Older Adults' Expectations about Mortality, Driving Life and Years Left without Driving

Transferability of Effective Consultation Skills for Decision-Making Support in the Voluntary Surrender of Older Adult Drivers' Licences in Super-Aged Japan

INTRODUCTION

Previously, we identified eight effective consultation skills to support decision-making in the voluntary surrender of older adult drivers' licences in super-aged Japan. This study aimed to clarify the transferability of these skills.

METHODS

We collected text data by interviewing 11 safe-driving counsellors (four police officers, four clerical staff and three nurses) in the License Division of the National Police Agency from February to March 2022. Interviews were semi-structured and conducted by telephone or email. During the interview, participants were asked to recall their experiences as counsellors providing decision-making support to older drivers and to compare their experiences with the eight consultation skills. We analysed the content of the responses by quantitative text analysis with KH Coder 3 software.

RESULTS

As a characteristic of the words and phrases used by counsellors in their narratives about consultation skills, the most frequently extracted words from among 3147 words were think, parties and family, and promote had the highest mediation centrality. The eight subgraphs were 'Respecting the will of relevant parties from their standpoint is natural', 'Listening attentively and empathetically to relevant parties is effective', 'Presenting objective data to guide decisions is successful', 'Showing cognitive functioning test results is often effective', 'Counselors with medical expertise can elicit positive counseling outcomes', 'Intervention by medical or police counselors facilitates the decision to surrender voluntarily', 'Counseling skills need to be improved' and 'A diagram of the 8 skills is helpful for inexperienced counselors'.

CONCLUSION

The results suggest that the eight consultation skills have similarities and are transferable. This transferability might contribute to practical application or cohort follow-up study research. These skills can be incorporated into counsellor training, and counsellors can be expected to use these skills in the future. Regardless of the safe-driving counsellor's years of experience, the skills can help them provide uniform and accurate support in decision-making regarding the voluntary surrender of older adult drivers' licences. These skills are a promising approach to help older adults lead safe and secure lives as they age.

Predicting Driving Cessation Among Cognitively Normal Older Drivers: The Role of Alzheimer Disease Biomarkers and Clinical Assessments

BACKGROUND AND OBJECTIVES

With the aging US population and increasing incidence of Alzheimer disease (AD), understanding factors contributing to driving cessation among older adults is crucial for clinicians. Driving is integral for maintaining independence and functional mobility, but the risk factors for driving cessation, particularly in the context of normal aging and preclinical AD, are not well understood. We studied a well-characterized community cohort to examine factors associated with driving cessation.

METHODS

This prospective, longitudinal observation study enrolled participants from the Knight Alzheimer Disease Research Center and The DRIVES Project. Participants were enrolled if they were aged 65 years or older, drove weekly, and were cognitively normal (Clinical Dementia Rating [CDR] = 0) at baseline. Participants underwent annual clinical, neurologic, and neuropsychological assessments, including β-amyloid PET imaging and CSF (Aβ42, total tau [t-Tau], and phosphorylated tau [p-Tau]) collection every 2-3 years. The primary outcome was time from baseline visit to driving cessation, accounting for death as a competing risk. The cumulative incidence function of driving cessation was estimated for each biomarker. The Fine and Gray subdistribution hazard model was used to examine the association between time to driving cessation and biomarkers adjusting for clinical and demographic covariates.

RESULTS

Among the 283 participants included in this study, there was a mean follow-up of 5.62 years. Driving cessation (8%) was associated with older age, female sex, progression to symptomatic AD (CDR ≥0.5), and poorer performance on a preclinical Alzheimer cognitive composite (PACC) score. Aβ PET imaging did not independently predict driving cessation, whereas CSF biomarkers, specifically t-Tau/Aβ42 (hazard ratio [HR] 2.82, 95% CI 1.23-6.44, p = 0.014) and p-Tau/Aβ42 (HR 2.91, 95% CI 1.28-6.59, p = 0.012) ratios, were independent predictors in the simple model adjusting for age, education, and sex. However, in the full model, progression to cognitive impairment based on the CDR and PACC score across each model was associated with a higher risk of driving cessation, whereas AD biomarkers were not statistically significant.

