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

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

will continue to drive, but that's an inappropriate continuation. in the lower left cell is where the person is competent to drive, but they perceive themselves as incompetent to drive. the likely outcome would be inappropriate driving cessation. where the person is no longer competent to drive, they recognize they are no longer competent, and there's appropriate driving cessation. house does this -- how does this have relevance? if you look at the first upper left cell, that likely represents the majority of healthy older drivers perceiving themselves as exe tent to drive, and they continue to drive. the upper right cell represents individual with dementia. they perceive themselves to

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

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

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

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

i'm sorry to say we make less money than a lot of men, so the men's cost will be higher. the $118 per capita for older male drivers was an average, and for older women it was $67, so the difference is here is largely due to the methodology which takes the medical spending plus the productivity losses, and the productivity losses are a bit skewed i guess. does that make sense? >> yes. >> and also as an aside, deaths usually don't cost as much as hobility decisions, -- on the hospitalizations, so if you die, you're a less cost than if you're in the hospital.

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

consistent, so my answer to that is we probably don't need another study that shows the risk of older drivers to older road users. i think we have that covered. >> thank you. dr. dobbs. >> thank you. i guess when i think about the older driver population and an area of research that is thoroughly needed is in terms of providing alternate transportation. we know right now there are challenges in providing transportation to seniors, and that's going only to grow over the next two to three decades. when i loo at the research that has been done on alternate transportation for seniors, and that's transportation that's outside the traditional public system so bus, taxis, transit, we know that there are a number of organizations in the

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

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

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

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

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

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

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

data bases in other countries. we do, as yo know, we have a sister agency, the highway loss data institute, and we get claims data for something like 85% of the insurers, and we do studies looking at older driver trends using this data. the difficulty, the limitations to the data are that they, it's a huge data base, huge sample size, but not a lot is known about the circumstances of the crashes so without doing a special study, there's no issues that can't be studied very well, but it is, it is a data base that we use. >> okay. do we continue with our table? >> sure. go ahead. >> thanks. this is a question from john king on the national institute of aging.

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

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

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

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

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

may sobber up, and the cognitively impaired driver won't. i think the reason that the restricted licensing looks so attractive is because of the awful inadequacy of alternate transportation to allow these people to stay mobile. i prefer we put our efforts towards developing responsive models of transportation to keep these people mobile as opposed to using something like a restricted license and keeping our fingers cross that they're not going to crash. >> that's all ours. >> thank you. we'll move to the back table. do you have an appointed spokesperson? please, go ahead. >> good morning, and thank you. at our table our first question has to do with again the

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

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

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

is it true despite the number of fatal crashes among persons aged 70 and older, the share of all traffic fatalities the order of this age group is increasing? and when you pulled this latter step from a recent paper written for the trb conference that was held this past summer i believe. >> i'm not sure i follow your question. you're saying that even though older drivers fatal crashes are going down at a faster rate than middle-aged drivers, they are an increasing percentage of all of the deaths? >> correct. >> i don't know if that's the case or not, because i know that we've seen very strong declines in team crashes. i don't know if that's correct or not. it doesn't sound logical to me, but maybe when you look --

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

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

workweek days and evenings, daytime and evening, and we know that when we look at senior transportation that often what is called life enhancing transportation needs are met savitt to the doctors, the get to the grocery store. but they are life enhancing transportation needs are not met, so the ability to go to social events and attend religious evens, so using a blend of peat drivers and volunteer drivers is more of costly. we also know that funding streams there also are not dedicated funding streams so alternate transportation providers as i mentioned earlier spend a great deal of their time and their resources fund raising to provide what they perceive as being affordable transportation for seniors. interestingly, that perception, that assumption that transportation should be

provided and no cost or little cost is a barrier in that all of us pay for transportation until we are 65 years of age. for some reason there's just assumptions that as soon as we turn 65 we should have our transportation subsidized. when you talk to seniors themselves, most of them say i quite expect and i quite willing to pay and pay more than what my service provider is charging me. i recognize that there are segments of the older driver population that don't have the resources for transportation and we do need to supply is that population, but for the most part like and there's more capacity from the seniors themselves to assist with building better models of transportation. >> thank you. >> i think it's a given there's not enough money because there is a huge demand in the there's not enough service. but some of the other issues are

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

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

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

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

drivers but if you look a deaths and include children and pedestrians i don't know how the total package has changed. but it gives me an opportunity of reiterating the importance of exposure measures. the reason our study was interesting or important media is that this is not what we expected because we have more older people come more drivers, and the best indication we have is that older drivers are driving more. some deaths are always the ultimate measure. always try to reduce but especially when you're comparing age groups or different types of drivers it's critical that you have an exposure measure. so i just wanted to clarify. i think our study wasn't focusing on death it was focusing on a licensed driver and if you look at the population week of the most traveled the same patterns. >> thank you. we will proceed to the next

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

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

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

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

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

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

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

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

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

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

cohort fannin my mother's colewort. having said that, so the next group would be sons or daughters and if they are living close to their prents, they may be a little bit more accurate, certainly asking sons and daughters the of no greater insight than you or. might take of the situation is if you have someone come a family member or a neighbor that you are concerned about their driving, the most evidence based assessment is to have them have a road test. >> they're actually is a lot of -- leaving aside whether the kids are right or not which is not trivial -- the is a lot of evidence about parents and kids, and a lot of it shows that olde parents don't want to listen to their children or their family] members. they just don't. or as i said earlier that women

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

they are equally worried about what is it going to mean to me when my mother stops driving. and it's not just the driving7 committed this will she come live with us, will we have to move her to a care facility. and it's hard to interpret what people say sometimes, but i see a sort of willful ignoring of some bad science about their adult -- about their parentswo because they see this crushing weight of responsibility hitting them, which i think gives us a window for policy because if we can be talking to be boomers -- beebee boomers experiencing problems with their parents and a vacancy the burden they are going to carry because there are not enough transportation and all but the options that maybe you never saw what was going to do for you because they never want to see themselves in that position -- but if we can say

okay, here is all the burden you're going to carry for your parents don't you think you want to find some more public transit and alternative services so those burdens don't hit you? >> dr. rosenblum's white is a good one. the longer afford in this area, the longer i'm starting to realize that for particularly for illnesses the driving is a canary in the coal mine and particularly for the cognitive disappear met. so if mom or dad have problems or memory problems, the families can usually explain that away. but when driving becomes affected, then they can no longer explain it away and that is when actions start occurring. so driving can become the early or not so early idicator of cognitive decline coming and w

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

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

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

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

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

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

certainly 20 years ago, maybe 1d years ago. and i think it has to do with house, but also just lifestyle and so, you know but again i'm looking at myself here and my colleagues. are different than their parents and i think i'll be different from my parents. my travel patterns will be different. i hope will be better i'm not representative of the population as a whole. there are lots of people who won't be healthier than the i think old age is not what will they choose to be. >> sandy, that same question is for you. do you think that they will be a difference in terms of lifestyle

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

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

baby boomer population that is going to be healthier than their parents. there also are going to be segments of the baby boomer population that are in poorer health. if you look right now and -- i'm sure the statistics in the united states are similar to the canada, diabetes is up epidemic proportions, cardiovascular disease fat epidemic proportions. right on the united states, one in seven has dementia. and that's project lead to increased sevenfold with the aging of the baby boomer population. so there may be segments of the baby boomer population that will be safer to drive as we move through senior years, but there's increasingly going to be segments of population that would be at risk.

