DiGuiseppi Carolyn G, Hill Linda L, Fowler Nicole R, Johnson Rachel L, Peterson Ryan A, Han S Duke, Josewski Brandon, Knoepke Christopher E, Matlock Daniel D, Omeragic Faris, Betz Marian E
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Herbert Wertheim School of Public Health, University of California San Diego, San Diego, California, USA.
J Am Geriatr Soc. 2025 Feb;73(2):492-505. doi: 10.1111/jgs.19293. Epub 2024 Dec 4.
Decisions about driving cessation can be stressful for older adults. We tested effects of a driving decision aid (DDA) on psychosocial outcomes among older drivers during two-year follow-up.
Multisite randomized controlled trial of licensed drivers ages ≥70 with at least one diagnosis associated with increased likelihood of driving cessation, without significant cognitive impairment. The intervention was the online Healthwise® DDA, addressing "Is it time to stop driving?"; controls received National Institute on Aging web-based information for older drivers. Outcomes were assessed at baseline, 6, 12, 18, and 24 months. Primary outcomes were the Decision Regret Scale, Decisional Conflict Scale (assessing decisional ambivalence or uncertainty), and PROMIS Depression (4a) Scale. Self-reported Life-Space Assessment (assessing community mobility), crashes and driving outcomes were also assessed. Using intention-to-treat analyses, we tested whether DDA (vs. control) effects on each outcome differed during follow-up using a study group by time interaction. Longitudinal outcomes were modeled using generalized linear mixed models, accounting for repeated measures, age, site, and baseline visit before vs. during COVID.
We enrolled 301 participants (age at enrollment: mean 77.1 (range 70-92) years; 51% identifying as female). During follow-up, the DDA group had less decisional conflict (p = 0.010) and decision regret (p = 0.012). The DDA had its greatest effect on decisional conflict immediately post-intervention (adjusted mean ratio [aMR] = 0.87; 95%CI: 0.79, 0.97) and on decision regret at 12-month follow-up (aMR = 0.45; 95%CI: 0.27, 0.72). Odds of depression were similar between groups during follow-up (p = 0.237). The intervention did not negatively affect life space, crashes, or other driving outcomes.
In older drivers, the Healthwise® DDA reduced uncertainty and regret about driving decisions during longitudinal follow-up, without adversely affecting community mobility or crash risk. Use of DDAs in clinical and other settings may reduce the distress older adults often experience when making decisions about driving cessation.
对于老年人来说，做出停止驾驶的决定可能会带来压力。我们在为期两年的随访中测试了驾驶决策辅助工具（DDA）对老年驾驶员心理社会结局的影响。
对年龄≥70岁、至少有一种与增加停止驾驶可能性相关诊断且无明显认知障碍的持照驾驶员进行多中心随机对照试验。干预措施是在线的Healthwise® DDA，主题为“是否到了停止驾驶的时候？”；对照组收到美国国立衰老研究所提供的针对老年驾驶员的基于网络的信息。在基线、6个月、12个月、18个月和24个月时评估结局。主要结局指标为决策后悔量表、决策冲突量表（评估决策矛盾或不确定性）和患者报告结果测量信息系统抑郁（4a）量表。还评估了自我报告的生活空间评估（评估社区活动能力）、撞车情况和驾驶结局。使用意向性分析，我们通过研究组与时间的交互作用，测试了DDA（与对照组相比）在随访期间对每个结局的影响是否存在差异。使用广义线性混合模型对纵向结局进行建模，考虑重复测量、年龄、地点以及新冠疫情之前与期间的基线访视情况。
我们纳入了301名参与者（入组时年龄：平均77.1岁（范围70 - 92岁）；51%为女性）。在随访期间，DDA组的决策冲突（p = 0.010）和决策后悔（p = 0.012）较少。DDA对决策冲突的最大影响出现在干预后即刻（调整后平均比率[aMR] = 0.87；95%置信区间：0.79，0.97），对决策后悔的最大影响出现在12个月随访时（aMR = 0.45；95%置信区间：0.27，0.72）。随访期间两组的抑郁几率相似（p = 0.237）。该干预措施未对生活空间、撞车情况或其他驾驶结局产生负面影响。
在老年驾驶员中，Healthwise® DDA在纵向随访期间减少了对驾驶决策的不确定性和后悔感，且未对社区活动能力或撞车风险产生不利影响。在临床和其他环境中使用DDA可能会减少老年人在做出停止驾驶决策时经常经历的困扰。
