i'm jon jarvis, i'm the director of national park service. i want to thank you for joining us here for the milestone. incredibly important milestone in the life of the national mall. joining me here today are the secretary of interior ken salazar, my boss tom strickland, and two of our partners, coca-cola who has been helping us, and the trust for the national mall, who has been an incredibly important partner that will be with us for the mall's future. we're in the perpetuity business.

we make sure all 193 of them are here to share the stories of the country for all visitors, all americans, and those who come from around the world. this century and into the next century as well. in order to do that, and to do it well, we have to do planning. and this particular plan has been long way coming, and it's quite thick. there. to express really the vision of this great place as well as the stakeholders that have provided extraordinary input into the development of this plan. more than 30,000 americans commented on this plan through the process and even got comments from around the world. one from moe semibeak. it speaks volumes to the values

that aric -- that are embedded. there are many farther -- partners, and my job here this morning is to recognize many of them for their contributions and involvement in the development of this. certainly the members of congress and the appropriations and authorizing committees, especially delegate, eleanor holmes norton and her direct support for the district of columbia. the national captain planning commission who we must and did send this plan through. we completed their review and their record of decision. the u.s. commission on fine arts, the smithsonian institute, the architect of the capitol, the national gallery of art, the district of columbia's planning transcription and historic preservation offices.

[airplane sounds] >> the transportation authority, the u.s. holocaust memorial museum, the national archives and records, the department of agriculture, general services, bureau of engraving and printing, national endowment for the humanities. i'm telling you, every one of those folks had involvement as well. plus we've had organizations, the american society of landscape, the american planning association, the american institute of architect, the american civil liberties union, the committee of 100 for the country, the national coalition to save our mall, the national parks association, and the national trust for historic preservation. frankly, without of help of all of those individuals and government agencies and

organizations we really would not be here today. i think with their input, we have crafted a great vision for the national mall. and one of those keys and absolute partner in the development of that -- of this plan and the future is the trust for the national mall. it's with great honor and pleasure i get to introduce the chairman, chip akridge. [applause] >> thank you, director jarvis, we appreciate your support and leadership over the last several years. i'd like to also thank secretary salazar, assistant secretary strickland, and peggy o'dell. he served as the park's superintendent for the majority of the time that the plan was being crafted. she had a major degree of input in what was in the plan. the trust is honored to be the

national service partner in the business and envisionary project. this is a terrific day. the secretary of state earlier, he said be careful what you ask for, chip, you might get a job. i want to acknowledge the 30,000 people that director mentioned that participated in providing input into the mall plan. their input was invaluable in helping craft the final plan. now we'll give a specific thanks to susan. susan will you stand up please? come on. susan. [applause] [applause] >> susan was the project manager for the team that put together the national mall plan. she and her associates put in yoman's effort. did you see all of the organizations that had to be consulted?

17 organizations. i want to thank her for developing the plan, but more importantly, finally getting it approved. thank you. americans have a great tradition of protecting the public spaces. about 25 years ago, the public private partnership emerged. it got many of the projects often of the drawing boards into completion. there's wonderful examples on the statute of liberty, and ellis island in new york, central park in new york, i'm not a federal public-private partnership. and the renovation of the star-spangled banner itself. the trust relationship with the park service has evolved over the last three years to a one of a 50/50 public-private partnership. we're ready to take on the

national mall project. money has been spent on serious renovation of any part of the mall. the valor and the bravery of those who have fought to preserve our freedoms, and those monuments of iconic leaders are being dishonored from simple neglect. america can not stand by and let the national mall continue to be a disgrace. the national mall plan is our guide, the trust is committed to raising the private sector's half of the required funds to restore and improve the space to make it something that we all can be proud of. mr. secretary, since your appointment, the steadfast supporter, and excellent partner, he has put his money where his mouth is. he committed a significant amount of money to three

critical restoration projects, the evidence of which is right here. we just toured it. we're excited to begin working with you and your entire team, the department of interior, and the national park service to execute this plan together with your leadership and the commitments that you've made to the project. i know that we will accomplish our shared goal. that is to make the national mall the best park in the world. thank you, sir. [applause] [applause] >> i'd now like to introduce steve cahillane, president of ceo of coca-cola refreshments. they are a great partner, they committed to the first recycling program at the mall. we are grateful to your generosity. we look forward to building a great relationship. [applause] [applause] >> thanks very much, chip. and thank you secretary salazar

for inviting coca-cola here today to share in this terrific national mall signing. the coca-cola company is thrilled to be standing next to our national park partners and to participate in the important work of restoring the national mall. one of our true national treasures. the coca-cola company has been partners with the national park service for more than 40 years. for more than 40 million visitors, there's no better place than to launch a comprehensive greening plan than right here. i told them 15 more minutes before i was ready. [airplanes above] >> this year coca-cola contributed more than $1 million to the national park foundation in partnership with the national park service and the trust for the national mall. today i'm proud to say we're launching a sustainable, permanent, recycling program to

help restore and preserve the national mall. before starting the project, we invested in research with our national park partners to determine not only what motivated people to recycle, but also what features make it easier for them to do so. this includes researching everything from what color bins to the shape and size of the lids on each receptacle. that's why starting today, you will see new blue recycling bins from the pool all the way down to the lincoln memorial, and here right at the jefferson memorial. the coca-cola company is donating 300 recycling bins to be used by the national park service throughout the great property. we recognize this is not enough to keep up with high traffic events that take place. we have donated two recycling trailers who house an additional 400 bins to be used during the great special events, such as

the 4th of july and earth date celebrations. because we formally believe that education is the key to changing people's behavior, coca-cola will also make available a mobile educational vehicle to educate consumers on the response of recycling. if you think about it, recycling is arguably the easiest and most effective way to protect our environment. and recycling is something that we can all do as individuals at home, employees at work, in businesses, and in our communities, and as visitors to the places like the national mall. that's why we started coca-cola recycling in 2007 to support the coca-cola's system goal to eliminate all of the waste in efforts to reduce, recover, and reuse all of the materials in our business. as part of this commitment, in 2009, we opened the world's

largest bottle to bottle recycling facility in spartanberg, south carolina. this 30-acre state-of-the-art plant is capable of producing 100 million pounds of recycled plastic each year. that's 2 billion 20-ounce coca-cola bottles. as the company, we are aimed at diverting 100% of the recycling waste. we all know that recycling is only one part of the equation. at coca-cola, we are looking for my -- for new ways to reduce our environmental footprint to make the business more sustainable. this includes introducing the first ever climate friendly beverage coolers on capitol hill and the delivery fleet, the hybrid trucks using 30% less fuel, and produce 30% fewer

emissions and development -- we also want to develop sustainable, renewable packages where 30% comes from plant-based materials. these are just a couple of examples of how coca-cola is making sure we are doing our part in building sustainable communities. caring for our environment is part of coca-cola's heritage. we are committing to reserving and protecting it. we look forward to continuing our partnership with the national park foundation and hope this is a successful, inaugural recycling program. after the press conference here today, i'd love it if you join me in a brief demonstration of the new recycling equipment that we have available for us here at the national mall. but now it's my great pleasure to introduce tom strickland, the assistant secretary for fish and wildlife. tom? [applause] [applause] >> thank you, steve. and thank you to coca-cola for

their support for this beautiful place. the national mall, like all of the national -- the parts of the national park system, the treasured landscape, and it belongs to all of the people of america. but it's unique because of all of the lands in america, it's the most popular place for people in this country to gather. it serves a unique role in terms of expression of our first amendment rights, a place to come as well to celebrate, to see the magnificent structures like the jefferson memorial. just about 22 months ago, an estimated 2 million people filled the mall to celebrate a moment. just a few weeks ago, we had congregation of folks with vastly different points of view seek out the national mall to express their views about their country and what it means. so it's the most popular piece of real estate in america. and i would suggest the most

profoundly important piece of real estate in the world for what it stands for. and yet we are loving it to death. this plan, today, this vision for the mall is the first step in bringing the mall back to the level of beauty and a special place that it so much occupies in our minds. so it's a product of a collective effort, i want to congratulation our leaders at the park service, and it is appropriate as we sit here today that the director of national park service, who i suggest will go down as one of -- if not the greatest directory in that troop's history. jon jarvis started his career as a park ranger at the jefferson memorial. you've come a long way, jon. we're very proud of you. with that, let me say we have a stewardship ability for the the natural and historic places, none more important than the historic of the country than the places we are honoring with the mall. we have on the secretary of

interior, someone who has a profound sents of historic and love for the outdoors who has shown great leadership in leading the country. join me in welcoming the secretary of interior, ken salazar. [applause] [applause] >> hey, so we're going to sign the record of decision. i'll make some comments. i'll be happy to make some questions. if all of you could join me, if i could have peggy odell, the great leader, maria bergs, i want everyone who's a park ranger, park officials, come stand behind us as we sign the record of decision, and those partners who are going to make this a reality. come on. sally lead the gang up here. come on all of you. stand right here. come on on both sides. tom, i think your -- tom, you and i are standing over here. then i'll make a few comments.

[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

[applause] [applause] >> let me make just a few comments and take questions from the press. hey, you parks guys, you work for me. come over here. don't go anywhere. if we could get the horses, we'd have you in here too. [laughter] >> let me just make a few comments. first and foremost, when we look at what's going on here today and the national mall in washington, d.c., this is about jobs in america. this is about jobs that are created by the 30 million people who come to our country to our nation's capitol who spend dollars stays here in our hotels, eating in our restaurants, and creating jobs

here in america. this is exactly the kind of project that's so important. when we think about the job creation challenges our nation faces. this is but one for us all across america and every single state. each one of our national parks and our wildlife and conservation system. everywhere that we go. we look at the outdoors and our historic preservation is an opportunity to create jobs for america. number two, this is an exciting time for us as a nation in what is america's front yard. yesterday, we were siting the record of decision, then i'll speak to it. we also know there's a lot of other thing that is are going on here in the mall. our parks people, our contractors, the other organizations that have been involved with us are doing a herculean effort in moving what was a static and stagment effort

just some 20 months ago, to been on the record and having things that will go down in history in the national mall. you don't have to think for a long time. just sense what is going on here. we have, yes, the celebration here at the jefferson memorial where about $12 million has gone into this project that will preserve the jefferson national memorial into a century and beyond. they tell me the, the yours -- the contractors, it's in perpetuity. down in the mall itself, when you think of the history, that place is already being reabandonned with a $30 million plus commitment that we have placed into the reflecting pool, the national mall. when you think about the d.c. wwi memorial. it's coming back as one of our renovation projects. it's not ending there, we pushed through just in the last year the final efforts on moving

forward with the martin luther king memorial. we hope to be celebrating next february one the iconic figures of america, and the civil rights and to an america that has been an america in practice. there's a lot that's exciting, a lot that's happening right now today in the nation's front yard. i want to give the people behind me a round of applause. they are the ones who make it happen every single day. [applause] [applause] >> number three, i want to say just a quick word about recycling. when you think about the world that we live in today, it wasn't so long ago, recycling wasn't even a consideration. yet over time and really the last ten, twenty years, recycling has become a way forward. i'm delighted with coca-cola and with steve and for all of the rest of the people who have come here together to help us get recycling done here on the national mall.

for me, as i have often run the national mall, as tom strickland has often run the national mall, i think it is a -- staying on our nation's capitol in our front yard that really did not have a recycling initiative to make sure that the thousands, in fact, millions -- it would have to be millions of bottles that are frankly disguarded here were simply going into the landfills of america. that will no longer be the case. it will no longer be the case because we frankly said that we were going to change it. as you -- some of you saw it wasn't done on the 4th of july. i counted, and we didn't have them all up. now they are up. for that, i want to thank the national park service, coca-cola, and tom strickland for making it happen. give them a round of applause. [applause] [applause] >> now, finally, as chip and sally well now, in the national mall trust, the record of decision is a pathway forward.

