Study steers toward goal of keeping seniors in the driver’s seat

Dec. 13, 2017
Ruby Vianzon, a professional research assistant with the CU School of Medicine's Emergency Department, is shown leading Gayle Craun through a contrast-sensitivity eye test.
Ruby Vianzon, a professional research assistant with the CU School of Medicine’s Emergency Department leads Gayle Craun through a contrast-sensitivity eye test in the Clinical and Translational Research Center in UCHealth University Colorado Hospital’s Leprino Building.

Pig, horse, sheep, lynx, tiger, lion, bear, sheep, snake, buffalo, cow, elephant, giraffe, hippopotamus, rhino, gazelle, and 11 other critters large and small.

That’s what Gayle Craun came up with during a morning in which she named animals, placed and removed pegs, stood on one foot, craned her neck, assessed weird shapes, sat and stood and sat and stood, all in the name of science.

Craun, 70, had 60 seconds to evoke as many animals as she could. Whether the 27 she came up with in that short span was good or bad is, broadly speaking, irrelevant (though it seemed pretty darn good). She was, in a sense, playing against herself – herself of two years ago, when she joined the $12 million, five-plus year LongROAD study not long after it launched in August 2015. The Anschutz Medical Campus is one of five study sites, and is now tracking 601 of the 3,000 seniors participating across the country.

LongROAD stands for Longitudinal Research on Aging Drivers, and its goal is to understand how physical and behavioral health, medications and many other factors influence seniors’ ability to drive safely. The AAA Foundation for Traffic Safety is paying for it. The study’s not about taking keys away from grandmas and grandpas – quite the opposite, says Dr. Marian (Emmy) Betz, MD, MPH, a UCHealth University of Colorado Hospital Emergency Department physician and co-lead of University of Colorado’s LongROAD study site.

Tough recovery

With more and more baby boomers hitting retirement (the oldest of them reached age 65 in 2011), the numbers of senior drivers is rising. A better understanding of the connections between aging and driving could lead to a sharper understanding of what can affect driving and, in turn, ways to keep seniors safely on the road. In this car-centric culture of ours, that means staying independent longer. Betz said her interest in understanding how aging and the physical, sensory and cognitive decline that accompanies it affects driving was itself driven by her experiences as an emergency room doctor.

“We don’t want people to think older drivers are unsafe, because on the whole they’re actually safer than young drivers. But when they get in crashes, they don’t do very well,” Betz said.

Gayle Craun is shown during a balance test as part of the LongROAD study.
The LongROAD study’s onsite testing, done every other year, ranges from the medical to the cognitive to the physical. Here, Craun does a balance test as Vianzon looks on.

Car accidents deliver more young people than old to the UCHealth University of Colorado Hospital Emergency Department, she added. But the older patients get hurt worse and recover more slowly – if they recover.

Dr.  Carolyn DiGuiseppi, MD, MPH, PhD, a professor in the Colorado School of Public Health and the co-lead for the CU LongROAD site, summed it up this way: “Our ultimate goal is to help older adults stay safe and independent in the community. We hope what we learn will contribute to that.”

She, Betz and colleagues are collecting much more information than they could capture, distill, and publish in peer-reviewed journals in a single career. The idea, Betz said, is to gather a lot of data on a lot of people. Then researchers in the near and distant future can tap into the data to answer questions they don’t know how to ask just yet. Ideally, Betz said, LongROAD will become a sort of Framingham Heart Study on wheels.

Early returns

That’s not to say that Betz, DiGuiseppi and colleagues don’t have questions and aren’t already looking for answers. Betz is working on a study connecting the medical conditions to driving habits. She found that about 11 percent of drivers had reduced their driving in the past year, and that nearly one in three of those who cut back on driving cited musculoskeletal problems such as neck, back or joint pain; arthritis; neuropathy; or broken bones as the reasons why. Even that may be understated, she said, given that the study’s cutoff age is 79.

“If you were to look at the general older-adult population, it’s probably higher,” she said.

DiGuiseppi’s first LongROAD study involves looking at marijuana and how using it affects driving habits.

