Exploring older adults hearing and vision and driving – The Swedish study

https://doi.org/10.1016/j.trf.2019.04.011Get rights and content

Highlights

  • Participants in this study were aware of their vision and hearing abilities.

  • Benefit of hearing aids was significantly related to hearing aid use when driving.

  • Spectacles are used 95% and hearing aids 57% of the time when driving.

Abstract

Aim

The aims of this study were to evaluate the self-reported driving abilities and use of visual and hearing aids for driving, among older adults with varying degrees of hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI). Visual processing related to driving performance was also assessed to provide a laboratory-based index of driving ability and safety. The research examined the associations between self-reported and clinically measured vision and hearing, and how they related to the level of comfort in various driving situations and the use of hearing and vision aids (spectacles) when driving.

Method

Participants included 109 older adults (58 women, 51 men) aged over 60 years (M age = 69.5 years (SD = 5.25), age range: 60–87) who held a valid driver’s license. Following attendance at the testing session that involved clinical measures of vision and hearing and an assessment of visual processing abilities, the participants were categorized into four groups according to their hearing and vision abilities: no visual or hearing impairment (NI), corrected visual impairment (CVI), hearing impairment (HI), and corrected visual impairment combined with hearing impairment (CVHI). All participants filled in a questionnaire covering subjective measures of vision, hearing, driving habits, and use of vision and hearing aids.

Results and Conclusion

There was a strong association between most of the subjective and objective measures of both hearing and vision, which indicates that participants in this study were aware of their abilities to some extent. Better hearing and vision measures were associated with higher level of comfort in several traffic situations. The results also show that spectacles are used more than hearing aids when driving (95% versus 57% of the time respectively). In addition, both the measured and the experienced benefits of hearing aids were significantly associated with the amount of hearing aid use when driving. The findings of this study provide the basis for larger scale studies to explore the impact of hearing and visual impairment on driving and the use of vision and hearing aids and should also include participants who have visual impairment even with their optimal optical correction to fully explore these effects.

Introduction

The ability to drive safely is associated with better health and well-being in older adults (Ellaway, Macintyre, Hiscock, & Kearns, 2003). However, driving is a highly complex task and aging is associated with deterioration of several abilities that are essential for driving including sensory function, such as hearing and vision; cognition, including the ability to sustain and switch attention; and physical function (Anstey, Wood, Lord, & Walker, 2005). The effects of aging are usually gradual and while some skills deteriorate with increasing age, other more strategic skills, such as route choices and compensatory strategies including lower speeds, may be adopted to a greater extent with increasing age (Haustein, Sirén, Franke, Pokrieke, Alauzet, Marin-Lamellet, Armoogum, & O’Neill, 2013).

A number of the functional changes that occur with increasing age have been shown to be related to driving safety in older drivers. Vision has been commonly researched in terms of its relationship with driving safety and is considered to be one of the main sensory inputs for driving; measures of visual function, such as contrast sensitivity and visual fields, have been shown to be useful for predicting driving safety (Thorslund and Strand, 2016, Wood and Black, 2016). However, only a limited amount of research has explored the relationship between hearing impairment and driving (Vaa, 2003).

The sense of hearing plays a role in sound localization, distance perception and detection of warning sounds (Campos, Ramkhalawansingh, & Pichora-Fuller, 2018). Auditory cues are also important in speed perception and speed regulation (Evans, 1970, Ramkhalawansingh et al., 2016). Picard et al. (2008) reported that auditory deficits, even those that are mild in extent, are associated with higher crash risk. Interestingly, older adults with hearing impairment have been shown to adopt compensatory strategies when driving, such as decreased speed and more frequent glances in the rear-view mirror (Thorslund et al., 2013).

Dual sensory impairment (DSI), where vision and hearing impairment are concurrent, is common in older adults, where as many as 21% of people aged over 65 years have DSI (Brennan, Su, & Horowitz, 2006). These sensory deficits have been shown to be associated with cognitive (Lin et al., 2004, Schneider et al., 2011) and functional declines (Crews and Campbell, 2004, Lin et al., 2004), diminished communication and well-being, and can cause social isolation, depression, and reduced independence (Crews and Campbell, 2004, Schneider et al., 2011). DSI can impact on many activities of daily living including driving. One study of older drivers reported elevated crash rates in those with DSI compared to those with no, or single impairments (Green, McGwin, & Owsley, 2013). The effects of DSI on driving requires further exploration, particularly given its association with other impairments such as cognitive changes (Lin et al., 2004, Schneider et al., 2011), which have also been shown to be associated with older driver safety (Anstey et al., 2005).