but there's a lot that has to be done. there are critical issues that have to be made and there are resources that will have to be invested into this front yard of america. yes, we have a head start. with the great help of the national mall trust, we hope to be able to raise the money in the private sector to really make the reality of this record of decision move forward. for me personally, as i have watched the condition of the mall, it has gone from a condition that was a very bad condition to one is maybe as i would give it a c grade today. one where we have to aim to give it an a grade. that's true where it's recycling or the condition on the turf on the malls, or where it's other iconic structures like the world war i memorial that we have to do more of. our work here today is one that will continue on into the future. and i am confident that with

those of you who are involved in making this happen, that we'll get it done. i want to make just a couple of comments. some of which are addressed here in the records of decision, some of which we've already addressed, even though they not have been made public. one the things that destroyed the national mall are the heavy impact uses on the mall. when you have vehicles the way 10 and 20 and 30 tons out on the mall. and you have places that are used essentially as construction on a national mall, it basically keeping our turf from growing. it creating lots of problems from the mall. yes, we are moving the solar, the capitol off of the mall. we don't believe it's appropriate to have those kind of heavy impact uses in this particular place. but as we manage all of the multiple uses that some of the earlier speakers talk about, they are addressed in this record of decision. how do we find those areas in this limited land of the mall where you can have those kind of

heavy impact uses. how do we make sure we preserve the opportunity for people to play baseball and do the other kinds of uses on the mall, and all of the first amendment right that is are exercised here? this record of decision has a road map that will take us there as we address all of those issues which profoundly affect each and every one the visitors that come here to the national mall. and the last thing i would say, yes, this is about jobs all over america. it exemplified what national tourism is and the millions of job that is are created through this kind of invest many. it's also another great part of the interior's responsibility. that's how we tell america's story. that is our job. senator inhofe has told me it's the america's history. as we tell america's story, there's no better place in the united states than here in the national mall to tell the story of america. so thank you all very much for

being a part of it. and we'd be happy to take questions from the press. yes? >> mr. secretary, we got a close up look at the shoring of the seawall, you are saying this is work that's going to last in perpetuity. the government will never have to come back out here to spend money to clean it again? >> i guarantee there will not be a need to reconstruct the wall in the life time of anybody here. i asked the contractors that question, it's built for more than 100 year life. it's being build in perpetuity. you see the signs going in, over 30 of them. they are going all the way down into bedrock, four feet, things will need maintenance. i think what you are seeing here is a permanent kind of construction that will sustain itself over generations. yes?

>> thank you. the question as people have the mall and all of the monuments honoring freedom, those that are worried about security, why now the capitol is shut off, all of the streets are closed, and new businesses maybe under ground and may not be able to watch the monuments. what are you going to do the monuments that are celebrating freedom open and free with no security? how serious is that issue? >> you know, we at interior will take the security of our national icons very seriously. whether it's the washington monuments here, or the statute of liberty in new york city. and they are important icons, and we have security plans around them. as we move forward in the post 9/11 world, we have already seen the restrictions that have been put into place. some of them more passive, some of them more aggressive. it is our responsibility, along with others in the united states

of america to make sure that we are keeping our places safe for people who come to visit them. we will take the appropriate measures that ensure safety at the same time, assure that there is a level of access that still provides enjoyment to people. other questions? yes? [inaudible question] >> the frame on the -- which one of the projects? [inaudible question] [airplanes above] >> let me just say i'm going to have peggy answer that. but i have a quick comment on that. that is that construction is -- whenever we take a construction project, it affects traffic. so right now you've seen in the

last year the martin luther king memorial efforts have affected construction in that area. there will be construction effects. there's a priority to try to minimize those construction effects. in terms of how long it will take to do everything that's set forth in the record of decision, that's a question that will only be answered by what kind of support we are able to get from the private sector to invest in the projects that are outlined in the record of decision. the support that we get from congress as well as we move forward in implementing the aspects of the plan. peggy? >> well, i think you did a really fine job. i'm not sure i need to add anything. i will say the good news is the plan is done. the next good news is the money will come in increments. not all of the projects will be started at the same time. they will be phrased as funding is available. we worked very hard with the district of columbia and all of the entities in town to make sure we each know what the

organization is doing and planning. we try to coordinate our work so we are not creating gridlock every day for our commuters. >> thank you very much for being here today. watch our work continue here at the national mall of america's front yard. thank you. [applause] [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

>> on tomorrow's washington journal, they accompany the move jobs overseas. a look at the security rules with former homeland security inspector clark kent ervin. >> next a look at the election cycle, they are host a discussion about the role of money and politics. watch it live on c-span and c-span.org. >> booktv this week, 43rd president george w. bush on his memoir, "decision points" as he discusses the decisions of

administration and his personal live. miami dade college c-span sunday at 4:00 p.m. eastern time. >> according to the national safety board in 15 years, one in five drivers will be 60 or older. speakers at this forum include government officials and representatives from ford and volvo. >> good morning, it's my privilege to serve as the chairman of the national transportation safety board. i'd also like to recognize my colleagues, member mark and earl. very good. i know we'll have some breaks. i encourage you to interact. welcome to the nts board room. we begin on safety, mobility,

and aging drivers. many of you are familiar with the safety board for it's role in investigating transportation accidents and determining the probable cause of those accident. however, we also have the opportunity to bring leading experts together with the safety risk and identifying solutions, even when they activity is not tied to a specific accident. today, we meet for that purpose. we are convening the public forum to explore the safety issues related to the aging drive and to discuss possible strategies to prevent and reduce accidents, injuries, and fatalities within this growing population. america is aging. baby boomers are now well into their middle years. people on average are living well into their 70s, compared with their 40s, a century ago. and more and more seniors are on the road than ever before. in fact, 30 million licensed

drivers in the united states are 65 or older. and the forecast is in 15 years, in 2025, this age group will comprise more than 20% of the entire u.s. driving population. that's one in every five drivers on the road. there's no precise way to define the term aging driver. just as no two 17-year-old drivers have the same set of driving skills, capabilities, and experience, neither do two 70-year-olds, two 80-year-olds, or two 90-year-olds. driver performance varies widely in every age group. and age alone is not a good predictor of how well one will perform behind the wheel. factors like cognition, motor skills, medical condition, and injury tolerance are also predictive. so when we talk about the aging

driver, we mean age in relation to one's capabilities, not age as in old or senior. older drivers tend to be conscious and safety oriented. they wear their seat belts, they may choose to forego driving when it's dark or when the weather is poor. they are less likely to speed or drive intoxicated. and they drive fewer miles than do other age groups. the good news is that drivers age 70 and older involved in fatal crashes has decreased in the past decade by 20%. even though the number of licensed drivers in this age group and the miles logged as increased. despite the encouraging numbers, we also know when there is an accident, it's the older driver who's more likely to be killed or seriously injuries. they simply don't fare as well as younger drivers.

this forum is an exciting opportunity to better understand highway safety trends. and to discuss ways to minimize the safety risks for a growing segment of drivers. whether we are the older driver deciding whether or not to set the keys aside, or the older drivers family or community, we are all responsible for making sure that no matter what your age or destination, everyone arrives safely. while many of these issues we will discuss are topics that have been explored by other organizations in recent years, this is the first time the ntsb is analyzing them in this format. we are very fortunate to have some of the leading experts in highway safety, academia, the medical community, and industry here with us today. i'd like to take a moment to recognize some of the groups that will be participating in the forum. triple a, the triple a

foundation for traffic safety, the alliance of automobile manufacturers, the insurance institute for highway safety, the american association of motor vehicle administrators, the american occupational therapy association, the governor's highway safety administration, the american opt metric association, the international association of police chiefs, national institute on aging, federal highway administration, the national highway safety administration, and aarp. thank you to all of the participates for sharing your time, your insight, and your expertise. as forour road map for the next two days, this morning we will begin with a discuss of safety metrics, accidents, injuries, and fatalities, and how we use these metrics to assess the risk associated with aging and mobility.

as part of this discussion we will also consider the travel characteristics and the travel needs of an aging population. we will then break for lunch. i'm pleased to announce during the lunch break, both today and tomorrow, we will be showing the documentary "old people driving" by director thérèse hoss. it shows milton and herbert as they confront the end of their driving years. i encourage you to take the opportunity to view the documentary. this afternoon, we dedicate a panel for aging drivers and passengers. this is an important issue, because at the core of our mission here at the ntsb is to prevent death and injuries. we know that older drivers face an increased likelihood of injury, hospitalization, and death as a result of a crash. and because older drivers have

decreased injury tolerance, we will also examine how to better protect older drivers in crashes, as well as the limitations of current occupant protection systems and the potential benefit of new technologies. we will then turn to highway and vehicle design. and how changes to those designs can affect the aging drivers performance. intelligent transportation technologicals are also emerging as safety enhancers. we will discuss its advances as well. the improvements to the vehicle environment discussed by this panel benefit not just the aging driver, but drivers in every age group. tomorrow morning we will resume by focusing on driver performance. how we qualify the capabilities such as self-screening and driving assessment, and how we remediate the decuriaments once

they are identified. when we then conclude the program with state programs and practices, including state licensing schemes, and the role of medical review board and state safety programs. i know this is a lot of ground to cover in two days. it's my hope the dialogue will be honest and open. for some, our discussion maybe eye opening. while for others, it maybe an opportunity to spell some of the many myths and misunderstandings about the aging driver. but even more significantly, this forum likely represents a collaborative launching point towards improved highway safety for us all. now for a few housekeeping items. as a reminder please silence your cell cell phones and famile yourself with the emergency exit that is are available in the front of the room or behind you. we welcome the public to view the forum, both those in the

audience, and those viewing via webcast on the ntsb web site. companies of the agenda are available outside the board room and the information of the participates and descriptions of the parties is also posted on the safety board's web site. so we've invited 20 panelist and over a dozen organizations to take part in this forum. notably, there are more organizations participating as parties that is typical at an accident hearing. this stems from our desire to fully air the range of voices on the topic. i urge you to work through your spokesperson and rotate the spokesperson as we move through the panels. you will find question cards on your tables. you can pass your questions to the spokesperson on those question cards. because we have such a full agenda, we appreciate your cooperation in helping us keep on schedule.