>> do you have anymore questions? >> no, we don't. thank you very much. >> excuse me, just one quick question. would any of you care to comment on the current or future way of doing things like shopping for my drugs online or by telephone or my groceries in that way? things that can actually meet your daily needs without causing the driver to get out on the roadway? >> i just saw a study that said that online shopping encourages in-store shopping. that is not a substitute. it was a compliment for that that you troll online and look at various things and you've got to go out to a story and look at them, too. it's a really interesting question that a lot of people are addressing, the extent to which online shopping and those sorts of things will substitute

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

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

curves for crash involvement you can make a case for 70 above. you could probably also make a case for 75 and above. but there is no right answer to that. >> i have a number of questions and so if you want to jump in. doc dürer rosenbloom and dobbs, i was interested in a segment to all raised. i was intrigued by your chart that showed how people felt selected, who self-select and that women tend to stop driving before they really should work. , but also by this statistic if you use that women outlived their driving ability by tenures and men by six. how does all of this can work

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

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

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

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

and i don't see that happening. so i see this dangerous situation, even among the very youngest women, they're still driving only eight miles for every 10 miles driven by men. and this older women are driving three -- women drivers are driving three and four miles for every mile driven by a comparable guy. and so, until this balance changes, i'm still worried that baby boomer women actually wants to look like baby boomer men. >> your question is a good one because it speaks to the need for research priorities. and perhaps what we need to do is we need to start looking more at the 55 to 64-year-old age group because that's over going to be dealing with an large part part over the next 20 to 30 years. >> well, i have to say this is all a little bit frightening because you're holding up a mirror on my life.

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

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

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

i'm so, i wonder if you own vision or are familiar with any scenarios in other countries, where the state or health care, medical services might pay for driver assessments or valuations to driving. >> in canada and all provinces with the exception of one, having a driver assessment is user paid. the province of british columbia now is paying for a driver assessment for medical reasons. and that's precedent-setting and it will be interesting to see if it results in policy change across the other provinces or territories. my argument would be that when a physician, because it's often the position that is charged with determination not competency and reporting into motor vehicles, if there be in

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

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

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

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

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

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

not talking about older drivers. i'm talking about all drivers. is there a particular medical condition that you think we really ought to be paying attention to? >> that's easy to answer. a guess, dementia. dementia clearly is a medical condition that needs to be on the radar screen. and it's interesting that when you mention the word dementia, people often thing about alzheimer's disease and certainly it's the most common form of dementia. but there're many illnesses other than alzheimer's disease that can result in a cognitive impairment with or without dementia. so in terms of the medical conditions, that is the condition that, from my perspective, we have to be most concerned about. when you look at the traffic data, individuals with dementia have crash rates that are two to eight times higher without individuals with dementia. we know they are very much a

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

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

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

.. >> they were over 150 write-in candidates to choose from. congress returns to session this coming monday. there will be a lame-duck session. leadership for the newly elected

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safety board conference on aging drivers. this is a part of a two-day conference here in washington. it is nearly -- in this nearly two-hour portion, researchers explain their findings that while older drivers are having accidents, fatal accidents involving older drivers are decreasing. >> welcome back.

>> dr., wang, would you please begin your introduction to this -- occupant panel.

elderly individuals are more frail in that they experience a worse outcome, they do poorly. what is for the, is that there is a difference in individuals. if you look at the data, this summarizes crashes over a period. these will just for belted drivers in frontal crashes. across the bottom there, you see the age. and on the one, you see the

predicted risk of an injury. you see all the lines generally go up, the one place you see it going up the greatest, and the quickest is in the thorax. if you look specifically at thorascic injury. in the most elderly population.

this is a side to just summarize some of the things we find. if you look here, there is almost a transparancy of the abdominal muscles. that's because it has become inf infiltrated with fat. the muscles have happened in the intercostal muscles.

the muscles and hard tissue is what's able to -- we found that it very significantly affects frailty as well. we see this all the time. we just want to see if we can recover from them. for many, many years we've been trying to find the best predictors of frailty. we're incorporating age or morbidities. we've been looking at muscle.

we experienced the highest amount. this is the best predictor. this is the best predictor for respiratory failure. after an abdominal problem of the aortic -- let me give you a scenario. you are hiking with two friends, a and b in the grand canyon.

the younger guy is a couch potato. the older guy likes to exercise. does a lot of hiking, biking. the younger guy is a smoker and a drinker. the older guy is a non-smoker.

i say what we found is that their bodies would be very different on c.t. scans. what we have found is what matters is the body condition and not the age. what we have learned to do is focus on the individual patient. medical care has become more personalized. we know that the population is comprised of a diverse group of individuals. and effective treatment and prevention requires that differences between individuals be taken into account. treat the patient and not the disease is what they teach us in medical school.

i would say in the last several decades, the population has gotten to be -- there are segments of the population that are more fragile. people are living longer. life is safer. there is also a substantial variability. think of the issue of obesity. the size of the patient population has changed substantially. while crash dummies are nice and represent a standardized segment of the population, my personal opinion is that this is going to become a problem as the population becomes even more fragile and frail and there is even more patient variability. so age is a poor desci -- descriptor of situation. it can't be ignored. it can't be average. it can't be design.

