Older driver training programs: A systematic review of evidence aimed at improving behind-the-wheel performance.

INTRODUCTION: Age- and health-related changes, alongside declines in driving confidence and on-road exposure, have been implicated in crashes involving older drivers. Interventions aimed at improving behind-the-wheel behavior are diverse and their associated impact remains unclear. This systematic review examined evidence on older driver training with respect to (1) road safety knowledge; (2) self-perceived changes in driving abilities; and (3) behind-the-wheel performance. Method Nine databases were searched for English-language articles describing randomized controlled trials (RCTs) and non-RCTs of driver training interventions aimed at those aged 55+ who did not have medical or other impairments that precluded licensure. Quality appraisals were conducted using Cochrane's Risk of Bias Tool (RoB) and Risk Of Bias In Non-randomized Studies - of Interventions tool (ROBINS - I). [PROSPERO; registration no. CRD42018087366]. Results Twenty-five RCTs and eight non-RCTs met the inclusion criteria. Interventions varied in their design and delivery where classroom-based education, or a combination of classroom-based education with on-road feedback, improved road safety knowledge. Training tailored to individual participants was found to improve self-perceived and behind-the-wheel outcomes, including crashes. Conclusions Interventions comprised of tailored training can improve knowledge of road safety, changes to self-perception of driving abilities, and improved behind-the-wheel performance of older drivers. Future research should compare modes of training delivery for this driver population to determine the optimal combinations of off- and/or on-road training. Practical applications Training programs aimed at older drivers should be supported by theory and research evidence. By conducting comparative trials with a sufficient sample size alongside well-defined outcomes that are designed in accordance with reporting guidelines, the most effective approaches for training older drivers will be identified.