and ask that panelist respect time limits and keep discussions focused on the subject at hand rather than slip into topics covered by other panels. we recognize that all stakeholders are not represented in person at this forum. because it was not possible to accommodate everyone who wanted to participate, those individuals and organizations who wish to submit written comments may do so until november 30th, 2010. finally, i'd like to take a moment to thank the ntsb staff for their efforts in organizationing and preparing for this forum. undertaking of this scope do not simply happen. they are the end product of many months of long hours of meticulous preparation and planning. thank you to the staff for your hard work and dedication. in particular, i'd like to recognize the technical staff who made the forum possible. dr. deb bruce, dr. molloy, and

janice colins, dr. mitch garber, dr. ivan chung, and dr. poland, steve and dave from the office of communications. we also have some excellent technical and administrative support by avis clark, michelle hall, robert turner, and bridget. with all of that, we are ready to begin. we will begin with the first panel on safety, data, assessment, on transportation risk and aging. we will begin with the metrics to help qualify what we know about the risk of aging drivers. because past forecasts that have projected an increase in

accidents and injuries associated with aging drivers has not materialized, we would like to understand why. this panel will examine the demographics of the u.s. population, at fault accident rates by age, the injury data for drivers, passengers, and pedestrians, the discussion will factor in consideration of exposure measures, such as the number of licensed drivers, active drivers, and trips or trip miles traveled by age group. we will also discuss how crashes differentially affect aging travelers. my colleagues here at the safety board, dr. deb bruce, and dr. braver have organized the panel. dr. bruce, would you please introduce the panelist? >> first, i'd like to introduce the four panelist. then we'll return to the comments. ann mccartt from the insurance

institute is the senior vice president. dr. mccartt recently co-authored a study with dr. chung in 2010. we've asked her to talk about some of those findings today. we received her b.a. from duke and doctorate from the state university of new york at albany. our second panelist, dr. sandra rosenbloom is a professor of womens studies at the university of arizona. she directed the roy b. drakeman institute, a research and public service unit of the university from 1990 to 2004. dr. rosenbloom has a masters in public policy and a phd from

california. dr. bonnie dobbs is at the centering for disease control. she's a professor in the faculty of medicine and dennist -- dentistry. she has a phd from medicine from the university in alberto. ann dellinger is at the centers for disease control and prevention. the center he's affiliated is the national center for injury prevention and control. dr. dellinger conducts research in safety focusing on older

drivers, occupant, and injury risk behavior. dr. dellinger received her bs in biology from the university in san diego, her masters degree from the graduate school of public health at san diego university, and her doctorate in epidemiology from the university of california at los angeles. we've asked each of you to get started this morning in summary remarks in your area of expertise. we'd like to take about 20 minutes to cover that. i'll help us do that by sort of stepping in and introducing the next topic as we go along. dr. mccartt, would you begin by talking to us about the trends and limitations of safety data and within that context, tell us what we know about the safety of drivers, 70, 80, and 90 years old? [inaudible comment]

>> anne anne -- there's a green light. that's it. >> the crash rate beginning to increase at age 70. this is true for fatal crashes and for crashes of all severity. as we've heard and know, the population of people 70 and older is increases, and is supposed to increase dramatically soon. by 2040, it will have doubled. when we look at the percent of the population with licenses, if we look at middle age drivers, we can see for about the last decade, that percent has been pretty stable. when we look at older drivers, these are three, 70, 79, 80 and older, you can see very dramatic increases and the percentage of people holding on to the licenses, the oldest drivers 80 and older. when you put the things together, when we expected to

see when we look at crash test of older people was an increase, in fact, weave seen just the -- we've seen just the opposite. when we look at crash tests from 1975 and forward, after a study, they peaked in 1997. then they've been coming down and coming down very strongly. two points that i want to make about fatal crashes of older drivers, first, most older drivers involved in fatal crashes are driving a passenger vehicle as opposed to more and more younger people driving a motorcycle, for example. and in a fatal crash involving the older driver, the people who die are primarily either the driver, the older driver, or the older driver passengers, who also tend to be older. we wanted to look at the trends. first the fatal crash license for licensed driver. we looked at the middle age

group for comparison. you can see for this group in the last couple of years, their fatal crash rate has some down. when you look at the older driver trends, you can see again, especially for the oldest driver, a very dramatic decline. so for drivers 80 and older, the crash rate has come down by half. we had two questions. after the initial study, one was two things could explain this. one is that older drivers might be getting into fewer crashes. and the second thing that might explain is it maybe they are also doing better at surviving crashes when they are in one. so we turn to the best data that we could find to look at nonfatal crashes. we weren't able to do that using the national databases. we went to 13 states database, when looked at the prolicensed

crash rate, these are nonfatal. we did see a decline. again, when we look at the older drivers, their decline was larger. when we look at property damage on the crashes, these are the middle age drivers. their crash rate went up a little. we look at older drivers, there's rates for down. so the answer to the first question is, yes. the crash risk overall for older drivers has come down. to look at the second question the survivorrability, we again look to these 13 states and we measured survivorrability in the terms of the percent of older drivers who died in a crash and compared them to middle age drivers. these are the middle age drivers, slight increase in the percent who died in a crash. looking at older drivers, down. so the answer to the second question is, yes, there are less

-- there are crash risk has gone down. when they are in a crash, older drivers are less likely to die. and a stronger way than compared to middle age drivers. we can -- i think in the questions we'll talk more about this. we can't -- we don't have good explanations yet for this. these are some of the high pot sis -- hypothesis that we have. there maybe indication that that is the case, older drivers are healthier and better physical condition, emergency medical and services may have proved -- have improved especially for older drivers. we think there's probably some travel patterns, looking at the latest national travel survey, older drivers are driving more in the aggregate, and also on average. and we know for drivers of any age, drivers who don't drive a lot of miles have higher crash rates.

we think either the quantity of the patterns of driving may help explain some of this. finally, it maybe that we know that roller drivers tend to self-regulate. at least some of them. if they are doing this, if there's an increase in the self-regulation, that might point to some answers. and then finally, just a last point, again, i think we'll talk about this in the questions, there are some really important limitations in trying to take a look at understanding why older driver crashes are down. we don't have, as i said, a good national sample of nonfatal crashes that would allow us to look in detail at the crashes of older drivers. we don't have perfect licensing data. we know they maybe critically

problematic for older drivers when the state has a pretty long renewal period. it may be that the numbers may over estimate how many older drivers are licensed. finally, as i indicated, we do have a national household travel survey. the sample is still being weighted, but we only have these surveys every few years. they could be more detailed than they are. and, you know, i certainly would like to make the point that's really important exposure measure for any age group, but maybe especially for older drivers is their travel patterns. thank you. >> thank you, dr. mccartt. our next panelist, dr. rosenbloom, what do we know about whether older people live and how that affects their travel patterns? [inaudible] >> now i have two mics.

and soon will electrocute myself. about 75% of older people either live in suburban or rural areas nationally. but they are over represented, for example, in rural areas where you could have -- we're talking about one in five drivers might be over 65 nationally. but it may well be 40, 50% in some rural areas. and folks as old as 80, 85, 90 can still be driving. that's their only option. one the issues is if folks are living in low density areas, their alternatives to driving is this. there's significant differences between women and men. women are substantially more likely, women over 65 to live alone. so they have no other driver in the house when they start to have problems. they are significantly less likely to have financial

resources, to allow them to purchase services or alternatives, have goods delivered to them when they no longer feel safe in driving. we know that older women generally seize driving much before older men because they don't feel comfortable, it's often not some kind of sharp medical reason or because they've had a crash, but because they don't feel confident. but at the same time, we know that over the last three or four decades, older people have been driving longer, they have longer trips, they make more trips, and the folks who have driven their whole lives will not have made the kinds of -- will have made the kinds of life decisions about where to live and so forth, based on the convenience and access and flexibility of the private car. it's hard to see how we can substitute for that. so there's a tremendous tension between mobility and safety.

i know we are focusing largely on safety. i think we have to deal with the fact that a lot of people will keep driving, maybe when they no longer want to, or when they are no longer safety because they simply have no other alternatives. it's very common, i speak on this a lot, that someone will get up in the audience and say, well, my mother won't have any problem when she stops driving. she'll use one the community resources available to her. later on in our discussions, if we have time, i have some slides that show how unlikely thereby enough community resources to deal with the vast number of older people who might want to cease or reduce driving. the resources aren't there. if we want to talk about safety, one the things we have to talk about is how to provide mobility for people that want to stop driving or should stop driving. in addition, i think there are important issues about self-regulation, but they -- we

have tremendous evidence that older drivers in particularly, women self-regular -- self-regulate. self-regulating can impact your quality of life and your mobility. it's one thing to make three right turns instead of making a left turn. that doesn't have a lot of impact on your life. it's quite another to avoid all congestioned areas, to avoid driving in the morning peak, the noon peak, or the evening peak, it's quite another to avoid certain brutes or so forth. :

>> one of the things we know is once they retire they tend to make longer nonwork trips than younger people. we think that because you remove the constraint of having to shop or take care of activities near your work location, once you're freed from those, older people are interested in going to different places to shop and different places for socializing. i think these patterns interact with safety issues in a profound way, so what i want to leave the panel with is you cannot address safety issues independent from how people live their lives and where they are living, and we

have to deal with them both. mobility and safety are two sides of the same coin and often we are forcing older people to choose between them, and that's not acceptable. thank you. >> thank you. next return to dr. bonnie dobbs. we asked you to help us understand aging from the driver's point of view and for that matter, the traveler's point of view. what are the special mobility considerations for an aging population? >> thank you, deborah. i want to talk about an inte greated -- an integrated approach. the approach has relevance to the older driver population in terms of enhancement in safety and mobility. the framework is relevant to the

topics i'll address today and that is what the abilities necessary for driving, the impact of medical conditions, and premature driving sensation. the framework that is on the overhead is the focus integrated approach that i used as my approach to research, and the three pillars is how do we identify older people, drivers in general who are at risk because of red call condition -- medical conditions, and once we've identified them, how do we assess them for driving competency, and final though who are determined not to be safe to drive, how do we support those individuals? i'm going to spend a brief moment on the three pillars. in terms of identification, we know the changes associated with normal aging are unlikely to

affect a person's ability to drive, but an illness plays a critical role, and that's important for the older driver population because of the age association of many illnesses such as dementia. because of the privilege of -- prevalence of medical conditions, it seems we need broad involvement of the medical community, law enforcement community, the individual, the families and friends, the community at large, and certainly licing authority -- licensing authorities. to assist the communities, we need evidence-based screening tools, and we also need a coordinated system, so we need the community, the medical community talking or working with the licensing community, we need individual families coordinating or talking with the medical communities, so we need to develop a more coordinated

system. as i mentioned a key component is it's one thing to screen or identify someone who may be at risk, but because of the importance of driving for mobility and independence, we want to ensure that when license is revoked, that the person really is at risk, and for that reason we need evidence-based standardized protocols, and those protocols are important because what they do is that they protect those who are safe to drive. in other words, ensuring that we're not revoking driving privileges from those who are still competent, but we're also protecting not only the individual, but other road users from those who are unsafe to drive. it's politically unpopular to talk about revocation of driving privileges, but my view is if someone is no longer safe to drive, let's remove their license, but let's support them, and that allows me to talk about

a third pillar in terms of support. when i think about support for the medically at risk driver or for any driver, it's in terms of psycho, social, and mobility. we know moving from the driver's seat to the passenger seat is one of the most difficult transitions that an individual will make. there's a psychological component, and we know from our research that we have to assist the individual and the family with that transition. we have developed evidence-based driving sensation support groups to help people make that transition and help their families. we also know that mobility is critical, and often if you look at mobility in the community, we tend to think of mobility in terms of public transportation, bus, lrt's, and taxis.