it can't be regulated away. in medicine we improve these results by personalizing and handling the treatment of vulnerable populations such as the elderly. i think the national institutes of health, the c.d.c. that have the necessary expertise in lives should take a greater role in addressing this growing public health problem. thank you very much. >> excellent. thank you, dr. wang. i would like to proceed with our second panelist. our second panelist is dr. richard kent. dr. kent is a professor of aerospace engineer at the --

engineering at the university of virginia. he is also head of automobile safety research at the university of virginia's center for applied biomechanics. dr. kent, could you proceed with your opening remarks. >> i'm sort of following up on what stu started with. i'm going to talk a little bit about some of the characteristics of our body that change as we age. certainly they are related to individual variability as well. there are some things that in general with aging have some important consequences with crash protection. i'm going to start reiterating some of the points that dr. wang made, because i think it is a critical one. that is this change in the distribution of injury pattern. this happens to be the pattern of injury by body region for drivers that are killed in frontal crashes. this is not the risk of injury, this is the proportion of injury, given that an injury

happens. we see this general trend periodically of head injuries decreasing as age increases whereas thorasic injuries make up a large number, and this persists. it is not just danger to drivers in frontal, it is by crash mode, and it persists in all sorts of trauma, including falls and moy motorcycle crashes. this seems to be an intrensic -- intrinsic aspect of aging. over 75% of these injuries are rib fractures. if you look at what people die of in the hospital, they will frequently die of injuries no more significant than rib fractures. so it is not significant problems that kill folks, it is rib fractures and sequelae that

happens from them. dr. wang talked upon the fragility issue. the frailty which i think of as not doing well given that an injury happens. that's something like dying. the third is the environment, which we heard about, and we'll hear more about today, changes also with aging. the biomechanics i think can help us understand the frajilt part, and why -- fragility part, and why it is easier for a person to be injuried as they age. i want to talk about length scales. this is the way engineers tend to think about things. if we talk about the smallest length scale, we can look at material property changes in the human body, and we are all aware of things like off the prosis -- osteoporosis that occurs with

age. also the percent of the bone that is inorganic compound goes down with aging. those are separate and distinct characteristics that both change with age. both tend to reduce the fracture, toughness with bone. in fact, there are other factors that seems like every time we learn something new about aging, they turn out to be something new with aging or fracture tolerance so even things like collegen cross-linking, filling of lacunae, all those things seem to increase the structure -- seem to decrease the structure of bone. we have found little to increase it. if we go to the cross-section of a rib, for example, so we've gone up now, we're not looking at a material, we're looking at a structure, and what i'm showing on the lower right-hand corner of this slight are micro c.t. images of the ribs. on the left you see a rib bone

from a younger individual and on the right from an older individual. what you see is this corticle shell, and that load bearing outer shell has decreased in thickness from young to old. this is a significant trend. it has been observed in lots of populations. you can see the individual variability that dr. wang was talking about, but also a variable trend to decrease in corticle thickness. what happens, essentially, is the way your bone grows, is bone is deposited on the outer surface of the bone, and it is on the surface of the bone. as that develops, the bone grows. what happens when you reach adulthood is the apposition stops on the outer surface but the absorption on the inner surface continues. so the bone actually eats itself

away from the outer surface. and that occurs with aging. dr. wang showed something even more dramatic. these are c.t. scans -- they were. maybe they weren't. maybe this is an image from the -- you see on the left, a 17-year-old and on the right a 64-year-old. in addition to the poreous appearance, you can see a dramatic difference in the shape of that relationship cage. we found that the ribs get more horozonta. you can see this as its manifested as a barrel-chested appearance as we get older.

and if you look at the way a seat belt might load those two structures, on the case of the left, that seat belt load is going to introduce deformations of the, -- of the spine, which is the kind of loading. on the right, you can imagine deforming that chest like a barrel, so instead of putting stress on the spine, you are putting it on the chest itself. so the chest is at a disadvantage for front-loading. so the biomechanics of aging are important to consider. we did a study where we estimated that the age of america over the last decade generated about half as many serious injuries as increased seat belt use prevented. i think biomechanics is a key solution and incorporating it

into things like federal standards and safety measures is important. thank you. >> thank you, dr. kent. >> our third panelist is chief of the human injury research division at the national highway traffic safety administration. prior to coming to ntsa, he worked at general motors research lab and at t.r.w. ought motive addressing biomechanics analysis. mr. ridalla can you continue with your opening statement. >> thank you for inviting us. i would like to talk about ntsa's document research. an approach we have identified for research has two goals, which would be to eliminate crashes due to aging and reduce accident-related fatalities due to aging. one research could entail driver

safety and pedestrian safety. i will only touch on the l research approach, specifically the biomechanics research approach we are working on at ntsa. in terms of data, there is an extensive body of existing research with respect to injury incidents by age, but the questions of the research engineering network, part of ntsa's data collection analysis, can inform us more. i will touch on more how we can use that date -- data in the future. what is necessary is analysis of older occupyants with respect to gender, body mass, preexisting medical conditions, as dr. wang mentioned, and dive into depth more with respect to crash direction and crash severity. regardless, analysis shows age affects injury outcome for

almost every individual in every crash mode. an example follows. 24r was work done by the university of michigan to combine ciren data analysis. ciren has the ability to give more injury data while nass gives us the power of the situation. when you look at a passenger card in a side impact in cumptly regulated conditions, the thorascic and head injuries dominate. it is almost a five-fold injury for increased risk in the thora sic area in the older population, everything else being equal. when you look at just nass data and look at rib injuries, it does go up in all ages. even at low-crash severities --

sorry. i went backwards. there we go. even at lower-crash severities, the risk for older folks goes up 15%. this indicates an increased riss accident. we should perhaps do something more in this area with respect to crash dummy development, because dummies only look at crash speeds in the moderate to high severity range. so we look at data from nass and injury causation situations. we have over 300 incidents with older occupyant analysis and we will publish on this to a great extent in the future. we are focusing on thorax injury research. as i mentioned in the previous

slides, those are the two areas we see the most potential for older occupyant protection. we're evaluating crash dummy response. we're determining the suitability of those dummies to predict older occupyant injury as a result of the analysis we do with ciren and nass data and determine if we need to revise data based on age. one thing that's parent, the use of computer models must increase. the use of computer data for older occupyants has to be explored in the future. with respect to that, we are doing work where we characterize age and gender cagse changes in ranges across all ages from the youngest to the oldest. we're collecting c.t. scans with using input such as age, gender, and the size of the occupyants, and changing the shape, the mesh

size, the density of the bone, and other mechanical properties to create a model that can be used in a variety of restraints and vehicle conditions. this video, which thankfully works for my computer, or my presentation, indicates what dr. kent was saying, as the occupyant ages the bone density and rib cage changes. so we're characterizing rib changes and changes to the head and brain. we are taking the youngest to the oldest. input such as age, gender, and other information that we get from c.t. scans will go into a brain model where we will change the shape, size, mesh density, thickness of the bone, and changes that we see in the morphology of the brain, and input what we discovered

recently, a brain model, and see what the differences might be as a result of input. so in summary, we have identified an approach to older occupyant research. we want to understand injury as a critical path to future projects and the most frequent injuries, as i said, brain and chest injuries. this will help us determine what dummies we need to use, reducing the seffvared of old -- the sevarity. thank you. >> thank you. our final panelist is dr. stephen ruhana. he has helped ford lead the development in inflatable crash dummies and seat restraints. thank you for being here. >> thank you for having me.

