Senior Driving Survey - Survey powered by eSurveysPro.com

Senior Driving Survey

Answers marked with a * are required.

1. Welcome to Our Senior Citizen Driving Survey

Although this survey was designed to give information to senior citizen drivers, the information is also useful to people with parents who are senior citizens and to people with younger children.

All questions are on this one page and all require a response. When completed, click NEXT at the bottom of this page to see the answers and more information.
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1. GLAUCOMA is a vision problem that generally affects older drivers. Knowing some symptoms so that you can watch for it in your own driving or that of others can help you manage the issue. Select all of the following that are TRUE. *

1. Bright headlights are upsetting to drivers with Glaucoma

2. Peripheral vision is reduced for drivers with Glaucoma

3. Vision is blurry for drivers with Glaucoma

4. Driving is safe for sufferers of Glaucoma if they avoid drinking alcohol

5. Driving is safe for sufferers of Glaucoma if they keep speed under 40 MPH

6. If treated early, Glaucoma sufferers can drive safely

2. A STROKE is a condition where the blood supply is cut off from a part of the brain and is more likely to happen to senior citizens. Select all of the following statements that are FALSE. *

1. A driver having a stroke will have trouble turning steering wheel or applying brakes

2. A driver having a stroke will be blinded by oncoming headlights

3. A driver having a stroke becomes confused or frustrated while driving

4. A driver having a stroke may drive across lane markings into other lanes

5. A driver having a stroke may not think clearly about traffic situations

6. After suffering a stroke a person should never drive again.

3. PARKINSON'S disease can cause your arms, hands or legs to shake, even when relaxed. Select the following statements that are TRUE for sufferers of Parkinson's disease. Answers and more information will be provided on the next page. *

1. A driver with Parkinson's disease may not be able to avoid road hazards

2. A driver with Parkinson's disease may not be able to turn the steering wheel

3. A driver with Parkinson's disease may not be able to properly use the gas or brake pedal

4. Persons with Parkinson's disease should never drive

4. ALZHEIMER'S disease is not readily detected and early warning signs can be helpful. Select all of the following statements that are TRUE symptoms of possibly having Alzheimer's disease. More information will be provided at end of survey. *

1. One symptom is forgetting where you are going or where you left your car

2. Another symptom is that other drivers frequently honk at you

3. Having difficulty making turns, especially left turns, is also a symptom

4. Experiencing blurry vision is another symptom

5. Having unusual calmness while driving is still another symptom

6. Finding dents and scrapes on your car that can't be explained is a symptom, also

5. CAR MAINTENANCE is also a factor for safe driving. Periodic maintenance is vital to having a car that performs properly. Select the ONE statement below that is TRUE. More information will be provided at end of survey. *

1. Headlights in newer cars are set at factory and do not need regular checks for accuracy

2. Windshields, both inside and out, need to be cleaned at least monthly

3. Modern tubeless tires need to have air pressure checked at least once a year.

6. DRIVER VISION is a major aspect of safe driving. Just being able to see through the windshield does not mean that a driver has adequate vision of the road ahead. Select the MINIMUM distance that a driver should be able to see the road ahead. More information will be provided at end of survey. *

5 feet

10 feet

20 feet

40 feet

60 feet

75 feet

7. CHILD SAFETY is a major concern for all drivers. What makes this an extra concern for senior drivers is that they may be driving grandchildren and may not be aware of the importance of where children should sit and the proper use of special seats designed for child use. Select all of the TRUE statements below. More information will be provided at end of survey. *

1. Rear-facing child safety seats can be used in either front or rear seats

2. Forward-facing toddler seats are designed for newborns through age 6

3. Booster seats can be used instead of toddler seats

4. All children age 12 and under should ride in back seat for safety

REVIEW ANSWERS on next page. Just press the NEXT button in lower right to see answers and other information pertaining to this survey.


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