welcome back. i really appreciate the film. i thought it was a great personal story about the decision all of us are going to face and was very well done. so this panel, the second panel for today's plan to discuss

occupant protection for aging drivers and passengers. the panel was going to explore the details of decreased injury tolerance with age and complications associated with recovery given crash injuries. the panel will also focus on the current limitations and occupant protection systems for protecting older adults and new technology that can be incorporated into the vehicle design to improve the outcome for older adults in a crash. dr. poland and garber have panel. >> thank you, chairman hersman. if it's all right with you plan before their opening remarks. so to begin dr. stuart wang mr. richter of university of michigan program for injuries research and education as well as the tractor of research for acute care surgery.

dr. wang, would you please present your direction for the panel. >> i would just like to comment this morning i very much enjoyed on the frontlines of taking care of elderly patients it seems to me elderly problems come pale to the it is full of geriatric patients. i would like to begin by seeking about the issue of the fragility of frailty of aging as i will be touching on the subjects. elderly individuals are more fragile and that the system more injuries given specific mechanical load they break more easily. this is different from affect the elderly individuals are also more frail and that the experience worse outcome given a certain injury. they do poorly. what's important is that there is substantial variability

between individuals and i will touch on that. let's touch first on the issue of fragility. we and older folks tend to breed more easily but it's very important to touch on the fact that the don't drink more easily and every single location so if you look up the data this is summarized as crashes over a period of ten years the we looked at and these are just for belted drivers and up the bottom you see feige and on the y axis and the risk of the injury and all lines go up the one place you see it going up the greatest and the quickest is in the thorax, and if you look at specifically thorax injuries is that the river fractures are very, very frequently observed in the most elderly population. and i would like to relate a common story we see all the time in the surgical icy you and there's been a motor vehicle crash.

patient comes with a chest injury and with the elderly these almost always involve a rib fractures. because of these red factors it causes a lot of pain. these elderly patients have decreased pulmonary reserve in the end up on the ventilator for support. once they're on the ventilator you have difficulty clearing secretions and we know that the longer they are on the ventilator the more likely they are to get pneumonia. we also know elderly patients have limited research in all areas and tend to get a lot more complications and what happens after a period of time in the dicey you where the different organ systems are being stressed and the experience organ failure and not infrequently death. so this is a slide to summarize some of the things we find. if you look on the upper left to see the rib cage and the nice looking ribs on a younger person and of the bottom left to see they are quite muscular with a very prominent on donato muscles and if you look in the upper right you see an older chest

with these ribs that look you could almost see through them in locations. you see there's a difference in the geometry and if you look on the bottom right, what you see is almost a transparency of the abdominal muscles and that because it's become infiltrated with fat and this is based on the setting it looks transparent. so the mussels have become raced with a lot of fatty tissue and this happens the same on this trip we've been looking on the ct scan. this is important because the muscles and hard tissue together or what is able to resist injury. now this issue of mosul was something we've been looking at quite closely and we found that in very sycophant the effects with fragility of a mentioned and also frailty. we know fragility because the more muscle they have the less likely they are to get severe fractures but a fixed royalty as well, and what we found his body

condition and a specifically core muscle mass predicts survival after surgery. if you think about it as a surgeon we in fact, on patients all the time, we just hope they can recover from them, that there's some sort of benefit from them, okay? and for many years we've been trying to find the best predictors of frailty, and what we find is that the body factors particularly muscles are better predictors that of models in corporate majeure comb abilities we've been looking at the core mosul and if you look at it, and this is on the upper right is a chart showing mortality on the left. it gets up between 60 and 70% and across the bottom are the core mosul the area. and when you see is the people that have the smallest amount of core mosul experience the highest level of mortality. this is by far the best predictor, better than the patch, the best predictor we've ever found to predict mortality for respiratory failure. so that's nice. well, this is for abdominal

repair and you see the same thing. this was proposed by your mortality rate in of the highest group has the best mortality rate. after an elective donald a. york repair and we go on this is for a liver transplant. we found the same thing after pancreatic transplant surgeries, after many things. so put me give you a scenario. hiking with two friends in the grand canyon bitten by a snake and you need to get and negative on into hours for your not going to do well, so who use and to get it? and all you have this age that seems to be a pretty simple solution, right? what we give you a little bit more information by week and i'm not stacking the deck. you have a friend that is a bit overweight and the other guy is normal. the younger guy is a couch potato who plays video games all the time or the older guy likes to exercise quite frequently, does a lot of hiking, biking.

the under guy is a smoker and a drinker. fielder dalia is a nonsmoker and in terms of medical condition they're both diabetic but the younger guy happens to be very noncompliant and the older one happens to be diabetic whose control on dalia alone. who would use a? we can argue about this but i would say b. you kind of goofy little fault after you got the additional information. and i would say what we found is that their bodies would be very different on ct scans. it's not affect about kolevar ability but how the deal with the mobility. so all i'm interested in saving lives and i don't -- they come to me after having sustained their injury and what we have found is that what really matters is the body conditioning , okay? and what we've learned to do is focus on the individual patient.

medical treatment over the last several decades have gotten better, and i think a lot of that is it has become more personalized. we know the population is comprised of a diverse group of individuals and effective treatment and prevention requires differences between individuals be taken into account. treat the patient and not the diseases with the teaching medical school and that brings us to the issue of crash injury and potentially dominguez. in the past the population of america was like this. this is not to scale but i would say that in the last several decades the population has certainly got to be segments of the population that are more fragile because people are living longer, and typhus fever. there's also a substantial more about the variability. think about obesity, the size of the population, the individuals change substantially. and while crash dummies are nice and represent a standardized segment of the population, my personal opinion is that this is

given to become a problem as the population becomes even more fragile and frail and there is even more patient variability. so in ages a poor descriptor of condition as the pre-existing medical conditions or co morbidities', body characteristics are much better indicators of fragility as well as frailty. patient variability is a fact of life and must be addressed. it can't be ignored, it can't be an average were designed, it can't be regulated away and in medicine we've improved them by personalizing were turning the treatment of the former rebel populations such as the elderly. why is it is the crash injury the basis collect no specific or objective data regarding the of two-point characteristics provide if possible age, height, weight and a member of co morbidities' none of which are sufficient. we need a more detailed

understanding of this complex problem in order to improve treatment and prevention and the federal agencies the national institutes of paul and putting the cdc that have the necessary scientific and technical expertise in a live human disease research should take a greater leadership role to address the growing problem. thank you very much. >> excellent. thank you, dr. wang to read the second panelist is dr. richard kent. dr. kent is a professor of medical aerospace engineering at the university of virginia with additional appointments in biomedical engineering and emergency medicine. he has also hit of automobile safety research at the university of virginia center for applied by yo mechanics. dr. kent, can you please proceed with your opening remarks. >> thank you, dr. poland. following up on what stewart started with i'm going to talk a little bit about some of the

characteristics from our body that change as the age and certainly they are related to individual variability as well there are some things that generally trend with aging that have pretty important consequences for the crash protection, and i'm going to start reiterating one of the plants dr. wang made because i think it's a critical one and that is the change in the distribution of injury patterns. this happens to be the pattern of injury by body region for drivers killed in frontal crashes. this isn't the risk of injury this is the proportion given that injury happens. and we see this general trend periodically of head injuries decreasing as age increases whereas thorax injuries like a larger proportion as age increases and this trend persists. it's not just dillinger is to drivers of this persistent by

crash mode and persistent in all sorts of trauma including things like false or motorcycle crashes so the team seems to be an intrinsic aspect of aging and the uprooting important is over 75% of those injuries are refractors and if you look at the injuries that older folks doherty of in the hospital, they will frequently die of injuries that are no more severe than rib directors so it's not a party head lacerations or things like that but it is rib fractures developed from them. i think the other thing important to recognize here is that this injury distribution reflects three independent aspects of aging and dr. wang touched on the news. the risk of stand injury, the frailty which is a conditional probability of the probability of not doing well given that an injury happens and that could be expressed on something like dollying and then the third thing is the environment which we heard this morning and we

will hear more routt today changes also with aging and the value mechanics really i think can help us understand the fragility part and why it is that it is easier to injured a person as they age again given the individual factors as well. but i want to talk about this issue of the link scale, this is the way engineers tend to think about things. if we start at the very smallest scale we can look at things like material property changes in the human body and we are all very aware of things like osteoporosis that are correlated strongly with age and the bone decreases with aging and also the percentage of the bone that is the organic compound so the mineral goes down with aging. koza separate and distinct characteristics that change with age and both tend to reduce what we call the fracture toughness of the bone, and in fact there are other factors it seems like every time we learn something new about aging it turns out to

be something the reduces tractor tolerance or toughness in the bohm to the phone so things like cross linking and you get over and all these things tend to decrease the toughness of the bone and we get to find many things that happen with the aging to increase it and if we keep moving up this idea of the land scale if we go to the cross section of a rib for example suite on up looking at material, looking at a structure and william schilling on the lower right hand corner of the slide our microct images of the cross sections of ribs and on the left you see under individual and on the right and older individual and when you see is this quarter, shell, the heavy dense blow bearing part of the bone that shows up three bins in these images has decreased in thickness from young to old and this is a significant trend that's been observed and lots of

populations. i'm showing a scatter plot to concede the bury the body the doctor wang was talking about and the ability to decrease in sickness and what happens is essentially is the way your bone who grows is bone is deposited on the outer surface of the bone and resort on the inner surface and as the brokers bone grows. but what happens when you reach adulthood is the acquisition stops on the altar surface but a resorption on the inner surface continues and so what happens is the bone he essentially eats itself away from the inside so you end up with bones that have similar outside geometry but the shell stems with aging. then we can go out to large-scale changes. dr. wang showed a nice example of a change of the red cage morphology and i'm going to show one that is more dramatic if to confirm those views. these are ct scans or they were.

maybe we can go to the next slide which is an image captured from those videos. but what you see on the left is a ct scan from a 17-year-old and on the wreckage on the right is a 64 year old and in addition to the appearance dr. wang mentioned you can see a dramatic change in the shape of the rib cages, and we have found the ribs tend to get more horizontal or perpendicular to the spine as one ages and you can probably see this anecdotally it manifests itself in a barrel chested appearance as we get older. and if you look at the way for example a seat belt might load something like this to structures on the case in the left the seat belt is going to induce defamations like rotation, which is the kind of rotation the lives do very well. that's what we do when we doherty it, it's a kind of floating rate cage can tolerate. on the right you can imagine deforming that chest like a

beryl where instead of putting stress on the chest you're putting it on the ribs themselves and at a disadvantage for the lowering. for this to conclude the biomechanics of aging are challenging problems but i think they are key to the idea of passive safety for older drivers. we did a study where we estimated the aging of america over the last decade generated about half as many see these increases increased seat belt use permit to because this is a pretty big deal. and again i think understanding by mechanics is a key part of the solution and incorporating it into things like federal standards and safety measures is important. thank you. >> thank you, dr. kent. our food panelist as mr. stevan rouhana of the national highway traffic administration. prior to coming in 2002, he

worked at general motors research lab and a automotive addressing by a mechanic analysis and restraint system design and performance. could you please continue with your opening statement? >> thank you for inviting us. i would like to talk about the research and approach we have identified for the research has two goals to eliminate crashes due to aging and reduce transportation related fatalities and injuries due to aging. a for full process could entail understanding the problem by data and safety and pedestrian safety. i will only touch on the data and the hinkle approach specifically to the by mechanics research we are currently working on at ntsa. in terms of the other is an extensive body of research with respect to injury incidents by

age. the crash injury research engineering network that is part of ntsa analysis can inform more on the causations and mechanisms and i will touch on a little bit of how we use the the the in the future. but i think what's necessary is the specific analysis for older occupants with respect to both gender and body mass from a pre-existing conditions and more of these as dr. wang mentioned and to drive more independent the causation mechanisms with respect to crash mechanisms and severity. regardless analysis shows age effects severe injury outcome for almost every region and crash mode. an example follows. there is work the wisdom by the university of michigan to look at a combined analysis on the ability to add more serious injury cases and analysis while the give the power of national representation and we look at the risk of chest and head injuries a specific population when you control whether it's

