed to reach them. Devices within easy reach that required minimal physical force enabled senior drivers to continue to use these safety features. One participant explained, “I can use the windows and sun visors [in my car]. They are all located within reach, and I don’t have to take my eyes off the road.”
Location determined whether participants were able to use devices while driving. For example, some participants would not operate functions such as climate controls, the radio, and windows while driving because of concerns about attention taken from the driving task. They waited until they could pull over to the side of the road to adjust the heat or air conditioning or relied on passengers to perform these tasks. For instance, one senior driver said, “My wife will operate the windows or adjust things so I don’t have to look down, and I can keep my eyes on the road.”
Vehicle storage areas that required minimal bending and stooping for use were preferred. One senior indicated, “The back trunk in my car is cut down. It’s easier for lifting out. I don’t have to lift up and then out. I don’t have the strength.” Conversely, many seniors used the back seat rather than the trunk to store heavy items so they could avoid lifting these items.
Use of Emerging and Changing Technology.
Rapid changes in vehicle technology may limit seniors’ ability to use it because of their unfamiliarity with, and lack of confidence when using, the technology. For instance, one participant indicated, “I’m scared to use certain devices in modern cars; I’m afraid I might press a button and open the door.” Another senior gave an example of the difficulty in adapting to control buttons on the steering wheel. He said,

You no longer have your whole hand off the wheel to use the horn. You [might] think we [seniors] should be able to comprehend this. In our adult years, we were used to the other type of horn. [Thus to use the new horn] you have to familiarize yourself with this feature.

Airbags were one feature that caused considerable concern to these participants. Many participants indicated that they were fearful they would be killed if an airbag was deployed. They wanted further information about these devices. Some of the older women who reported that they were small in stature and size wanted to know how to disengage them.
Strategies to Enhance Safety of Self and Others
Two subthemes emerged that captured how older drivers managed the safety of themselves and others: beliefs about safety and managing safety of self and others.
Beliefs About Safety.
This theme involved seniors’ perceptions of the vehicle as being safe and of both their own ability to drive and that of others. The perception of what constituted a safe vehicle was diverse, with some seniors responding that a smaller vehicle was safer because it was easier to maneuver or conversely that a larger vehicle afforded the occupants greater protection. As one participant indicated, “I feel secure with a big heavy car. A Mercury Marquis is what I drive … you feel like you are not going to get crunched in a larger car if you are in an accident.”
Some of the participants expressed the opinion that they were safe drivers, following the rules of the road and retaining confidence in their ability to drive: “I use a defensive driving mode. I check the rear view mirror regularly. Being aware of what is happening on the road is critical.” Conversely, the opinion that other drivers on the road compromised their safety and influenced how they drive was also apparent. One older female driver said,

Other drivers impair my safety. I feel insecure when they don’t follow the rules. Senior men don’t think women, for the most part, should be driving. They don’t demonstrate very good road courtesy. Men feel superior to women, and in my age group, they are not able to change.

Managing Safety of Self and Others.
Personal appraisal of fitness to drive.
Participants identified several strategies they used to enhance their safety as vehicle occupants. Drivers reported that they considered both their physical and their mental readiness to drive and environmental conditions when determining whether to initiate a trip. Some participants indicated that they planned their trips around times when they knew they were most alert:

I don’t drive when I’m tired. I’m aware of my energy level. I’m a better driver in the morning than at night; therefore, I arrange my driving patterns so I’m more fully awake. As I get older, I have to be more mindful of these things.

Making choices.
Participants described choices they made about when to drive and the factors that influenced these choices. Factors in the driving environment, including poor weather, time of day, traffic speed and congestion, and access to secondary roads over freeways were common influences on when and where to drive. If a trip was not vital, senior drivers reported that they would stay home rather than risk driving in unfavorable conditions.
Use of adaptive equipment.
The lack of congruence between vehicle design and seniors’ needs and abilities required that they use alternate strategies for many tasks associated with use of a vehicle. These adaptations included the use of after-market devices such as cushions or relying on assistance from others as needed. Often challenges with vehicle ingress and egress required adaptation to promote safe access. Grab bars and swivel seats (when available) were key strategies. Seniors also identified strategies to improve stability and reduce friction between the vehicle seat and the person’s apparel to facilitate vehicle ingress and egress: “I put a green garbage bag on the seat; turning on that is easier than turning on the seat fabric”; “I grab anything to give me stability”; “I sit on the edge of the seat first, then turn toward the front and lift legs over the sill one at a time”; or “I grab the steering wheel and I use it as a boost. I swing my legs out and get up.”