unfortunately, for the medically impaired driver or the frail older driver, those forms of transportation are simply unacceptable, so our focus has been on developing more responsive alternate models of transportation to keep people mobile and independent. thank you. >> thank you, dr. dobbs. >> one of the findings from the iihs report that was spoke about concerning the increase fatality risk for the very old driver. what can you tell us about crash involvement? >> thank you. it's a pleasure to be here today and speak about this. i'm going to give you my bottom line message up front, and then i'll explain, and i think that the issue of crash involvement and fragility or frailty is trying to answer the question of

responsibility. the main question around the issue of crash involvement or frailty is older drivers have higher crash rates when you take into consideration how much they drive. is this because they truly have more crashes or is this because they're more likely to be hurt or killed in a crash? then they end up in our data bases and they appear to be more of a problem than they are, or they appear they're a problem, and they're not. that's the issue we're trying to get at. the answer is critical because if you're causing say more than your share of crashes, maybe the safety measure that we need is to take you off the road. in short, you're responsible, but if the answer is that you're just more likely to be hurt, the safety answer might be to improve vehicle safety features

or roadway safety features. in short, you're physically frail, you're not responsible. research has investigated the factors affecting crash involvement, and i'll mention a few on the slide here. how much do you drive? so the low milage bias mentioned, drivers who drive a lot tend to have fewer crashes, and drivers who drive fewer miles tepid to have more -- tend to have more crashes. is this because they're self-restricted to speed on urban roads where there's potential conflicts and crashes or is it because of a reduced driving ability, so they drive the minimum they need to get by? crash involvement may not differentiate between a cause sal action that you've sewn, you've caused a crash, and your responsible or crashes someone

else caused, but you couldn't avoid it. factors affecting whether your physical frailty leads to injury or death in a crash include whether you were buckled up, how safe your vehicle was, and what kind of medical care you received. that's a mix of factors that you have control over, and factors that you have no control over as a driver. part of crash involvement is whether you're a risk to yourself or others on the road or both. researchers have quantified this risk in addition to quantifying the proportion of excess crash involvement that can be explained by fragility or frailty, and i keep using fragility and frailty at the same time and people typically use them interchangeably, it's just interesting that the medical people say frailty and the traffic people say fragility, but from the

literature, they normally are used interchangeably, so if general when you whsh in general when you look at the data, there's risk to typically older drivers who are in fragile health, but the risk is small when you compare it to say teen drivers or young adult drivers. the contribution of frailty to excess crash involvement is interesting to quantify, and in fact the proportion has been estimated at 60-95% of the exceases crash involvement and it's been estimated that half the crash involvement, it's hard at this point to put an exact number on it, but it is a significant portion of the excess crash involvement among older drivers. when you take into consideration

frailty and fragility, a low milage bias and maybe the types of roads that older drivers are driving on, it makes a difference in your consideration of how much of the excess crash involvement the responsibility of the drivers themselves or not. i think i'll stop there. thank you. >> thank you. the way we've structured the format for the panel this morning, we're going to now take an opportunity between dr. braver and myself to ask you questions. i've targeted these questions to individual panelists, but i want to take this opportunity to encourage you all to step in. there is met to be an interactive discussion at this point, and by way of foreshadowing, we'll do the questions to the panelists until

10:20 giving us a half hour to set your time. thank you for the timing on your opening remarks. we really appreciate your respect of the clock. after we do the question and answer from the front of the table, we'll turn it over to the parties, and you will have 50 minutes or so to ask questions. we will help rotate that through the different tables, and again, just to reiterate, we've asked that one person from the table be a spokesperson for that table and that the questions you want to ask you write on the question cards to make the questions sus together when they come around. >> i'll turn to dr. mchart. the earlier studies warning us we were facing an older driver problem and your june 2010 report tells us those drivers

are not the drivers we anticipated. what might have changed from the earlier studies to today? >> well, i think that the challenge in this is we can think of lots of things that have changed, but our study for safer vehicles, for example, we know through research we have done and others have done, we are driving safer vehicles than we used to, but the key in the study is whatever explains our findings is a factor that has affected older drivers more than middle age drivers. you think about vehicles, for example, it's a challenge to look at that, but older drivers tepid to drive -- tend to drive older vehicles. we know they are buckled up, but it has to be the key to answering our questions that comes from our studies are these factors have to be something that affected older drivers much more strongly than middle-aged

drivers. you know, i talked about a couple of possibilities. certainly improved health and basically, you know, better physical conditioning of older drivers stands out. how we do the studies to see whether that's a part of an answer, we're not sure how to do that, and again, i think travel patterns are important. when we get the data from our latest travel survey, again, the preliminary findings show older drivers are driving a lot more overall and on average, but we need to look at beyond just the quantity of driving. we need to know if it's been suggested, for example, we know older drivers tend to have certain kinds of crashes. they tend to crash at intersections and that is

particularly high because they tend to drive in more urban areas. has this changed? are they driving on high speed roads that would have a lower crash risk and are safer if you crash? these are the things we want to try to take a look at, but again, it's very challenging to figure out how to do the studies to come up with the answers, so basically, we're not sure. >> thank you. you eluded to this in your opening comments, but i want a question answer to the question. people worry about older drivers posing a risk to other road users. how do older drivers compare with teenage drivers, those in their 20s and those middle-aged 30-60? >> older drivers do less harm to other road users compared to

teens and people in their 20s. >> thank you. >> they are, you know, again, they are mostly a danger to themselves and to their passengers who also tend to be older. >> and then the last of my three questions to you is self-restriction such as limitations for time of day of travel or avoiding unknown routes appear to be common in older drivers. does this get rid of the excess risk of them being involved in crashes? in other words, does self-restriction solve the right they pose to themselves? >> well, i don't think we have the answer to that question. i think that it leads to a series of other questions. do the right people self-restrict? you know, we're doing a study now that's following older drivers over a five year period asking them about their

imperments, physical ability, and their travel patterns. we have a couple questions, but one is does it look like the right people are self-restricting? these are self-reported impairments, and then to see whether people report increased impairments over time, does that translate to increased self-restricted driving? so i don't, i don't think we know the answer to that question. another thing though i will point out and there may be other people talking about this later is there are state programs, and we looked at one in iowa that have -- that attempt to identify drivers of any age, but especially older drivers who maybe should be restricting their driving. iowa administers a road test and

can remove the license, renew the license without restrictions, but some drivers have restrictions. we interviewed drivers in these categories, and we found that the drivers who reported the greater impairments were the drivers that iowa was identifying for a road test and then getting restrictions. another thing that we found was that the older drivers complied with the restrictions, but they also in general affirmed or strengthened their restrictions the older drivers were also making. there is a lot of evidence that older drivers self-restrict, but whether it's the drivers who should always be self-restricting, i think in the long run that would not totally eliminate the higher crash risk. >> thank you.

so, anne, you've been showing a very dramatic increase among drivers who are 80 and older, and you've said these drivers are driving more than in the past, but i'm also wondering whether this age group might contain a lot of people who are holding on to their licenses because we use licenses for all sorts of purposes at the bank, airports, and so forth, and whether you might have a larger proportion of people in their 80s holding on to their license, but in fact, are not active drivers. is that one possible explanation for that very, very dramatic decline? >> well, i keep pointing to the national household travel survey. there may be other surveys that

aren't national that might answer some of those questions, but that's one of the questions i think we could answer when we have travel patterns, although i should point out that survey does not specifically ask if someone is a licensed driver. they ask if they drive, but that is a possibility. i would guess that would not fully explain the large declines, but, you know, again, without travel, without a good survey with detailed travel data, i don't think we can answer that. >> with a follow-up question, do you expect the national household travel survey when the latest version is available to provide adequate data on the amount of driving and type of driving performed by older drivers? >> well, i'm a researcher, so i'll never say anything is adequate, but i think it would go a long way.

for example, talk about the numbers of trips, the length of trips, to some extent the types of roadway circumstances for older drivers, so i think it, i think it would go a long way. >> it has information on the vehicle being driven for example, but it's a sample. it's a very large sample, but still whether for the very oldest drivers there will be adequate data to look at everything we want to look at by state, for example. in our study i could mention in our study in our models that included the 13 states we controlled, but we did find differences among the 13 states, and so one of the things we'd like to look at more is, you know, whether by state, whether by urban rule, we'd like to look

at the geographic component of what we see in crash trends. in a national sample, even a very big national sample quickly becomes problematic when you get down to a state level or, you know, a city level for example. i wanted to point one more thing out because a couple people have asked about the question of gender in our study. we didn't -- we did a couple studies, but in the second study we didn't specifically look at whether there were differences in men and women in the trends that we saw, so we did take a look at that. my co-author took a look at that, and we found the declines for women were somewhat stronger, but not significantly so, so whatever is explaning these differences is it's not the answer, the answer doesn't seem to lie in differences among the genders. >> thank you very much.

that's very interesting. i'm now going to turn this over a deb bruce who's going to ask questions of dr. rossenbloom. >> hi. i can't do this without my glasses. what's that telling us? where people live dictate their travel patterns, and so the first general question is what do we know about where seniors live, and i'm curious what kinds of knowledge we have about the types of trips they take and where that trip information comes from. >> could i have slide number two? thank you. well, as i suggested, older people live in low density places. these numbers are from the census, and one of the problems with the census is determining

what's suburban. you can live 30 miles from downtown houston, downtown tampa, downtown phoenix, and be considered in the central city. these numbers actually underestimate the percentage of older people living at fairly low densityies, and i invite you to read this chart from left to right because the younger cohorts are very suburban, and they're moving through, and the cohorts behind them are even more suburban, and so what we're seeing as people age in place and they mostly do age in place, the largest percentage of older people live in very low density areas, and some are around a little less than a 4th living in rural areas, so what this means is the car is really the only feasible mobility option in many of these areas, and we have to

be looking at -- and people talk about well, what if older people move back to the central city, but that's not what they're doing. let me see chart -- could you put up four please? this is brookings institute data. the census does not every year figure out a one-year move rate. these are people who moved home, and these are in thousands, not a per percentage. wait a minute, that's not -- well, leave that one up. okay. you can see older people are substantially less likely to move than younger people. they are substantially less likely to move states. they're not moving very far. we think that a lot of movement at older ages is into care facilities. the idea that older folks move from chicago or detroit to tucson or tampa or houston

actually they're less likely to do that than they were 20 years ago, it's just that there's so many more older people, so those of us living in the sun belt states, we see older people coming in, but it's a smaller share of the population. most stay in the home where they were when they were still in the labor force, and what we need to talk about then is talking about mobility and access to ability and walk ability in those communities because as older people encounter difficults with driving or don't feel lie driving, there's few options in those communities. we're seeing people staying in low density communities. in fact, for every person in 2006 and 2007 which is my slide number four, but apparently not this anymore -- there it is. for every -- now remember not very many older people are moving, but for every older person who moves from

suburb to central city which may not -- i need to remind you moving to much higher densities, there's two people moving the other direction, so the stories about older folks moving to the downtown of an area and you see those in the paper sometimes, those are what we call man-bites-dog stories. they are reported on because they are unusual. in fact, older people that do move are going the other way. let me show you something else. could i see number 8? no, it's a map of tucson. there we go. that's it. i'm sorry, this is a really terrible picture, and i'm not sure the colors are going to show up. in the sort of to the left is tucson, arizona, the shaded areas are the city of tucson.

the little map that you can't see on top is north of tucson. the map to the side is south of tucson, and those red dots which are hard to see are active adult retirement communities like web, and inform mall groupings of folks who moved out in trailers. if you can see the red dots, you'll see almost all of these are on the edge of the moe -- metro area. they moved in largely from the snow belt to the sun belt. they didn't -- when they moved out of detroit and chicago and cleveland and came to places like phoenix and tucson and tampa, where they move is to the edge. most older people don't move their aging in place in low density areas, but those who do

move particularly out to other states are moving out in the boonnies, and they are moving to communities, many of the communities that have no resources for transportation resources whatsoever. no bus services, these are people who move when they have a car and don't have it in their mind they won't have a car in the future. >> thank you. i have one more question. i hope it's on a positive note. can you give a urban planning for aging communities? do you have experience with public policies or transit systems that you know of in other countries serving as examples for us? >> well, yeah. i agree with my fellow panelists, public transportation is not generally the answer.