DISCUSSION

Female sex, CDR progression, and neuropsychological measures of cognitive functioning obtained in the clinic were strongly associated with future driving cessation. The results emphasize the need for early planning and conversations about driving retirement in the context of cognitive decline and the immense value of clinical measures in determining functional outcomes.

Impact of cognitive impairment on driving behaviour and route choices of older drivers: a real-world driving study

Maintaining driving independence is important for older adults. However, cognitive decline, a common issue in older populations, can impair older adults' driving abilities and overall safety on the roads. This study explores how cognitive impairment influences driving patterns and driving choices among older adults. We analyzed real-world driving patterns of 246 older adults using GPS dataloggers. Our sample included 230 cognitively normal older adults (CN; Clinical Dementia RatingR [CDR] = 0) and 16 older adults with incident cognitive impairment (ICI; CDR = 0.5). The CN group had an average age of 68.2 years, with 46% females and an average of 16.5 years of education, while the ICI group's average age was 69.2 years, with 36% females and an average of 16.0 years of education. We employed spatial clustering and hashing algorithms to evaluate driving behaviours. Significant differences emerged: The ICI group used fewer distinct routes to their most common destination. These differences can be leveraged to develop driving as a digital biomarker for the early detection and continuous monitoring of cognitive impairment.

A Systematic Review of Effective Interventions and Strategies to Support the Transition of Older Adults From Driving to Driving Retirement/Cessation

Background and Objectives

In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation.

Research Design and Methods

A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies.

Results

Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented.

Discussion and Implications

The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Social Cognitive Theory, Driving Cessation, and Alternative Transportation in Later Life

Having viable alternative transportation options could help individuals stop driving when appropriate. This study employs the Social Cognitive Theory (SCT) to understand the barriers and facilitators of alternative transportation among a sample of adults aged 55 and older (N = 32). Using a daily transportation data collection app, MyAmble, the research team asked participants questions structured around environmental, individual, and behavioral factors as outlined in the SCT framework. Responses were analyzed using directed content analysis. Findings suggest a substantial reliance on motor vehicles and it was evident that many participants had never seriously considered what they would do if they could no longer drive. We posit that SCT principles may be applied to help older adults build self-efficacy to transition to driving cessation when needed.

Association between driving frequency and well-being among older adults

OBJECTIVES

Research on driving in older adulthood suggests that driving is a form of independence for older adults and is often associated with increased social capital and overall-being. However, few studies have examined whether the frequency of driving, and not driving alone, affects likelihood of having well-being among older adults. This study aimed to examine the association between frequency of driving and well-being among older adults, guided by the activity theory of aging.

METHODS

Data were drawn from the 2018 National Health and Aging Trends Study, a longitudinal panel survey of Medicare beneficiaries living in the United States. Bivariate analyses were conducted using Chi-square tests and the association between frequency of driving and well-being was tested with a multivariable logistic regression model. Well-being was determined by 11 items measuring positive and negative affect and asking participants if they agreed with certain statements about their lives.

RESULTS

After controlling for other factors that could influence well-being among older adults, results showed that those who drove every day were the most likely to have high well-being, followed by those who drove most days, those who drove some days, those who drove rarely, and those who never drove.

DISCUSSION

The study results indicate that as frequency of driving increases, the chance of having well-being increases among older adults. This supports the activity theory of aging and highlights the importance of productive aging.

The Subjective Experiences of Driving Cessation and Life Satisfaction

Compared to the driving group, the driving cessation group in this study was found to be a high-risk population in terms of their life satisfaction. This study evaluated data from 315 older adults, aged 55 or older, using the 2018 Korean Older Adults Driving and Mobility Service Trend Survey. These data were collected from 17 representative cities and provinces in South Korea. To minimize the potential for selection bias and the confounding factors inherent in observational studies, this study employed the propensity score matching (PSM) method. Following the matching, multivariate regression analyses were conducted to compare the driving cessation group (n = 65) with the driving group (n = 50) in terms of their life satisfaction. After adjusting for demographic and health-related variables, the older adults who had ceased driving were found to have lower life satisfaction (Coef. = -1.39, p-value = 0.018). Our results highlight the importance of establishing preliminary evidence to guide the development of tailored programs for older adults-especially for those likely to experience diminished life satisfaction and heightened risk-to address the mobility challenges stemming from driving cessation.