i'm going to talk about taking what we just heard from the other three panelists and putting it into systems in vehicles that can actually make a difference. we hope. excuse me. if i can start with a look at the summary of what goes on with aging, we have three take-aways from this slide. young kids think they know how to drive, but don't have the experience, and they drive too fast many this is the fatality for 100 million vehicle miles vs. age. older occupyants don't get into many crashes but they are over-represented in terms of the fatalities. the third thing to take away from this, this is the only piece of scientific evidence, that i know of, that shows there is a medical benefit to middle age. in the 1970's renault put load-limiting seat belts into an experimental fleet which they then allowed people to drive. every time there was a crash, they studied the injuries and

the crash schematics. when i was at general motors in my former employment, we looked at the study of survival of people and the injuries they experienced. we came up with a relative graph. in the age category of 16 to 35, if that's the best you can do with belt-loading, by the time you are in 36 to 65, you have half the ability to withstand belt loading on your chest and over 66, less than half the ability to withstand belt loading. this was a study done by others in my lab. they looked at data and did a whole series of models using mathematical models under similar crash conditions to what's found in the field. this crash those a serious thorascic risk in terms of hyper

3 chest deflex. hyper 3 is the crash test dummy used in the crash. if you are in a crash in which the hybrid dummy, if you are a -- if you were a 20-year-old, you would have a 25% risk of injury when you get 60 millimeters of chest deflex. when you are a 70 yearly 0 -- 70-year-old, you would have a 90% risk of chest injury with the same crash and the same chest deflex. -- chest deflection. we wondered if there was a way to reduce the risk for older occupyants, and we thought of an inflatable belt. not just safety for people, but safety in the rear seats of our vehicles. so what is an inflatable belt? it is a tube lar airbag

sandwiched between lining. it inflates within 10 to 20 miliseconds. this is what the system looks like. there is a shoulder belt retracter, and then standard wrapping which goes to a d-ring which holds the belt to the loop, and then the shoulder portion of the belt actually has an airbag placed inside that inflates to about six to eight inches in diameter. then on the left side, there is a lap belt retractor and a standard lap belt. the lap belt does not inflate. this is a close-up of the inflateor and the latch plate and the buckle. the inflateor is attached to the buckle. it is a gas that upon a crash receives an electrical signal from our crash module, restraint control module. the electrical signal fractures the die freshman in that -- the

diaphram in that buckle and flows through the latch belt to inflate the shoulder belt. this is a video of the inflation as it occurs. you see the gas in the cannis ter? the gas flows through and inflates the shoulder belt within 10 to 20 miliseconds. i'm going to need to come out of my powerpoint presentation and play this in windows media here. this is a crash test that we've done with a small female dummy on the right and a 6-year-old child dummy on the left side showing the inflation in slow motion. one of the things you can see is that we capture the chin, and that reduces the forward excursion of thhead. we also expand the area of the belt on the chest by five to seven times which reduces the pressure on the chest to

one-fifth to one-seventh of what it would be normally, and that reduces the likelihood of injury. so many of the benefits that we expect from inflatable belts is that bazz we are inflating the shoulder portion, it increases in size and as it increases in diameter, it pulls the belt closer together and takes slack out of the system, and we have a load limit associated with it to help reduce the chest loads. then the increased size of the bag helps reduce occupant head excursion, so we reduce the ok pant -- occupy pant neck load -- occupant neck loads and that results in less head injury. this is from the federal motor vick safety standard 208 pulse. we have normalized everything to the standard belt in red, the

inflatable belt is in blue. you can see the head injury criterion, or h.i.c., has been reduced by about 40% with the inflatable belt. i am happy to say that this system is going into production in the 2011 model 11 ford explorer which should be out in the first quarter of next year. it is optional in the second row outboard seats. we feel it will have great ability to protect older occupants by reducing chest injury which as you saw from my colleagues is one of the major problems for older adults in car crashes. >> thank you very much. it gentlemen, thank you very much for a -- an overview of a very challenging problem. i feel like i could talk about this all day. i apologize if i go over, if i

have time. i think it is interesting that you have separated out frajilt and -- fragility and frailty. what i'm gathering from what you have said to me so far is that fragility is the chance for me to get an injury given that i'm in a certain type of a crash, and frailty is the outcome, once i have that injury. .

>> i have normalized everything to age 20 and what we see is this fragility issue, the risk of getting an injury in the first place goes up by a factor of eight. whereas the frailty thing, the risk of dying once you get an injury only goes up by a factor of two. in terms of what is important for aging or what changes more with aging, we found it to be this fragility issue.

>> so you are 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 in a certain way so that outcomes are better, but prevent the injury in the first place. >> i would say that is more important. yes. >> you talked about different types of injuries. yes talked about chest injuries. when i'm talking about preventing injuries to older adults, what part of the body and my most interested in? is it the chest or the head? typically for children, i want to protect the head. it is it not the head that is the most important part of the body to protect anymore? >> every case we see with any

older occupant that as a chest injury, getting to the point about frailty, we see for a given age or injury, the outcome is down and reduced for the older art depends. the justice definitely the top and the head is not far behind. >> when we talk about chest injuries and refractors, if i sustain a rib fracture, is that an injury i may die from? is it only because of these additional complications with breathing difficulties -- because it's difficult to get a deep breath because it's difficult to breathe and it leads to some complications or is a red fracture a severe injury and people die from it? >> we see football players all

the time at the university of michigan with bruised ribs or fractures. what we typically do is give them a motrin ask them to take a hot soap and they will be sore for a couple of months but it will get better. they can mage the pain with medication. what typically happens with an older person is they have limited cardiopulmonary reserved. you need to be able to breathe and move your chest wall and pulled out on your diaphragm to pull the air in. you only have enough oxygen in your system to live for a couple of minutes. we find that older folks tend to have a limited reserve. when they get a couple of rib fractures, they're not moving air very well.

then the whole vicious cycle i showed occurs. it is much more impact fall in an older person that would be in a young person. >> so you are telling me that i need to protect the chest and older persons can typically have a poor outcome. as people age, they don't tolerate bulk loading as well as they do when they are younger. the inflatable restraint are at interesting option. are there additional options to look at to make the belt system to make older adults more tolerable this bulk loading? we certainly don't want the seat belts to cause injury in and of themselves. >> the data shows you are almost

always better off with a seat belt on, even if you are an older occupant. many technologies are currently being researched to look at this fragility of the chest. in many vehicles today, there are load limiting shoulder belts. as you move forward, you apply pressure to the seat belt and it will start to pay out and that keeps the force at a constant level, hopefully below the level required to break your ribs. all three of my colleagues have shown the rib cage deteriorates with age and the load gets lower and lower as you get older and older. force limiter's can only go so far in terms of force before you allow the occupant to have to much excursion, and which case

the base are going through air bags are hitting the things in the compartment that you don't want to do it. load limiter's are one mechanism or a tool in the arsenal. we have been doing research undouble shoulder belts. we got that from racing. you see these crashes all the time at 200 miles an hour and parts fly everywhere people get up and walk away. we have been trying to find out what is in that environment we temple into the passenger car buyer but. the double shoulder belt connected at the lap, this is something we have done a lot of research on and hopefully we will continue their research.

