A 10-YEAR SCOPING REVIEW OF SCREENING AND ASSESSMENT TOOLS USED FOR DRIVING REHABILITATION IN OLDER ADULTS

This scoping review aims to explore the screening and assessment tools used for driving rehabilitation in older adults and the domains that these tools evaluate. Web of Science, Scopus, and PubMed databases were used to search for potential studies published from 2012 to 2022, and 34 studies met our inclusion criteria. The findings revealed various types of tools used to screen and assess older adults’ fitness to drive, including off-road screening tools (n = 54), off-road assessment tools (n = 21), and on-road assessment tools (n = 20). This review also identified five main domains evaluated by these tools: general information, physical, cognitive, vision, and driving competency. This review provides valuable insights into the screening and assessment tools available for evaluating driving rehabilitation in older adults. The results of this study may assist in the growth of the occupational therapy profession in the area of driving rehabilitation by guiding them in selecting the most appropriate tools to evaluate older adults’ fitness to drive.


Introduction
The mounting number of senior drivers is alarming to health professionals, especially occupational therapists who are playing their roles in promoting older adults' functional performance, which also includes driving activity.In the baby boomers' generation, driving activity symbolises independence and well-being.Driving enables older people to lead active lives, maintain social ties, and contribute to self-confidence (1).The ability to drive among older people is also linked to undeniably higher access to healthcare, shopping, and social opportunities, and there will be critical impacts on the older person in terms of socialisation and isolation when the ability to drive is lost (2).
Occupational therapy practitioners play vital roles in addressing driving issues among older adults.In comparison to other health professionals, occupational therapists are more likely to recognise when a client is no longer fit to drive (3)and health professionals should advise patients accordingly.This study examined the knowledge of occupational therapists, other therapists and psychologists regarding medical standards for driving, their attitudes to advising patients about driving, and barriers to giving that advice.Method: A structured questionnaire measured knowledge of medical standards and attitudes to advising patients about driving.Analyses compared responses of occupational therapists with those of other therapists and psychologists.Semi-structured interviews were carried out with therapists and psychologists after they had watched a video-taped clinical consultation with an actor-patient who was unfit to drive.Interviewees, unaware that the study was about driving, were asked how they would advise the patient.Focus groups were held with a range of health professionals to discuss facilitators and barriers to giving driving advice.Results: Eighty-two questionnaires were completed.Occupational therapists were most aware of driving guidelines and most likely to advise patients to stop driving (p < 0.01.With the knowledge of pathology, injury, and driving activity requirements (4)public healthcare users equate the ability to drive a motor vehicle to employability and access to essential services.When injury or illness threatens the ability to drive, the multi-professional medical team usually refer the problem to the occupational therapist who will make decisions about patients' fitness to drive a motor vehicle.Method: Over the course of five years, a collaborative task team applied multiple Action Learning Action Research (ALAR, occupational therapists should be able to assist these older drivers by using their capacity as health professionals who are practising driving rehabilitation.
Driving rehabilitation is a program that helps evaluate skills and provides retraining related to driving activity, which is often staffed by occupational therapists (5).Compared to other health professionals, occupational therapists are those who are more aware of mobility issues such as driving (3)and health professionals should advise patients accordingly.This study examined the knowledge of occupational therapists, other therapists and psychologists regarding medical standards for driving, their attitudes to advising patients about driving, and barriers to giving that advice.Method: A structured questionnaire measured knowledge of medical standards and attitudes to advising patients about driving.Analyses compared responses of occupational therapists with those of other therapists and psychologists.Semi-structured interviews were carried out with therapists and psychologists after they had watched a video-taped clinical consultation with an actor-patient who was unfit to drive.Interviewees, unaware that the study was about driving, were asked how they would advise the patient.Focus groups were held with a range of health professionals to discuss facilitators and barriers to giving driving advice.Results: Eighty-two questionnaires were completed.Occupational therapists were most aware of driving guidelines and most likely to advise patients to stop driving (p < 0.01.As driving is an important means of community mobility for an individual, occupational therapists play a critical role in assessing fitness to drive and enabling clients to continue driving when it is deemed safe (3)and health professionals should advise patients accordingly.This study examined the knowledge of occupational therapists, other therapists and psychologists regarding medical standards for driving, their attitudes to advising patients about driving, and barriers to giving that advice.Method: A structured questionnaire measured knowledge of medical standards and attitudes to advising patients about driving.Analyses compared responses of occupational therapists with those of other therapists and psychologists.Semi-structured interviews were carried out with therapists and psychologists after they had watched a video-taped clinical consultation with an actor-patient who was unfit to drive.Interviewees, unaware that the study was about driving, were asked how they would advise the patient.Focus groups were held with a range of health professionals to discuss facilitators and barriers to giving driving advice.Results: Eighty-two questionnaires were completed.Occupational therapists were most aware of driving guidelines and most likely to advise patients to stop driving (p < 0.01. As part of the rehabilitation professional, occupational therapist participates in the process of screening and assessing potentially unsafe older drivers.Screening is a process that involves administering quick tests, examinations, or other procedures to identify an unrecognised disease or defect and, therefore, determine those who need further evaluation concerning their driving safety (6).In the driving context, many often-used off-road screening tools are beneficial in screening for older drivers with enhanced risk (7).Meanwhile, assessment is a process that involves a more detailed and comprehensive evaluation of the individual's driving-specific skills and safety, particularly in domains that were identified as potential concerns during the screening process (6).
The therapist will commonly perform a pre-road screening and assessment as a preliminary step to detect problems or issues before deciding if on-road testing is appropriate (8).In order to make accurate decisions, it is crucial to use standardised assessments, which can help improve the quality and quantity of the information gathered (9).However, there is inconsistency in selecting and administering screening and assessment tools for this population.Therefore, this scoping review sought to provide an overview of the current screening and assessment tools used for driving rehabilitation in the older adult population.