Adaptive equipment was used to enhance the passenger safety as well. Participants described assisting others with ingress and egress and with fastening seat belts. One senior who regularly drove his elderly mother on outings used a step to assist her with climbing into his vehicle.
Minimizing distractions.
Participants commented that they sought to minimize distractions, either inside or outside the vehicle, to ensure that they focused on the driving task. For example, one senior reported that she regularly asked passengers not to talk. Another indicated that she asked passengers not to touch control buttons on her vehicle. Others avoided the use of the radio while driving to remove this potential distracter. The previously reported choices to drive in favorable weather conditions, during the day, and on quiet roads are examples of how participants attempted to reduce distractions that were outside of the vehicle.
Discussion
The participants in this study described important aspects of vehicle safety features that affect whether they are used. Consistent with the work of Herriotts (2005), they identified design issues related to the vehicle door, the height and depth of the trunk, and the complexity of control interfaces, such as for the radio, that affected their ability to easily use a vehicle. This study also supports the work of Blanco et al. (2006)  and Pauzié (2002), who recommended legible and intelligible information displays.
The participants described various strategies to maximize their safe transportation and that of their passengers. Many of the strategies are commonly included in driver retraining programs (e.g., restricting driving in poor weather and avoiding congested roadways; Kostyniuk, Streff, & Eby, 1998; Kua, Korner-Bitensky, Desrosiers, Man-Son-Hing & Marshall, 2007). Some of the strategies they described, however, are not apparent in the literature. Their use by the study participants suggests that seniors recognize the cognitive load implications of driving in combination with other demands, such as listening to the radio or conducting a conversation, and take measures to reduce this load. Inclusion of information that assists seniors to recognize situations in which cognitive demands are high and strategies to reduce these demands is an important addition to driver retraining programs.
The finding of seniors assisting other seniors is one that has received little attention in the literature. Given the growth in the proportion of seniors in many countries and the reduction in the assistance that many seniors receive (Rosenbloom & Winsten-Bartlett, 2002), awareness of this issue and development of educational strategies for those people providing assistance will be increasingly important. One particular implication for occupational therapists is the need to teach spouses and caregivers how to assist with a transfer into and out of a vehicle, with attention to safety of both the person transferring and the one assisting.
This study’s results have implications for a wide range of people concerned with safe transportation for this population, including seniors and their families, clinicians, driver rehabilitation specialists, driver educators, policymakers, and auto manufacturers. These findings reinforce the need to consider the fit between the abilities of the user and the demands of the technology to maximize occupational performance.
Implications for Vehicle Design
In this study, seniors discussed vehicle safety devices they used or felt were the most important to their safety, including seat belts, air bags, electronic door locks, sun visors, and adjustments to steering wheels. Size, complexity, location in the vehicle, and potential to be adjusted were all features that influenced whether a device was considered to promote or deter safety. The congruence of device design with seniors’ changing abilities supports the call to incorporate universal design principles into the vehicle design process (Vrkljan & Miller Polgar, 2005).
The lack of knowledge about the function of air bags and fear related to their deployment were surprising issues of concern raised by seniors. Current air bag designs accommodate for lighter vehicle occupants, decreasing the risk of injury during deployment; yet, the study participants did not seem to be familiar with these changes.
Personal security while using a vehicle was an emergent concern. Use of electronic locking systems were not only important for ease of use but also a feature to assist seniors with managing their own security at night or in places where lighting was poor. Seniors indicated that they felt more secure with an electronic locking system that activated the interior lighting because they were then able to see inside the vehicle to be alert for any possible threat to their personal safety.
Two other devices were identified that enabled drivers to keep their hands on the wheel and their eyes on the road: adjustable steering columns and extensions to sun visors. Adjustable steering columns allow drivers to attain a comfortable position for driving. Visor extensions blocked glare from the sun, something to which seniors become increasingly sensitive with age (Green, 2001; Herriotts, 2005). Although simple, these devices were highly valued by the participants.
Participants identified aspects of their functioning, such as physical, sensory, and cognitive changes that affect their ability to use vehicle features effectively. In many situations, these difficulties when using a vehicle posed a significant risk of injury. In some instances in which use of a feature was difficult because of lack of range of motion or force required to activate a function, use was simply avoided. Participants described the importance of keeping their hands on the steering wheel and their eyes on the road. They expressed the need to focus their attention and concentrate more on driving tasks and minimize potential distractions resulting from age-related changes. They limited or avoided reaching for dials that control the temperature or the radio or glancing downward or sideways to access information on the instrument panel. In circumstances in which safety equipment with demonstrated effectiveness such as seat belts is avoided because of difficulty with use, the consequences can be tragic.
