Association between decision-making under risk conditions and on-road driving safety among older drivers.

Objective: Despite theoretical models emphasizing the likely importance of adaptive decision-making to maintaining safety on the roads, there has been a lack of research investigating this topic. This exploratory study aimed to determine if decision-making under risk conditions, as measured by the Game of Dice Task (GDT), can explain additional variance in on-road driving safety beyond other well-validated predictors. Method: Two hundred and thirty-nine cognitively normal Australian drivers aged 65-96 completed demographic and health questionnaires, vision testing, a neurocognitive test battery assessing cognitive flexibility, cognitive interference, episodic memory, verbal working memory, verbal fluency, and visuospatial function, the GDT-a lab-based assessment of decision-making under risk conditions, validated off-road driver screening measures and an on-road driving assessment along a standard route in urban traffic conditions administered by a trained Occupational Therapist (OT). Results: The number of risky choices made, but not the number of strategy changes, across trials of the GDT independently predicted on-road safety ratings after controlling for visual acuity, cognitive test performance, and off-road driver screening measures, B = -.146, 95% CI [-.276 to -.016]. Conclusion: Overall, this study offers the first evidence that decision-making is related to older adults' on-road driving safety, and makes recommendations for future research exploring the contribution of decision-making to on-road safety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).