Medication and Road Test Performance Among Cognitively Healthy Older Adults

Importance

Older adults are increasingly prescribed medications that have adverse effects. Prior studies have found a higher risk of motor vehicle crashes to be associated with certain medication use.

Objective

To determine whether specific medication classes were associated with performance decline as assessed by a standardized road test in a community sample of cognitively healthy older adults, to evaluate additional associations of poor road test performance with comorbid medical conditions and demographic characteristics, and to test the hypothesis that specific medication classes (ie, antidepressants, benzodiazepines, sedatives or hypnotics, anticholinergics, antihistamines, and nonsteroidal anti-inflammatory drugs or acetaminophen) would be associated with an increase in risk of impaired driving performance over time.

Design, Setting, and Participants

This was a prospective cohort study of 198 cognitively healthy adults 65 years and older with a valid driver's license who were followed up annually, with rolling enrollment. Data were collected from participants in St Louis, Missouri, and neighboring Illinois who were enrolled in the Knight Alzheimer's Disease Research Center. Data were collected from August 28, 2012, to March 14, 2023, and analyzed from April 1 to 25, 2023. Participants with healthy cognition, defined as a Clinical Dementia Rating score of 0 at baseline and subsequent visits, who had available clinical, neuropsychological, road tests, and self-reported medication data were included.

Exposure

Potentially driver-impairing medication use.

Main Outcomes and Measures

The primary outcome measure was performance on the Washington University Road Test (pass or marginal/fail). Multivariable Cox proportional hazards models were used to evaluate associations between potentially driver-impairing medication use and road test performance.

Results

Of the 198 included adults (mean [SD] baseline age, 72.6 [4.6] years; 87 female [43.9%]), 70 (35%) received a marginal/fail rating on the road test over a mean (SD) follow-up of 5.70 (2.45) years. Any use of antidepressants (adjusted hazard ratio [aHR], 2.68; 95% CI, 1.69-4.71), serotonin and norepinephrine reuptake inhibitors (aHR, 2.68; 95% CI, 1.54-4.64), sedatives or hypnotics (aHR, 2.70; 95% CI, 1.40-5.19), or nonsteroidal anti-inflammatory drugs (aHR, 2.72; 95% CI, 1.31-5.63) was associated with an increase in risk of receiving a marginal/fail rating on the road test compared with control individuals. Conversely, participants taking lipid-lowering agents had a lower risk of receiving a marginal/fail rating compared to control individuals. There were no statistically significant associations found between anticholinergic or antihistamines and poor performance.

Conclusions and Relevance

In this prospective cohort study, specific medication classes were associated with an increase in risk of poor road test performance over time. Clinicians should consider this information and counsel patients accordingly when prescribing these medications.

Driving under the influence of substances and motor vehicle fatalities among older adults in the United States

OBJECTIVE

This study examines contribution of substance use (including alcohol, cannabinoids, stimulants, narcotics, depressants, and hallucinogens) on the probability of drivers being at-fault for a crash on U.S. public roads, with specific emphasis on older adult drivers.

METHODS

Data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) for the years 2010-2018 were employed for 87,060 drivers (43,530 two-vehicle crash pairs) involved in two moving vehicle crashes. The quasi-induced exposure (QIE) method was used to compute the relative crash involvement ratios (CIRs) for each relevant substance and illicit drug. Mixed-effect generalized linear regression models were fit to examine the effect of substance use on the probability of a driver being at-fault for a crash.

RESULTS

There were 75.51% males and 73.88% Non-Hispanic Whites in our sample. The CIR for those aged 70-79 years was 1.17, and more than double (2.56) for the ≥80 years old drivers, while being relatively low among drivers of ages 20 to 69. Substance use, in general, disproportionately increased the probability of being at-fault during a crash, regardless of driver's age. Though older drivers are less likely than other age groups to report substance use, presence of substances among older drivers increased the probability of their being at-fault two to four times during a crash across almost all substances. The regression models, after adjusting for driver's sex, road grade, weather, light conditions, distraction, and speeding at time of crash, revealed that older drug-impaired drivers were twice as likely to be at fault in a fatal crash (aOR = 1.947; 95% CI = 1.821, 2.082; <0.0001) compared to their middle-aged counterparts. Similarly, most substance use categories were responsible for the probabilities of higher CIRs among the drivers.