Materials and Methods
This scoping review was reported in accordance with the preferred reporting items for systematic reviews and metaanalyses extension for scoping reviews (PRISMA-ScR) (10) and conducted according to the framework proposed by Arksey and O'Malley (11), which uses the following steps: (i) identifying the research question, (ii) identifying the relevant studies, (iii) study selection, (iv) charting the data; and (v) collating, summarising, and reporting the results.

Step 1: Identifying the research question
This scoping review addresses the research question: 'What are the existing screening and assessment tools used for driving rehabilitation in older adults?' and 'What are the domains assessed by those tools?'.

Step 2: Identifying relevant studies
The studies were identified in October 2022 through the following electronic databases: Web of Science, Scopus, and PubMed.The main keyword used were "screening tool", "assessment tool", "older adult", "driving", "driving rehabilitation", and "occupational therapy".The reference lists of records found through the electronic searches were extracted into reference management software (Mendeley™) for duplicate removal.A total of 728 records were screened after removing 80 duplicates, and no new potential articles were found from cross-reference and hand searching.The flow chart of study selection is illustrated in Figure 1.

Step 3: Selection of studies
A total of 728 articles were screened based on their title, abstracts, and year of publication.The inclusion criteria in this scoping review were: (i) published between 2012 and 2022 to reflect the most up-to-date literature; (ii) full-text articles published in English; (iii) screening and assessment tools used must evaluate older adults' population related to their driving activity.Articles were excluded if they were

Step 4: Charting the data
The data was charted and summarised in Table 1 according to the characteristic of the studies, such as author, year, study design, the aim of the study, population, country, screening or assessment tool, and summary of findings.Further, the data was then extracted concerning the domain and characteristics of the tools (Table 2).

Step 5: Collating, summarising, and reporting the results
A narrative summary of the results was also presented to summarise the extracted data.The authors conducted the analysis, and the results were described in relation to the research questions of this scoping review to provide a clear understanding.This content analysis focused on the domain and characteristics of the tools used to assess older adults related to their driving activity.

Results
Thirty-four articles were eligible for this scoping review.The summaries of the selected articles can be found in Table 1, and the domains assessed by the tools and their characteristics are shown in Table 2.

Overview of the studies 1. Study design
There were fourteen cross-sectional studies, four validation studies, four case-control studies, two observational studies, in the form of comments, editorials, letters, or review papers or if the older adult population was not the study's highlight.Only 34 articles fulfilled the inclusion criteria and were retrieved for this review.

Computerbased
The total scores of the three subtasks were reported as percentile ranks with higher scores indicating a better performance      three longitudinal studies, three retrospective studies, one prospective observational study, one secondary analysis, one cohort study, and one retrospective, cross-sectional, and prospective observational study.