traditional public services are not met for older people, but the commuters. they report frequently that they don't, they don't like the vehicles starting before they get to their seats and all the other inconveniences that the rest of us put up with when we use public transportation. there are some services that have been tried abroad particularly in scandnavia where there is smaller vehicles, and they like them being closer to the driver so if they have a problem, the driver can see they have not made it to their seat and they are rooted to the test destinations that seniors are more interested in. they are successful in europe. they are more expensive, but

they're not more expensive than doo-to-door services. can you show me slide 20, please? this is when it comes up, this is i just took some public systems at know the americans with disability act requires public transit operators to provide curb-to-curb services or door-to-door services. i didn't cherry pick these. i was looking to get those sun belt and rust belt cities. the first column is the annual number of trips that are provided by the transit operator in that community in their ada service. if you look at the next column, that's what percentage of the total system ridership of all the services each provider provides, and what percentage

are the ada trip, and you'll see it's very small. the highest is miami at 2.4%. looking at the next column you'll see what a one-way pair of transit trip costs. if you take mrs. jones to the doctor in boston, that costs you $33.21. if you take her to the doctor and bring her home, it's $66.42, and in fact the number for the largest 50 systems in the country is about $37 a one-way trip that explains the 4th column, the total percentage of system costs these ada systems require. miami is spending one out of every four transit dollars to provide these ada services to a very percentage of the total ridership. it means these systems are not

very likely to -- this is today, these systems are not very likely to expand. i wonder if i could see my slide 22, please? >> this is a study that i did a couple years ago for the institute on medicine who was mandated by congress to look at the extent of disability. now, these are not just older people. these are all people who reported to the census that they had a serious disability, and all i did was divide the number of trips by the number of people who might be eligible for those services. in chicago, for example, the average person of any age with a serious self-reported disability got less than one-fifth a trip a year. now, in fact, what happens is the overwhelming number of people eligible for the services

never use them at all, and a small number uses them frequently, but the last column call calculates for each system their 2004 costs that was in the previous chart somewhere between $25-$45 a trip in 2008 data. i said, well, what if the transit operator provided for every person with a serious disability of any age, just provided them with one-round trip a year? you're talking about in atlanta, for example, $290 million a year just to provide people with various disabilities with one trip a month. so these options are not going to be -- these are not realistic options for the large number of older people who are not going to be able to drive. i do think there's public transit options more geared to older people, but i think the answer really is to use the

underunittized seats in cars and i'm a big advocate of volunteer driver programs which are much less expensive than these things and are a way to provide services in the low density areas where public transit and these kinds of services are not going to mix in. thank you. >> thank you very much. this is very interesting, and we really appreciate you covered the questions we were going to ask. i'm going to now move on to ask some questions of bonnie dobbs. i know that you have an expertise with the area of premature driving sensation, giving up driving even if the person drives well. i want to ask a couple questions about it. you know, what evidence is there that safe drivers are misjudging their own skills?

>> thank you. >> the issue of determination of driving competency particularly self-determination driving competency is an interesting area, and when i think about the senior population, it's often -- people think of the older population being homo genius. when i think of people assessing their ability to drive, i think about a framework. if you think about a person's real competency and their perceptions of competency. if you look at the framework on the overhead, there's four cells, and if we look at the

combination between real competency and perceptions of competency in the first upper left cell, you can see that there are a group of people that are come percentage tent to drive, and they see themselves as competent to drive and those individuals will continue to drive and appropriately continue to drive. the next cell in the upper right corner is when individuals do not perceive themselves as being confident to drive or sorry, thanks, deb, sorry, where the individual is no longer competent to drive, but see themselves as competent to drive. in this case, the individual will continue to drive, but that's an inappropriate continuation. in the lower left cell is where the person is competent to

drive, but they perceive themselves as incompetent to drive. the likely outcome would be inappropriate driving cessation. where the person is no longer competent to drive, they recognize they are no longer competent, and there's appropriate driving cessation. house does this -- how does this have relevance? if you look at the first upper left cell, that likely represents the majority of healthy older drivers perceiving themselves as exe tent to drive, and they continue to drive. the upper right cell represents individual with dementia. they perceive themselves to drive, but they are not confident but continue to drive. research indicates if you ask them to rate their driving

competency, they likely will overestimate their driving competency such they perceive themselves better to drive than their age-matched individual, so using screening tools in this population, self-screening tools is not going to be helpful at all. they perceive themselves as competent to drive and will continue to drive. interestingly, the lower left cell where the person is competent to drive, but they perceive themselves as not, that's representative of older females. we know looking at the data older females often engage in premature driving cessation. i think this cell is interesting in that we can do interventions to have them continue or to give them training and increase their

perceptions of competency and keep them mobile, and then the ones that appropriately restrict their driving, those are the ones we have to provide alternate transportation for. >> i read something i just wanted to lead you into a quote because i like it so much. how much longer can we expect to live than we drive? >> thanks, deb. this is research done by foally, and men outlive their driving careers by six years, and females outlive their drives careers by 10 years. >> thank you. so most of us should prepare for the day we will longer drive. >> there is truth in that. >> you have been the cleanup panelists for two rounds in a row. i'd like to turn to you and i thank you for your opening remarks. they were right on. a recent study from cbc shows

the annual average costs of traffic accidents are $500 per licensed driver, and older drivers have an average annual cost of $118 per driver. that's such a difference. why are the costs so much less than licensed older drivers? >> right. if i could explain to the audience what we did in the study, and i think that will make sense. i'm from the injury center at cdc, so you'll understand when i tell you when we do cost studies, and in this one in particular, we added medical cost, medical spending, and productivity losses. what did you lose because you couldn't work? we're less concerned say with property, damage, costs, travel delays, that's not what we're about. we're more about injury prevention, so it's a very conservative cost estimate of motor vehicle crashes in the

u.s., so to tell you that first. we estimated $99 billion a year, and to cover that cost because it's a great way to get people's attention, that would mean $500 every licensed driver would have to pay to cover the medical and loss productivity costs of all driver crashes, and it would be fatalities, hospitalizations, and if you visited the emergency department. we captured those cost plus lost productivity. this human capital approach, one thing that it does because of the lost prubility -- productivity, the work part of it, it undervalues children, women, and the elderly. why? because we either don't make any money as children or as women, i'm sorry to say we make less money than a lot of men, so the men's cost will be higher.

the $118 per capita for older male drivers was an average, and for older women it was $67, so the difference is here is largely due to the methodology which takes the medical spending plus the productivity losses, and the productivity losses are a bit skewed i guess. does that make sense? >> yes. >> and also as an aside, deaths usually don't cost as much as hobility decisions, -- on the hospitalizations, so if you die, you're a less cost than if you're in the hospital. >> thank you very much. we're running a little bit low on time here. we want to allow the parties

time to ask questions too. i would like to ask the entire panel to make some brief remarks about their recommendations for future research bearing in mind we want to leave time for the parties to ask questions. since you've been last, you start out first, dr. dellinger. >> okay. one question that might have come up that i think we've discussed were what of risk to other road users and what kind of research in that category do we need and what are the exposure measures? my point there is there's been several studies on risk to other road users by older drivers, teenage drivers, and i'm not sure we need to do that again. the results are fairly consistent, so my answer to that is we probably don't need another study that shows the

risk of older drivers to older road users. i think we have that covered. >> thank you. dr. dobbs. >> thank you. i guess when i think about the older driver population and an area of research that is thoroughly needed is in terms of providing alternate transportation. we know right now there are challenges in providing transportation to seniors, and that's going only to grow over the next two to three decades. when i look at the research that has been done on alternate transportation for seniors, and that's transportation that's outside the traditional public system so bus, taxis, transit, we know that there are a number of organizations in the communities that are providing transportation for seniors, but there are more gaps in that

transportation provision than there are strengths, and research that we've done in alberta indicates that in order to build a responsive model that will meet the demands today and in the next two to three decades, we need leadership that both the local and state and federal level. we need a need for more intersector cooperation for seniors. there's a need for the identification for new funding streams to start building the alternate transportation models needed, and we need implementation of innovative, sustainable models. it's interesting when you look at alternate transportation for seniors, most of the organizations are working tire leslie. they do a lot of work for fund raising providing transportation to seniors at a cost that is acceptable, however, that

approach often ends up being a barrier in that they spend most of the time fund raising so they can't afford to provided transportation. i think that when i look at transportation for seniors right now, there's a lack of capacity building and there's a lack of stainability and research is needed and implementation in order to address those needs. >> thank you. your thoughts dr. mccart on research? >> i have three. first is following on our studies to dig down deeper and look at geographic differences for example to better understand why we're seeing this very positive change. the second would be, and i know you have a panel on this, has to do with vehicles.

you know, i think when you look at highway safety, # one of the real amazing things is how much better we were doing in protecting people in crashes, and of course older drivers benefited from that as have other ages, but i think all we can do to look at the particular issues of older drivers in terms of crash ratings, and a different thing about vehicles are all the new crash avoidance technologies which people are looking at in being promises from preventing crashes from happening at all. it's hard to research on this about how older drivers may either find them confusing or how will they benefit compared to younger drivers? i think that's a promising area, and then finally, i think we need to continue to look at restrictions by states because when there are bad crashes

involving an older driver, it's always the first thing to figure out a way to impose restrictions on older drivers, and i think there's still a lot we don't know about visual requirements or other special restrictions that are placed on older drivers which in the end affect their mobility, so that would be the third area i would suggest. >> thank you very much. dr. rosenbloom, you know, your brief thoughts on directions for future research. >> well, one, i'm very interested in the whole issue of premature driving cessation. i do a lot of work here and abroad, and the whole issue of women, it tends to be women giving up driving earlier than they need to and they have fewer resources to fall back on, and increasingly women are entering

their senior years living alone with no family members. i'm interested in that and in the issue whether men and women receive safety messages differently. there seems to be evidence about that and that may be related on how to keep women driving safer longer and men who are unsafe to stop driving. we need to look at the range of how women who are likely to accept rides from other family members and friends and people in the neighborhood so i'm interested in seeing what kind of alternatives might be more appropriate. it may be that the systems that we look at will be very gender based because women will be willing to look at options that men aren't. i think we need to be looking at that, and i want to disagree a little with dr. dobbs. i'm not sure we need a lot of

research about why things are expensive. they are. i think what we ought to be looking at is how we can develop a package of options including people moving to facilities that serve them better. i don't necessarily mean assisted living or nursing homes, but find a way for people to live in their own neighborhoods, for example, but not in the same 2500 square foot house they lived in when they were in the work force. >> thank you very much. this has been a very interesting set of presentations and questions, and this is going to continue. i'll turn this over to the chairman to work with the parties. >> wow, this is great, and you certainly helped me understand my parents better by explaning what to give up when. would you like a short break? okay. we'll move to the parties, and

we're going to just go in a round-robin and allow each of the tails to do questions. we'll begin. >> good morning, and thank you for the presentations, all very interesting. looks like we have a couple questions here. question for you, dr. mchartt. you thought the national data bases were not sufficient for answering these questions. are there other data bases in other countries or insurance data bases or others that would be useful that we should look to for comparisons? >> well, i have to say i'm not really familiar so much with data bases in other countries. we do, as yo know, we have a sister agency, the highway loss

data institute, and we get claims data for something like 85% of the insurers, and we do studies looking at older driver trends using this data. the difficulty, the limitations to the data are that they, it's a huge data base, huge sample size, but not a lot is known about the circumstances of the crashes so without doing a special study, there's no issues that can't be studied very well, but it is, it is a data base that we use. >> okay. do we continue with our table? >> sure. go ahead. >> thanks. this is a question from john king on the national institute of aging. pardon me, my throat is a little sore. what's the best estimate of premanyture driving cessation in

older driving given just the cost of transportation and goods and services to older adults in their homes? should i repeat that? [laughter] >> well, if that's directed to me, i don't know what the dollar costs are, but i think if someone prematurely stops driving, they probably don't qualify for most of those community-based services. you have to be fairly significantly disabled to qualify for ada service, and i think it's hard to quantify the social isolation and the lack of interaction, and i think there's a lot of evidence that those kinds of symptoms lead to earlier to morbidity and i think it's tragic, but i don't know that anybody can put a dollar figure on it. >> thanks.