CONCLUSION

These findings necessitate continued efforts to bring awareness to the deadly consequences of "drugged driving," especially among older adult drivers.

"I don't trust it, so I don't read it": How do older Australians navigate and search for information about their health and driving?

OBJECTIVES

Driving is pivotal to successful aging, yet older people may need to adapt their driving to changes associated with aging or transition to driving retirement at some stage. However, most older people are reluctant to discuss or plan for changes to their future mobility. This study describes formative research to inform a social marketing campaign to promote the "DRIVING AND STAYING INDEPENDENT" resource assisting older drivers to make informed decisions about timely changes to their driving.

METHODS

Semi-structured interviews were conducted with 16 drivers aged between 67 and 84 years living in the state of NSW, Australia. A discussion guide based on social marketing principles was used to explore the perspectives and experiences of older drivers seeking health and driving information. Thematic analysis was conducted on the interview data.

RESULTS

Succinct, clear messages with a clear call to action were identified as essential features of social marketing campaigns targeting older drivers. Realistic portrayals of older people in marketing material are important in engaging the audience. Older drivers preferred positive messages that emphasize the relevance of the product to them. Trusted and reputable sources were of utmost importance when seeking health and driving information. Traditional channels such as TV and radio remain the dominant media consumed by the older participants, however, digital resources are being used increasingly.

CONCLUSIONS

This study provides important insights for an evidence-based social marketing campaign promoting the "DRIVING AND STAYING INDEPENDENT" resource to older drivers. The findings add to the limited literature on campaigns targeting older adults and may prove valuable for promoting other issues relevant to older adults. Campaigns targeting older drivers should consider selecting clear messages, demonstrating relevance to the audience, using trustworthy sources and selecting channels used by older adults.

Non-cognitive factors associated with driving cessation among older adults: An integrative review

Exploring the factors that affect driving cessation is crucial, because sustained mobility plays an important role in successful aging. This study aimed to collect evidence on the non-cognitive factors associated with driving cessation among older adults. The method used in this study was an integrated review of published research on the factors affecting driving cessation. A comprehensive search was performed using electronic databases including PubMed, Web of Science, Scopus, CINHAL, ProQuest, EBSCO, and Google Scholar. The results revealed six main categories (physical health, psychological health, interpersonal influence, transportation support, policies, and sociodemographic characteristics) and 24 subcategories for driving cessation. Given the potentially serious consequences of driving cessation in the older adult population, exploring the predictors of driving cessation can be used to design interventions for optimizing drivers' health, rehabilitating the functional limitations that affect driving ability, creating a safer driving environment, and optimizing vehicles to meet the needs of older drivers.

‘…it's hard to prepare yourself, it's like a death’: barriers and facilitators to older people discussing and planning for driving retirement

Driving is the preferred mode of transport for many older drivers, providing mobility to maintain independence and quality of life. The loss of driving privilege has negative psychosocial consequences, including depression. Early discussions and planning for driving retirement are therefore essential. Driving retirement, however, is typically a taboo topic for older drivers and their support networks. To understand why discussions and planning about driving retirement are avoided, 43 semi-structured interviews were conducted with older drivers in New South Wales, Australia. Drawing on Löckenhoff's ageing and decision-making framework, thematic analysis of transcripts offers insights into why discussions and planning for driving retirement are avoided or facilitated. The findings reveal most older drivers had not discussed or planned for driving retirement. Barriers to discussing and planning for driving retirement included: perceptions of loss, change, death and denial. Facilitators to discussing or planning for driving retirement included: declining health and driving confidence, medical advice, age or car accident. Driving retirement in car-dependent societies is a major life event, symbolising an end-of-life stage for many older people. This paper calls for strategies to encourage early and regular discussions about driving retirement with older drivers. To support older drivers’ transition to driving retirement, an understanding of the value and meaning placed on driving in the context of the individuals' identity and lifestyle is recommended.

