Strategy and safety at stop intersections in older adults with mild cognitive impairment and visual decline.

This study assessed the impact of age-related cognitive and visual declines on stop-controlled intersection stopping and scanning behaviors across varying roadway, traffic, and environmental challenges. Real-world driver data, collected from drivers' personal vehicles using in-vehicle sensor systems, was analyzed in 68 older adults (65-90 years old) with and without mild cognitive impairment (MCI) and with a range of age-related visual declines. Driver behavior, environmental characteristics, and traffic characteristic were examined across 2,596 approaches at 173 stop-controlled intersections. A mixed-effects logistic regression modeled stopping behavior as a binary response (full stop or rolling/no-stop). Overall, drivers who scanned more on intersection approaches (OR = 0.77) or had more visual decline (OR = 2.28) were more likely to make full stops at a stop-controlled approach. Drivers with a contrast sensitivity logMAR score > 0.8 showed the greatest probability of making a full stop compared across all drivers. Drivers without MCI were ~ 5 times more likely to come to a full stop when they scanned more (23 % versus 5 % when they scanned less) compared to drivers with MCI, who were only twice as likely to stop (14 % versus 6 % when they scanned less). Drivers were more likely to fully stop on two-lane roadways (1.5 %), during night (2.0 %), and at intersections with opposing vehicles (10.4 %). Findings illuminate how driver strategies interact with underlying impairment. While drivers with visual decline adopt strategies that may improve safety, when drivers with MCI adopt strategies it did not result in the same degree of improvement in stopping which may result in greater risk.