gender to drive a normal pmi and passenger in a side impact typical of currently regulated conditions the thorax and head injuries domenici as age go up and it is a fivefold increase in risk for serious injury in the fornax and a twofold increase in the risk of head injury, serious injury in the older population. everything else being equal. when you look at the data and refractors as a function of both age and crash severity it does go up in all age groups as a result of the increased severity but even that will crash severities -- sorry, i went backwards. even at the low crash surveys the it goes up to 15%. this indicates the low crash severity which perhaps do something more in this area with

respect to both crash types as well as development because the dummy is only look at the crash and the moderate to high severity range. so emphasis on the research we do is be the as i mentioned earlier the research engineering at work looking at injury causation and mechanisms we have over 300 cases of older occupant injuries with in depth analysis and we will be publishing extensively in the future. with respect to injury by the mechanics we're focusing on the research and head and brain injury research as i mentioned in the previous slide those are the two areas where we see the most potential for older protection. we are evaluating the crash dummy response, the value in the current dominguez we have for the older fidelity which is determining said ability to predict injury as a result of the analysis that we do with the data and determine if we need to

revise the criteria based on age. one thing that is apparent the use of computer models must increase and the computer model of the older human occupants is we think from here that needs to be explored to evaluate restraint systems and vehicle designs in the future. with respect to that we are doing work characterizing age and gender changes of ages across all ages from the youngest to the oldest for collecting ct scans the develop the rift age models with using input such as age, gender and the size of the occupancy and then changing the shape, the size, the density of the bone as the doctor mentioned and other mechanical properties to create a model that can be used in a variety of restraints and vehicle conditions. this video indicates what dr. kent was trying to say as you get older the bone density

changes and the protection will change. for head injury research we're characterizing age and gender to be cut to the brain. we are taking scans of a variety of odd events from the youngest of the oldest and head computer models and put such as age and gender and other information we get from the ct scans will go into a brann model and we will change to save, size, thickness of the bohm, fitness and change we see in the brain and input into what we have published recently on the brain model to predict a brain injury and older occupancy as well as gender occupancy with the differences might be as a result of input. so in summary, we have identified an effort to do over occupancy research and we want to understand injuries and causation as a critical path to the development of projects and the most frequent injuries as i said brain and chest injuries. this will help determine what

dummies we need to use, models, test procedures that address reducing the severity of injuries for older occupants. thank you. >> thank you for the overview of the research. our final list to the cup final panelist is dr. stephen rouhana. he's the technical leader for safety and passive safety research of engineering. he's also helped lead the development of inflatable speedboats and pediatric crash dummies. mr. rouhana, your opening remarks, please. >> thank you, dr. paul wind, for inviting me. i'm going to talk about taking but we just heard from the other panelists and putting that into systems and vehicles that can make a difference we hope. excuse me. if i can start with a look at the summary we have three takeaways from this slide, young kids think they know how to

drive but don't have the experience and drive to fast. this is a fatality rate for 100 million vehicle miles per age and older occupancy as you see 85 plus. we don't get into as many crashes but the year over represented in terms of the fatalities and the third thing to take away from this is the only piece of scientific evidence that shows there's a benefit to middle-age. [laughter] in the 1970's where and with the automotive company put stultz into an experimental fleet which they been allowed people to drive and every time there was a crash the studied the injuries and the crash schematics, and when i was a general motors, one might former employment, we did a study that looked at the survival of the forces of people that were experiencing in the injuries the experienced and we came up with a relative tolerance shown here so in the age category of 16 to 35 if that is the best you can do in terms

of your tolerance, but the time you're in the category of 35 and by the time you're over 65 to have one quarter of the the the the to withstand velte loading. this is what i for employment. they looked at the data and they did a series of models using mathematical models under similar crash conditions to what's found in the field and this graph shows a serious thoracic or chest risk as a 50th percentile. so the crash test dummies used in frontal impact. the take away is it your 20-years-old and have -- and are in a crash and a hybrid three dummy would get 3 millimeters of destruction if you were in the same crash, and sorry, if you were a 20-year-old you would have to 25% risk of injury when

you get 60-millimeter of chest deflection and when you're a 70-year-old you would have about a 90% risk of chest injury in the same crash with the same test deflection. so we wondered is terry waite to reduce the chest injury risk for larocco pence? and we answered that with me be an inflatable velte and i should say this is in the context of the research project to try to enhance not just safety for aging people love for people in the back seats of power vehicles. and so what is an inflatable veldt? it is a two-door air bags and which between two pieces of shoulder belt in the event of a crush the airbag in fleet's across the chest with intent to 20 milliseconds. and this is what the system looks like to read you can see there's a shoulder belt retractor and those to the rain that is the little luke that holds the belt to the vehicle and the shoulder portion of the belt has an air bag placed

inside that in fleets to about 68 inches in diameter. then on the left side there is a retractor and standard lap belt that does not in fleet. this is a little closeup of the impleader and the buckle said the inf leader is attached to the buckle. it is a canister with inner to gas that upon a crash receives an electrical signal from our crash module, restraint control module. a signal for actors the diaphragm and canister and allows the gas to flow through the buckle and also flows through the plate to inflate the shoulder belt. this is a video of the inflation as it occurs. so you see the gas in a canister. the crash occurs and the diaphragm bursts, the gas goes through the plate into the shoulder belt and in fleet's the

shoulder belt within ten to 20 milliseconds. now i'm going to need to come out of my powerpoint presentation and play this in windows media player. this is a crash test we've done with a small female dummy on the right and a 6-year-old child dummy on the right showing the inflation in slow motion and one of the things you can see is what capture the chin and that reduces the excursion of the head. we also expand the area of the chest by five to seven times which reduces the pressure to one-fifth or one seventh of what it would be normally and that reduces the likelihood of injury. can i go back to the presentation? some of the benefits we expect from inflatable belts because we are inflating the shoulder portion of increases in size and also reza increases in diameter

it pulls the end of the build closer which takes slack out of the system, and we of a load of letcher associated to help reduce the chest load and the increased size of the bag helps reduce occupant had excursion by reducing the head excursion we reduce the polling, mexico we reduce the nec load and by the increase of the size we distribute the pressure over the chest resulting in less risk of chest injury. this is from a frontal crash test using the standard polis and these are some of the results we normalized everything to the standard build which is in the red, the inflatable belt is in blue so you can see the head injury criteria hic has been reduced and the chest deflections which we believe is the right measure for a chest injury has been reduced by 40% with the inflatable belt. and i am happy to say that this system is going into production

in the 2011 model year ford explorer but should be out the first quarter of next year. it's optional in the second row of the board seats but we feel that will have greater ability to protect older occupants by reducing their likelihood chest injury as you saw from my colleagues is one of the major problems for older adults in car crashes. thank you very much. >> thank you, doctor. gentlemen, thank you for the comprehensive overview of a clearly challenging problem. chairman hersman, i'm going to try to restrict my questions to the purpose of time to get the parties time but i feel like i could talk about this all day so i apologize if i go over. i think it's interesting that you have separated out fragility and frailty. this morning when we were hearing the discussion seemed like the two words were interchangeable and i guess i am gathering from what you said so far is that the fragility is the chance for me to get an injury and given all i am in a certain

type of crash and frailties the outcome once i have the injury, if i have a rib structure how long am i going to recover and what kind of decrement in my going to have; is that correct? >> i would say that is very well stated, and in fact we have done some work looking at the relative importance of the two things as one ages. i don't know if we can pull the slide appeared that i'm showing, but we looked at again mathematically describing this phenomenon where this thing we are calling for agility would be expressed as a risk of injury given exposure and the frailty metric would be a conditional probability of death given the injury and what i'm showing you here is the rate at which the two things change with age securing showing the relative probability of any injury given exposure that's this fragility

metric candida the dashed line and the frailty metric which is the probability given an injury and if normalized everything to one of age 20 and what we've seen is that this fragility is the risk of getting an entry in first place goes up a factor of about eight from 20 to 80 where the frailty, the risk of dying once you get an injury goes up by another factor of two so in terms of what's more important for aging or what changes more with aging we found it to be this fragility issues affect the get hurt in the first place is where the low hanging fruit is. >> so you're basically saying we need to prevent the injury from happening in the first place. it's not that we need to improve the medical treatment and in certain ways of the outcomes are better but it's prevent the injury in the first place? >> they are both important but i would say maybe that's more important, yes. >> you talk a lot about different types of injuries and i'm going to maybe have a couple

questions hidden. you talked about chest injuries so i guess my first question to you is when i am looking at trying to prevent injuries to the older adult what part of the body and i'm most interested in? is it the chest with a head because typically are here for children i want to protect the head but is it different for older adults is it not the hid that is the most important part of the body to protect any more? >> we clearly her to the chest was probably the major one. the injuries that we see and every case we see with any older odd event has a chest injury and getting to the point made a while with a one of frailty you see for any given major injury like chest injury felled, the quality-of-life is even down and much more reduced for the older occupancy and the young rocket and, so i would say that the chest is definitely the top and

the head is not far behind. >> to be clear when we talk about chest injuries and then go into rib factors, fisa stand rib tractor is that an injury that i may die from or is it only like we talk about -- that dr. wang talk about this earlier is it because the additional complications with breathing difficulties because it's difficult to get a deep breath because my chest hurts because i fractured my rib and benet leads to some complication or is a rib fracture just a severe injury and people die from this? >> the patient's condition has every substantial influence on the outcome after the refractors we see football players all the time at the university of michigan with bruised ribs or factors or some younger people that fall off their out bayh can we give them and motrin and ask them to take a hot so that they will be sore for a couple of months but it will get a better.

the year in a bit of pain but certainly the can manage it with pain medication. what happens with an older person is the limited pulmonary reserve. so you need to be able to breathe, you need to be able to move your chest wall to expand it out and your diaphragm to pull air in and you only have enough oxygen in your system to live for a couple of minutes. so this is something you have to be giving all the time. what we find is the older folks tend to have a limited reserve, okay? when they get a couple refractors pretty soon they are not moving the air very well and the whole cycle that i showed them a curse. so it's much, much more impact will in an older person than would be in a young person. >> you're telling me i need to protect the chest and younger adults typically have tractors that can have a poor outcome for older adults, and you've also

told me that as people age they don't tolerate built loading as well as they do when they are younger, so dr. rouhana taught the that is what can be done to decrease the bulk loading. it's an interesting option. are there additional options to look at to be able to make the belt loading because whatever the to be able to wear seat belts but we don't want the seat belts to cause injury in and of themselves. >> if you could data shows you are almost always better even if you are interrupted. there are many technologies that are currently available research done to address this frailty of the chest or fragility of the chest. for example in many vehicles today there are a low of limiting shoulder belts, so as you move forward in the crash

you apply to the seat belt and the road will build up to a certain value and then the belt will in a controlled fashion start to play out and keep the force at a constant level, hopefully below a level that is required to procure read this. but as both dr. kent and actually all three of my colleagues have shown, the rib cage dtv rates with age so that load gets lower and lower as you get older and older. so for us limiter's can only go so far and so low in terms of the force before you allow the occupant to have to much excursion forward in which case they might start going through the air bags or hitting things in the compartment you don't want them to hit and hit injury could be the problem. so it is one mechanism in the arsenal. we've also been doing research on what is negative four-point pelts which are double shoulder belts. we got that from racing. we've done a lot of studies

looking at recent drivers and to see the crashes of the time to hundred miles an hour the car crash parts fly all over and people get up and walk away as we've been trying to find out what is it in that environment we can pull out of the faster car environment and one of the things we consider is the double shoulder belts connected at the lack. we've done a lot of research on that and we are hopeful we continuing that research until we can come up with a solution to put in a vehicle. >> one thing we've been looking at, if all one has to be adaptable restraint systems and dr. wang touched on the individual in other words the restraint or buildup to the individual or the body condition, crash condition and the next generation as might take out of going beyond just what steve mentioned but beyond to adaptability for the

individual. >> i think there is also an intermediate phase between the two systems we are talking about where the adaptability is in the future but not now. but the load limiting their our systems extremely clever and one we looked in my laboratory is a load limiter that at depths below the limit based on the speed of the crash so you only get as much force as you need so in a low crash it would be quite low and that's good for everybody but it's disproportionately good for older people because they tend to get hurt in more severe crashes so if it isn't needed, then that should have disproportionate benefit for older folks and that is much more proximate technology than the full adaptability that steve ridella must talking about. >> i guess it is kind of a party

