Background Safe mobility is key to healthy, active ageing and community participation. Driving is a preferred mode of travel, however, declines in function associated with ageing can negatively impact skills critical for safe driving. Discrepancies between driving exposure and driving ability may increase the risk of crashing. The ‘Behind The Wheel’ program was designed to promote self-regulation of driving exposure to help older drivers maintain their safety whilst preserving their mobility, however, little is known about its longer-term effectiveness.

Objective To examine changes to driving and self-regulation four years after the completion of the ‘Behind the Wheel’ randomised controlled trial.

Methods 366 participants who completed the original RCT were invited to participate in the follow-up. All individuals participating in the follow-up completed one home visit where information on driving was self-reported using the Driving Habits Questionnaire. The Keele Assessment of Participation measured community participation while depression was defined as a score of ≥2 on the five-item Geriatric Depression Scale. Two odometer readings collected eight weeks apart were used to estimate driving exposure. Changes to driving exposure and self-regulation were analysed using generalised estimating equations and regression models run in R v4.2.2.

Results 215 participants (mean age= 84 years; 57% of original cohort) completed the four-year follow-up. Most were still driving with no plans to limit or stop (intervention=88%, control=92%). Those in the intervention were more likely to only drive in their home suburb or local government area than those in the control (Odds Ratio (OR) 1.77, 95%Cl 1.22 – 1.40, adjusted for sex and living arrangement). However, intervention participants were approximately half as likely to report using alternative transport in the last month (OR 0.55, 95%Cl -1.22 – 0.07), though this was not significant (p=0.06). There were no differences between the two groups on driving exposure, community participation, crash involvement or depressive symptoms.

Conclusion Older drivers who had the education program restricted their driving to more local areas but may have preferred not to rely on alternative transport. Older driver education programs may therefore have long-term impact on driving patterns. Further work is needed to balance safe mobility and healthy ageing.