Some aspects of vehicle use pose a risk of injury because the vehicle dimensions do not fit the older user’s physical abilities. These findings are consistent with the work of Caird et al. (1998), who proposed a framework for evaluating emerging technology and its relationship to the needs of older drivers. Participants in this study expressed concerns about the strain on or exertion of lower and upper extremities required to enter and exit their vehicle. They feared a loss of balance when reaching out to close the door after entering the vehicle. They also identified the potential of tripping over the sill and hitting their head on the door frame, which has not been identified as a safety risk in other studies. Because use of a vehicle obviously requires the person or occupant to enter and exit, these findings have implications for vehicle design that would reduce the risk of injury during this activity.
Emerging technology may pose challenges if seniors’ needs are not considered (Caird et al., 1998). Some participants in this study indicated fear when using unfamiliar technology, suggesting that they refrained from using some technology because they were uncertain of the results of their actions. Similarly, seniors’ ability to readily understand and retrieve information from various technologies should be considered during development as well as the device’s potential to distract an older driver (Caird et al., 1998). Consideration of the older driver’s ability to use various vehicle safety features not only will enable their use by this population but also will have more widespread benefits for other users (Vrkljan & Miller Polgar, 2005).
Vehicle safety features should be flexible, meaning that they can be adjusted or easily altered to accommodate the user’s needs. Vehicle seats that provide a continuous range of accommodation in terms of distance from steering wheel, height, and seat-to-back angle are a good example of a flexible feature. Similarly, the ability to control the dashboard’s luminescence facilitates quick retrieval of information under different light conditions and with different age-related visual changes. Some authors have suggested that universal design principles be applied in the design of vehicles to match seniors’ needs and those of other vehicle occupants (Herriotts, 2005; Steinfeld et al., 1999; Vrkljan & Miller Polgar, 2005).
Seniors’ reticence to use emerging technology because of unfamiliarity and fear that they might break the device or have some other catastrophic result because of an error suggests that these devices need to be designed with minimal complexity and a high tolerance for error. Other researchers have proposed evaluation guidelines for determining seniors’ abilities to use emerging technologies (Caird et al., 1998; Mitchell, 1997) and strategies for reducing driver distraction from in-vehicle technologies (Transport Canada, 2003).
Senior-to-Senior Implications
Many study participants identified seniors’ actions and behaviors to prevent injury to themselves and their passengers while using a vehicle. For the most part, seniors in this study used their vehicles at least once a day to carry out daily occupations. They offered insights into everyday proactive solutions and strategies that assisted them in minimizing risks and hazards when using a vehicle. These action strategies offer a rich and credible source of information. Programs that would connect seniors with other seniors to share driving strategies would be an effective means of educating a wide range of people in this group. Because driving is so critical to older adults’ independence, some seniors may be quite reticent to disclose difficulties they are experiencing with driving. This reticence may be compounded if they believe their license may be revoked if these difficulties are disclosed to someone with perceived authority. Another senior, someone who shares a common experience, may be less threatening. Thus, more opportunities are needed for seniors to learn about and become more aware of responsible safe transportation. Opportunities for seniors to share this information with other seniors through groups and formats such as Web sites are potential means of providing education to help other seniors achieve safer transportation.
Implications for Health and Safety Professionals and the Family
This study draws attention to the potential concerns of family members who transport their older relatives as passengers. For example, families might consider the design of vehicles they purchase or acquire to support safe transfers for seniors (e.g., vehicles with hip-level seat heights and easy access for entry and exit). They suggest the usefulness of a vehicle with sufficient interior space to allow a family member to assist an older passenger with transfers into and out of the vehicle and with fastening and unfastening the seat belt.
Many of the strategies that participants identified to enhance their safety, such as regulating their driving, are already well known and included in driver refresher programs (e.g., 55 Alive). What is less obvious in these programs, but evident from these findings, is the need to assist seniors with the selection of vehicles or useful after-market technologies. Moreover, these findings suggest the inclusion of information in driver refresher programs about how to use emerging technologies to reduce the reticence some may have to use these devices and to ensure that they are used to their full potential. With their knowledge of occupational adaptation and assistive technology, occupational therapists have a role to play in this area.
This study’s findings emphasize the importance of promoting senior awareness of safe transportation. Health professionals, such as public health nurses, occupational therapists, and doctors, have a role to play in translating knowledge and teaching seniors how to evaluate their health status and consider their fitness to drive or travel. In addition, health professionals should encourage seniors to be more aware of their approach to using and operating a vehicle.