in the sky question to the kind of talk about how ages and messily the predictor the condition of the body. is there some way again the kind of policy in the sky type processing can measure the condition of my core muscles like dr. wang was talking about, some measure that can give a prediction of my help, and then have my car know what i am so that when i'm driving my car or when my husband is driving the car or when my mom drive my car that the intelligence systems can appropriately to apply to maximize the benefit for the driver or the passenger? >> there are a number of different techniques the idea of becoming available, for instance we process so far about 1,000 full body ct scans on surgical patients and trauma patients so we are getting a better idea of

being able to predict some of conditions based on measurement of specific points. so it may be fairly simple in the future just to show the dealership or anyplace people get readings quite frequently. there are now ultrasound machines that are quite fast, painless and obviously without exposure to radiation that can measure the core muscles firm quickly and with a few parameters measured on the outside i think it's a fairly feasible to come up with a objective measure of subject condition of a patient's condition and i think that could be used to adjust the settings as dr. kent talked about. >> i think we do need to acknowledge the bio mechanics is probably a few decades behind in terms of knowing what to do with that information so we think there is technology that can tell all sorts of things about the person and the question is

what do you do and questions of individual variability and tolerance and where you put loans on the individual are certainly to be answered. >> i guess that leads me to my next question which is i am going to address it to dr. rouhana but the others may want to join in as well. we've seen a lot of advancement in child safety and i think some of that is because the amount of testing that's involved and the encouragement for the safety systems to become excellent to be able to provide protection for children. are there tests the insurance institute has a best picked and a star rating system. is their something manufacturers can design and to encourage them to adapt their vehicle to better

address older adults and along with what dr. kent was just saying to we have the technology to buy a mechanically assess this if you make a change to we know what the injury needs to be, do we know how much chest deflection is okay for an older adult to be able to even have some sort of the rating system? >> there several parts to that question i will try to remember them all. first is there some sort of a standard protocol that we need to assess our vehicles for elderly occupants and the answer to that is no. in the cap, the testing doesn't really address older occupants per site. that said, we are doing research, we just published research last week in fact on our human body model that we have determined what it's ages and we made a younger version and an older version so we can go ahead and look at different restraint systems with different

versions and see how they affect the aging population the other part of the equation we are talking about is by the mechanics is ergonomics we do a lot in our research to make our vehicles friendly for older people to drive. bigger numbers and things like that on the speedometer and egressing issues and it's a different subject for a different day. did i answer all the questions? >> yes and i'm actually also being hurried along to keep us on schedule so i would like to turn over to my colleague to see if he has some follow-up questions based on our discussion so far. >> what a doctor poland and unlike many others in the room i could talk about this all day as well but in order to keep this moving along pie think i've got one point of clarification i want to go and maybe come back at the end after the parties and perhaps the board has discussed this. you talk about the fragility and

frailty and some specific definitions of the terms i think we all sort of have in our mind the 80-year-old great-grandmother when you talk about this that's a picture we look at and in fact we are seeing an epidemic of obesity in this country and in the aging population we are seeing them become obese. i don't think we tend to think of those fragile or frail but i would like you to address how those may apply to the population as well because again that her to think of it to enter the pound great-grandfather has been fragile or frail when they may be at increased risk and perhaps you could discuss that just a little bit. >> o.k. that's a lot to answer in that question, but so in looking at this issue, what i have found is the literature is absolutely replete with studies showing that obesity is an independent risk factor of death following a car crash but the

literature is sorely lacking the studies of which of the factors is it coming as it fragility or frailty and if you go into a, you know, it is a difficult question to study because the question of what is the risk of getting an entry in the first place is hard to answer because we have a good fatality data but once you start working at the injury the question gets much more murky so pretty much all the literature is contaminated with this combining of serious injury so that is both the frailty from the by a mechanical studies we've done we see obesity as makes the bone growing lot stronger. if a test a rib cage from a cadaver those redds will be stronger than a comparable rib cage four negative person and it's the way the bone remodels carrying a bone around and so they tend to get a bigger and there's all issues about how

people move in crashes that may disadvantage an obese person in terms of restrained performance it's a complex question and i think getting at the answer to your question is difficult and we don't have it now. >> if i could address that. the obesity epidemic we have been seeing and we notice is quit is correlated with an increase in severity and of the number of lower extremity factors and where it plays from our perspective is i think in the op east population -- op east population obesity plays a greater role for realty and that's because in the heavyset population what we typically have is a little bit more fragile and degette flow extremity injuries but what tends to happen is the obese folks have a harder time getting back to and elation and what that means is a prolonged

hospital stay during which the complication rate goes up. on top of that when you have a very heavy set person who has a difficult time weight bearing and the elderly have a hard time recovering strength so that means a very substantial impact on their long-term sort of quality-of-life. so i would say certainly in the elderly obesity is having a frailty among fragility even though we see fragility as effect. islamic it shows every analysis with the most severe spinal injuries limited to the population the oldest group of people and also the fattest people and it shows up over and over again in this analysis. >> chairman hersman, i would like to turn over to the parties, please. >> thanks a lot, it's the lead going to encourage us to have a

resolution. to get more exercise and build our core strength, so pillates and yoga are in my future. i've been asked to make sure each of the parties spoke persons for the table if they could identify themselves by name and their organization for the people who are watching who are not here with us. so i will go to the first table, fhwa. >> im beth alexandria with the federal highway office of safety and we have one question from our table. do you have one? just one. funding for the crash by a mechanics has decreased over the decades with a handful of government agencies and a couple of larger car companies doing the work. i should have let john reed this question. how can we maximize effectiveness of research efforts to lead to earlier deployment of technological improvements?

>> okay i will take a stab at that the answer is correct there's been a larger emphasis the last several years on crash avoidance and safety technology but when you go to the congress worldwide and number of people doing research or collaborating on bye mechanics are still quite high and all those in the community think there's a lot left to do. what we are finding and trying to do is more international collaboration. we started some collaboration in the impact dummies and side effect dunnies with government and research agencies across the world. we've been meeting quite regularly the past year. they are joining together companies come academia government took a biomechanics research and we are starting to join those as well to leverage the dollars and expertise around the world so that is one area we can best maximize our resources. >> i would like to weigh in on this one, too.

we continue to do research at ford, but they're used to be much more public money for research in this problem and injury from automotive crashes is the number one cause of death between one and 34 and it's not getting the attention that i think it means in terms of the public dollars better off there for the research compared to some of the better known causes that are getting funded so i think there's a lot of room for improvement. >> from the perspective of the guy chasing the money the university research i certainly have noticed that phenomenon and a couple of comments, one is that in recent years in particular there has been sort of an increased level of funding coming out of the dod and other military focus groups and it's because, you know, crash injuries are a big deal and wars

and this kind of thing so there has been increased their in terms of ability to look at these questions. another thing that has recently been discussed at least is the va. veterans have disproportionate crash involvement and the va also has tons of money and this might be a good way to spend at s so there have been some of these more military focus areas where we have been trying to proceed on the paths and a red ford has record profits this quarter. so i don't know -- [laughter] we will see if that translates into the research budget. [laughter] >> kind of follow-up? the other part is how we maximize the effectiveness of the money that we already have. >> i think steve hit on it by

seeking out collaborations were we maximize the number of people in the labs participating and each person brings their own perspective and can contribute. >> one thing we did recently as heavy focus symposium in arizona and you find people are doing research arm of the world and the best thing to do is to not be redundant and focused people in different areas so we can maximize the results. >> it turns out we have another question at the table. for dr. wang and kent, how truly modifiable are the fragility risk factors for older adults is the first question. the second one is or older women at a greater risk for reductions etc.? >> i will try to address the first question is how modifiable our day? we are in the process of studying that right now. we certainly think that for

instance we have been seeing these substantial effects of core muslim the operative felt come. we believe substantial number of those can be addressed with its by intervention placing a lot of surgeries for instance are can be delayed so people can get conditioning. obviously in a trauma such a region that is impossible when these patients are coming in and there i will say you can perhaps modify the population in general as one thing. i believe, however, working with a lot of automotive engineers in southeast michigan elsewhere there are substantial number of technologies which are i think on the near horizon which if they are adapted for a more elderly and more real document i think can provide substantial benefit. as i think in that way as i think it's smarter and more attuned vehicle system can prevent a number of injury because you don't have time, the

patients are going to come because of the trauma and you can't say you're going to get in a crash in two months in each exercise. how it can be addressed in the long term there or where nutrition and exercise specific regimens that can be addressed. >> the second part of the question is older women at a greater risk due to the greater reductions in bones. >> we see that trend is a very equally large contribution from muscle mass and conditioning. as i mentioned, we have processed over 10,000 ct scans and we see substantial differences. the other thing that's interested is men and women are quite different and surprise news flash, but they get completely different patterns of injury. so the men and women, there are certain types of crashes where

men will get in a frontal crash the can get away from the chest a little bit and a frontal crash men tend to have fractures' whereas women it's like in all its ratio of 9-1 where netz if you flip it around to a side impact it's about 9-1 and it's interesting it's a younger female that are more likely to get these other factors. so while osteoporosis goes down there are much more substantial gender differences which we are only now getting to get an inkling of. >> one quick comment on that. i have some data that illustrates that if the answer to your question on the gender question is it should, but it often doesn't manifest itself in very clear ways. what i'm showing you up here is relative risk again on the function of age and this came out of combining a whole bunch of exposures, motorcycle crashes

and attempts made for exposure so the idea a cure is this is the risk of injury given a comparable exposure at a function of age and on the left is men and on the right use the mail and all of it is expressed of men to age 20 and it's a lot, but the point is that women have about a 20% greater risk of dying and given exposure and it's almost constant across the entire spectrum infected almost maintains into the preadolescence that ratio stays reasonably constant, and i cannot tell you why. certainly things like osteoporosis to manifest themselves at younger ages although they do show up in both genders. and the other thing that tends to make the difficult question to answer is to risk the whole size issue where men are bigger and so this is just simply a size manifestation or is there some gender issue here? i would say getting to a quantitative answer to that is

probably in the future but i don't think we have a good one now. .. dozens older dummy change the entry criteria and injury criteria for frontal and side impact test procedures and what a sight if any would this have

>> a lot of questions. good questions, too. i'm not sure i would want to go to in old crash test dummy. i know there is some thought about that. i think the best way to handle this might be by modeling. as i mentioned, we made an old version of her human body model and can use that to simulate various restraints. an older dummy would look like a dummy with perhaps different response force to flexion properties of the chest. it may have different rib angles as both dr. hwang and dr. kent showed as they change as age. the injury criteria most likely would remain the same. i think chest deflection is the criterion of interest for old people as well as young did that cover it all? >> would there be any resulting effect on vehicles? >> that the really tough

question to answer. one of the things that hasn't come out as it sounds simple that we can have systems that automatically adjusts for an occupancy age, but it's not quite that simple. because age is only one of the variables and crashes or the amount of room you have in the vehicle limits how far you can allow the occupant to move. so if you have a shoulder belt for example and you make them really low for an older person, as i said earlier you'll end up with a lot of excursion. all crashes are different. crash pulses are different, so there's a lot of factors that have to be factored into this adjustable restraints that some do make it a little bit more challenging. it's not to say we couldn't do it, but it will take significant effort to do an adjustable system in that regard that encompasses overruns. variability is enormous. the two accommodate from the

smallest occupants to the largest and from age eight in most states onward to the oldest person who's in the vehicle has do be accommodated. and they're all sorts of shapes and sizes. it's a complex problem. >> one of the things were kind of immune to or blind to is the effect is of restraint systems because of the weight the dummy designed this measure. current measures only measure her chest to flexion went by. we have a project of an advance crashed on me that look that red single properly like a human set for different locations on the chest. this shows the advanced technology were putting leds on each rib of the dummies and we can measure to flexion any point along the ribbon three dimensions. the question is we don't know what that means. we know the chest flexing about the floating. all of us have pictures -- amazing pictures of both postmortem human subjects and dummies you can see. we have to figure out what that

means relative to the current dummy doesn't want to mention the known one dimension in multiple spots. i think it will make us value eight by having more advanced capability and criteria, but we still have to work on what that criteria means. >> l. be something they'll be applicable to all ages. >> talking about protection, could you talk about the airbag, how that comes into play with the occupant or driver and working with the restraint system? >> before we had airbags, which has had held and we broke a lot of chess. the risk from belts alone is, especially for elderly

occupants, we had the ability to change the amount going to the ballot. we could amount by having them come out and take some of the forces of restraint. the risk of energy from a combined restraint is so much in between what it would be for airbag alone, which distributes the load completely amassed the lowest risk for chess industry. the airbags work in conjunction with the seatbelt to reverse the risk. more importantly they reduce the risk of head and neck injury. but they are positive forces in chest injury protection. >> i think one of the things that's been discussed on this panel and the panel prior to this is that death from rib fractures often occur subsequent to the accident of 30 days, possibly longer than 30 days after the accident.