Sample of population
All of the studies included in this review used older adults as their sample of the population.74% (25 studies) and 24% (9 studies) had older adults as their sample of the population aged more than 60 years old and 45 years old, respectively.

Location and setting
Out of thirty-four eligible studies in this review, fourteen were conducted in the United States of America (USA), seven in Australia, six in Canada, and 1 in New Zealand, Italy, Japan, Korea, Argentina, Portugal, and the Netherlands.
The included studies ranged from the year 2012 until 2022.

Screening and assessment tools
There were many variations in the types of tools used to screen and assess older adults' fitness to drive.The tools included were off-road screening tools (n = 54), off-road assessment tools (n = 21), and on-road assessment (n = 20).All tools were either self-rated, clinician-reported, interview/questionnaire, pencil-and-paper, performancebased or computer-based.The characteristics of the tools are given in Table 2.

Main findings
There were five main domains covered by the screening and assessment tools utilised for older adults to examine their fitness to drive: general information, physical, cognitive, visual, and driving competency.

General information
Health practitioners, such as occupational therapists in particular, would always start with the gathering of general information (e.g., demographic data (12-30)a wide range of motor, sensory, and cognitive skills that are imperative for driving are affected in older adults.Though on-road tests are most indicative of driving ability, they are costly, stressful, time-consuming, and risky.Application of tabletbased cognitive tasks is investigated in identifying unsafe drivers in a population of healthy and at-risk for driving older adults.Method: Forty-nine older adult participants aged 54 to 81 (M = 78.08,SD = 9.78, medical condition and comorbidity (13,15,22,23,25)Montreal Cognitive Assessment (MoCA, medication intake (13,23,26)mean age = 73.86,standard deviation = 6.05, driving history and driving behaviour (13,21,(25)(26)(27)mean age = 73.86,standard deviation = 6.05, patient-and caregiver-reported driving concerns (31)leaving subjective reports of concerns by the patient or family as common initiators of objective driving evaluation referral.This observational study evaluated the correspondence of patient and caregiver report of driving concerns relative to objective behind-the-wheel (BTW, depression scale (32) and sleepiness scale (18).

Physical
A total of five off-road screening tools were identified in evaluating the physical domain of older adults, with the most used tool was the Rapid Pace Walk (RPW) (17,23,26,32)St.Louis, MO and 38 community-dwelling controls were enrolled.Participants, ages 55-90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist.Overall driving performance of pass vs. marginal/fail and number of wheel and/or brake interventions were recorded.Results-Fiftytwo percent of glaucoma participants scored a marginal/ fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30-13.14;p=.02,which was represented in four studies.Other significant tools included were the range of motion (ROM) test which was administered by using the standard goniometer (17,32), motor strength test, by using manual muscle testing (17), grip strength, by using the Jamar dynamometer (32), and nine-hole peg test (32).

Cognitive
Thirty-two off-road tools related to the cognitive domain were found in this review.Administration methods of the tools to screen older adults' cognitive domain were dominated mainly by pencil-and-paper based (n = 27), followed by performance-based (n = 2), computer-based (n = 2), and clinician-rated (n = 1).From the result, it was notable that Mini-Mental State Examination (MMSE) (n = 10) (13,(16)(17)(18)20,23,25,26,33,34) (27).Trail-Making Tests (TMT) (14)(15)(16)(17)20,22,23,27,28,30,32,33,(35)(36)(37)(38)(39)(40)(41)Australia.Questionnaires were administered to assess driving habits and functional assessments to assess driving-related function.Self-reported restriction was prevalent in this cross-sectional sample (62% were another remarkable screening tool widely known for its ability to screen older adults' executive functions.In addition, three studies administered the Clinical dementia rating (CDR) scale (17,20,34)a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment.A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia.The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid to rate the severity of dementia before continuing with the other screening tools.Besides, we found that three studies utilised Digit-Span Task (16,24,39)drivers with mild cognitive impairment (MCI to screen the older adults' attention span.Attention was a significant sub-area in screening older adults' cognitive function to identify their driving fitness.Other significant sub-areas include visual perception, which was commonly screened using Motor-Free Visual Perception Test (MFVPT) (16,28,32)

Vision
There were seven screening tools found in this review concerning the vision domain.Six of them were administered based on clinician-rated: visual field confrontation testing (17), Snellen-type eye chart (17), Early Treatment Diabetic Retinopathy Study (32,33), Mars Letter Contrast Sensitivity chart (33,37), Pelli-Robson CS chart (18,32) and Vector Vision chart (32).One study used a computer-based screening tool for visual field testing (32).

