An online driving decision aid for older drivers reduces ambivalence and regret about driving decisions: Randomized trial

IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Carolyn G. DiGuiseppi MD, MPH, PhD, Linda L. Hill MD, MPH, Nicole R. Fowler PhD, MHSA, Rachel L. Johnson MS, Ryan A. Peterson PhD, S. Duke Han PhD, Brandon Josewski BS, Christopher E. Knoepke PhD, MSW, Daniel D. Matlock MD, MPH, Faris Omeragic BS, Marian E. Betz MD, MPH
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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

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 (pinteraction = 0.010) and decision regret (pinteraction = 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 (pinteraction = 0.237). The intervention did not negatively affect life space, crashes, or other driving outcomes.

Conclusions

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.

一种针对老年司机的在线驾驶决策辅助工具,可以减少对驾驶决策的矛盾心理和后悔:随机试验。
背景:对于老年人来说,决定停止驾驶可能会带来压力。在两年的随访中,我们测试了驾驶决策辅助(DDA)对老年司机心理社会结局的影响。方法:多地点随机对照试验,年龄≥70岁,至少有一项诊断与戒烟可能性增加相关,无明显认知障碍的有驾照的驾驶员。干预措施是在线Healthwise®DDA,解决“是时候停止驾驶了吗?”;对照组收到了美国国家老龄化研究所针对老年司机的网络信息。在基线、6个月、12个月、18个月和24个月评估结果。主要结果是决策后悔量表、决策冲突量表(评估决策矛盾心理或不确定性)和PROMIS抑郁量表(4a)。自我报告的生活空间评估(评估社区流动性)、撞车事故和驾驶结果也进行了评估。通过意向治疗分析,我们通过时间相互作用测试了DDA(与对照组相比)在随访期间对每个结果的影响是否不同。纵向结果使用广义线性混合模型建模,考虑重复测量、年龄、地点和在COVID之前与期间的基线访问。结果:我们招募了301名参与者(入组时年龄:平均77.1岁(70-92岁);51%认为是女性)。在随访中,DDA组的决策冲突(pinteraction = 0.010)和决策后悔(pinteraction = 0.012)较少。DDA对干预后立即的决策冲突影响最大(调整平均比[aMR] = 0.87;95%CI: 0.79, 0.97)和12个月随访时的决策后悔(aMR = 0.45;95%ci: 0.27, 0.72)。随访期间,两组间抑郁的发生率相似(p - interaction = 0.237)。干预对生活空间、车祸或其他驾驶结果没有负面影响。结论:在老年驾驶员中,Healthwise®DDA在纵向随访期间减少了驾驶决策的不确定性和后悔,而不会对社区流动性或碰撞风险产生不利影响。在临床和其他环境中使用dda可以减少老年人在决定戒烟时经常经历的痛苦。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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