do you feel that that will ultimately occur from the rib fractures are reflect in the fatality data? or to what extent do you think they're reflected? >> if i could just pull up my site here. give me one second. >> this is sort of getting to an even bigger issue. so here i'm showing you -- maybe if we can get this slide up, here i'm showing you do some proportions. if you pull out fatal data in the u.s. and look at -- on call and make young group kind of a middle-age group aged 30 to 45. if you try to compare all the script teenagers are really gets crazy. here in comparing age 30 to 45

and a group aged 75 and older. nec a lot of different things that go to the sort of crash exposure issue. my plan is to delay depth question. it's about 30% of people over 75 who died in a car crash after that crash, whereas only about 10% in the middle-age group very low in teams is somewhat counterintuitive. you might think the young robust people hang on and try to live, but now, they kill themselves quickly in this crash is so severe a massive head injuries, were he older folks don't have those kinds of crashes. i have a couple of examples of case studies because they illustrate the point. this is the first case, so not a teenager. this is a single vehicle crash with a drunk driver at night, goes headfirst are roofers into

a tree. and there's massive intrusion in the roof of this person died immediately a massive head injuries. and that's an architect really of a fatal crash. it's not the kind we study, but the typical fatal crashes they tend to be pretty crazy offense. and i'm appalled that some of the older cases, if you go to the next slide. here's a 75-year-old male and a minor crashed at 16 days later from the preexisting ballot position. that's enforced. here's 189 euros for a solid surface across the yard, back to the house coming back to come in germany the house as their time instead it stays later cause of not knowing. we found several cases with heart attacks, listed by the medical examiner explicitly at the cost of debt. of these cases to show up in forest. we see all sorts of cases of modern severity of occupancy who have died. one of the things i think is illustrated if you go to the next slide, this is the distribution by age.

if you look back their comely cvh 65 gives you 45% male, 45% female. 15% are unknown or pregnant females. not many of them are pregnant females. what that means is 15% don't even have the gender coding. and this reflects the investigations of elderly driver fatalities are not done very thoroughly because it's not apparent they're going to die. when a young person dies, you know it and it gets a lot of investigation. they survey the scene, take a lot of photos. when an older person dies there's no pictures, no investigation. in fact come iphone cases for the police report that noted no which fatal had been tracked. so it's not apparent these guys will die and it's a good question of what is an elderly fatality and when should it be included as being caused by the crash? it becomes gray.

>> as a follow-up question, what you just said, calls into question the lower fatality rates that were discussed during the first half today. >> and never thought about how that might be affecting them, that kind of data. i don't know how pervasive this is or how much it affects the database in overall trends. i don't know about that. >> i think is our final question, are there, aftermarket design options, to address the needs of older drivers and passengers who are likely under protected by the current designs on the market for >> i've seen things like type errors or comfort devices for belts, typically don't like this because they may interfere with the performance. but in general, most of those products we don't know what their effect and misses.

we just don't test them. but we don't think actually there that effect did. the problems of the ones we see the most, just for comfort reasons, for ease of use to put them on and off. >> some of the aftermarket held devices that aimed to get the belt off the shoulder actually change the routing of the shoulder belt and cause an increased risk of submarine fighting under the ballot. so i don't like to see those systems that all. we do a lot of the valuations with their belts systems to try and get them today good dynamic performance. when you start altering geometer of the system you can run into a lot of problems. >> thank you. >> thank you. as i just for the third panel, for the third title.

>> at afternoon. i'm kelley brightman, thank you for your presentation. they're all very interesting. we have a few questions. since motor vehicle safety can drive restraint designs coming to think any will help vehicle manufacturers further out to my performance for the older population? >> i'd like to say i'm just a research guide. so i'll let stephen theriot. >> well, currently better mortar gold standard vehicle 208 has us test unbelted. and that can drive restraint system design, in particular the airbag to find to be regressive are more aggressive perhaps then it needs to be because we have to protect 50% male, 160-pound occupant in a 30-mile an hour d-delta v., which is a lot to manage.

so that could cause compromises in what we do to the bell system because it has to work with the airbag. so i guess the answer -- the short answer is yes, i think there are aspects of the regulations that could have an effect on performance for all occupants actually, not just occupant. >> thank you. this next question is similar to a question at the other table asked with a little bit different. i'm my own procedures from dummy sufficient for predicting patterns of crash injuries were older population? if not, what i'll should be done? >> i think modeling will take us a long way. we need to understand better than the material properties they certainly showed some data relative to muscle versus fat. some of those aren't well-known for that fact or distribution of

fat or bone changes. so a lot of our work has to be done. he could do more work like that. but it is necessary. we're investigating those things, looking at with properties and bring properties. it's going to take a while, but we can't do them by scaling or what we think is right. there's a lot of literature that takes detailed analysis of tissue is to come up with the solutions. >> i guess one of the things that like to say about modeling though is the dummy is a model. it's a bomb of the human also. it's a physical model. and it's named appropriately. because we make a lot of approximations in developing those models. the mathematical models that we have developed, not just ford, but the whole industry has many different models being developed around the industry. we've mentioned simon which is a model of the brain in school. these models are much more

detailed. they are much more detailed than the crash dummy can be. the crash dummy as a tool to be repeatable. they run the tests in a contract lab, we get the same answer hopefully. and because of that, to make it a laboratory too many compromises have been made. it's a good representation and we've done a lot with the dummies as many people have noted the number of fatalities have come down. i think a lot is due to the economy in the last three years. in fact, michael feedback from university of michigan have a study on that. i got off track, sorry. the fact of the matter is that the computer models i think it is much more detailed answers. the caveat is that steve said, there are many properties we don't know a computer models are only as good as properties we put into them.

so this is -- compromises everywhere a guest. >> also address that question. there is a substantial impact deficiency right now. at the modeling will be very helpful in adding additional properties as dr. heyman mentioned, which you end up with is much more detailed. hopefully with models sorted detailed injury locations. what we've done and looking under a very large substantial -- we see differences in the location and the specifics i have injuries and how they're related to each other. now very different from a young person versus an old person. you pulmonary conditions, whereas an older person the ribs break in a different spot, which leads to lung lacerations in liver injuries and whatnot. so i think what's necessary is a

three-dimensional entry mapping. all the injury databases are basically lines with a specific injury -underscore. they don't give you the three-dimensional locations. how much you need to see is the exact location in 3-d space as well as how well they relate to each other into the location of the force loading on the exterior surface of the body. all that was very easily attainable by processing of ct scans. i believe it's absolutely necessary to support modeling. you have to have a target for any sort of task that you have. you have to have a valid target. so that's a very substantial and glaring deficiency right now. >> thank you. polypharmacy effects on any thoughts on bone density, fragility and frailty of? >> as a trauma surgeon, i don't believe i'm the most qualified person to say that. we certainly see polypharmacy, a

substantial portion of the american population seems to be on multiple drugs at this time. with the interaction of those effects are an osteoporosis i cannot say. >> thank you. >> thank you very much for those questions. will proceed to the final table and i think ann is going to lead this time. >> and he missed on manual and where from and back. you kind of touched upon it earlier, but are there gender differences in terms of the older driver diametric some of the policy implications of the difference in one of the things i was thinking about was we talk about in the last session that females tend to be the passengers then there's a male presence in all age groups. are there any implications for detecting those are what are the

policy implications? >> well, i'll start with that. we certainly see very substantial differences and we know that we attribute to many of the differences in energy patterns to the anatomic differences we see between the genders. my personal feelings against speaking from the outside and not being one that defines the dummies for the test devices as i don't believe there is sufficient gender specificity in the tests. i think certainly when you lump all the energy risks together come you kind of lose a lot of that understanding. and zero, my personal opinion is there is not sufficient gender specificity in the test devices. >> that aside, we still do use small female dummies in regulatory and consumer level

test. i mentioned earlier were helping to evaluate worldwide hub of midsize mail and small female based on more recent i/o mechanical data of the fragility of the females relative to males. >> on maybe make one quick comment. the front passenger position, i don't have this data, but one thing we've been looking at lately which is a hot research issues is the real seat, which goes to your point about nondrivers. we do know some things about rearseat and do a policy implications. what i'm showing you here is the effectiveness, the fatality effectiveness as the real seat compared to the front seat. it's a number means the rearseat is safer compared to the front seat with the same kind of exposure. if there's historical truth, it's that it is safer and intrinsically safer environment

than the front seat. it's only in recent years this has become untrue and it's become untrue for older drivers. what you see they are about age 50, the front seat has positive effect. when you get into the older age groups, the rearseat becomes negatively affect it. so in other words, the front seat is safer than the rearseat for the oldest occupations. there was some working hypotheses and why that is. one of them, if you coach the next slide, he says. this is the% of various technologies that are in the sea. we see things like retention are some of the murders. it is a bit dated now. you would see essentially all of them, 100% of these technologies driver seat and that's been largely motivated by compliance test which about dummies and the driver seat, but there are no such tests involving driver dummies in the rearseat. so the rearseat sort of, you

know, it's still a safe environment, but intrinsically the front seat is caught up because we've been working so hard on it. and that's starting to show it self. there may be some advances to be made there by incorporating some technology from the driver's seat into the rearseat and there may be policy issues. >> i like to weigh in on that one too. but this doesn't show as the driver for the factor pretension nurse in the front seat. of course -- i didn't mean that by the karcher for her. i meant that by the major factor i guess. i should have said that. there's always the driver in the vehicle and one third of the time they are summoned in the rearseat. nevertheless, vehicles themselves have become -- have been forced to become for all of our faith more fuel-efficient, which makes them typically

later. also a lot of the design trend in recent years have been too sure at the end. out of these trends making them lighter and more stylish drives the crash pulse. the crash pulse of the region we have the members of the acceleration experience because the structure of the vehicle is much different now than it used to be. if you were to plot the structure as a function of time, which would be a good name to do, my guess is you would see the mcat also follow the same trend in so these technologies are needed. and it's time for them to come to the rearseat, which is why we put inflatable boats of the rearseat. >> .or bruce. >> i just have a very short question. it's actually going back toww?? dr. kent. when you talk about your delay desk flight and you don't need to bring it up because the question is for dr. wang.