Age-related impairments develop gradually, so older adults may not be aware of the severity of their decline, or may not perceive that their driving skills have deteriorated. Accordingly, a number of jurisdictions have introduced additional tests at licensing for older drivers. For example, in most European countries, vision requirements for drivers are introduced between the ages of 45–70 years dependent on the country and are administered at intervals between 1 and 5 years (Bohensky, Charlton, Odell, & Keefe, 2008). Sweden is one of six countries in the European Union which does not require medical testing at driving license renewal for older drivers. In the neighboring countries of Norway and Denmark, a medical certificate is required from 75 years of age, and in Finland an eye examination is compulsory from 45 years of age. Because of the national legislation in the Nordic countries, a person with visual impariment may be required to meet different visual standards depending on which country they live in (Bro & Lindblom, 2018). Current debate in Sweden, which has been driven by the Swedish Transport Agency, has focused on whether a periodical medical test should be implemented for adults aged 65 or 70 years of age to assess their fitness to drive. In Sweden, drivers of private vehicles do not have to meet any hearing criteria, however for professional drivers, the hearing requirement is that they need to be able to communicate with their passengers (Transportstyrelsen, 2015).

Traditional vision tests, such as visual acuity, are increasingly being combined with tests of visual processing to improve the ability to predict driving capacity and safety. The Useful Field of View (UFOV) test which assesses speed of visual processing and visual search, has been demonstrated to be a strong predictor of driving performance and safety (Ball et al., 2006, Classen et al., 2009, Cushman, 1996, Hoffman et al., 2015, Johnson and Wilkinson, 2010, Myers et al., 2000, Wood and Owsley, 2014), with impaired UFOV performance being linked to elevated crash risk among older drivers (Owsley et al., 1998). Performance on other tests of visual processing that involve visual search and executive function, such as the Trail Making Test, have also been shown to be strongly associated with driving performance and crash risk (Dobbs and Shergill, 2013, Papandonatos et al., 2015, Reitan, 1986, Stutts et al., 1998, Vaucher et al., 2014).

An important issue when considering the effects of hearing and vision impairment on driving is that age-related visual impairment is commonly reversible through optical correction of refractive errors (Dimitrov, Mukesh, McCarty, & Taylor, 2003), while correction of hearing impairment is often more complex. For example, while hearing aids can improve the audibility of signals and may have a positive impact on balance during standing and simple walking (Negahban et al., 2017, Rumalla et al., 2015, Shayman et al., 2017), they are also known to interfere with sound localization abilities, which may introduce difficulties during mobility-related tasks (Akeroyd, 2014), such as driving. Several studies have shown that hearing aids are not commonly used; only 22–30% of adults who could benefit from wearing them actually use hearing aids (Chien and Lin, 2012, NIDCD, 2015). Even among those who do use hearing aids, many do not wear their hearing aids while driving, for example, one study reported that only 36% of those with hearing impairment wore hearing aids while driving (Hickson, Wood, Chaparro, Lacherez, & Marszalek, 2010).

It is clear that more information is needed to better understand how vision and hearing aids are used in daily life and more specifically, for driving in older adults. It is also important to understand how older drivers perceive their own vision and hearing abilities in relation to clinically measured abilities and to what extent they use their prescribed aids for driving. This collaborative project between the Swedish National Road and Transport Research Institute (VTI), Queensland University of Technology (QUT) and The University of Queensland (UQ) in Australia was initiated to examine this topic in both countries. While both vision and hearing impairment were considered, there was a particular focus on hearing impairment, given that the link between hearing impairment and driving safety is less well understood and correction of hearing impairment is relatively complex, whereas the link between vision and driving and correction of vision impairment has been more widely researched. This paper presents the results from data collection in Sweden.

Section snippets

Aims and research questions

The aims of this study were to evaluate the self-reported driving abilities and use of visual and hearing aids for driving, among older adults with varying degrees of hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI). Visual processing related to driving performance was also assessed to provide a laboratory-based index of driving ability and safety. The research examined the following questions:

  • What is the association between self-reported and clinically measured

Methods

All data collection was performed in Stockholm at St Erik Eye Hospital by trained optometrists, who were also trained to perform the hearing and visual processing tests. The study was approved by the human ethics committee in Linköping (EPN 2015/120-31).

