A major research program is giving new hope to older adults who want to continue driving safely and maintain their mobility.
In a series of studies, University of Alabama at Birmingham experimental psychologist Karlene Ball, PhD, and colleagues have shown that people 65 and older who are trained to process visual information more quickly are less likely to drive dangerously and are able to keep their licenses longer than a control group of older adults.
Ball developed the intervention, known as Useful Field of View (UFOV) Speed of Processing Training, to address the fact that our mental processing speed declines as we age. The training helps older adults strategically focus and expand their range of attention.
"Obviously we don't want people driving if they're going to get hurt or they'll hurt someone else," says Ball. "But at the same time we want to make sure that the people who are safe to drive remain mobile as long as possible."
The program recently passed an important empirical litmus test: In a six-state study of 980 older drivers that Ball presented in January to the Transportation Research Board, she and colleagues showed that people who took the training were half as likely to crash over the next six years than those who did not take it. The finding is important, says Ball, because it demonstrates that cognitive training can transfer to real life—something psychologists have been skeptical about because such training tends to target specific areas of cognition, whereas everyday tasks rely on many different cognitive processes.
"This new evidence should go a long way toward substantiating that this transfer can in fact occur," she says.
In fact, the UFOV assessment is starting to make important inroads in the real world. Maryland, California and Florida all are using the program to assess subsets of older drivers for driving competence, and those states are also conducting larger studies to consider requiring more comprehensive testing for all older drivers. Meanwhile, Allstate and State Farm insurance companies are testing the intervention for possible widespread use with clients, and occupational therapists have been using the program to help people in rehab get back on the road.
From lab to street
Ball first developed the concept of Useful Field of View in the 1970s as a graduate student studying sensation and perception. She was particularly interested in improving visual processing in older adults, who reported difficulty in seeing, yet often showed no demonstrable sensory or ophthalmic problems. She combed the literature on attention and age-related differences in visual and cognitive function and determined that the problem often had to do with information processing—a cognitive issue.
"Compared to younger adults, older adults showed a deficit with respect to how quickly and how much of the visual field they could process in a given amount of time," she explains.
That's when she developed the UFOV concept, which she defines as the visual area that people can see and process in a brief glance without moving their head or eyes. Her research found that older adults' UFOV range better predicted crash risk than other visual or cognitive measures. She then developed computerized training exercises that help people to expand and strengthen this visual window of attention, both in the driving arena and in other areas of daily functioning. The work is part of a major applied gerontology study funded by the National Institutes of Health (see "NIH funds research to keep older minds sharp").
In the driving task, people identify items on a computer screen that are in their direct field of view, such as cars, trucks or traffic signs. If they identify them correctly, the items appear more quickly on the screen. Over time, the tasks grow more complex and layered, with researchers adding in tones and other auditory distractions, for example.
"We do all kinds of things to mess them up!" Ball says.
Two decades of research have honed Ball's training program and proven its effectiveness. A 2007 meta-analysis in the Journals of Gerontology Series B: Psychological Science and Social Sciences (Vol. 62B, No. 1), found that people who took a general UFOV speed-of-processing test improved their visual processing capacities, maintained those benefits up to at least two years and were better at driving than people in control groups who did not take the training.
Ball and colleagues also are conducting a longitudinal study—running for 25 years so far—that has examined the training under a range of conditions. They are now evaluating whether training gains can be enhanced when combined with physical exercise.
Ball's UFOV took a leap into the commercial realm in 2008, when Posit Science Corp., a San Francisco-based company that develops brain health programs, licensed the product. It is now part of a computer program called InSight that uses computer excercises to strengthen people's visual memory abilities. One of these, Road Tour, uses the same challenges as the original UFOV training program, but jazzes them up with whimsical-looking roadsters, attractive scenery and catchy music.
A recent Corporation for Public Broadcasting special called "Brain Fitness 2: Sight and Sound," features InSight's underlying research, including Ball's work. The program sparked the interest of Arnie Slavet, a 76-year-old Boston-area attorney who has been using InSight on a regular basis.
"As you use the program, you start to focus in a way where you see things you wouldn't normally see," says Slavet, who credits Road Tour with helping him to notice a car that was coming on too fast and a pedestrian who was difficult to see in the dark.
He believes the program has affected other areas of his life as well: He has more patience for fixing things around the house, and his golf game has improved considerably, he says.
Ball is now conducting a study with State Farm to test the use of UFOV and InSight as potential benefits of insurance coverage. In the study, she is analyzing data on about 3,000 policy holders who voluntarily take an assessment based on her program and answer questions on mobility. If they do well, they can immediately print out a certificate and get an insurance discount. If they don't qualify for the discount, they can receive InSight for free, train with the program and take the test again later. Ball is finding that 70 percent of those who take the test the first time qualify for the discount.
Ball will also anonymously analyze the crash rates of those who qualify and do not qualify for a discount based on the initial assessment, as well as of those who go on to take Insight and those who do not. Depending on the results, State Farm—which currently offers the voluntary program in Alabama—will consider whether to roll it out on a larger scale, says State Farm spokesperson Dick Luedke.
The company is excited about the product because of its potential to help adjustors more accurately assess accident risk in older adults and to set rates accordingly, he says.
But it's not just about the bottom line, Luedke adds. More important, "the program has the capacity to potentially improve the cognitive skills of older adults," he says. "Those of us who are getting older are pretty excited about that."
Tori DeAngelis is a writer in Syracuse, N.Y.
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