Naturalistic driving measures of route selection associate with resting state networks in older adults

Our objective was to identify functional brain changes that associate with driving behaviors in older adults. Within a cohort of 64 cognitively normal adults (age 60+), we compared naturalistic driving behavior with resting state functional connectivity using machine learning. Functional networks associated with the ability to interpret and respond to external sensory stimuli and the ability to multi-task were associated with measures of route selection. Maintenance of these networks may be important for continued preservation of driving abilities.

Planning for Driving Retirement: The Effect of Driving Perceptions, Driving Events, and Assessment of Driving Alternatives

Most older adults will eventually stop driving, but few engage in planning for driving retirement. This study assessed whether driving stress, enjoyment, confidence, concerning driving events, and assessment of driving alternatives influence planning. Demographic factors were also included. Data were collected via a mailed transportation survey, with a final sample of 551 older adults who currently drive. Linear regression analyses revealed that more driving retirement planning was associated with greater driving stress, less driving confidence, and a more positive view of driving alternatives. Driving enjoyment and recent concerning driving events were not significantly related. Among the control variables, race and income were significantly related to planning, suggesting that lower income and identifying as Black race were associated with more planning. Gender only approached significance, suggesting that females may plan more than males. Overall, these findings suggest that more driving retirement planning is warranted. Some of the groups known to be at increased risk for driving reduction and cessation plan more for that eventuality than their counterparts. Implications of the study and suggestions for future research are discussed.

How Accumulated Wealth Affects Driving Reduction and Cessation

Background and Objectives

Older adults can expect to live between 6 and 10 years after they give up driving, but driving reduction and cessation (DRC) are not equally experienced by all groups. Individual characteristics such as poor health, impaired vision, older age, and female gender are known to affect DRC. Using cumulative disadvantage theory as a guide, this study assessed the role played by wealth in DRC among older adults.

Research Design and Methods

Data from the National Health and Aging Trends Study were analyzed using multinomial logistic regression techniques. This allowed for the effect of each predictor on the odds of engagement in a given driving status (full driving, driving reduction [DR], and driving cessation [DC]) to be compared to each of the others.

Results

The final sample included 6,387 participants. After controlling for the effect of covariates, less wealth was associated with higher odds of DR compared to full driving, DC compared to full driving, and DC compared to DR. Confirming previous research, several other factors were also significantly related to driving status including age, health, vision, gender, race, education, relationship status, household size, and work status.

Discussion and Implications

The influence of wealth on driving status among older adults represents another disadvantage unequally distributed to some in older adulthood. Those with less wealth will have fewer resources to meet their mobility needs using alternatives and may already be facing additional financial constraints due to worse health and other challenges associated with lower socioeconomic status.

A Systematic Review Examining Associations between Cardiovascular Conditions and Driving Outcomes among Older Drivers

There is a vast literature on stroke as a cardiovascular disease and driving outcomes, however little is known about other cardiovascular conditions and driving. The purpose of this review is to examine the literature for studies assessing the effect of non-stroke, vascular conditions on daily driving, reported crash risk and driving decline in older adult drivers as captured by naturalistic methodologies. A systematic review of Embase, Ovid and Scopus Plus examined articles on driving and vascular conditions among older adults. A search yielded 443 articles and, following two screenings, no articles remained that focused on non-stroke, vascular conditions and naturalistic driving. As a result, this review examined non-stroke, vascular conditions in nine driving studies of older adults that used road testing, driving simulators and self-report measures. These studies fell into three categories—heart failure, vascular dementia and white matter hyperintensities/leukoaraiosis. The combined findings of the studies suggest that heart failure, vascular dementia and white matter hyperintensities (WMH) negatively impact driving performance and contribute to driving cessation among older adults. Future research should examine cardiovascular risk factors like hypertension, hypercholesterolemia, myocardial infraction or atherosclerosis using naturalistic driving measurement, as well as traditional measures, in order to more fully characterize how these conditions impact older adult driving.