>> we have been looking at advanced restraint systems. the restraint system would adapt to the individual, whether it is their body condition or crash condition or gender. we might go beyond that to adaptability for the individual. >> there is an intermediate phase between the two systems we're talking about where this fall adaptability is in the future. billowed limiting, there are systems that are extremely clever. one system we have looked at is a load limiter that adapts the limit based on the speed of the crash. yuli get as much built force as you need. so at a low limit crash, the limit will be low. it is disproportionately good

for older people because they tend to get hurt in low severity crashes. that should have a disproportionate benefit for older folks. that is more of a proximate technology. >> it is kind of a pie in the sky question. he talked about how aids is not necessarily the predictor, but the condition of the body. is there a way you could measure the condition of my corpuscles are some measure that can give a prediction of my outcome and have my car no what i am so when i'm driving my car or when my husband as rent-a-car or when my mom drives the car, these intelligence systems can

appropriately deploy to maximize the benefit for the driver or passenger? >> there are a number of different techniques becoming available. we have processed about 10,000 full body ct scans on patients and we're getting a better idea of being able to predict a condition based on measurement of specific points. it may be fairly simple in the future to show up at a dealership -- there are a ultrasound machines are fast and paid less and without exposure to radiation that can measure corpuscles very quickly. with a few parameters measured outside, it's feasible to come up with an objective measure of subjects condition of a patient's condition.

that could be used to adjust some of the settings. >> i think we need to acknowledge the by mechanics is probably a few decades behind in terms of knowing where you actually do with that information. there is technology and tell you all kinds of things about the person. but it would be do? where the blood of an individual questions of tolerance are yet to be answered. >> that leads me to my next question. i'm going to -- we have seen a lot of advancements in late child safety and think some of that is because of the about the testing done courage and for these safety systems to become excellent and provide protection

for children. are there tests -- the insurance institute has a best pick or a star rating system -- is there something manufacturers can decide to encourage them to adapt their vehicle to better address older adults? do we even have the technology to assess this? if we make a change, do we know what the injury value needs to be? do we know how much chest the flexion is ok for an adult to have a ratings system? >> there are several parts to that question. first, is there a standard protocol we use to assessed vehicles for elderly occupants. the answer is no.

the testing doesn't really address older occupants. that said, we're doing research. we just published some research last week on the human body model where we have determined what its age is that we have a young bear version that older versions of its delicate restraint systems with the two different versions at sea at the affect the aging population. the other part of this equation is ergonomics. we do a lot in our research to make our vehicles family for older people to drive. we look at ingress and egress issues. that's a different subject for a different day. did i answer all the questions? >> yes. i'm being hurried along a little bit here to keep as of schedule. i would like to turn it over to my colleague to see if there are follow-up questions.

>> i could talk about this all along. but i will come back after the parties and the board has discussed this. you talk about fragility and frailty and gave us specific definitions. we all have in mind the 80-year- old great-grandmother when you talk about this. that's the picture we think of. in fact, we see an epidemic of obesity in this country. i don't think we tend to think of those people as fragile or frail, but i would like for you to address how the serbs may apply to the population. it's hard to think of a 280 pallet great-grandfather as fragile or frail when they may perhaps be at greater risk.

>> there is a lot there. in looking at this issue, what i have found is the literature is replete with studies showing that obesity is an independent risk factor of death following a car crash. but the literature is sorely lacking studies of which factors is it -- is it fragility or frailty? it is a difficult question to study because what is the risk of getting an injury in the first place is hard because we of good fatality data. would you like injury, the question is much more murky. all of the literature is contaminated with serious injury and death and what that incorporates is both the fragility and frailty -- some of

the studies we of them in our lab, we see obesity makes the bonds go much stronger. -- test abbey's cadaver, the bones tend to get bigger. they're all sorts of issues about how people move in crashes that may disadvantage a it obese person, so it's a complex question, so getting the answer to your question is difficult and we don't have it now. >> the obesity epidemic, what we have noticed is highly correlated with a release in severity in lower extremity factors. where it begins to play in is in the of these population, in the elderly population, obesity

plays a much greater role in terms of frailty. in the heavier set population, there a little more fragile and get more lower extremity injuries. but what tends to happen as of these folks have a different -- have a difficult time getting into the emulation. that means a prolonged hospital stay during which the complication rate goes up markedly. on top of that, when you have a heavyset person and the elderly have a harder time recovering, that means a substantial impact on their long term quality of life. certainly it has an impact of frailty even more so than fertility even though we clearly see fragility in affect. >> it shows up in every analysis. the most severe cervical spine

injuries, there were the oldest group of people and also the fast. it shows up over and over again in these analyses. >> i would like to turn it over to the parties. >> it is not new years, but you've home encouraged us all to have more exercise and build up our core strength. i have been asked to make sure each of the party spokespersons for the table, if they could identify themselves for the people watching who are not here with us. highwayith the federal administration office of safety and we have one question from our table. funding for crash by mechanics

has decreased steadily over the decade of the way handful of government agencies and the handful of larger car companies doing the work. how can we best maximize the effectiveness of our efforts to lead to earlier deployment of technological improvements? >> i will take a stab at that. there has been a larger emphasis on crash avoidance them active safety technology. but when you get to congress's worldwide, the number of people collaborating is still quite high and all of us in the community think there's a lot left to do. what we are really trying to do is more international collaboration. we had then rear impact studies and have a meeting quite regularly for the last year.