Driving competency
The driving competency domain could be evaluated using both off-road and on-road assessments.Overall, twentyone off-road assessment tools were used to specifically address older adults' driving competence.Five of them were based on self-reported assessments: Driving Habits Questionnaire (DHQ) (32,37) (24,34,40)cognitive and visual functions.We compared perceptual and cognitive skills and driving behaviour in a Japanese population.Methods: We used a driving simulator to measure the effects of spatial navigation skills and eye movements on driving ability.Participants were 34 older and 20 young adults who completed a simulated driving task involving a lane change and a right turn at an intersection.We used an eye tracker to measure gaze.
We measured visual recognition (Benton Judgment of Line Orientation Test (BJLO was often used to assess older adults' driving skills by controlling the steering wheel or the brake to respond appropriately.The driving simulator used computer graphics to produce road traffic scenes in exchange for real-world driving situations.To assess older adults' cognitive function related to driving, two studies were identified using the Stroke Drivers Screening Assessment (SDSA) (27,40), a pencil-and-paper-based tool and one of the best predictors of on-road driving performance.Other available pencil-and-paper-based tools related to driving tasks were the Neuropsychological Assessment Battery (NAB)-driving scenes (17), 14-item Road Rules and Road Craft test (38), and Road Sign Recognition Test (32,35) with each of the tools assessed the older adults' visual attention, knowledge of road law and knowledge of road signs respectively.
Findings from this review revealed that all of the older adults' driving performances were also assessed by the administration of the on-road assessment.There were a total of twenty different on-road driving tests used to assess older adults' driving performances.Two studies were found to use the Rhode Island Road Test (RIRT) (20,41)89 controls, which was modified from the Washington University Road Test (33).RIRT assessed 28 driving behaviours which were rated by the professional driving instructor or trained specialist.Each behaviour was rated in a trichotomous manner; 0 = unimpaired, 1 = mildly impaired, 2 = moderately-to-severely impaired.Upon completion of the test, the instructor or specialist rated the individual's driving performance as 'safe', 'marginal', or 'unsafe'.
Meanwhile, the Washington University Road Test (33) assessed 93 items along 7.5 miles (45-minute) route in a dual-control car.For scoring, a certified driving rehabilitation instructor rated the global judgment driving safety of overall performance as 'pass', 'marginal', or 'fail'.Aside from these two mentioned standardised on-road assessments, other assessments were also used with slightly different protocols (e.g., routes, road course, items assessed, and scoring method) but had the same purpose; to assess the individual's on-road driving performance.

Multi-domain
This review identified two multi-domain tools to screen older adults' fitness to drive.These two tools were categorised separately as 'multi-domain' due to their ability to screen an individual's sensory, physical, and cognitive functions.A few sub-tests were brought together in the Occupational Therapy-Driver Assessment Off-Road Assessment (OT-DORA) Battery (42,43)and if this could be predicted using the occupational therapy -driver off-road assessment battery (OT-DORA Battery and Assessment of Driving Related Skills (ADReS) (21), and thus, making it easier to screen the client's functions before proceeding to an on-road assessment.

