“是否该停止驾驶？”：一项针对老年驾驶员的在线决策辅助工具的随机临床试验。
"Is it time to stop driving?": A randomized clinical trial of an online decision aid for older drivers.
机构信息
Department of Emergency Medicine, University of Colorado, School of Medicine, Aurora, Colorado, USA.
Geriatric Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA.
出版信息
J Am Geriatr Soc. 2022 Jul;70(7):1987-1996. doi: 10.1111/jgs.17791. Epub 2022 Apr 20.
BACKGROUND
Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality.
METHODS
This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores.
RESULTS
Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations.
CONCLUSIONS
The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility.
TRIAL REGISTRATION
ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.
背景
许多老年人面临着何时停止驾驶的艰难决定。我们旨在测试在线驾驶决策辅助（DDA）是否会提高决策质量。
方法
这项前瞻性、双臂随机试验纳入了英语熟练、有驾照的老年人（年龄≥70 岁），他们没有明显的认知障碍，但有≥1 种诊断与增加停止驾驶的可能性相关；所有参与者都在与研究地点相关的诊所接受初级保健。干预措施是针对“是否该停止驾驶？”的在线 Healthwise® DDA；对照组为仅面向老年司机的网络信息。主要结果是由决策冲突量表（DCS）估计的决策冲突（得分越低表示质量越高）。次要结果是关于驾驶决策的知识和决策自我效能感。我们使用广义线性混合效应模型，根据研究地点和随机分组前的得分，调整后比较了试验组和对照组的主要和次要结果的差异。
结果
在 301 名参与者中（平均年龄 77.1 岁），51.2%为女性，大多数为非西班牙裔（99.0%）和白人（95.3%）；98.0%居住在城市地区。参与者的特征按研究分组相似，但在不同地点有所不同。干预组的 DCS 得分较低（12.3 DDA 与 15.2 对照组；调整后的平均比值[AMR]0.76，95%CI 0.61-0.95；p=0.017）。干预组的知识得分较高（88.9 DDA 与 79.9 对照组；OR 1.13，95%CI 1.01-1.27，p=0.038）；两组的自我效能得分没有差异。DDA 的接受度很高；86.9%的参与者表示他们会向类似情况下的其他人推荐该工具。
结论
对于没有明显认知障碍的英语熟练的老年人群体，在线 Healthwise® DDA 降低了决策冲突并增加了知识，尽管大多数人选择继续驾驶。在临床或社区环境中使用此类资源可能会支持老年人从驾驶过渡到其他形式的出行方式。
试验注册
ClinicalTrials.gov 标识符“推进交通选择理解（AUTO）”NCT04141891。
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