when you see your sequence of energy failure, how long does that typically take? >> that could take in the order of weeks to months. what happens -- and i think this goes back to one of the issues that dr. kent brought up is the one thing -- we tend to get a very early read on them. and they have enough reserve they begin to what happens if they cannot a lot of intensive care support. in these days, advances in critical care which have been substantial were able to keep folks going for weeks and after they typically dwindle in it could be months before that pops out. >> so it would be fair for me to say that the delayed deaths number is an underreporting? >> .com and i'm not familiar

with dr. trainee's database, but i would say i would be quite concerned about that. i think if you add on top of that not just death, that the very poor long-term outcome. you would have to follow that much longer because they will be much larger portion of the elderly population that failed to return to full function worsened the elderly they bounce back and have that recovery function much more substantial. >> just for the record you had a 30 day window. >> thank you. dr. price, i'm going to keep you busy trying to pull up a couple slides. dr. kent had a slide that showed had energy and thoracic energy. one was going one direction and one was going one direction and the other was going the other direction. what i'm trying to understand is why does head injury, if i read this correctly, why is head

injury decrease? is it because of the operation of the vehicle, speed or belt use? what is going on here? >> i should've made that more clearly. should the risk of any injury to anybody goes up with aging. so this is not numbers are risks. this is proportion. so when an injury does happen, it's more frequent in the thorax an older person. so they actually have a higher risk in the hunt as well. >> okay, thank you. >> it increases faster. >> okay thanks that's what i needed. i think when you cannot talk about the example are asked every of the 39-year-old female driver in the train, it's like because there have been these catastrophic high-speed accidents, but we're not seeing that in the older driver. but they have as many head injuries, just the proportion is not as high. >> i do know about numbers, the

risk is higher in older folks, but their exposure is less than they are driving as much. the total number of head injuries, there's probably more, but the risk is higher in the old and the proportion is higher in the young. proportionally younger people have injuries more frequently. i think it's also true that older people do not get into this figure crashes younger people do. >> yeah, that's the environment issue which is very important. >> great, you had another slide and it was the one that had the category of unknown and pregnant female. i don't know if there's a gender bias because last time we had women on the panel and now we have four men. but i'm just confused as to why unknown and pregnant women are in the same category? >> i think my postop with them that way. i'm not sure why. but there are some that are

coded. i was trying to make the point that's pretty clueless neighbor plays. if your code is unknown or 65 plus his pregnant female in both issues you probably missed. and so that's why i combined them to show over 10% of the database is coded and completely incorrectly. >> okay. >> mr. ridella, i think we kind of talked a lot about the dummy types. i'd be curious as to what type of dummy. i know you're talking about modeling. modeling is a great solution. but there's a reason we we have dummies. and we talked about obesity. we talked about fragility. what do you think is the single most critical area that were missing in our family of dummies? what would we benefit most if are going to go through the

effort of putting together a new dummy? what is that we don't do well in her modeling now? >> i think we do well everywhere. we touched on it. the word that comes to mind is via fidelity and that means how lifelike as the dummy? how well does that then make not just the injury, but also the kinematics. in other words, when they look at fire and crashes, we try to reduce where was the occupant initially and where does that go? we try to re-create that in the lab. the dummy doesn't always want to go with the human does. part that is the process we don't want to break the dummy because if you matter to lifelike you'll break over and over again. it's expensive and i think make it the feed. if we can make dummies smarter, more bio for dollar, more likely to respond to the crashed direction, the crash forces and to have the instrumentation that can predict the injury. that's why we're moving into

rotational criteria, multipoint chess and thank him acetabular load cells, so we understand what's happening at the pelvis. more complex lower extremities and more lifelike lowers germany's, which we completed the project on. what comes with them as complexity of dummies gets more issues of calibration, repeatability, durability, reproducibility from dummy to dummy that we have to tackle and we will do that, and it's a process we have to go through. >> i hope that answers your question. >> it sounds like all dummies need to have better fio patella d., but is there one kind of prototype human that is not well represented in the company's? i think that's what i'm trying to understand. we talk about dummies performing like human beings, but is the dummy that is the heaviest? and when we look at obesity, are we able to capture that?

>> i would like to weigh in so to speak. a couple of comments. i guess go to the very last question you asked. we have done some work looking at a fat jacket for one of the dummies. you know, the rib cages are quite like the rib cages of anyone else. if you get to the bony structures, they're about the same. there's visceral fat, but the thing that affects the most is the most stettinius facsimile can represent that number started looking at that. wicked repeatability and robustness and all of that. and so, the point i'm making is we have this question by resources. to my mind, the resource required to develop a new dummy to get worldwide except in senate and to get people to start using it. it is never happen in my lifetime. you know, we got one around the time i was born, but we were

keen on them ever since and it's very hard and takes a ton of work. and i just don't see that as the best use of resources to build yet another dummy. we can work on rates and making them better and also ways of interpreting what they tell us. things like simon. you know, simon uses a dummy input to drive a model and give us more information on what a human would experience a not exposure. those kinds of things seemed to me to be a better use of resources and enter again what they have rather than building another one. >> i was interested in the back seats. and i'm really glad people ask the questions in your able to put some sides on that information. if you could pull off that side that dr. kent used that had the vaccine information. i think.they are roughana, one

10th the time is the backseat. help us to understand the data of the love that more with respect to the benefits of bush's favorite seat passenger, not talking about a driver. the benefit of a front seat passenger gets out of having the combined airbag in seatbelt versus a backseat passenger, not have an airbag. maybe you can talk us through the data here again. whoever feels the way of something to add here. >> so this effectiveness issue to sort of start trying to understand a little bit come within a couple things for my lab. one is looking at the distribution by roddy region, where these things happening? it is the chest, surprise. it's just even in the young. the chess seems to predominate in the rear seat more than a dozen different view. and so that's one clue a number

started looking at restraint performance in the rear seat. and there are challenges in the rear seat that are unrelated to the lack of an airbag. an airbag is an omelette had here but there's other look past the front seat and not in the rear seat like a neat poster. we have quite a bit more flexibility and certainly dr. roughana can speak to this more than i can, but the design of the front seat is much more able to be changed and then decided they receive. to receive this type to the chastity of the vehicle. it has huge consequences if you try and change it. a front seat, driver seat is very ingeniously designed to restrain your pelvis. it's an extremely important part of the restraint system. in the rare street is difficult to get the same kind of public restraint. in the rare street testing would seem to spend public motion that is in the most concern to us because it tends to vote the lower portion of your chest, keeps the torso reclined, which

has been in moments and things like that. so the rearseat poses challenges. a lot of them with the inflatable ball addresses eloquently, things like restraining the pelvis. and so, there are things being done back there along those lines. and so, a lot of good nose for those restraint sees this as the next market. because this is an area where they can sell technology and there's a lot of work in this area. >> i don't know if the site is still up out there and i apologize. i'm just not understanding exactly what the data is telling us. i think in particular stuff on the zero to five. i think these age groups, passenger eight groups, zero to five are not in the front seat. explain to me what's going on. and really were hoping the six to eight on the front seat and the nine to 12. help me understand that these two colors are showing us where the passengers are.

>> well, they're not supposed to be that they are. so their children in the front seat. and so what that is as compared to boat to fatality risk of kids in the front seat versus kids in the rearseat. and what we see is it's about 50% more effective to be in the rear seat for children. that actually stood across the age range to 50. it's about 50% pay for to be in the rearseat than the front seat. we encourage parents to put them in the back, but there are still kids in the front. >> where is the airbag though? >> in this case, the blue line as representing cases where there is an airbag deploys in the front seat. the red line is is for motor vehicles where there's not an airbag deploys in the front seat. and so it's a little bit confusing. the reason i was putting the side of, but the rear street -- the decrease in rearseat effectiveness is more pronounced because the airbag divisor

benefit to the front seat. it makes the rearseat posted by faith. the effect is bigger which is why at the blue lines. the point is the same. >> humdinger might help is this a study done by anita published in 2005. the data is more than five years old. it's probably more like 10 years old and know about markets in the front seat 10 years ago than there are today. >> this child passenger safety technician. i just don't like to see annie, you know, data showing kids in the front seat and think the airbags are effect is. but it's a challenge depending on how their restraint. but i'm curious, mr. roughana, does the belt with the airbag provide the same benefit or have you been able to quantify that were talking about a combo airbag in seatbelt versus the

seatbelt and it? >> we have tested -- i showed one side with the standard bell. that standard belt had released an airbag unit and routers to chest deflection over that system. we've also tested this side impact and compared to the inflatable bell. a standard belt by itself and a standard belt plus a side airbag. and we can see reductions in chest deflection from the inflatable bell. so i think we will have a much more effect system for the people in the rearseat. >> create. thank you area much for sharing that video with us. and it did go very quickly. so i see you're very close to that site again. i don't know from going to pass off to.dirk garber, but if we could show the video again while we're transitioning.

>> you know what, it's okay if you can't -- dr. garber, do you some additional questions? >> just a couple of follow-up things i wanted to sort of get on the table. we've talked a little bit and i think dr. wang in particular address to a certain extent the issues of exercise. i meancome the budget for patients exercise for a couple months before they can enter their accidents. can you comment more specifically on what the effect is of exercise in the older population with regard to those types of markers of fragility

and frailty like low mineralization and muscle mass and what that does as far as their ability to withstand some of these impacts. i know the surgeons are fond of talking about physiological versus chronological age. perhaps tell us what it would mean for an 80-year-old who is running, versus a 6-year-old perhaps is sedentary. >> i have a discussion site, which will come here shortly. i'm not sure i can answer exactly your question. the question of whether -- how exercise affects core muscles, but we have decided that the perspective fashion. we certainly see a patient that they appear to have a good core muscles. in this kind of made that association. the other thing we've done is we've studied patients better in

the icu at that large cohort i showed it had a very hyper toddy rate. we know this os muscle can change acutely within the course of a couple weeks of being critical yield. so we certainly know it can drop very substantially in size. how quickly it can go back up, we haven't sorted out yet. we have a number of studies which are going forward to try and study that. so this latest round thing that helps to drive home the point if i haven't already to the point home, that agent comorbidities are insufficient. in that condition is much better. so what we did as i mentioned we sedate this in liver transplant surgeries, multiple surgeries. and we found that this os muscle is by far the best predictor, far better than comorbidity.

we check -- this is the 10% worst so as area and we look at how they matched up compared to the 10% with the highest age and the 10% with the largest number of comorbidities. so in the past we've always used agent comorbidities at her assessment of frailty or fragility. and what we found is that it was muscles seems to indicate something different. and in fact, this treatment area come which is by far the best predictor of poor outcome. >> and that leaves another question, to what extent does that or any other markers that you're looking not represent a reflection of actual medical conditions that individuals may have. also those aging associated conditions such as emphysema or cardiac disease or diabetes? have you separate those from the effect of each unit of?

>> it's very difficult. in order to have a good psoas musso, you have to have good nutrition. you can't have, disease, which is causing you to be ill and not been able to exercise. so this is just a marker. and it's very difficult to separate out those processes and right now all of this is something that we have found -- this is by far the best market we found so far and were attempting to sort out the factors that contribute to it. >> one last question for me is you've talked a lot about the data, which are mostly fatality data with regard to the older occupant. we didn't really discuss too much except sort of referentially what the effects are of even relatively what we might consider minor injuries on long-term disability for these occupations. i know it had discussions and conferences about lower extremities in particular an

older adult, even things as simple as sprains and contusions may result in long-term kinds of disability. faq to discuss that a little bit if you can. >> it's hard to speak about in general allergies what happens is the more frail. i'll get away from the word out early. the. decommission patients, they're able to push them over the edge. we say typically these frail or what decommission patients or the elderly with a couple of her fractures that end up with pneumonia. certainly when we did our population, think about 80% of 85% fatalities had her fractures in quite a substantial all they had were fractures. now we also have a substantial number of patients who sustain what we would consider relatively minor orthopedic injuries. but again, because they're

decommission, what ends up happening is they're unable to get with the very quickly. you go to a nursing home, being that bound for very substantial periods of time. became one complication or another and that we admitted. so even small orthopedic injuries can lead to very poor outcomes in a significantly decommission patient. we see this over and over again, so it's a very common and go. i can't give you the exact injury him with the fact is in more detail. >> the point about less severe injuries. we tend to focus on lower extremity injuries tend to be on the gore side of two plus injuries. not shamanic ring injuries that doesn't have a whole lot of research in this field, but something we think we can get a handle on also by doing further research and see where that goes

in the future. so that's one area for going to focus on also. >> thank you. that answers all the questions i've got. >> dr. poland. >> i think i just had maybe two or questions. the first to show that video again. i think jenna has it ready so we conceived about complaining and diversity. >> dr. roughana, those are 60 children. >> the man left is a fixture of china and a booster street and on the right entity not representative of the fit percentile in this either way. >> will be interested to hear more about that when you come to our child passenger form next month. i've heard some information about these belts also been

potentially beneficial in rollover crashes. first of all is that true an acerbic iteration for having this type of restraint system in the first seat? >> well, we have airbags in the front seat and those are mandated by congress. we believe they are marginal and incremental benefit for putting the inflatable belton as well because we also have low limiters and pretension or cynicism. and we haven't really assessed a rollover performance of the belt systems at this time. >> okay, my last question in the first panel we talked a lot about crash rates and one crash rates are to increase. it looks like we were seen some increases around the 70-year-old range and maybe some more increases around 8-year-old, possibly fatality rates were looking up for the u. shaped curve where we had high rates for the young is. was i fatality rate i'm talking

about? and a higher fatality rate for the old. is that when injury tolerance starts to decrease? is said about that 75-year-old range? or is it earlier than not? >> it ends but injury you're talking about. for bony injury, we see an increase from the majority as you start losing bone mass. however, i think maybe dr. kent showed the organs -- the abdominal organists and that they don't age quite the same way. in though, so for long injury come unless it's secondary to a rib fracture, we wouldn't expect to see a major change with age. >> you know, overall risk of fatality given a similar insult. i showed those relative to 20 megawatts from age 20. you can see biomechanical consequences of aging in the early twenties, things like the

cost of cartilage starts to show an old predispose you to injuries. unfortunately it's gone. >> even after a show on a if they are associated with less tolerant the because are getting older? >> yes. >> thank you for a match. thank you, gentlemen. i appreciated the opportunity speak with you on this panel. we've just about reached the end of our panel session. thank you chairman, hersman. >> is a very informative. thank you for side, presentations, all of it was great. i did want to recognize ms. haas. if you could please stand in the back. ms. haas, was awarded honorable mention at the 20-ton los angeles international tone

festival that we got to see a bunch and i'm sure you've all can understand that. she also was a founding member of one of my very favorite program so that the oral history project is called story quarter. so i can totally hear those too general and setting down to tell us the stories on a program like story course. thank you for sharing us that excellent video. ms. haas will be available if you don't like to talk to or during the break. so thanks so much to our panelists. and we will adjourn. we actually get a very generous break of 30 minutes so you can go get a cup of coffee and we'll come back at 3:00 for the last panel today. [inaudible conversations]