Discussion
The result of this review provides evidence that occupational therapists had functionally utilised various off-road screening and assessment tools to determine older adults' fitness to drive.These off-road tools employ either self-rated, clinician-reported, interview/questionnaire, pencil-and-paper, performance-based or computer-based.
Conducted away from the vehicles, off-road procedures are set out to provide the occupational therapist with the client's information to guide further evaluation during the on-road assessment and to screen out clients who are inappropriate for on-road assessment (44)mobility and freedom (Korteling & Kaptein, 1996.A comprehensive driving evaluation commonly includes off-road and onroad assessments (6,45).Although it is a time-consuming process, the combination of these two procedures is viewed as the gold standard in determining driving fitness of an individual (42)and if this could be predicted using the occupational therapy -driver off-road assessment battery (OT-DORA Battery.However, due to the availability and administrative issues, Malaysian occupational therapists, in particular, are faced with challenges in deciding on applicable assessment tools for their clients (46).To date, there are only two online publications provided briefly by the web portal of the Ministry of Health Malaysia, which are "Functional Assessment of The Older Driver" (47) and "Medical Assessment of the Older Driver" (48) which explain on occupational therapists' roles in driving rehabilitation specifically for older drivers and within the Malaysian context.However, both are not thoroughly explained and are not specified for the use of the occupational therapy profession.
This review also reported five main domains evaluated by the screening and assessment tools for older adults to evaluate their fitness to drive.The first domain covered is general information which commonly includes information on demographic data, medical condition, medication intake, and driving history.It is worth noting that a comprehensive evaluation should begin with the taking driving history of the older driver (49).The information asked usually includes recent changes in driving habits, history of traffic accidents, and history of driving license withdrawal (50)Vaud, Neuchâtel and Jura, which can also be elicited from family members or close relatives (49,50) Vaud, Neuchâtel and Jura.Medical history is as crucial as driving history.Compared to younger counterparts, older drivers are more prevalent for having multiple chronic medical conditions.The use of medications may potentially impair the driving performances of older drivers, mainly if there are side effects after consuming, such as drowsiness, confusion, low blood pressure, low blood sugar, nausea, loss of consciousness, weak muscle tone, and poor coordination (51).Thus, information that can be obtained may include the list of current medications used and a history of any cardiovascular, neurological, or psychiatric diseases (50)Vaud, Neuchâtel and Jura.
The second domain evaluated by occupational therapists is the physical domain.This review showed that the RPW was the most common tool used to screen older drivers' physical functions.A previous study found that older drivers who performed poorer on the RPW had a 45% increase in chances of failing the on-road test (23).A review of critical appraisal also concluded that RPW has good reliability and excellent validity due to its evidence of linking scores with on-road performance (45).Meanwhile, in current practice, a cross-sectional study in Malaysia found that the most utilised standardised assessment by occupational therapists was the ROM test, followed by manual muscle testing (52).Both ROM and manual muscle testing were used to evaluate the drivers' physical capacity.
The third domain evaluated by occupational therapists is the cognitive domain.From the result, MMSE and MoCA were the most utilised older adults' cognitive screening tools to identify their fitness to drive.However, MMSE was less accurate in predicting on-road performance and, thus, amplifies the evidence that the MMSE should not be used as a stand-alone test to evaluate driving performance (25) (32), and if needed, specialised examination by an ophthalmologist can be employed (55).This is because some visual examinations such as contrast sensitivity assessment need their specialisation and specialised equipment (55).
Last but not least, this review also determined the domain of driving competency, which could be evaluated using both off-road and on-road assessments.Based on the result, UFOV was the most utilised off-road, computerbased assessment used to identify older adults' driving impairment.UFOV subtest 2 (divided attention), in particular, confirmed its utility among older adults by demonstrating the best single predictor of at-risk drivers with an area under the curve (AUC) of .84(33).Moreover, a recent study reported that UFOV subtest 3 (selective attention) could optimally predict pass/fail outcomes with a sensitivity of 78.9% and a specificity of 73.5% (14).Besides, this review also identified pencil-and-paper-based tools such as the SDSA, which could also use to predict on-road driving performance specifically.SDSA had reported the ability to successfully predict pass/fail classification of onroad performance with p < 0.05; 78.9% agreement with the principal evaluator sensitivity, 71.4%-79.3%;specificity, 77.8% (40).Those who failed the SDSA should be advised to cease driving, and these recommendations are about 80% accurate (56).Another off-road assessment found from this review was the driving simulator which used computer graphics in producing driving situations.Compared to middle-aged adults, older adults were found to perform the simulation test at significantly slower speeds (57).
Analysis of performance from a previous study had also successfully revealed that older drivers with MCI had significantly slower responses on both tasks of the driving simulator, as shown by the Traffic Signal Reaction Score (p < 0.0001) and the Brake Reaction Score (p < 0.01) (24).Receiver Operating Characteristic (ROC) analyses of the driving simulator demonstrated good predictive accuracies in determining individuals' fitness to drive with AUC = 0.861, SE = 0.089, p = 0.015 (34)a strategy was composed for the assessment of fitness to drive, consisting of clinical interviews, a neuropsychological assessment, and driving simulator rides, which was compared with the outcome of an expert evaluation of an on-road driving assessment.
A selection of tests and parameters of the new approach revealed a predictive accuracy of 97.4% for the prediction of practical fitness to drive on an initial sample of patients with Alzheimer's dementia.The aim of the present study was to explore whether the selected variables would be equally predictive (i.e., valid.On-road assessments, on the other hand, are administered in real environments and are designed to accurately understand the most significant aspects of driving needs (58).Several different on-road driving tests were used to assess older adults' driving performances are found in this review.A previous study had identified that older drivers who passed the on-road driving test recorded fewer errors than those who failed.
(range 1-53 versus 14-99 errors, Z = -6.83,p < 0.001) (58).Therefore, on-road driving tests have been considered to be the gold standard in predicting driving ability among the older adult population (17,24) and are usually accompanied by a professional evaluator, such as a driver rehabilitation specialist (DRS) (17).
Overall, this review indicated that various screening and assessment tools are used to examine older adults' fitness to drive.It is significant to note that most of the tools were widely used in the USA and Australia, thus reflecting insufficient research done for the Asian population, especially Malaysian in particular.This is supported by a recent study in Malaysia which found that there is indeed a limitation of local research evidence, as well as insufficient specialised training in the field of driving rehabilitation (52).While aiming for the best practice for older adults' care, occupational therapists need evidence-based findings to guide their practice related to driving rehabilitation (59).The older population is increasing, and the need to support them with driving and community mobility is also increasing.However, there is limited evidence in the literature related to occupational therapists' practice in addressing driving issues among older adults, specifically in the Malaysian context.Therefore, the exploration of contextually appropriate screening and assessment tools that can be used by Malaysian occupational therapists in addressing driving issues among this group of population are highly encouraged.