there's a consortium in europe joining together companies and academia to look at by a mechanics' research to leverage the dollars and expertise around the world in this area. it is one area where we can best maximize our resources. >> we continue to do research up for, but there used to be much more public money for research for this problem. injury from automotive crashes is the number one cause of death between the age of 1 and 34. it is not getting the attention and terms of the public dollars out there for research compared to some of the better known causes out there being funded. i think there's a lot of room for improvement there. >> i have certainly noticed that

phenomenon at a couple of comments. in recent years, there have -- there has been an increase level of funding coming from the department of defense and other military groups. crash injuries are a big deal in this kind of thing. there has been an increase in terms of the ability to look of some of these questions. another thing that has recently been discussed is the va. veterans have a disproportionate crash involvement and thea has tons of money and this might be a good way to spend it to keep these guys out of the hospital. there have been military-focused areas where we try to proceed down these paths that are dried up and i also heard that ford

record profits this word -- this quarter. >> how do we maximize the effectiveness of the money we already have? >> by seeking out collaboration's where we maximize the number of people in the labs are participating in each person can contribute to the project. >> we recently had a symposium out of arizona and defined people are doing research real- world and the best thing to do is say let's not be redundant and try to focus people on different areas silicon maximize the results. >> we do have another question. how truly modifiable are the

risk factors for older adults? our older women at greater risk due to osteoporosis? >> i will try to address the first question. we are in the process of studying that right now. we think we have been seeing substantial effects of core muscle on operative outcome. we believe a substantial number of those things can be addressed by placing a lot of it can be delayed so people can get conditioning. you can perhaps modify the entire population, but i believe in working with a lot of automotive engineers that there

are a substantial number of technologies on the near horizon that if they are adapted for a more elderly or frail occupant, i think it can provide substantial benefit. i they smarter and more attuned vehicle system can prevent a number of injuries because you don't have time and patience will command because you have to say you're gonna have to go to exercise. but the frailty can be addressed, whether for nutrition or exercise, specific regimens or that can be addressed. >> are older women at greater risk due to greater reduction in bones? >> we certainly see that trend as equally large contribution from a muscle mass in conditioning.

we have processed 10,000 ct scans and we see substantial differences. men and women are quite different -- news flash -- they get a completely different patterns of injury. men and women -- there are certain types of crashes where men will get in a frontal crash and men will tend to get fractures whereas women -- it's a ratio of about nine to one. if you flip it to a side impact crashes, what is interesting is it's a wonder female let's more likely to get some of these other factors. so while it goes down in general, there are more substantial gender differences which we are only beginning to get an inkling of. >> i ha some data here -- the

answer to your question as it should but it often does not manifest itself in clear ways. what i'm showing here is a relative risk which came out of combining a bunch of exposures like motorcycle crashes and falls. the idea is this is the risk of injury given a comparable exposure as a function of age. it is all expressed relative to men at age 20. the point is women have a 20% greater risk of dying and it is almost constant across the age spectrum. it almost maintains into pre adolescence that the ratios days pretty constant and i can't tell you why. certainly things like

osteopetrosis manifest themselves in both genders. the other thing that tends to make that a difficult question as there is the whole size issue whereas men are bigger. is a size mafic station or is there a gender issue here. i think getting today quantitative answer to that is in the future and i don't think we have a good one now. >> i don't like those numbers to much. thank you lawyer questions. we will go to the second table. you could identify yourselves with your names and organization. >> i am with the aarp. the first question is for the whole panel. would an older crash dummy aid in the development of more effective protection for older

drivers and passengers? does an older demi change the injury criteria performance levels for frontal inside a bag test procedures? what affect would this have on current vehicle design? >> all lot of good questions. to go to an i want old crash test dummy. i think the best way to handle it might be by modeling. we just made an old version of the human body model and can use that to simulate various restraints. and older dummy will look like a dummy with different properties. maybe different rib ankles.

the injury criteria would likely remain the same. >> with the be any resulting effect on vehicle design? >> that the tough thing to answer. it sounds simple that we can have systems that automatically adjust for an occupant age, but it is not quite that simple. age is only one of the variables. the amount of room you have in the vehicle limits how far you can allow the occupant to live. if you make the load limit really low for an older person, you're going to end up with all lot of the excursion. all crashes are different. there are a lot of factors that

have to be factored into this adjustable restraint system that make it more challenging. that's not to say we couldn't do it, but it's going to take a significant amount of effort to create an adjustable system that encompasses everyone. bio variability is enormous. we have to accommodate for the smallest occupants to the largest. from age 8 to the oldest person in the vehicle has to be accommodated. and there are all sorts of different shapes and sizes. it is he a complex problem. one of the things we are blind to is the effectiveness of these restraint systems. current crash dummies only measured chest deflections in one spot. but we have the project of advanced crash dummy that measures four different locations on the chest. the slide shows advanced

technologies where we can measure to flexion at any point along the ribs. the question is we don't know what that means. we know the chest deflects and we have all these amazing pictures of dummies and the amount of the flexion you can see. we have to figure out what that means. i think it will make us evaluate restraint systems in a different way by having a more advanced capability. but we still ought to work, that criteria means. >> that's something that will be applicable to all ages. >> talking about occupant protection as a system. did you talk about the air bag. how comes into play with the older occupant or driver and

working with the restraint system? >> before we had air bags, we just had belts and we broke a lot of chest. the risk from belts alone, especially for elderly occupants is quite high. with the advent of air bags, we have been able to change the amount of load going to the belt by having the air bag take some of the force of the restraint. the risk of injury for a combined restraint is in between what it would be for an air bag alone which distributes the load completely. off airbags do work, but they work to reduce the risk of head and neck injury. they are positive forces in chest injury protection.

>> i think one thing that has been discussed on this panel is that death from rib fractures often occurs subsequent to the accident -- do you feel these are accurately reflected in the fatality data? >> if i could just pull up my slides. this is getting to an even bigger issue.

if you look at the fabled data -- you compare the oldest group to teenagers, it gets crazy. you see a lot of different things that go through this crash exposed issue. one of them is the delayed death question. about 30% by age 75 and older guy a they are more after the crash. italy about 10% lead a middle- aged group and it's very low in teams. that's counterintuitive because you think these young girl people would be more resilient. where is the older folks don't

have those kinds of crashes. i have a couple of examples of case studies we did where i pulled up random cases because they illustrate the point. this is a 39-year-old vehicle, a single vehicle crash with a drunk driver at night. those headfirst into a tree and there is a massive intrusion in the roof and the person dies immediately of massive head injuries. that is an archetype of a fatal crash. typically, fatal crashes tend to be crazy events. we pulled out some of the older cases -- here is a 75-year-old male that died 16 days later due to complications from a pre- existing bowel condition. this person here backed up and driven to the house and died

