Hearing Impairment Affects Older People's Ability to Drive in the Presence of Distracters

Louise Hickson, PhD; Joanne Wood, PhD; Alex Chaparro, PhD; Philippe Lacherez, PhD; Ralph Marszalek, BPsychSci(Hons)


J Am Geriatr Soc. 2010;58(6):1097–1103 

In This Article

Abstract and Introduction


OBjectives: To investigate the effects of hearing impairment and distractibility on older people's driving ability, assessed under real-world conditions.
Design: Experimental cross-sectional study.
Setting: University laboratory setting and an on-road driving test.
Participants: One hundred seven community-living adults aged 62 to 88. Fifty-five percent had normal hearing, 26% had a mild hearing impairment, and 19% had a moderate or greater impairment.
Measurements: Hearing was assessed using objective impairment measures (pure-tone audiometry, speech perception testing) and a self-report measure (Hearing Handicap Inventory for the Elderly). Driving was assessed on a closed road circuit under three conditions: no distracters, auditory distracters, and visual distracters.
Results: There was a significant interaction between hearing impairment and distracters, such that people with moderate to severe hearing impairment had significantly poorer driving performance in the presence of distracters than those with normal or mild hearing impairment.
Conclusion: Older adults with poor hearing have greater difficulty with driving in the presence of distracters than older adults with good hearing.


Driving is a complex everyday activity that is particularly difficult for some older people, as evidenced by the high fatal crash rates of older drivers, who are more likely than younger drivers to be involved in multivehicle crashes in complex traffic conditions and at intersections.[1,2] The driving environment and, in particular, the in-vehicle environment are becoming increasingly complex, with vehicles being equipped with sophisticated navigation and entertainment systems that, like mobile phones, may add to the driver's attentional burden, distracting them from their primary task.

In line with this, recent research has highlighted the potential effect of distraction while driving, particularly auditory distractions and mobile phone use.[3–8] Attending to auditory information has been shown to impair performance on concurrent cognitive and motor tasks, and the degree of this interference varies as a function of the effort that the secondary tasks require.[7,9–11] This may be particularly relevant for people with hearing impairment, who have been shown to suffer greater distractibility in some situations.[10]

Previous research has suggested a link between hearing impairment and difficulties with driving (cessation or adverse events) in older people. Much of the research has relied on self-reported hearing status, and no measures of actual driving performance have been included. For example, a significant relationship has been shown between self-reported adverse driving events and hearing impairment in 589 adults aged 60 and older.[12] Likewise, a study of the driving habits of 2,379 current drivers aged 50 and older found that higher crash rates were associated with poorer visual acuity and moderate self-reported hearing loss, especially in the right ear.[13] Research with the same population of older drivers, but including those who had stopped driving as well as current drivers, found that people who reported hearing difficulties were 1.6 times as likely to have ceased driving.[14] Similarly, a recent study of 752 people aged 65 and older found that poor self-rated hearing was associated with cessation of driving.[15] Other influential factors were older age, marital status, self-rated vision difficulties, and level of independence in activities of daily living.

Further evidence concerning the possible effects of hearing impairment on driving performance is available from a study that explored the role of occupational noise exposure as a risk factor for motor vehicle accidents.[16] Driving records were examined along with pure-tone hearing threshold levels and noise exposure records of 46,030 male workers employed in noisy industries in Quebec, Canada. Daily noise exposure and measured hearing impairment were associated with greater risk of traffic accidents, and the odds of having a traffic accident increased with greater bilateral hearing loss at high frequencies (3, 4, and 6 kHz).

The current study examined the relationship between objective and self-reported measures of hearing and real-world measures of driving performance conducted in the presence and absence of in-vehicle distracters to make the level of complexity more representative of everyday driving tasks. A group of older participants with a range of hearing impairment were assessed, and their performance while driving with no distracters and in the presence of in-vehicle distracters, visual or auditory in nature, was compared. It was hypothesized that hearing impairment would affect driving in the presence of distracters given previous evidence of the greater distractibility of those with hearing impairment in some situations.