how do the demographic changes related to people staying in the labor force longer affect older driver issues. that's not addressed to anyone, so if anyonements to take that -- anyone wants to take that one? staying in the work force longer. >> well, actually it's women staying in the labor force longer, so i don't know. presumably they'll keep their driver's licenses if they have to keep working and don't have any alternatives, but i think that's an interesting question, but one that i don't know that anyone has done in the research on. >> we've got one last question. someone, and i don't remember which panelist it was that seat belt usage rates for older drivers is perhaps different. how does it compare to the average age driver if you will, and then secondly, does seat belt use rate change for drivers

who are under restrictions? restrightded driver -- restricted drivers? >> my understanding -- i may have mentioned that, but if i did, that's not what i meant to say. i don't think the belt use for older drivers is problematic compared to younger driver, and i don't know about belt use and how restricted drivers, how that relates to restricted drivers. i wanted to follow-up on the insurance data base. i should have mentioned that. when we did our study, we did in our discussion to the paper, we do talk about when you look at trends in the insurer claims data base, they aren't seeing the lower -- they're not seeing the decline in claims rates for older drivers compared to younger drivers. there are some differences. their data really relates to

newer vehicles, and these are crashes reported to insurers not police-reported crashes, so those are two different reporting systems. it is different, and we tried to figure out why that might be, and we're not sure why. i should mention that that it does present not as positive findings you might say for older drivers relative to younger drivers, and these are crashes of all severities, and the data are dominated by very low severity, noninjury crashes. >> could i address the issue of restricted driving? the issue of restricted licensing is interesting in that i think most often it's predicated on the issue that mobility is central to our mobility and indpeps, and -- independence and restrictions in

driving are necessary for some segments of the older population like visual impairments today time only -- daytime only makes sense, but they are extended to individuals with cognitive impairments, and in those instances, it's inappropriate. my analogy would be we wouldn't think about letting an alcohol impaired driving drive within a 5 kilometer radius of their home or let an alcoholic impaired driver drive within 10 and 2 in the afternoon, and that's what we doing to an individual with a cognitive impaired individual. the difference between the two is the alcohol impaired driver may sobber up, and the cognitively impaired driver won't. i think the reason that the

restricted licensing looks so attractive is because of the awful inadequacy of alternate transportation to allow these people to stay mobile. i prefer we put our efforts towards developing responsive models of transportation to keep these people mobile as opposed to using something like a restricted license and keeping our fingers crossed that they're not going to crash. >> that's all ours. >> thank you. we'll move to the back table. do you have an appointed spokesperson? please, go ahead. >> good morning, and thank you. at our table our first question has to do with again the premature cessation of driving, and are there other sources of premature cessation and ideas on

addressing these? things like doctor orders to stop driving that may not really be sub substan united. >> in terms of the medical community, to my knowledge, there are no data that indicate what the prevalence is in terms of doctors advising those in department of vehicles of driving cessation when it's inappropriate, however, i suspect that does occur. what that suggests is that we need to provide the medical community with better tools to help them identify people who may be at risk and then we have to do a better job of implementing the protocols that allow the person to be referred to or assessed in the motor

vehicles or through an evidence-based driving assessment to ensure that when physicians do identify people as at risk, that they are aseesed using evidence-based protocols, and that we're revoking privileges of those people who are unsafe, but leaving those people who are safe still on the road. ..

where they have the men who went through raise themselves before the program as good drivers and after the program has good drivers. the women rated themselves worse before and better after, and what seems to be occurring is that women are getting -- are seeing okay, this is what good driving is and i'm doing it, so i feel better now. so why can't that we need to be looking at, in terms of premature driving -- if we can get some evidence based things that tell safe drivers i am a safe driver and here's some proof i can say to my husband or just to myself to feel good about writing. >> ok. thank you. our next question is for anne mccartt. is it true despite the number of fatal crashes among persons aged 70 and older, the share of all traffic fatalities the order of

this age group is increasing? and when you pulled this latter step from a recent paper written for the trb conference that was held this past summer i believe. >> i'm not sure i follow your question. you're saying that even though older drivers fatal crashes are going down at a faster rate than middle-aged drivers, they are an increasing percentage of all of the deaths? >> correct. >> i don't know if that's the case or not, because i know that we've seen very strong declines in team crashes. i don't know if that's correct or not. it doesn't sound logical to me, but maybe when you look -- again, our study looked at passenger vehicle drivers, which

wouldn't actually support your hypothesis because motorcyclists deaths have gone up among young bird drivers we didn't will get that, so i -- i don't know if that's the case or not. would be easy to check. i can check while you're asking other people questions. but i don't know. >> thank you. and a following question has to do with barriers in the use of cars, and volunteer programs, but in the type of program that some outside the traditional options with these be in shorter the become a training, cost of gas, etc., so dr. dobbs and dr. rosenblum if he might address some of the barriers. >> the barriers that we've identified and alternate transportation service provision

and just for clarification ultimate test provision as transportation outside of traditional modes such as public, ultimate transportation provided of the community level by community organizations, senior organizations, church groups. typically, the model is such that alternate transportation service providers for seniors rely primarily on volunteer drivers. some organizations use a blend of peat drivers and volunteer drivers. when you look at the service professional cross t's to come the paid driver, a volunteer driver model is a more responsive model because it allows the service provider to provide transportation not only on weekdays but weeknights workweek days and evenings, daytime and evening, and we know that when we look at senior

transportation that often what is called life enhancing transportation needs are met savitt to the doctors, the get to the grocery store. but they are life enhancing transportation needs are not met, so the ability to go to social events and attend religious evens, so using a blend of peat drivers and volunteer drivers is more of costly. we also know that funding streams there also are not dedicated funding streams so alternate transportation providers as i mentioned earlier spend a great deal of their time and their resources fund raising to provide what they perceive as being affordable transportation for seniors. interestingly, that perception, that assumption that transportation should be provided and no cost or little cost is a barrier in that all of us pay for transportation until

we are 65 years of age. for some reason there's just assumptions that as soon as we turn 65 we should have our transportation subsidized. when you talk to seniors themselves, most of them say i quite expect and i quite willing to pay and pay more than what my service provider is charging me. i recognize that there are segments of the older driver population that don't have the resources for transportation and we do need to supply is that population, but for the most part like and there's more capacity from the seniors themselves to assist with building better models of transportation. >> thank you. >> i think it's a given there's not enough money because there is a huge demand in the there's not enough service. but some of the other issues are not as pressing -- it turns out insurance is not that big a problem. people talk about it a lot and

some of the volunteers systems to provide additional insurance coverage. you can be covered under the national agency or the agency's service, and that sometimes i think makes drivers -- volunteer drivers feel better. but there's not a lot of the finance these people are running around getting into terrible crashes, so it's less of an issue than you might think. one of the problems that i see is when any of these services get to any side they've run quickly into diseconomies of scale. and i run earlier in my career the red cross was running a service in el paso, texas, and i went on their assuming -- rediker had a contract from the texas department of transportation -- i went down there assuming they would have the cheapest cost of any big city in texas. and in fact they were somewhere in the middle and i couldn't understand that. the had volunteer drivers. well, they had to have a lot of people sitting around called coordinators' or social service providers or -- for the drivers

who didn't show up when you have a large system of drivers and a lot of them are themselves seniors, then they don't feel well or it's raining and so you have to have paul fees paid back up drivers. so i think one of the problems is -- i don't want to do too much about this thousand points of light business but i do think that a lot little services, like thousands and thousands of little services might actually be a better way to do it. once you start to aggregate them up, then the drivers wages go up then you have to have dispatches and backup drivers. then you start to be a business, and i have looked at the in the beverley foundation has as well which looked at some of the costs of some of the well-known volunteers systems and they are running 20 to $25 on one-way trips. so with volunteer drivers in their own cars. so i think the problem -- there is an issue of how big you can get before you start to be very

expensive. >> the one area where there are opportunities, certainly the use of technology in terms of allowing the local service organizations to start using technology to the scheduling of rights and there is cost efficiency in that. >> thank you. our group has time for one more question. okay. sandy, you mentioned land use is a major issue, and as a city planner, could you talk more specifically about what some of the potential land use solutions might be? >> well i think it's very heartening the federal transit administration has taken on along with their promotion of transferree into development and understanding that you have to have affordable housing at the same time. one of the problems is that land value goes up a lot of not like real and very good transit service, and you gentrify and there's neighborhoods in san francisco where they put in the service simply to hit

populations of elderly people and forced them out because the rent went up and prices went up, so i think we have to be looking at a coordinated way to make sure that in the denser areas with more transportation choices, with more land use choices that you can walk to grocery stores and all those sorts of things, that they remain affordable. now there's plenty of older people with a lot of money, but i think we have to be watching to make sure that as we provide more desirable neighborhoods the people we are looking at naturally live there, afford to live there. >> i wanted to just follow up. i don't have the information to answer the question. it's a really good question and i should know the answer, but i wanted to -- and it is possible when you look at the deaths come if the study looked older drivers but if you look a deaths and include children and pedestrians i don't know how the total package has changed. but it gives me an opportunity

of reiterating the importance of exposure measures. the reason our study was interesting or important media is that this is not what we expected because we have more older people come more drivers, and the best indication we have is that older drivers are driving more. some deaths are always the ultimate measure. always try to reduce but especially when you're comparing age groups or different types of drivers it's critical that you have an exposure measure. so i just wanted to clarify. i think our study wasn't focusing on death it was focusing on a licensed driver and if you look at the population week of the most traveled the same patterns. >> thank you. we will proceed to the next table. looks like the alliance of manufacturers is going to be designated to ask questions for the table.