[inaudible conversations] [inaudible conversations] >> welcome back for our last panel of the day. we'll be examining highway and vehicle designs targeted to improve the performance of aging drivers. fhwa has a decade of experience

as handbook for older drivers and pedestrians and is preparing to release the next edition in 2011. the panel today we'll look at what we've learned and where were going with highway guidelines for aging drivers and a loss of consider the role of idiot and automobile technology in improving safety for aging drivers and pedestrians. with opinions from both researchers and manufacturers. in addition to the specifics of the infrastructure and vehicle design changes, the panel will consider the more general question of how technology will shape the future of public policy and drive innovation. dr. robert malloy and dennis colin are leading the panel this afternoon. dr. molloy, will you please introduced the panelists. >> certainly. our first panelists is schafer with the federal highway administration. is the aging road user manager at federal highway and he's developing the latest update to the 2001 highway design handbook

for older drivers and pedestrians. you can give us a presentation. >> excuse me. thank you, doc derrick molloy, chairman hersman. i would like to say the handbook is a document that is all involved in gains in safety and mobility. we really are working towards the countermeasures for users that will benefit not just simply the older bro deserve because we have all tribals of all ages on a road race. and this is also designed to leave engineers and road designers for some flexibility is with modal needs conflict between pedestrians for example, between bicyclists and even between them predominately. were trying to reach a balance between different note. first of all, -- let's find it.

we'll be growing. as you know, baby boomers and just on the edge of that is coming of age or when it comes around to getting head to 65 and we're going to grow from 40 billion at 271.5 billion by 2030 and we're going to be a large piece of the will of the road users. and at the same time, we're looking at how, you know, everything is suspect did. your cognitive fiscally with the root user and at the same time, we're looking at -- let's see, move ahead here. how the 1998 older driver handbook design handbook really look at it. that was done over 12 years ago that's the first practical information source on the older driver indicates recommendations

and traffic engineering. and it does include pedestrians within the intersection area. three years later, that was a dated. and to the 2000 highway design handbook for older drivers and pedestrians. so this one is a look at spinning the data and recommendations on older pedestrians and drivers. it was based on recommendations from local and state-level practitioners and that's what we want to update it because we died and turned out for my 298 were missing a few things. we have assistance from 2001 and older training course taught by resource center in which we take this around the country to really show traffic engineers and traffic specialist why this is important and how to use it. we're looking at updating this in 2011. we're going to incorporate new

research and 2009, that's a very important part of our document is as lower preference to not to be included in do this before and. it expands the applications from a 2001 handbook. it identifies innovative techniques and best practices. they may not be hard research. this has been a research document and still is. we do want to show around the country where there may have been some practices of local communities have used, taking some of those measures. it's like other web-based version and it's going to improve the access by professionals by all users. were lucky not be older pedestrians, surely. now, were looking at intersections where the highest conflict exists for matches saw

both uses, but surely the altered road users. they're looking that most of the actual crashes and collisions occur within those intersections. that's also where the pedestrians, alter pedestrians are, simply because they follow the actual marked crosswalks more than those younger than that. interchanges where you have off ramps, off ramps and on ramps to freeways, where accelerations have to be done very quickly. in getting on and off the freeway relatively quickly. when you're looking atquickly. when you're looking at a left turn lane, other measures that are occurring that they need to be looked at. and we want to provide pedestrian refuges for sure, where those exist and where they're needed, simply because

pedestrians need a place where they can be within the roadway and they can move safely across a roadway. and were all so promoted to countdown pedestrian signals, which will find in the 2009 and tcb. dr. molloy. >> thank you. thank you very much for the presentation. our next presenter is dr. joe coughlin, director of the u.s. transportation new england university transportation center. he is based at mit. he's also the founder of the mit age lab, doing research on the impact of aging on automobile design of public policy. you can give us a presentation. >> thank you very much, madam chair.

but if the gentleman, thank you for having me. i like to briefly discuss the convergence of the wealthy type allergy and older age and have a think about some design considerations we may want to think about the future of the car as well as the future with the rest of us. if the gatto industry is fast and researchers are asked, this is essentially what are looking for. we'd like to get the driver out of the front seat. ..

how these new technologies fork in the car and how it changes how we drive. we have new systems that are going to require us to learn how to drive. if he think about it, the car has been remarkably the same for decades. under the hood it's different but now it is changing dramatically in sight. no one told us he essentially have to drive into a lot of breaks or prepared for safety. so let me talk about three things. load, learning and longevity. these are the three ideas i'd like to leave you with. frist, a driver were quote certainly changes over time. this is a picture inside that detects different biological, physiological and tracking activities of the driver. technology adoption does increase believe it or not with older adults. it gives greater confidence. i will work with hartford shows data nationwide it is the safety will use technology. they are also more likely to regulate using the technology is

likely to distract the there are natural age changes that require us to change how we get to the driver overall. more important, we just discovered a recent the cut in our lab that indicates certain categories may change how we are actually able to manage workload in the car. moreover, they're seems to be an issue of distraction of technology is not in the way you think the younger drivers trust new technology almost implicitly to the point did a longer look to see if there is a truck behind them. they wait for the warning to go off. our research shows, however, older drivers will learn the technology that will be restricted if the technology goes off and it isn't readily apparent as to why it did. longevity. this is an issue we few will of thinking about the car overall in how we age. the fact is that birthday's do not kill, health conditions do. as we live longer wheel of greater co morbidity and be taking your medication. when 110 million americans,

60 million l2 mac. can we imagine a car that not only detects how you're driving but the text your state? you're well-being? sola driver will car and these are one of the vehicles we instrumented how we can manage the idea hall or older drivers tend to be safe drivers. can we envision a car that will help coach and a monitor overall well-being for the driver and change its performance in real time to match the driver? and have queue was whether it is to say that you're running out of your performance range or you should be improving your overall performance behind the wheel. let me end with a few recommendations on product policy process and policy. kristoff we need to conduct research, if you will come on how we understand and adopt technology across the life span. this hasn't been done in the iowa area let alone any other areas. more important, we need to develop quantifiable guidelines

to mitigate the impact and interaction on the design, workload and age on driver performance. stimulate lifelong education technology included. that is if the car is going to be changing as rapidly as we think it is going to become just because you're 25 the longer makes it a good driver because you graduated driver program. this is something we need to think about across the life span. thinking about that, really to experience the way we buy our cars today is no different than our parents and grandparents. we take the car, we are excited, the dealer is excited, here's the air-conditioning, the entertainment system, here's how you adjust the seats and here are the keys. we need to do what we see in european other places where the experiences education that gets you with familiar with the technology on what to expect to drive. last a policy issue which is recognizing that i believe we have a new emerging class of

drivers. in the law would we talk about it is the reasonable man standard with the aging population, far more women on the road we need to engineer not just a reasonable standard who happens to be 5-foot ten, 25-years-old and 165 pounds but a reasonable older smaller woman standard and what that means in terms of design as well as technology and last week developing policy standards around him and automation, learning and trust acceptance across the life span for the car and beyond. thank you for the time. >> thank you very much, doctor. our next presenter is mr. thomas with the volvo car corporation. he's been on a management team since 1999 and is also pursuing a doctorate right now looking at safety and aging population. your presentations, please.

>> thank you. madame hersman, chairman, it's a great pleasure to be here. i deliberately changed the title here to all drivers. and the vehicle designed for all drivers and why is that? well, at volvo we have our own internal vision and that is that in the future cars should not crash. we have also set up an ambition to work towards this and that is by 2020 no one should be killed or injured in a new volvo. the strategy to move in a direction is quite holistic. when looking of course into the crashes and what happens before the crash as but also divided the events before the potential collision in two different phases and the different phases of course have challenges as we move back in time before the collision and how it relates to the driver.

well, what we know, and this specifically in relation to older drivers. in sweden it's quite similar to what is been previously shown today with the statistics data showing the frequency of collisions, the high increased risk of injuries, as well as the self cessation for older drivers. and others are coming back to this, studying real-life accidents and we use that as a basis for how we better understand both accident causation and of course injury risk and injury causation. if he specific accident here, which i've picked, is one of our recent. it's a volvo against another car and one of the cars you have an 18-year-old driver, and the

other 73-year-old driver and a 75-year-old passenger. the young driver actually came over on the wrong side of the road. and the old driver tried to swerve felt and actually hit the curve of the road but could not avoid the collision. luckily in this defense, the outcome was good as all of the participants have recovered. but, of course, we have to ask ourselves what caused this collision, but the technology have helped in this case the younger drivers to avoid the collision, and other circumstances it could have been the older driver that was the cause of this accident. so called the challenge here for us is to understand and know the driver because we are all different. we are all different as human beings. there are 5 billion of us out there and when we decide technology and the eagles we have to understand the

differences between us or if there is differences in our behavior when we drive our motor vehicles. so this is really live challenge as we see when we move to the future and this relates all more significantly to the growing population of new drivers to release understand the factors that are necessary there. and what right to build knowledge, and that's actually one of my main subjects working with volvo is looking into the aspects of the older driver population and driving behavior related to the older drivers. what factors or important and when we know those factors how should be addressed and from a technical perspective? well, we do have some knowledge already today in relation to what is causing accidents. there are a few big ones, destruction being one of course, alcohol involvement, drivers

falling asleep. and of course we are addressing this and this is just a few examples of this technology that are in the cards today, and as you see here we are actually addressing all the different phases that we have in our strategy with different types of technology, and what's really the emphasis is to push it to the left, try to help drivers stay out of a critical situation in the first place. we have already launched technologies that helped the drivers avoid a collision in certain circumstances. we ran crashing into pedestrians and so forth. we have dynamics that help in critical situations like the car is sliding and you have the traction control to help you stay on the road. but we are also looking into how we can assist drivers to be in a good state both from a destruction point of view with

actually trying to reduce the workload from the car for the drivers with for instance power into the -- intelligent driver system. so the car can actually recognize how the driver is performing with the vehicle. and this is actually one of the keys. we are starting to get cars senses. today the car can see and feel. they can feel with the driver is doing or with the driver is not doing and in certain situations where it is appropriate the car can help but driver avoid collision. the basis of knowledge is how we proceed to meet our future, the crash free future, take us down to see roe. the knowledge of driver behavior and how drivers at that -- adopt

technologies is a key as we move forward. and we also have to humble you recognize when our company was founded eight years ago, carlos rogers and by people. they are today and of course they will be also in the future. and its whiff of that basis that we have to decide technology. so we have to decide the technology around the human being and not the other way around, and the key is understanding. thank you. >> thank you very much, mr. speed. the next presentation will be given by dr. david eby with the university of michigan's transportation research institute. he's a research scientist and head of the behavioral sciences at that office, too. dr. eby research in constructing and dementia, older drivers decision making and key beavers among young drivers, use and