Analysis

One-way ANOVAs were performed to examine differences between the four groups (NI, CVI, HI, and CVHI) for the questions about general health, self-reported driving performance and driving pleasure. All statistical analysis was performed with IBM SPSS Statistics (version 22) and p < 0.05 was selected as the significance level. Bivariate correlations were used to examine the three research questions covering the association between self-reported and clinically measured abilities, the association

Results

The gender, age distribution and self-reported driving habits are shown in Table 1 as a function of the four different groups; there were no significant between group differences for any of these measures. Table 2 presents the mean values for the self-reported and clinically measured vision and hearing measures for the four groups and p-values from the one-way ANOVAs. Only three of the participants in the CVI-group had corrected high contrast VA worse than 0.80 (20/25 Snellen equivalent), and

Discussion

The aims of this study were to evaluate self-reported driving abilities and self-reported use of visual and hearing aids for driving, among older adults with varying degrees of HI and corrected VI. The research questions are discussed under separate headings.

Conclusions

The strong association between self-reported and clinical measures of both hearing and vision, indicates that participants in this study were aware of their abilities. Better hearing and vision (as assessed using clinical measures), was associated with higher levels of comfort in several traffic situations. Spectacles were also shown to be used more than hearing aids when driving, (95% versus 57% of the time respectively). In addition, both the measured and experienced benefits of hearing aids

Acknowledgements

We would like to acknowledge Promobilia and NVF (Nordiskt Vägforum), Sweden for funding this study. We would also like to acknowledge Maria Nilsson and master students at the Optometry School, Unit of Optometry, Karolinska Institutet for their assistance with the data collection.

References (65)

  • K.K. Ball et al.

    Can high-risk older drivers be identified through performance-based measures in a department of motor vehicles setting?

    Journal of American Geriatric Society

    (2006)
  • M. Bohensky et al.

    Implications of vision testing for older driver licensing

    Traffic Injury Prevention

    (2008)
  • A. Bowers et al.

    On-road driving with moderate visual field loss

    Optometry and Vision Science

    (2005)
  • M. Brennan et al.

    Longitudinal associations between dual sensory impairment and everyday competence among older adults

    Journal of Rehabilitation Research and Development

    (2006)
  • T. Bro et al.

    Strain out a gnat and swallow a camel? – vision and driving in the Nordic countries

    Acta Ophthalmologica

    (2018)
  • W. Chien et al.

    Prevalence of hearing aid use among older adults in the United States

    Archives of Internal Medicine

    (2012)
  • S. Classen et al.

    Useful field of view as a reliable screening measure of driving performance in people with Parkinson’s disease: Results from a pilot study

    Traffic Injury Prevention

    (2009)
  • J. Cohen

    Statistical power analysis for the behavioural sciences

    (1988)
  • R.M. Cox et al.

    Measuring satisfaction with amplification in daily life: The SADL scale

    Ear and Hearing

    (1999)
  • J.E. Crews et al.

    Vision impairment and hearing loss among community-dwelling older americans: implications for health and functioning

    American Journal of Public Health

    (2004)
  • L.A. Cushman

    Cognitive capacity and concurrent driving performance in older drivers

    IATSS Research

    (1996)
  • P.N. Dimitrov et al.

    Five-year incidence of bilateral cause-specific visual impairment in the Melbourne Visual Impairment Project

    Investigative Ophthalmology & Visual Science

    (2003)
  • C.M. Dobbs et al.

    How effective is the Trail Making Test (Parts A and B) in identifying cognitively impaired drivers?

    Age and Aging

    (2013)
  • J. Elgin et al.

    Evaluation of on-road driving in persons with hemianopia and quadrantanopia

    American Journal of Occupational Therapy

    (2010)
  • L. Evans

    Speed estimation from a moving automobile

    Ergonomics

    (1970)
  • S. FerriteI et al.

    Validity of self-reported hearing loss in adults: Performance of three single questions

    Revista Saúde Pública

    (2011)
  • E.E. Freeman et al.

    Measures of visual function and time to driving cessation in older adults

    Optometry and Vision Science

    (2005)
  • S. Gatehouse et al.

    The speech, spatial and qualities of hearing scale (SSQ)

    International Journal of Audiology

    (2004)
  • K.A. Green et al.

    Associations between visual, hearing, and dual sensory impairments and history of motor vehicle collision involvement of older drivers

    Journal of the American Geriatrics Society

    (2013)
  • Haustein, S., Sirén, A., Franke E., Pokrieke, E., Alauzet, A., Marin-Lamellet, C., … O’Neill, D. (2013). Demographic...
  • S.A. Haymes et al.

    Glaucoma and on-road driving performance

    Investigative Opthalmology & Visual Science

    (2008)
  • L. Hickson et al.

    Hearing impairment affects older people’s ability to drive in the presence of distracters

    Journal of the American Geriatrics Society

    (2010)
  • View full text