Browsing by Author "DiGuiseppi, Carolyn"

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    Impact of a Driving Decision Aid on Decisional Conflict Among Older Adult Drivers and their Study Partners
    (Oxford University Press, 2022-12-20) Fowler, Nicole; Johnson, Rachel; Peterson, Ryan; Schroeder, Matthew; DiGuiseppi, Carolyn; Han, Duke; Hill, Linda; Betz, Marian; Medicine, School of Medicine
    Forty-four million US licensed drivers are ≥65 years old and at higher crash risk. Decision-making about stopping or continuing driving is difficult and often involves family and friends. This study examines if decision conflict about changing driving habits is associated between older adult drivers and their study partners (SPs) (i.e., family member or friend). Data were from a multi-site trial assessing a driving decision aid. Decision conflict about stopping or continuing driving for drivers and their SPs were measured with the Decision Conflict Scale (DCS). Dyadic associations between drivers’ and SPs’ DCS scores pre- and post-decision aid implementation were analyzed using an actor-partner interdependence model. Among 228 driver-SP dyads, driver mean (SD) age was 77.1 (5.1) years; 50.0% female; 98.7% non-Hispanic; 94.7% white; and 97.8% urban-dwelling. SPs mean age was 66.1 years (13.9); 65.8% female; 95.6% non-Hispanic; 92.1% white; and commonly the driver’s spouse (54.6%) or adult child (21.1%). Most drivers (71.7%) and SPs (63.3%) had baseline DCS scores < 25 (drivers mean 18.5 (SD 12.3); SPs 20.5 (16.8)), suggesting low decision conflict. DCS was correlated within dyads at baseline (r=0.18, p < 0.01), and baseline DCS was associated with post-decision aid DCS (p < 0.001 for SPs [β=0.73] and drivers [β=0.73]). While SPs’ baseline DCS was not associated with drivers’ post-decision aid DCS, drivers’ baseline DCS and SPs’ post-decision DCS were (β=0.10; p=0.036). Higher decision conflict about driving felt by older drivers is frequently shared by their SPs, in whom decision conflict may persist even after a driving decision aid intervention.
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    Impact of the COVID-19 Pandemic on Older Adult Driving in the United States
    (Sage, 2022) Betz, Marian E.; Fowler, Nicole R.; Han, S. Duke; Hill, Linda L.; Johnson, Rachel L.; Meador, Lauren; Omeragic, Faris; Peterson, Ryan A.; DiGuiseppi, Carolyn; Medicine, School of Medicine
    Objectives: To examine how the COVID-19 pandemic affected driving and health outcomes in older adults. Methods: We compared Advancing Understanding of Transportation Options (AUTO) study participants enrolled before (December 2019 to March 2020) versus during the pandemic (May 2020 to June 2021). Participants were English-speaking, licensed drivers (≥70 years) who drove weekly and had a primary care provider at a study site and ≥1 medical condition potentially associated with driving cessation. We used baseline self-reported measures on mobility and health. Results: Compared to those enrolled pre-COVID-19 (n = 61), more participants enrolled during COVID-19 (n = 240) reported driving reductions (26% vs. 70%, p < .001) and more often for personal preference (vs. medical/emotional reasons). While mean social isolation was higher during than pre-COVID-19, self-reported depression, stress, and overall health PROMIS scores did not differ significantly. Discussion: Our findings highlight the resiliency of some older adults and have implications for mitigating the negative effects of driving cessation.
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    “Is it time to stop driving?”: A Randomized Clinical Trial of an Online Decision Aid for Older Drivers
    (Wiley, 2022) Betz, Marian E.; Hill, Linda L.; Fowler, Nicole R.; DiGuiseppi, Carolyn; Han, S. Duke; Johnson, Rachel L.; Meador, Lauren; Omeragic, Faris; Peterson, Ryan A.; Matlock, Daniel D.; Medicine, School of Medicine
    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 post-randomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and pre-randomization 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.
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    Relationship of Decisional Conflict About Driving Habits Between Older Adult Drivers and Their Family Members and Close Friends
    (Sage, 2024) Fowler, Nicole R.; Johnson, Rachel L.; Peterson, Ryan; Schroeder, Matthew W.; Omeragic, Faris; DiGuiseppi, Carolyn; Han, S. Duke; Hill, Linda; Betz, Marian E.; Medicine, School of Medicine
    This study examines the relationship of decisional conflict about driving habits between older adult drivers (≥70 years old) and their family members and close friends. This secondary analysis utilizes data originating from a multi-site randomized controlled trial assessing the effect of a driving decision aid (DDA) intervention. Decisional conflict about stopping or changing driving habits for drivers was measured with the Decisional Conflict Scale (DCS). Dyadic associations between drivers’ and study partners’ (SPs’) DCS scores were analyzed using an actor-partner interdependence model. Among 228 driver-SP dyads, Dyadic DCS was correlated at baseline (r = .18, p < .01), and pre-intervention DCS was associated with post-intervention DCS (p < .001 for SPs [β = .73] and drivers [β = .73]). Drivers’ baseline DCS and SPs’ post-intervention DCS were slighly correlated (β = .10; p = .036). Higher decisional conflict about driving among older drivers is frequently shared by their SPs. Shared decisional conflict may persist beyond intervening to support decision-making about driving cessation.