long use of safety restraints and the use of the technology to advance and safety and mobility. proceed with your presentation, please. >> one of the good things about going last in the session is most of the points at 40 been made so i will go over this quickly. the president's technology and vehicles is increasing. we've already heard that in several presentations today. this includes technology that his original manufactured technology, technology that's built into cars and some of the technology we were just hearing from volvo but also cell phones and smart phones can do all sorts of things and people bring those into cars to help him drive such as navigation systems

and all of these technologies are guinn to be much more common in the future. we know the u.s. population is aging and so is the population and other western countries and with that aging comes functional decline based on medical conditions and medications to the jury that can impact seat driving and advanced technologies have the potential to increase the safety of older people as well as their quality-of-life. now we've heard a lot about different kinds of technologies, all sorts of technologies are available here are some examples technologies. i know the most about the guidance systems. these systems that provide turn by turn instructions to people as they drive. gps signals to locate vehicles and the design features can vary widely including provide terms signal, turn symbols for people and voice control to let people know to look of the display with

the next maneuver is. there's also night vision enhancement. these are systems that use infrared technology that can detect warm bodies in the roadway especially under limited view conditions like fog or might time, so animals, pedestrians and so on. and the information can then be displayed to the driver, warning them of those animals and people out in the roadway. there's a whole different set of crash warning systems. there's for collision warning system is complete departure, curve speed warning systems, these are systems designed to help a person present getting into a crash. the use various kinds of sensors, radar to let you know where traffic as in front of you. sensors that can pick up where the line markings are so you determine what position in the lane and you have and then

provide warnings and some cases they can be as simple as an audit will be alert or hectic alerts where there is a shaking or in more advanced systems there can also be some control of the vehicle like braking that takes place without the driver having to do anything. finally, there are automatic crash notification systems. these are systems that in the event of a crash information is sent directly to any urgency responding system, and that information can be fairly sophisticated including from the dynamics record in the crash. so our research findings as well as findings of others show that older people like these advanced technologies especially the ones that help them go to places they might not be comfortable going to as well as the technologies that help improve safety. older drivers also use these technologies as much as drivers of with her aegis so they can

use them and do use them and in the case of navigation system it shows the argues with the younger populations. if drivers report many of these technologies make them feel more confident while driving and less stressed while driving which helps them be comfortable going to places and other destinations it increases their driving space. drivers to report difficulty understanding symbols and the warnings more so than for younger people so i still think we have work to do on developing the symbols and warnings. older drivers report more difficulty using the systems and especially their require some sort of input and all the drivers have also told us they would not press this defeat to -- purchase this technology. advanced technology to be useful means to be affordable and that

comes with economies of scale. they need to be easy to use and intuitive so if you learn to use one navigation system hopefully that will translate to others. the system should enhance safety or at least not decrease safety and should not increase distraction in the long term and buy the long term i mean many of these new technologies can be distracting until you learn how to use them so research needs to check out the destruction levels over longer terms and a few weeks and see if it still causes destruction. the technology should recognize how older drivers drive and self regulate ferc sample in our studies with navigation systems we've found that people, some older people wanted-navigate the hattie's house that was in the passenger sheet, the spouse operated device and the device we were using the device cannot

be manipulated when the vehicle was in motion and that bothered the passengers so there are differences in the way people drive and technology should take that into account. finally older drivers take longer to learn how to operate advanced technologies. we've found it can take quite a bit longer to understand the technologies, however once they do learn how to use the technologies they can use them just aspelin and understand them just as well as younger people. people told us that the handoff procedure for a sample with the new car will they wanted was a hands-on demonstrations of the can work through it and then they want to come back in a few weeks and ask more questions. we need to keep this in mind when we are implementing. thank you. >> thank you all for your presentations. my first question builds upon a theme when he talked about throughout your presentation,

technology and we are at a time technology is becoming much more affordable and realization of intelligence transportation systems are becoming actually something we can see potential benefits for cars talking to each other, cars protecting themselves. how do you think the work has included -- how well has included the aging driver in its research and development? >> from the road we perspective we talked about that for some time and in 2001 for the example we have addressed i.t. estherville ackley . this is a guidance document. it is one that we recommend that work for the benefit of the road users as well as the pedestrian but taking for example some of those directional signs that we

recommended fly felt the be no more than two phases and get too much information in multi phased signs it can affect any drivers especially the aging driver their attention to the roadway and so you get the two phases you're not plan to be having your attention of the road very long so that's something we strongly looked at. we also were the ones that recommended that the change that finally led to the countdown signals into to thousand nine mt cd so pedestrians could truly see not just senior pedestrian's but all pedestrians could know how long they have to get across the roadway so those are some applications lead one to mention from the roadway point of view that have been used as far as guidance and actually turned into some standards.

>> if i may respond as well. i would argue the last 20 years from when icts became ips from intelligent vehicle systems that the use of information technology has been largely on how to improve the operation of the infrastructure and in some cases to get the vehicles to talk to each other. i would also submit it in recent years its has been used as what does it do for the actual consumer, not the state highway department or the federal government or anyone managing the congestion on the highways but the actual user. to that end i would think the older driver is somewhere in that list but i don't see a very big push. i've seen many papers talk about how it can be of help. but we really need to start asking ourselves at what point do you become an older driver with technology given the fact this is coming faster and is cheaper in out there in the karzai would submit a 25-year-old driver is as antiquated as a 75-year-old driver given the speed with

which these will be deployed. >> yes, if i may as well i think one of the aspects when we are starting to get the infrastructure starting to get the possibility psyching we still need to put the human aspect on it, the interaction with the driver as such a only the elite of course to the older drivers but all the drivers and i think dr. coughlin will agree there is -- we need to learn more how we can use interaction with of the driver to help them stay alert as to make sure not to overload the driver with informational interaction to have performance in those cases. two aspects, and the lack is knowledge from the behavioral science point of view. >> it's my opinion that in the last decade we have begun to recognize we need to design for

older drivers fees' its technologies that would try to understand how they might use them and what benefits they might get from using these technologies. in the past ten years i have seen a lot of interest in that and research is just starting. sometimes it takes a long time to get research funded, projects going. i know that we always have an older driver group now. we didn't do that in the past but now we do. things are changing that we have a long way to go. spectral when what you touched on the last decade in the video we saw at lunchtime we saw a gentleman who basically aged with his car and continued to drive in model t and did some of the basic operations of the vehicle, the operation of the vehicle is basically the same that it's been for quite some time. i just want you to comment on any changes you'd seen the last five to ten years that have been changes to vehicles that have

assisted older drivers. >> of course the changes i think we've been trying to do not only related to the older drivers would be to look at the aspect of how we can make an interaction with the driver more intuitive, for instance if you're in a situation where we want you and you're in a critical situation and we want you to act in a correct way and you have a limited time to do that, the interaction with the car has to be extremely intuitive and in your backbone so that's one of the principles that we have applied. on the other end of that coming back to my holistic picture of how we work with c50 when you were in circumstances where you are driving normally so to speak and have more time to the

introduction of is more a state of the driver to understand that and it's just recently we started to get the platforms in the sense of having sensors in the car, feeling the environment but also feeling with the driver is doing and with the driver is not doing in different situations. it gives us neighbors to address these issues and as i said my presentation we start with the obvious ones. maybe not specifically addressing older drivers but our hypothesis is if we do something for older drivers they would benefit the old drivers and more specifically the research we do related to understanding the older driver and older driver behavior if we understand the factors important for this group of drivers and we do something to address those factors it will not only benefit the older

drivers but also the younger ones. >> with the adages that is true in the industry and with repelling you cannot rebuild and dance card because if you do a young man will not buy it but neither will with an old man so with respect to mr. speed's comment about making ageless technology that is the case but let's talk with the technology we are seeing a change, the gentleman's car, the model t. today it is as mr. broberg said it is going to sense how you're driving and find out is going on outside the vehicle but if i want to communicate with you in a variety of ways it will vibrate you, your we will start to shake, you will hear warnings. as we age our challenge gets blurred. now put the car is granted be feeling and talking loudly in multiple ways i'd suggest 25 gil troy fer hasn't been trained how to do data fusion and checked out pilot has been but most certainly someone who has been tried in 40 or 50 years which makes them in many cases a better driver of their judgment

is now coming to be challenged to lure a new and that is probably the greatest change to the driver has remained the same and that is where the disconnect -- policy and personal use as are arriving. >> i have a question for the entire panel. as an investigator, i would like to know if we go out to an accident and we think trevor age or performance may play a role what features of the vehicle or highway should we be looking at both to help you and your understanding of the problems and to help us in our determination of probable cause? >> let's talk about the road we first of all that to the investigators and putting the police are going to be looking at and so they are going to be looking at yes, the age of the driver.

they are going to be looking at the cause of the actual collection or the crash, so therefore they are going to be looking at particular factors that led to this collision or crash and as such it is the treatments we are recommending everything from a stenciling along the roadway intersections especially are an area there is a much conflict that older drivers need a lot of continuity they need to really see things much better so therefore that is why stenciling matters and slowing them down matters and for walking. those things really do matter so if they are there those things will help but in actually investigation of those accidents that are collisions and crashes,

that's what we would be looking at as a way to improve that roadway or particular intersection. >> i would hope that investigations both local level and certainly the national level would not be in search of dwi driving. win to look at the condition of the driver, the disease condition, were they taking medications, are there issues that were not age specific that impacted their performance much would be the wave you went to a commercial carrier aviation or anything else. second we need a new level of discovery brought to the car we have in other modes which is looking at the single technology and whether the technology actually works or was be the lead to being used appropriately. so in looking at the disease and how the technology is being used would be two things i would

focus on. >> i agree coming back to the second panel talking about the condition of the driver from the perspective working with the drive from the mission as well as preventative counter measurements, the condition of the driver in the sense of the aspects brought up by the second panel but also brought up here by dr. coughlin, and what i also urges to have a standard sort of methodology applied and when it comes to investigations related to the actual causation of the collision because looking at the investigations as we do we usually know when we follow the trail there is a number of possible causations of that coalition and in order to be able to analyze it, you need to have a good structure and we've been working for quite some

years to develop methodologies in order to address this and we are cooperating with the university and others called safe when we have an in-depth investigation team that looks into this and have narcolepsy a, i think more than six under 700 accidents and analyzed in-depth analysis with interviews with all parties involved and the methodology to see the different possibilities of causation so that's the aspect from our perspective. >> i would like to reiterate some of the points. first of all i agree we should not be looking at this in terms of whether there is an aging driver crashed but more in terms of whether or not this is a crash but potentially result from the planning abilities that resulted from an aids-related

medical condition or medications and some things you might people to look at looking at potentially accused a certain practices flexible one practice that we've seen people have told us about is people that have recovery problems sometimes wear sunglasses at night. if it is a night time crash, sunglasses. these are things that might point to a functional decline in the depths of having actual medical information or driving evaluation information so that is just an extreme example of the kind of self regulatory behavior you might be able to look at. >> thank you. mr. shaffer, can you talk briefly about what elements in the design have been most

effective in reducing accidents or collisions? >> thank you for that question. yes, what has led to a number of treatments, not just guidelines but treatments in the manual on uniform with traffic control devices we feel have led to to safety improvements and hopefully less crashes and collisions of those particular locations both among drivers and pedestrians and first i would like to speak of intersections where the majority of those collisions and crashes occur and that is where particular stenciling that particular environment, everything from stock lines to making sure you have good retroreflector if not only signals but also signals in place and what i mean in place right over the actual landing will be using. as we age of has become a problem to people especially

when you have at least one turn lane if not more for them to understand where that is and then to be able to stenciled that lima really does matter and so putting that over the lane as well as stenciling does matter. another thing that can help the pedestrian that has worked well as reducing the right turn radii and what that does this reduces the speed you can take that particular right turn and as well as this other guidance that reduces those speed and at the same time helps the older pedestrian because there's a lot less speed and a lot less -- the generally can help save on a distance but if they don't they can also look to the pedestrian island for example where they can use that to actually as a refuge island they can truly use that for safety purposes so

there's a number of countermeasures that have been recommended that truly have led to a standard that is occurring and a standard that isn't being done for the older driver that is being done just across the country that's why they are in the manual itself now and are being done all over the country and all in different locations regardless of the age of the population and so we feel that has been truly a success as well as in making it safer for the driver and pedestrian. >> what elements, again to mr. schaefer, what elements of the 2001 design daoud didn't show the anticipated improvement either for older drivers or drivers in general? >> didn't show? well, i think that when you