“We’ve had very, very few participants report that they have used marijuana and driven soon after,” DiGuiseppi said. “But quite a few do use marijuana, so we’re looking for differences in driving among people who use marijuana and those who don’t.”

Keep on truckin’

Age-associated decline and/or disability needn’t force someone to hang up their keys. UCHealth occupational therapist Karen Hookstadt, OT, said physical and occupational therapy as well as even modifications to vehicles can help extend the freedoms of the road. Vehicle adaptions may include bracket adaptations to ease transferring in/out of the vehicle, panoramic rear view mirrors, left foot accelerators, hand controls, adaptions to accessory controls such as adjusting the placement of turn signals, steering wheel adaptations to enable one-handed driving, and prescription prisms to increase the field of vision, she said.

Eleanor Mills, an emergency department professional research assistant, is shown during an inspection of a patient's car.
Eleanor Mills, an Emergency department professional research assistant, checks out Craun’s wheels. She looks for everything from driver-assist technologies to tire pressure.

“We’re not trying to take away their driver’s license – we’re trying to do the opposite. What’s needed to keep this person safe behind the wheel and maintain independence and the activities of daily living?” asked Hookstadt. She is proposing a formal UCHealth program with specialized hardware to assess senior drivers, patients with neurological diseases such as Parkinson’s, multiple sclerosis, stroke, brain injury, stroke and tumor resections, among others.

Craun, who needs no such help, has made scientific contributions well beyond animal-naming. She spent a solid two hours doing a physical exam and answering raft of questions about her use of medications, drugs and alcohol, and her driving habits. Does she get angry with other drivers? Use her horn? Pass on the right? Does she use the phone or eat while driving? Does she avoid driving at night or in bad weather? Are friends or family available to help with driving? How would she handle being told she couldn’t drive anymore? Does she use Uber or Lyft?

Craun, who used to teach defensive driving for the National Safety Council, had good answers.

“There’s the old saying: what does it mean when somebody’s left turn signal is blinking?” Craun asked. “The answer is their left turn signal is blinking. You don’t know what they’re going to do.”

In the garage

Then came the physical tests – balance, grip strength (using a silvery item that looks like a spaceman’s pistol but is in fact something called a hydraulic hand dynamometer), reaction time (on a computer) – and cognitive ones, including a tricky memory test that had her repeat a series of random nouns (woman, rock, blood, corner, shoes, letter, girl…) right after Professional Research Assistant Ruby Vianzon said them. Then again a few minutes and a couple of totally unrelated tasks later, to Craun’s surprise, Vianzon asked her to recall them again.

Meanwhile, in the Leprino garage, Eleanor Mills, a professional research assistant with the Emergency Department, was checking out Craun’s wheels, a 2005 Jeep Liberty.

Mills noted the mileage and the state of the headlights, turn signals and tail and brake lights (one of those was out, she would tell Craun), tire pressure and other things. She looked for scratches and dents, noting here only “insanely minor scratches on the driver’s side and front bumper.” She recorded no driver-assist advanced technologies such as lane-departure warnings. She checked to see that the onboard-diagnostic plugin Craun’s car has carried during the study was working. In addition to GPS tracking – which adds objective data to the participants’ survey answers – it provides an array of vehicle diagnostics.

Gayle Craun completes a cognition test in this photo.
Cognitive tests include reaction time, memory, and object recognition, among others. Here, Craun does a nasty twist on connect-the-dots as Vianzon times her. The results of the tests will be compared to baseline testing doing the same things, which Craun did two years ago when she joined the LongROAD study.

“I know cars way too well,” Mills quipped.

DiGuiseppi said the data aren’t used to track movements in real-time, but rather aggregated over time and used to understand not only speeds driven and things like sudden stops, but also what she called “driving space,” or the area in which a person typically drives. “Does it contract as you age? Do you avoid driving longer distances?” she asked.

The study already provided a serious short-term benefit for one participant.

“He had his car stolen. His wife called us and asked if we could find out where it was,” Betz said. “We were able to get the GPS coordinates, the police used them to find his car, and he got his car back.”

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.