days later. we have for the medical examiner listed specifically at the cause of death. we see all sorts of cases of moderate severity where they died. this is the driver gender distribution by age. if you look at the rice -- a look at the right, you see 40% male -- 15% hour and non are pregnant females. not many are pregnant females. 15% don't even have the gender coated. this reflects the fact that elderly driver fatalities are not done very thoroughly because it's not apparent they're going to die. when a young person dies and gets a lot of investigation and a survey the scene and take a lot of photos, when an older person dies, there are no pictures generally and no

investigation. i found cases where the police report had been devoted no injury or minor injury which had been blighted out and they all had been checked. so it's not apparent these guys are going to die, so it's a good question, what is an elderly fatality and when should it. >> [inaudible] >> i have not thought about how much this affects the database or overall trends. i have not thought about that. >> are their after-market design options to address the needs of older drivers and passengers who

are under protected by current designed the market? >> i have seen things like comfort devices for belts. typically i don't like those because they may interfere with the belts performance. in general, most of those products, we don't know what their effectiveness this. we don't think they are actually that effective. the bill twins are the ones we see the most for comfort reasons. >> some aftermarket belt devices that aim to get the belt off the shoulder actually change the routing of the shoulder belt and cause an increased risk of sliding under the bell. i don't like to see those systems at all. we do a lot of evaluations to get good performance and

restart altering the geometry of the system, it can have problems. >> thank you. >> good afternoon. thank you for your presentations. they are very interesting. we have a few questions. since motor vehicle safety standards can drive restraint design, d think any changes to the standard would help manufacturers construct belts for the older population? guy, so it a research will have steve absurd that. >> currently, standards require us to test unbelted.

that can drive restraint system design to be more aggressive than it needs to be. we have to protect a 160 lb occupant in a 30 pound delta which is a lot of energy to match. that could cause compromises in what we do because it has to work with the air bag. the short answer is there are aspects of the regulation that could have affects on performance for all occupants. >> this next question is similar to what the other table asked.

[unintelligible] >> modeling will take us along way. we need to understand properties of the folks who showed interesting data as far as muscle verses fat. some of the properties are not known so a lot more work has to be done. it is necessary and we are investigating as things, looking at brain properties. we can't do it by what we think is right. there's a lot of literature but it takes detailed analysis to come up with these solutions. >> the dummy is a model. it is named appropriately.

we make a lot of approximations in developing those models. the mathematical models we have developed, these models are much more detailed than the crash dummy camby. the crash dummy is a tool. it is meant to be repeatable. to make a laboratory tool, many compromises have been made. we have done a lot with the dummies. the number of fatalities have come down.

the fact of the matter is the computer models can give us much more detailed answers. but there are many properties we don't know and the computer models are only as good as the properties we put into them. there are compromises everywhere, i guess. >> i think there is a substantial and growing deficiency right now. i think adding additional properties, you end up with a more detailed -- hopefully detailed injury locations in looking at a very large set of crash cases, we see differences in the specific sites of injuries at how they are related

to each other. in a young person, the ribs tend to collapse. in an older person, the reds break in a different spot which leads to law and lacerations and injuries. all current databases now are lined with a specific injury and a score. they don't give you the three- dimensional location. you don't see how they relate to each other and the forced loading on the body. all of that is very easily obtainable by processing ct scans. you have to have a target for any sort of tests you have, so i think that's a glaring deficiency right now.

>> one last question. there is a lot of information on cognition, but aren't there any sdies of the intensity or frailty? >> as a trauma surgeon, i'm not the best qualified person -- a substantial portion of the american population seems to be on multiple drugs. what the interactions of those affects on osteoporosis are, i cannot say. >> thank you. >> thank you for those questions. we will proceed to the final table. >> you touched upon this earlier, but are the gender differences and terms of the

older driver, what are the policy implications of this difference? one of the things i was thinking about as we talked about in the last session that females tend to be the passengers when there is a male present. are there implications for protecting the passengers for those genders cholera a policy implications? -- what are the policy implications? >> we see substantial gender differences and we know we attribute many of the differences in injury patterns to the economic differences we see between the genders. speaking from the outside and not being one that designs the theres, i don't believe is specific gender specificity in the tests. when you lump be injury risks

together, you lose a lot of that understanding my personal opinion as there is not enough gender specific specificity in these devices. >> we still do use small female dummies in our tests. we are helping to have mid-size mail and e-mail based on the fragility of females relative to males. >> let me make one quick comment. the front passenger position, i don't have this kind of data, but one thing we have been looking at is the rear seat which goes to your point about non-drivers. we do know seven things about the rear seat and what i'm

showing you here is the fatality of effectiveness of their seat compared to the front seat. a positive number means the rear seat is safer compared to the front seat and if there has been a historical truth, it is that the rear seat is an intrinsically safer environment. it has become untruth for older drivers. up through about age 50, the front seat -- the frenzy has positive effects. the front seat is actually safer than the rear seat for the oldest occupants and are working hypotheses on why that is. you go to the next slide, it is illustrated here. we see things like load limiters

-- this is a little bit data -- a little bit dated at right now. this has largely been motivated by consumer information and federal compliance tests which involve dummies in the driver's seat. but there are no tests with dummies in the rear seat. it is still a safe environment, but intrinsically, the front seat is caught up because we have been working so hard on that. it's starting to show itself and there may be advances to be made into the rear seat. there may be policy issues that could drive some of that. >> i would like to way and on that. this does not show there are low limiters in the front seat. i did not mean that by the car driver, i meant that by the

major factor -- there's always a driver in the vehicle and a third of the time there is a passenger and one-tenth of the time there's some in the rear seat. nonetheless, vehicles themselves have been forced to become more fuel-efficient which makes them typically lighter. a lot of the design trends in recent years have been to shorten the front-end. both of these trends, making them lighter and more stylish tends to drive the crash paulson up. that's why we have loaded limiters in our vehicles. the structure of the vehicle is much different now than it used to be. if you apply stiffness as a function of time, my guess is you would see it follows the same trend, so these technologies are needed.