>> yes, and excellent presentations so far and questions by the other panel. this is for the whole group and it's kind of a two-part question. data is lacking on the effectiveness and validity of many screening methods, assessment programs and associated licensing policies. what, if any of the above, should have national priority for data collection? and also, the second part, how should priority areas be defined for large skillet and national epidemiological studies to address those issues? >> could you repeat the first -- could you repeat the first part of your question, please? >> sorry -- it's a long question and i tried to rush through it. data is likely ineffectiveness and the validity of screening method assessments, and

licensing policies. what, if any of the above, should have a national priority for data collection itself, the actual collection of data for the los -- >> well, i think there are a couple of efforts under way. i know california and maryland have both been progressive in looking at the development of screening tests that could produce reductions in crashes and i know california isn't just focusing on older drivers, i've done a series of studies comparing the drivers of all ages and different screenings so i think the priority with a lot of countermeasures and older drivers' safety is relating them

to crashes. so i think the priority would be, whether through random assignment or other very strong research methodologies, to try to -- to try to get to that goal, which is to identify specific screening instruments there would not only change driving behavior or self reported behavior's, test behavior is the national tv contract will test reduction and that won't be easy, believe me. >> i could talk about what's happening in canada. we have just developed a screening tool for the identification of cognitively impaired drivers and one of our jurisdictions in canada, the province of british columbia, the new screening tool which is called the smart md has now become the new screening tool for cognitively impaired drivers

and it's a requirement by their department of motor vehicles evidence based driving and evaluation and in alberta the screening tool was increasingly being used by the medical committee looking at our website the screening tools are also being used a lot or picked up a lot by the medical community, the occupational therapy community in the united states. i think it would be -- it is really important for us to start looking at the effectiveness, the efficacy of these tools when they are introduced, but love to see research done. we are doing research in canada, but it would be nice to see some research, the state level in the united states as well. the screening tools, the smart m.d., focuses on akaka to flee impaired drivers, but we need some type of development and then a implementation and result of that implementation for motor

conditions and visual conditions, so to me there would be a parody particularly when you look at the demographics that are coming out as said earlier that it's most often illness, not age, that in paris a person's ability to drive. so if we can start targeting the at risk population, then there should be reductions in collision as a way of written defining the appropriate drivers who are at risk. >> the next question is for dr. rosenblum. is there evidence of change in the pattern of drivers of older drivers that may help explain their greater crash reductions compared with younger drivers? >> no i think that is what is ironic about it they are driving more, they are driving to different places, they appear to be driving in situations they

didn't before peke period traffic has spread out so much you can't avoid it so they are driving more in congested times because they can't avoid it, so i think it's sort of interesting and i think that's the issue that's been raised the hour driving while the original these things why aren't they getting into more crashes, and i don't think we have good data on that. >> ethical so we don't know the relationship -- why are the driving more. maybe they are healthier. so i think all of these things are bound up together, and in terms of looking at the root cause, you know, it's hard to figure that out. >> i was just asked to pay in. we can't really explain fully the huge drops we've seen in the last couple of years overall,y and so for the first time in

decades we have only 34,000 deaths a year in 2009, almost 34,000 deaths. on the one hand, it's amazing that it's gone down that far. on the other hand, i'm not willing to say that 34,000 deaths is anywhere near good news. part of the good news mabey is older driver safety seems to improve more than anybody else and we have the shocking safety gains over the last couple of years. but we can't fully explain it. people talk about the economy and differences in discretionary driving and that might affect older folks and teams more than it affects people that are working everyday. but a lot of it is guessing. even when you put together a the economy and safer vehicles and on the other hand driving more

we can't explain it. it's interesting, but we can't explain it. >> i think also that, you know, i seem to be the bearer of bad times of a today that, but the survey, the last was conducted during the gas crisis and during the downturn in the economy and that will make it -- now the last one was also during the recession but not as bad a recession. so if we didn't have to have a national trouble -- if it were not only every seven or eight years we do a survey we would be these things, but i think it's7% going to be effective life the latest travel data we have were collected during a very unusual period think flecha hopefully unusual. but that will make it challenging, especially when you're trying to look at how one age group differs from another that will make it very challenging to draw conclusions on how things have changed since

2001, 2002. >> okay. another one for the whole panel. we know the boomers are coping with how to deal with aging parents and their driving skills and safety that is their research that looks of the influence adult children have on their parents driving decisions and cessation? >> i think that question goes back to the accuracy of self assessment or the accuracy of assessments. we know that self assessment of driving competency is pretty inaccurate and not risk populations. we know that most older people overestimate their driving competency. everybody's better than average. research that we've looked at in terms of family members, caregivers making assessments of driving competency and these assessments are compared to

actual on road driving assessments where the individual was determined to be safer on the road test is that family members are not free accurate either. caregivers, spousal caregivers tend to be less accurate than sons and daughters who live nearby. and i think that there's some good reasons for that. if you have an older couple, if it's the gentleman who's driving, competencies' been questioned, she doesn't drive, the wife doesn't drive. she is going to be less reluctant to admit or to disclose that his driving has declined to an unsafe level because if his driving privileges are revoked their with obliged. that may change with the baby boomers because there are more females licensed to drive in my cohort fannin my mother's colewort. having said that, so the next group would be sons or daughters

and if they are living close to their parents, they may be a little bit more accurate, certainly asking sons and daughters the of no greater insight than you or. might take of the situation is if you have someone come a family member or a neighbor that you are concerned about their driving, the most evidence based assessment is to have them have a road test. >> they're actually is a lot of -- leaving aside whether the kids are right or not which is not trivial -- the is a lot of evidence about parents and kids, and a lot of it shows that olde parents don't want to listen to their children or their family] members. they just don't. or as i said earlier that women are more likely to listen to criticism than men are. what i found some funny things. i did a major study for the

british government rarely interviewed a lot of battle to children of older drivers in britain compared to the united states command while they both expressed both sets of kidsró express concerns either about their parents' current drivingmñ or what would happen in the future, i found that americans were much more worried about what it would mean for them if their parents stopped driving. and i liken it to white parents that teenagers who are, you know, much more dangerous, why[o would you let your teenager's drive all the time? and it's because it makes your life easier. once those kids get a license and you don't have to cart them around your life gets easier. what i am seeing a non-adult children in the united states is that yes, the are worried thatew they are equally worried about what is it going to mean to me when my mother stops driving. and it's not just the driving7

committed this will she come live with us, will we have to move her to a care facility. and it's hard to interpret what people say sometimes, but i see a sort of willful ignoring of some bad science about their adult -- about their parentswo because they see this crushing weight of responsibility hitting them, which i think gives us a window for policy because if we can be talking to be boomers -- beebee boomers experiencing problems with their parents and a vacancy the burden they are going to carry because there are not enough transportation and all but the options that maybe you never saw what was going to do for you because they never want to see themselves in that position -- but if we can say okay, here is all the burden you're going to carry for your parents don't you think you want to find some more

public transit and alternative services so those burdens don't hit you? >> dr. rosenblum's white is a good one. the longer afford in this area, the longer i'm starting to realize that for particularly for illnesses the driving is a canary in the coal mine and particularly for the cognitive disappear met. so if mom or dad have problems or memory problems, the families can usually explain that away. but when driving becomes affected, then they can no longer explain it away and that is when actions start occurring. so driving can become the early or not so early indicator of cognitive decline coming and we know that in the primary care setting, two-thirds of all

dementia are missed and mild cognitive impairment, so the driving issue really does need to be on the radar screen. the other point a finger is really important is that austin, when trifling privileges are revoked because of illness, the blame is put on the driving that mom or dad, there now has to be all of these lifestyle changes because they can no longer drive. well, in fact it's because there is an illness and lifestyle changes are going to occur. the loss of driving privileges means the family has to step in or somebody has to step in and make the arrangement, so those arrangements are going to have to be made anyway. it just becomes the red flag >> thank you. thank you all for your honesty in answering the questions. it's very refreshing.

moving to the last table, gssa will ask the questions for the last table. >> first question is for anne mccartt and it has to do with subgroups within the aging population -- >> if you could pull the microphone close, there you go. >> do you see -- thank you. are there differences within the aging population -- in other words, are there differences in crash risks between those drivers who are say 65-75 and those who are maybe older than research? >> yes, in our study we had @ three older groups. we had 70, 74, 75, 79, and older and consistently what you saw was the beneficial with the

improvements we were seeing were the strongest for the very oldest drivers and i believe in a were initial study we did take a look at 65-69, and i believe" we found that they were not that different actually, in our study, they may be in other ways but in our study using thata method they were not that different from the middle age group we were looking at. >> another -- to have you make some projections if you can. crash risk and older drivers to continue in the future? >> do i expect our were studied, the improvements that we have sought to continue? >> [inaudible] >> i would say yes. but i'm intrigued by the question and i couldn't answer

it very well because whenever you're looking at a group and you're looking at other groups there are other great things going on and we were partly looking at not just are they doing better but are they doing better than other groups and children, for example. the gains to be made for children in crashes is phenomenal. but yes. and i don't have a scientific reason for tabhat, but i think that what really stood out for me in our study was the consistency of what we were saying. so it was almost every year there was a decline in deaths. we looked at all these different severities of crashes in the states and was very consistent, and i didn't talk about it today but we look not only at whether older drivers are less likely to die. we look at whether they were less likely to die or be seriously injured. so i think that what was compelling to me was the strength and consistency of what

we were seeing, and while we can't explain that, what that says to me is that part of something that may be long lasting. the big question, which one of the other panels mentioned is what happened in the last couple of years, and i agree wereally . we don't really understand it, and -- but putting that aside, yes. i think whatever is happening will continue to happen, but could be wrong.

and people who will be older in the future? >> is this for me? >> yes. >> well, it's hard to be object of about this because i'm going to be older pretty soon. i'm going to be 70 and older. but yes, this is purely speculative on my part. there's an expression i never get right, but the new 70 is the 60 or whatever. i think older -- i think people who are older are really different than they were certainly 20 years ago, maybe 1d years ago.

and i think it has to do with house, but also just lifestyle and so, you know but again i'm looking at myself here and my colleagues. are different than their parents and i think i'll be different from my parents. my travel patterns will be different. i hope will be better i'm not representative of the population as a whole. there are lots of people who won't be healthier than there. i think old age is not what will they choose to be. >> sandy, that same question is for you. do you think that they will be a difference in terms of lifestyle and demographics and geography? >> one of the things that anne said that while women increased

safety faster there were an assist statistically different. if she hadn't said that, what i would guess is there more women having their 65th birthday with a lot of experience under though about. they're coming into their senior years of better drivers with higher exposure over the outcome you know, 3000 low mileage prius. and not what i would guess, that women are coming in with 30 and 40 years of driving is so hectic situations, with screaming kids in the car and all of that. so even if she can't see a statistically, i still suspect that some of it, that women are just more experienced drivers now. and also, i think people do have a healthier attitude towards these things. it's hard. you see up going into people's

behavior. >> i don't know what the data looks like in the united states, but paul bowles from transport canada, he and i a data last year in terms of the baby boomers. and we looked at the female and male crash rates. and historically in terms of the older driver population that male crash rates are higher than female crash rates. and what we found in or transfer data that the baby boomer females are looking more like the male baby boomers, both in terms of amount driven, but also in terms of crashes. based on those projections, we can expect our cohort, the baby boomer cohort, the females to look more like the males. in the second consideration is while there is a stigma of the baby boomer population that is going to be healthier than their

parents. there also are going to be segments of the baby boomer population that are in poorer health. if you look right now and -- i'm sure the statistics in the united states are similar to the canada, diabetes is up epidemic proportions, cardiovascular disease fat epidemic proportions. right on the united states, one in seven has dementia. and that's project lead to increased sevenfold with the aging of the baby boomer population. so there may be segments of the baby boomer population that will be safer to drive as we move through senior years, but there's increasingly going to be segments of population that would be at risk. >> do you have anymore questions? >> no, we don't. thank you very much.