Occupational therapists can draw on these findings when working with seniors one on one or in groups to provide education and knowledge about the use of vehicle safety devices, the features to look for when choosing a vehicle, and strategies to improve the safe use of devices while operating a vehicle. Therapists can partner with seniors’ organizations to provide education on safe transfer into and out of the vehicle and proper positioning in the vehicle to support low effort and reduce fatigue while driving. In addition, therapists can work with seniors to provide advice on the selection and use of adaptive devices such as seat cushions and visor extensions and to support safety while traveling in a vehicle. Occupational therapists are in an ideal position to provide support to family members and caregivers on strategies to promote the safety of passengers in a private vehicle.
Study Limitations and Future Safe Transportation Research
We do not intend the data reported in this study to represent the experiences of all seniors; rather, these insights are meant to inform the development of a national investigation related to seniors’ transportation needs. Study participants were retired, which means that many had flexibility regarding the scheduling of activities for which they used a private vehicle. Risk management strategies that involve avoiding driving in unfavorable conditions may not be a choice for some older drivers. The study participants may have provided different insights from those of the senior consultants who provided input into this study. Moreover, we recruited many older adults through events targeting seniors, which might suggest that study participants were more mobile and engaged than their peers. Again, we might have received different input if we had included seniors who used their vehicles infrequently (e.g., ≤1/wk). Although the participants were nationally representative, most were from one region of Canada, which tends to have milder weather and a higher population density than the remainder of the country. Future research should include a larger sample that is representative of the older population.
Conclusion
Safe transportation for seniors encompasses a dynamic interaction of person (driver) and environmental-related factors and a commitment by seniors to manage their driving safety. Findings from this initial investigation suggest a need for more participatory research that includes seniors in the research process. Application of universal design principles to the design of vehicle safety features is suggested as a strategy that will extend their usability to people with a wider range of abilities and experiences. Opportunities for seniors to share strategies that maintain their community mobility with other seniors are also suggested as beneficial. Further research will ensure that as seniors age, they can continue to access and use safety features while driving a private vehicle. The conceptualization of the themes and issues from this study will inform the development of a national survey to further elicit seniors’ experiences and needs with regard to safe transportation. The interaction of variables related to the person and vehicle technology and the influence of this interaction on use of these devices and driving strategies should also be explored.
Acknowledgments
This project was funded by a grant through the AUTO21, a Canadian Network of Centres of Excellence. We thank all the seniors who participated in this study and shared their views on using vehicle safety devices.
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Figure 1.
Themes related to seniors’ perceptions of vehicle safety and safety device use.
Figure 1.
Themes related to seniors’ perceptions of vehicle safety and safety device use.
×
Table 1.
Participant Demographics and Information (N = 67)
Participant Demographics and Information (N = 67)×
Participant Demographicsn
Age range (n)
 55-594
 60-6928
 70-7926
 80-896
 ≥903
Gender (n)
 Male23
 Female44
Disability (n)
 Without disability58
 With disability9
Drivers and passengers (n)
 Drivers47
 Passengers20
Urban or rural (n)
 Urban35
 Rural32
Daily use of vehicle by participants, n
 ≤1/mo1
 1/wk4
 4/wk8
 6/wk3
 1/day18
 >1/day23
Top 5 reasons for using a vehicleRank order (1-5, where 1 is the top reason)
 Leisure and recreation events1
 Groceries2
 Shopping2
 Running errands3
 Restaurants4
 Social and visiting5
Top 5 vehicle safety features identified by seniorsRank order (1-5, where 1 is the top reason)
 Seat belts1
 Airbags2
 Electronic devices (e.g., mirrors, locks and seat adjusters, mirror electronic devices)3
 Manual seat and steering adjustments4
 Weather-related safety features (e.g., air conditioning, sun visors, climate controls such as defrost)5
Table 1.
Participant Demographics and Information (N = 67)
Participant Demographics and Information (N = 67)×
Participant Demographicsn
Age range (n)
 55-594
 60-6928
 70-7926
 80-896
 ≥903
Gender (n)
 Male23
 Female44
Disability (n)
 Without disability58
 With disability9
Drivers and passengers (n)
 Drivers47
 Passengers20
Urban or rural (n)
 Urban35
 Rural32
Daily use of vehicle by participants, n
 ≤1/mo1
 1/wk4
 4/wk8
 6/wk3
 1/day18
 >1/day23
Top 5 reasons for using a vehicleRank order (1-5, where 1 is the top reason)
 Leisure and recreation events1
 Groceries2
 Shopping2
 Running errands3
 Restaurants4
 Social and visiting5
Top 5 vehicle safety features identified by seniorsRank order (1-5, where 1 is the top reason)
 Seat belts1
 Airbags2
 Electronic devices (e.g., mirrors, locks and seat adjusters, mirror electronic devices)3
 Manual seat and steering adjustments4
 Weather-related safety features (e.g., air conditioning, sun visors, climate controls such as defrost)5
×