that's why we put inflatable belts in the rear seat. >> i have a very short question -- when you talked about delayed death -- when you see your sequence of injury failure going on, how long does that typically take? >> it could take on the order of weeks to months. what happens -- this goes back to one of the issues that was brought up, we tend to get a very early read on the young people and they have enough reserves that they begin to get into convalescence. they end up on a lot of intensive care support but with advances in critical care over the last two decades, we are able to keep folks going for

weeks. afterwards, -- it can be months before that pops up. >> it would be fair to say the delayed death number is an under reporting. >> yes. i am not familiar with the database, but i would be quite concerned about that. if you add not just death, but the very poor long outcome, you would have to get that out much longer. there be a larger portion of the elderly population of failed to return to full function. whereas the elderly tend to bounce back and have that recovery function much more substantial. >> >> thank you. i'm going to keep you busy trying to pull up a couple of

slides. this was a slide that showed head and the thoracic injuries. one error was going one direction and the other was going the other direction. i'm trying to understand why does head injury decrease with age? is it because of the operation of the vehicle speed or belt use? what is going on here? >> i should have made that point more clearly. this is not numbers or risk, this is proportion. when an injury does happen, it is more frequently in the thorax. they have a higher risk of injury in the head as well. >> thank you. i was having trouble understanding that. when you talked about the

accident area of the 39-rolled female driving into the train, is because they're having these catastrophic, high-speed accidents of their not having that in the older driver, but they have as many head injuries but the proportion is not as high. >> i don't know about numbers, but the risk is higher. the total number of head injuries -- there are more head injuries and the proportion is higher in the young. they will have head injuries more frequently. that they don't get into the higher speed accidents. >> you had another slide -- it was the one with the category of an unknown and pregnant female.

i don't know if there is a gender bias i'm confused as to why unknown and pregnant women are in the same category. i'm not sure why. >> there are some -- i was trying to make the point that it is clueless in either place. in both cases, you're probably messed. that's why i combine them to show over 10% of the database is coded clearly incorrectly. >> we have talked a lot about the dummy types. how i would be curious as to what types of demi -- and anything modeling is a great

solution, but there is a reason why we have dummies we have talked about obesity and fragility. what is the single most critical area we are missing in our family of dummies. what would be benefit most by if we're going to go through the effort, what is it we do not do well in our modeling now. >> i think we do well everywhere. the word that comes to mind is by no fidelity. how lifelike is the dummy? how well does that make not just the injury, but when we looked at crashes, we tried to deduce where was the occupant and try to recreate that in a lab. the dummy does not always want to go where the human went. we don't want to break the dummy because of we make it to life

like, it is too expensive and we get complaints because they don't want to -- we want to make it more lifelike to respond to the crash forces and have implementation that can -- that is why we're moving into multi- point chest sensing so we understand what is happening at the pelvis more complex and lifelike lower extremities. those are all great things to move forward with. repeat ability, durability, reproduce ability -- it's a process we have to go through. >> it sounds like all dummies' need to have better by of

fidelity, but is there a type of prototype human that is not well represented in the dummies? when we talk about dummies' performing like human beings, what is the dummy that is the heaviest? >> when we -- a couple of comments, could the very last question, we have done some work looking at a fat jacket for one of the dummies. the rib cages of obese people are like the red cages of that else. if you get down to the bony structure, it's like anyone else. this thing that affects crashed schematics most is the subcutaneous fat. it gets into issues of repeated

ability and all that. the point i was going to make is we have this question of our resources there resources -- the resources required to build better dummying get people to start using it, that never happened in my lifetime. we got one right around the time i was born. it's very hard and it takes a ton of work. i just don't see this as the best resources. we can work on ways to make a better and ways of interpreting what they tell us. simon uses a dummy and put to give us what a human >> ok. i was interested in the back seat and i am really glad that

the last table asked the question and you're able to put some slides about that information. if you could pull up that slide that dr. kent used that had the back seat information. i think that you tried to shade a little bit of information and there are about one-third of the time, there will be a passenger. help us to understand the data all little bit more with respect to the benefits a front seat passenger gets out of having the combined air bags and seat belt versus a back seat passenger in not having an air bag. maybe you can talk this through your data here again. whoever feels like they have something to add a year. >> this effectiveness issue --

we he done a couple things in my lap. where are these injured -- in my lab. that is one clue. then we start looking at restraint performance. there are challenges that are unrelated to an air bag. we have quite a bit more flexibility -- the design of the front seat is much more able to be changed. the rear seat is tried -- tied to the chassis of the vehicle. it has a huge consequences if you tried to change it.

the driver's seat is very genius sleek designs. in the rear seat, it is difficult to have that same kind of public restraint. that tends to keep the torso reclines. the rear seat poses some challenges. things like -- it helps to restrain the pelvis. there are things being done? there along those lines. a lot of good news is that manufacturers see this as the next market. they see this as an area of technology. >> i am just not understanding exactly what the data is telling

us. i am stuck on this 0-5. these age groups, 0-5 are not in the front seat. explain to me what is going on it right here. help me understand what these two colors are showing. >> they are not supposed to be, but they are. there are children in the front seat. that is comparing the relative fatality risk for kids in the front seat versus kids in the back seat. it is 50% more effective to be in the back seat for children. that is true across the age range until about age 50. we encourage parents to put kids in the back seat, but there are still kids in front. >> where is the air bag, though? >> in this case, the blueline is representing cases where the air

blast -- air bags deploy in the front seat. it is a little bit confusing. it is not ride -- is not the reason why i was putting this up. their rear seat -- the decrease in the rear seat effectiveness is more pronounced if there is an air bag. the air bag provides more benefits to the front seat. the effect is bigger if there is an air bag. that is why i have the blue line. the point is the same. >> one thing that might help is that this was a study that was done by nhtsa in 2005. the data is more than five years old. it is probably more like 10 years old. there were a lot more kids in the front 10 years ago. >> as a child safety passenger technician, i do not like to see any data that shows kids in the front seat.

that is a challenge depending on the restraint. what i was curious was be dealt with the air bag provides the same benefits or have you been able to quantify that when we are talking about a combo air bag and seatbelt versus the seat belt that has the integrated air bags in it? >> we have tested -- i showed that one slide with the standard build test. we reduced the chest deflections over that system. we have also tested this and compared it to inflatable belts, standard belt, and a standard belt plus a combo back. we saw reductions in the chest deflections from the inflatable belt. i think we will have a much more effective system for people in

the rear seat. >> great. thank you so much for sharing that video with us. it did go very quickly. i see that you are very close to the slide again. i do not know if i'm going to pass off to dr. barbara. but if we could show the video again while we are transitioning. it is ok if you cannot.

we address the issues of exercise. you would like to have your patience exercise for a couple of months before they get into 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? what does it do as far as their ability to withstand some of these impacts? i know that the surgeons are fond of talking about physiological bursas chronological age. tell us what it would mean for en 80-year-old coot is exercising and training versus a 60-year-old to a sedentary. >> i am not sure if i can answer is exactly the question.

the question of whether how exercise affects core muscles. we certainly see that in our patients with a history of activity, they appear to have better core muscles and we made that association. how weekend -- the other thing we have done is studied patience in the icy do that had a very high mortality rate. we know that deep muscle can it change acutely within the course of a few weeks has been critically ill. how quickly it can go back up, we have not sorted out yet. we have a number of studies that were going forward to try to study that. this slide is something that helps drive home t