>> excuse me, just one quick question. would any of you care to comment on the current or future way of doing things like shopping for my drugs online or by telephone or my groceries in that way? things that can actually meet your daily needs without causing the driver to get out on the roadway? >> i just saw a study that said that online shopping encourages in-store shopping. that is not a substitute. it was a compliment for that that you troll online and look at various things and you've got to go out to a story and look at them, too. it's a really interesting question that a lot of people are addressing, the extent to which online shopping and those sorts of things will substitute for travel or almost all improvements in communications,

technology and travel technology have led to more trips. now because we can easily cost them in europe, were more likely to go see them. so it may well be that all of these online kinds of things don't in fact substitute. but i don't think we fully know that. >> the one area i think is interesting is the social networking. and particularly when you look at life enhancing needs for social interaction, increasingly people can have those needs met, so i don't know of any research that's going to be done in that area, but it's an interesting area that people will be about to meet more of their social needs without having to get into the car appeared >> thanks. that's a great question. i think that goes back to what

ms. mccartt said that we will be the same seniors, but i think things are changing. i have a question for all of you. is there any agreed-upon age at which we would say someone is an older driver? i guess this also goes back to a 70 the new 64 is a new 70? what is an older driver and do we have a definition, maybe not there dellinger i'll go to you. >> the short answer is no. i think we've used 65 and 70 as the most common ages to talk about older drivers. i think 65 because that's when traditionally social security started. i don't think there's any biologic or physiologic reason that we decided to use 65 and above. we can use 70 and above. i think that those u-shaped curves for crash involvement you can make a case for 70 above.

you could probably also make a case for 75 and above. but there is no right answer to that. >> i have a number of questions and so if you want to jump in. doc dürer rosenbloom and dobbs, i was interested in a segment to all raised. i was intrigued by your chart that showed how people felt selected, who self-select and that women tend to stop driving before they really should work. , but also by this statistic if you use that women outlived their driving ability by tenures and men by six. how does all of this can work together to demonstrate how people are making the right choices and self-regulating or

not. how do you reconcile all of that and outlive men can't but they'll self-select earlier. what does that mean for us as society? i'll take a go at it and then dr. rosenbloom can take a go at it. in terms of self-selection -- well, first in terms of 9/11 are driving careers six years women, 10 years, that is due in part because women live longer. it's going to be interesting whether that trend halt for the baby boomer population. the other is what is the trend in terms of premature driving cessation will halt for the baby boomer population. my sense is that likely it will

not. i agree we're not going going to look like our mothers that are driving habits and our driving habits when they were our age. and so, i think you're basically going into the unknown. if i was going to project at all or predicted all, i suspect that there will be a certain segment of the female population that will look like the current population and they may stop too soon. but overall i think that female boomers are going to look more like male boomers and that we won't be prematurely stopping our driving. >> i think there's two conflicting things going on here. i do agree that probably the baby boomer women will look more like baby boomer men. on the other hand, women are so

much more likely when their drivers to sit in the passenger seat. and i think they're going to show a slide in a minute. if you look at older women drivers, they're hardly ever driving -- if they're in a car with another driver, usually male driver, they're not driving. okay, so this is already women over 65, so you can see if they get older, these are women drivers now, not just women. these are women drivers and how often they're actually driving the vehicle that they're in. and it's never more than 43%. and it gets less and less and less. so even though we know -- even though women are coming into their senior years as drivers with all pics experience, are still sitting in the passenger seat, which put them at risk for the low mileage bias. and i looked -- i didn't bring it with me, but i look all the way back, all the way through

417-year-olds, if a women is in the car with a man, she's not driving most of the time. so i see two conflicting things. i see women with see women with all the driving experience that looked more like men. and then i see all these women sitting in the passenger seat and some well-known swedish researchers, lisa huckabee's bloom quest has looked at it inside if women drive as much as men, they have the same driving patterns, it better. her solution is women should insist on driving when they're in a car with the male driver. and it's very clear that men often have a different psychological investment in driving. so i can see all the sites across america, no, let me drive today so five years from now but you're too decrepit to drive i'll be able to. and i don't see that happening. so i see this dangerous situation, even among the very

youngest women, they're still driving only eight miles for every 10 miles driven by men. and this older women are driving three -- women drivers are driving three and four miles for every mile driven by a comparable guy. and so, until this balance changes, i'm still worried that baby boomer women actually wants to look like baby boomer men. >> your question is a good one because it speaks to the need for research priorities. and perhaps what we need to do is we need to start looking more at the 55 to 64-year-old age group because that's over going to be dealing with an large part part over the next 20 to 30 years. >> well, i have to say this is all a little bit frightening because you're holding up a mirror on my life. and so, i'm questioning some of the decisions that i make in my

family. i always tell myself that my husband is a bad passenger and so i'd just rather him drive. but you know, regardless, i think one of the questions i was a little bit troubled with is how do you undo 40 years of conditioning for women who might have been told you're not a good driver? and so, if they're prematurely stopping driving, they're not confident or they're not comfortable. and how appropriate is it for us to say you should drive when in fact the individual doesn't have confidence or comfort behind the wheel and is that an appropriate thing for society to be doing? >> i think you're right on. if people do not feel like they're competent to drive and they don't wish to drive and they could meet their mobility needs in other ways, who are we to push them to be behind the wheel? it has to be an individual choice. we can as a society empower

them, give them driver training, it tends to increase their confidence. but if they don't feel confident to drive, i don't think they have the right to say you have to be behind the wheel. >> i had this vision of police coming to your ask to your ask and ask him how many miles you've driven. and if it's not enough, they give you a ticket. what we see in the data that we can't quite -- there is a little uptick and the number of women driving between 80 and 85. and you see it in lots of data sets in the british in australia's davis said that i work with, too. i think what is happening is that is the reason when the husbands die or become capacitive and start driving. no, of course we shouldn't force anyone. i think if people are competent drivers were not offered in a meaningful alternative, we do have to provide ways for women

to judge whether they are in fact safe and to encourage them to keep driving as they are. because were not given them anything else. until we give them something else, that is the question for society at large. there are environmental issues of course. but until we have mobility options for people, then i think we have to help women see if they are competent to drive. it's a vicious cycle. you don't drive coming so don't drive, so you don't drive. producing are below 3000 miles a year and you're running the same issues that when you're out are more likely to have a crash. i think we have to offer women a way to assess whether they are competent drivers. in most cases i suspect that will mean they see they are more competent they thought they were and will drive more. >> mobility sounds like it's a big piece of baldness. i'm so, i wonder if you own vision or are familiar with any scenarios in other countries,

where the state or health care, medical services might pay for driver assessments or valuations to driving. >> in canada and all provinces with the exception of one, having a driver assessment is user paid. the province of british columbia now is paying for a driver assessment for medical reasons. and that's precedent-setting and it will be interesting to see if it results in policy change across the other provinces or territories. my argument would be that when a physician, because it's often the position that is charged with determination not competency and reporting into motor vehicles, if there be in charge of that responsibility, they're having to make that assessment. they refer for catskill blood

test. those are paid for by the health care system. if the referring to driver assessment for medical conditions, it should be paid for by the health care system. >> great. a couple of data questions. are any of you are familiar than a statistics. were talking about passenger schools. are you familiar with any statistics about older commercial drivers? the safety board investigates accidents primarily in commercial vehicles. and we do see there at many cohorts, whether its truck drivers or school bus drivers. these are things many people may elect to do in their retirement. and so they certainly have a high mileage component, but they also have maybe some other challenges. can you all speak to that? >> there was just a study released by one of the cooperative research programs of

the research board on the older commercial drivers. and i recommend it to you because there's not a lot of research about older commercial drivers, so they reviewed -- it's a very good review of all the research on older drivers. and what they concluded was older commercial drivers are doing the same thing that all older drivers are. they're self-regulating, staying out of dangerous situations and their greater experience makes for any physical deficiencies. they're not having higher crash rates as commercial drivers. i recommend that report to you. >> and that report has been submitted to our docket. thank you for summarizing it for the audience. one other question i have about data and i don't know if ms. mccartt or others who have looked at this, but how is the composition of the population potentially affect the data? i say this -- i drive in an

urban highly congested area. my parents live in a very rural area. the way people drive is very different and i've also experienced to florida during the wintertime in a few see there's very different training patterns on the road. and so what is potentially more of a risk? has the more they risk as we have a higher number of drivers on the road that may be older drivers, they may have some performance issues? or is it more of a risk to have a mix of population of drivers that she got some very jong fast drivers and you've got older drivers who may be self-selecting are going our because that may be how they feel comfortable? do we have any understanding as we get to 2025 and one in every five drivers on the road will be an older driver? for that change the statistical information were looking not? >> that's a tough question. well, the last -- if you look at

what i think is the best exposure measure of vehicle miles traveled, the latest data we have 2001, 2002, it does show when you get old enough, that the crash rate, whether it's the overall crash rate or the fatal crash rate goes up. i think the issue of the severity of the crash gets complicated because as we've heard, when you're looking at fatal crashes and probably three century parishes, what's going on is not so much that the older drivers are riskier or they're more likely to be killed as are their passengers. i'm not sure what the answer to your question is. and again, is part of what is changing about older drivers as they are beginning to drive more than they used to unsafe for

highways, that is the factor that has to be considered, too. >> i'll just pay pin. so today, i think we've heard a lot of good news about older drivers and their risk on the road and the risks to others, for example. and i think we're having this conversation because we thought a few years ago that this burgeoning baby boom population when one in five drivers is going to be over 65 and a couple of decades was going to be this horrible thing. so i think the question is complicated as even now we don't see that. so what we were hoping would not have been doesn't look like it's going to happen. so now we have to change our

whole viewpoint about what it means to have one in 541 in four drivers on the road that are older when they're not even looking now like we thought they were going to look. so i guess that the long way of saying we don't know. i think you're saying we don't know. but i think were confident enough to say it's not as -- it won't be as bad as we thought it might. we don't know why. it's not going to be as bad as we thought it might be, but it's not going to be as bad. >> well, maybe it might even be better for all of us. my last question -- i think dr. dobbs, we'll have some panelist to talk about medical issues with respect to screening and things like that later. i'll get a sense from you i'm not talking about older drivers. i'm talking about all drivers. is there a particular medical condition that you think we

really ought to be paying attention to? >> that's easy to answer. a guess, dementia. dementia clearly is a medical condition that needs to be on the radar screen. and it's interesting that when you mention the word dementia, people often thing about alzheimer's disease and certainly it's the most common form of dementia. but there're many illnesses other than alzheimer's disease that can result in a cognitive impairment with or without dementia. so in terms of the medical conditions, that is the condition that, from my perspective, we have to be most concerned about. when you look at the traffic data, individuals with dementia have crash rates that are two to eight times higher without individuals with dementia. we know they are very much a high risk group. >> and what do you recommend as the best way to address any

driver that has dementia? >> for individuals with a progressive dementia, the question is not, will their driving become unsafe? the question is, when will there driving become unsafe? for that reason, we absolutely need the medical community to be engaged. for the medical community, we need to give them evidence-based grading tools. we now have that screening tool that they can use to identify when their patient may be at risk. we need to, in addition to the screening tool, we need to embed particularly in primary care practices or her family medicine practices because they're the positions that are going to be seen people with dementia appeared ready to embed embed the evidence-based protocol. we need to have the medical community is working with the driver fitness communities, the dmv is in order to streamline

the reporting system. and then we need to have several reimbursements for physicians, for engaging and the medically at risk driver issue. we need reimbursement for driving assessment so that the cost of the driving assessment doesn't fall on the user. so we need to work really hard, i think, over the next two, three, four years to get a scientifically-based integrated system in place to address the issue. >> fantastic. >> anemone to get the alternate transportation systems in order. >> fantastic. succinct answer. thank you very much. and thank you to everyone on the panel. you've done a great job of setting everything in the table for us. it's almost lunchtime. we know what she built as the next several panels will help us in our conversations. sit thank you for your participation. before we break, i want to

remind everyone at noon it's show time and we've actually got special dispensation to be able to even treat in the boardroom while you watch. i know our staff are all about to fall on the floor. so bring our lunch back and this was originally a movie theater. and so, please come back to watch elise haas's work and you won't want to miss this. it's a really poignant portrayal of milton and herbert and the decision that all of us are going to face one day. so we are adjourned. the movie starts at 12:00 and will reconvene at 12:12:30. [inaudible conversations] [inaudible conversations] ..

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