don't have changes in that manual that in 2000 for example that want their the recommendations we made in 2001 for example because of the way the as a guidance document they take years, in other words, to actually get into one, to train, to go along and train the trainers if you will around the country and secondly, to actually get into the mbdct. it takes years, one, to get the road we intersections as well as all segments of the roadway and approved in those particular areas and to get them apply. so when they get around finally to where they are being used commonly takes many, many years, so that is to stay -- that is just a process. and i wanted to win out it is a

balance. it is not something you can just say we are going to do this for the driver because we want to think about the flow of traffic but you also have to look at the balance between the mode and i think that's something that we have been very successful in doing that at the same time things do take time if you will, and that is something that is the nature of it, but the nature of everything and overtime we have seen a reduction in those collisions and improvement in the roadway for seniors. >> for the 2011 design guide what are some of the new elements that you're including to manage or reduce risk for drivers? >> if you can get a little sneak preview i guess. >> i can give a slight sneak preview. we are using the 2009 manual, and yes, we've made

recommendations in the countdown signals and the like. we've done that. but we've also made -- so those are there but we can now use the manual directly and say these are right there and use them, but the other thing is we are looking at how best practices are being done around the country and really looking at what particular treatments, i will call them treatment for countermeasures are the most effective, and that's what we are looking at producing is a document where they can see the transportation specialists, the engineer can truly see what's most effective and how they can balance because this is a guidance document and it does give them an understanding that, you know, and you can do these things for the driver and not really harm the pedestrian in the process, so we feel that's why this document is going to be

much more antimobil land comprehensive than any of the documents -- any of the handbooks, excuse me, that we've had before, so that is going to be a great change, and second we will be able to show loyalty is best innovative practices that are being done in places across the country that are using treatments that have been very successful and so this is why i think this document is now gone into the beyond where we were before to be much more intermodal and comprehensive and addressing the the aging robie user. >> thank you. >> thank you. >> the national institute on aging and if i can just remind everyone for the canada to introduce yourself with your name and organization. >> thanks. this is jonathan king asking the

questions from our table. first is asked by john maddox from ntsa and what requirements should the regulators to consider to minimize destruction for older drivers? >> may i start of -- i want to address what you're looking at the roadway itself if you don't mind, simply because that's where a lot of -- you get around to a lot of conflict area and i will point out intersections and i'm sure you have seen intersections where they are just loaded with signs, just loaded, and you're wondering my god, where do i go? well, that's an issue, to be very honest, and how that is addressed is very important and that's why we address that and

also the fact that as we age when of the things about this line is basically can you see it? can you see it at the time and can you see it at night and that is where it is the reflectivity there was definitely recommended in bouck 2001 and is continuing on is shrewdly important and those are the types of things that we are really pointing out so everybody can see the signs -- >> why you're the question again? wasn't it -- >> okay, i'm speaking out of -- are just wanted to point out on the roadway -- >> i think that's important, too because that is clearly part of the destruction is obviously the signs and the fact wait, is that where i was supposed to turn? does anyone have a instance of

the vehicle design? >> driver destruction of course is a hot topic and it's also very complex topic. we have started to address it with advanced warning technologies. we also understood as i sit in my presentation the aspect of the driver workload so the car actually senses the driver and with holtz necessary information that could cause destruction for instance when you're in the middle of a left-hand turn in a city and where might you don't need to run that -- know that you're running out of washer fluid. it's sort of information you don't need, so we don't have to give that. so the car is actually recognizing this itself. i would actually like to come back to this what i said before, this being a complex issue because there is actually a balance between how you keep the

shriver attempted and engaged while driving. you don't want to reduce the workload because you might end in a state where you're becoming drowsy or tired or not concentrating or you put your attention to something else. so we would like to change it may be bought from destruction but talk more about inadequate attention of occasion as a better word for it. sweating we really need to understand the balance and i know for sure at mit you've been looking at some of these aspects there is a balance on what we are doing, destruction being a major cause, yes, we have to address it and we are addressing it in the terms of both having the car break itself if you're about to collide to another vehicle, a vulnerable user like a pedestrian today we have the technology and that of course

helps drivers not only the older ones but drivers in conflict situations to have a different user or if you're in a heavy traffic environment. but really, we can do only so much with the car to help drivers but we also have to look at what the drivers are doing that are not related to the car and can be anything around the car and anything the drivers bring into a car. so what we can try to do is again, assessed the driver in the situations to keep the balance of their attention and try to keep their attention looking for work and their hands on the wheels. >> if i may just -- if i may i would suggest their right now we do not have enough data to know whether it is age or disease so from a research point of view i would say we need to get better data to see how the driver destruction changes and workload

changes across the life span. we have some preliminary data that seems to indicate and my colleagues develop disease such as diabetes in the motor carrier industry in places like that may have a big impact on how much you're able to manage behind the wheel. that said, the other part of consumer electronics that have entered the car we think this technology is something the car industry is developing, they are migrating from avionics and the consumer electronics industry. what we should be looking at is not an age specific fix but personalization. do you want the system on? to one that displays that larchwood at small? rather than trying to say one fits all what we should be looking at is with the baby boomers is all about, is all about me, so make it personalized. >> i just want to reiterate a few points. talking about a workload management system and there is work going on on the systems right now to say the project just completed a couple of years ago but was designed to basically come up with a system that can detect what's going on

in the environment where the traffic is, the potential workload produced by the environment and then predict what the workload is for the driver and i will say that those studies are all very much in their intensity and we don't know as was just mentioned we don't know how the workload changes with age and somebodies medical conditions, so the system needs to be eventually smart enough to be able to adjust itself to that driver and a lot more research needs to be done in that area but this is how we're going to manage the destruction and the cars with technologies coming in. >> some are addressed to the second part of the question of the second part may be open. as vehicles get smarter and safer to we see the potential to be less attentive to the driving task and i think that is already addressed also to forget how to be alert much as we have

forgotten other things like how to use actual maps and similarly with behavioral adaptation effects are we expecting to see with smarter cars? and this was from fhwa. >> i would say there is still much more we need to learn about this. the approach we are taking so far is that we try to promote good behavior from drivers comes a for instance if we implement a technology say for instance departure warning would promote you use your blinker and there are some studies looking at that and see that it actually helped drivers use their blander even more because they didn't get the warning every time they left their name. we are also addressing it if you take the brake technology has such we do not want to encourage

behavior where you know the car will break so we don't have to pay attention to we have intentionally made the break intervention harsh and very late so we put it outside of your comfort zone so if you are an attentive driver you will think you are about to crash and we've studied that using driving salaries to understand that we promote that peter in the sense that yes, the driver will break if it knows it is about to impact something the driver will actually break the for the system does so we are approaching it from that perspective but it's really from the behavior there's really much more research required and we just launched a study where we have 100 cars with all the latest technologies and they will be german for a long period of time and actually during the first four months the drivers were not able to use any of these technologies.

we would turn them off and after four months turn them on. we are in the midst of analyzing the data so we can see the drivers if there's a change in behavior with and without these technologies but there is more than needs to be done here. is that we get a lot of the applications on drivers and driving, and in this section tomorrow morning i anticipate many more so i would have lots of questions plan will do for them all except for one that started coming a few weeks ago due to a story in "the new york times" about the google putting together and people started asking how far away is this going to happen and what should we do about it and i think for the panel the idea is that isn't necessarily what we want because that is inflating the driver

from the experience and what we don't want to have happen. nevertheless is this something we can see in the near future and what should we be doing to prepare for it? >> well, we are actively looking into the same aspects and we are involved in a project which is actually looking into cars of the platoon in perspective to where the driver can actually connect to a train so that you can do your ordinary business typically on your way to work your in the line of cars to just driving and there's just consuming times of the idea being that we can help you drive more safely if you connect to a train and plus you have the convenience of being able to do your e-mail or estimates in the

daily work and also since the technology is quite advanced we are able to make the traffic flow more dense so we can add more cars on the road so to speak so you have a better flow. and also the environmental aspects of the fuel consumption. so the idea is to connect to a train where you have a commercial drivers, train driver up front and then if you come to your exit you actually disengage from the train. the aspects of these technologies is it is a choice of the driver. the driver is making the choice and in a pure basis of the automobile has the freedom to be able to drive whenever you want, wherever you want so that's going to be hard to take away but there are some situations where a thomas driving can be

convenient for you and something a lot of drivers may choose but it's still the choice of the driver and the driver is always in control. >> one comment and one warning. the comment is what you buy and the showroom today is at least 10-years-old and so in the speed of having the autonomous vehicle here i'm not sure when that will be the premise of my initial presentation is that's where researchers, the industry and many who are concerned about human error behind the wheel would like us to go. the warning is the following: the road to autonomy is going to be rot with many errors and accidents. how do we do and infrastructure that has a mixture of robotic drivers and individual drivers? how we learn to use these technologies as they enter the vehicle? what we are looking at right now we are literally looking at older drivers as becoming the lifestyle and leaders of this new autonomy technology over the next ten to 20 years. so the baby boomers we are the guinea pigs of the future.

>> our question time is up. next table. >> aarp and controlling question from the american occupational therapy association and the american optometry association. my first question comes back to road design, and i think -- but really from the perspective of all panelists' because i think your expertise have something to contribute to each of you. in the last panel session we learned that fragility is a bigger issue than frailty and so we should really be trying to reduce the number of severe and fatal crashes as much as possible. and this considerable research shows how excess of vehicles for a given environment be it in urban or to lay in a highway

leads to increased crashes and severity of crashes. several european countries needn't be in one of these have dramatically reduced the urban road fatality rates in particular. in large part because of reduced overall road design fees. so my question for the panelists have to consider whether the traffic measures such as narrow tribal lands, roundabouts, tighter turns might actually benefit older drivers in urban areas in particular one because it may reduce the severity of crashes, to because it should essentially provide increased reaction time by providing a slower environment. so throw that out there. >> good question and we understand the lower speeds are to the benefit especially within an urban environment and the intersections to words all of the users especially the age. now, having said that, this

particular document as you are well aware looks at particular treatments of which speed is just one of the particular elements where specifically it is looked in the manual as what warrants will bring down that speed and that gets about the road complete streets. those mannerisms or treatments are for the whole world will not just one particular intersection or roadway segment. but entirely to look at that in time year speed. now having said that really that's why we are looking at this particular document of where our particular treatments in part or as a whole have been used to make such an environment whether it is a senior zone or any particular environment have been used around the country to make things better or in treatments if you will that are not in -- is no hard research,

they are innovative, so we are looking at that, and what we have already noticed dysphoric sample whether you were going to take the floor of the war new york city were houston or places in arizona where the truly have slowed things down and use the number of treatments all ready to make it easier to drive around as well as to walk so a number of treatments if you will used, but not in a if you will in part you could call that a road by it, but more on the effect of making it safer. >> certainly for any age group the enemy of a driver is cluttered and complexity so if the roads can be made in such a way they are still making sense but also balance the demand going on that road there are many experiments that have been

out there to try to traffic and what has often happened is to increase the stress of the drivers in that area to maintain the trucks, bikes, pedestrians all in one place so done well with a balance to mitigate clutter and complexity will help the older driver whose difficulty managing this and the young driver trying to have a cheeseburger on the cellphone and drive up the same time. >> we are referring to sweden and the swedish national traffic of fenestration and the work with their vision and again, yeah, we have a number of increased number of round bouts in sweden and there's a study that to decrease the severity of the collision but it also increased the number of collisions and consequently we have developed a technology that addresses safety. but more importantly when we are working with our vision we've

realized that if we are going to strive across the future we have to cooperate. we can't do it with the car alone. the infrastructure is a very important part of it and also understanding the human being and the driver. so we actually started out in sweden and we actually have an agreement with the swedish administration not only to conduct research together in order to understand and get the know-how, but we also split responsibilities, so we have to declare what we think we are able to do with the car and what we think that they are required to do with infrastructure and that has been very positive on their part because then we can focus our resources and actually get more gains and address more issues together. it's no use that we are working on the same issue with different countermeasures when we can actually split the responsibilities so they can focus their financing plans for

the future as well as we can make sure that we have to meet our ambition and vision.