Limitation
This review has a few limitations.Aforementioned, only three databases were included, and non-English articles were excluded.Besides, this review only incorporated evidence over the past ten year's period of time to ensure its relevance to the current practices.Hence, other potential studies might be missed during the review process.In addition, this study did not evaluate the quality assessment of the included studies as this scoping review focused on identifying available evidence and the existing gaps.Nonetheless, this review adhered to the systematic framework by Arksey and O'Malley (11) to strengthen the confidence and trustworthiness of these findings.

Conclusion
This review has significantly provided critical information on screening and assessment tools currently available to determine older adults' driving fitness.Overall, this scoping review found five main domains (general information, physical, cognitive, vision, and driving competence) and two main types (off-road and on-road) of screening and assessment tools utilised for this group of population.
Considering most of the tools identified were westernoriented, future research should focus on identifying if the tools are indeed contextually sensitive and practical for the Malaysian population.Nevertheless, the results of this review may still potentially assist the growth of the occupational therapy profession in the area of driving rehabilitation and, thus, guide them in selecting the best tools to evaluate older adults' fitness to drive.

Figure 1 :
Figure 1: Flow chart of study selection.

Table 1 :
Articles summary

Table 2 :
Characteristic of screening and assessment tools

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued)

Table 2 :
Characteristic of screening and assessment tools (continued) *NA= Not applicable, NR= Not reported

Table 2 :
Characteristic of screening and assessment tools (continued) Older drivers are at risk for age-related cognitive and visual dysfunction, which may reduce mobility and increase errors that lead to crashes.Understanding patterns of real-world behavior, exposure, and cognitive-perceptual processes underlying risk in environmental context and in older drivers requires new approaches.Methods: We assessed patterns of objective, real-world driver risk exposure and vehicle control related to steering, braking, and accelerating in older adults with a range of cognitive and visual functional abilities.Real-world driver behavior was collected from passive-monitoring systems installed in 77 drivers' vehicles and analyzed across 242,153 km (150,467 miles.The older adults' visual function was usually examined by testing their visual acuity and contrast sensitivity using Snellen-type eye chart, Early Treatment Diabetic Retinopathy Study, Mars Letter Contrast Sensitivity chart, and Pelli-Robson CS chart.A previous study mentioned that vision tests were examined using the individual's normal corrective lenses