Sociodemographic and health factors in driving patterns after 50 years of age

Modeling of older adults' driving exposure and avoidance using objective driving data in a naturalistic driving study

Older adults in the United States rely heavily on driving their own vehicles to commute to work, shop for groceries, and access public services. To effectively help older adults maintain mobility and independence,we need to better understand how thecognitive, visual functioning, and health declines influence their tendency to self-restrict their driving. The objective of this study is to develop a causal model to examine the effects of age, gender, household status (specifically living alone), physical, cognitive, visual abilities, and health status on older adults' driving mobility in terms of driving exposure and avoidance. Driving exposure was measured by actual driving data, whereas driving avoidance was assessed by both self-report data and actual driving exposure to challenging situations. Structural equation modeling was used to analyze data collectedin the Second Strategic Highway Research Program Naturalistic Driving Study for establishing relationships between the selected factors and mobility. The structural equation model included a total of794 participants aged 65 and over (367 or 46.22%femalesand 427 or 53.78% males). Results indicate that poorer health is associated with less driving exposure; deteriorating cognitive and physical capabilities are associated with more self-reported driving avoidance and less actual driving in challenging situations; visual function is associated with self-reported avoidance; living alone is associated with higher driving exposure in general as well as in challenging situations; self-reported driving avoidance of challenging situations has a negative association with actual driving in those same situations. The final model could be applied to predict older adults' mobility changes according to their age, gender, household status, as well as their visual, physical, cognitive and health status.

Sex differences in cognitive-motor components of braking in older adults

Fast and accurate braking is essential for safe driving and relies on efficient cognitive and motor processes. Despite the known sex differences in overall driving behavior, it is unclear whether sex differences exist in the objective assessment of driving-related tasks in older adults. Furthermore, it is unknown whether cognitive-motor processes are differentially affected in men and women with advancing age. We aimed to determine sex differences in the cognitive-motor components of the braking performance in older adults. Fourteen men (63.06 ± 8.53 years) and 14 women (67.89 ± 11.81 years) performed a braking task in a simulated driving environment. Participants followed a lead car and applied a quick and controlled braking force in response to the rear lights of the lead car. We quantified braking accuracy and response time. Importantly, we also decomposed response time in its cognitive (pre-motor response time) and motor (motor response time) components. Lastly, we examined whether sex differences in the activation and coordination of the involved muscles could explain differences in performance. We found sex differences in the cognitive-motor components of braking performance with advancing age. Specifically, the cognitive processing speed is 27.41% slower in women, while the motor execution speed is 24.31% slower in men during the braking task. The opposite directions of impairment in the cognitive and motor speeds contributed to comparable overall braking speed across sexes. The sex differences in the activation of the involved muscles did not relate to response time differences between men and women. The exponential increase in the number of older drivers raises concerns about potential effects on traffic and driver safety. We demonstrate the presence of sex differences in the cognitive-motor components of braking performance with advancing age. Driving rehabilitation should consider differential strategies for ameliorating sex-specific deficits in cognitive and motor speeds to enhance braking performance in older adults.

Older Driver Crash Involvement and Fatalities, by Age and Sex, 2000-2017

Federal reporting of crash fatalities has limited age-by-sex stratification, but both age and sex are associated with driving reduction and cessation. We described older driver fatal crash involvement and fatalities using Fatality Analysis Reporting System data to calculate rates (per 100,000 licensed drivers, per 100,000 population) with age-by-sex stratifications. Nationally from 2000 through 2017, 110,422 drivers 65+ were involved in crashes resulting in at least one death within 30 days, and 67,843 of these older drivers died. Involvement and fatality rates per 100,000 licensed drivers in 2017 were lowest for females 65-69 (7.7 and 3.6, respectively) and highest for males age 85+ (34.3 and 25.5, respectively). Females had lower driver fatal crash involvement and fatality rates throughout the lifespan, even when rates generally decreased over time. Elaborating fatal crash trends and rates by age and sex helps to differentiate the public health burden of older driver crashes and fatalities.

Psychological Resources and Driving Status: A Study of Current and Former Drivers 55 Years of Age and Older

Psychological resources can help individuals adjust to changes associated with aging. In this study, we examined the effect of demographic, health, and psychological resource variables in explaining driving status among adults 55 years and older. A convenience sample of 222 adults between the ages of 55 and 91 years (mean = 72.20 years) completed questionnaires that included measures of driving status, self-rated health, and psychological resources (e.g., life control, life purpose, and locus of control). Multiple logistic regression models that controlled for confounders were constructed with driver status (i.e., current driver or former driver) as the outcome. Former drivers were older, reported being in poorer health, and reported more depression symptoms. After controlling for age and health, current drivers reported higher levels of life control and life purpose and a more internal locus of control. Results highlight the importance of considering psychological resources when examining driving cessation.

The Social Utility and Health Benefits for Older Adults of Amenity Buildings in China's Urban Parks: A Nanjing Case Study

As China's population rapidly ages, research and discussion on how to better optimize public spaces for the elderly's health and benefit continue to deepen. This study uses observational surveys and questionnaires to investigate the elderly visitors of Nanjing's urban parks and explore the impact the parks' amenity buildings (structures built to provide visitors with conveniences, e.g., shelters and pavilions) has on their health and associated socialization tendencies. Data were collected from ten amenity buildings in ten separate parks to compose a total dataset of 728 activity statistics and 270 valid questionnaires. The study's results indicate that amenity buildings significantly increase opportunities for older adults to socialize and thereby can increase this demographic's associated health benefits. The social activities formed around amenity buildings are found to improve social interactions and connectedness among older adults more compared to other age groups. Elderly participation in social activities is also found to positively correlate with environmental characteristics. High-quality landscapes ensure healthy development of social activities within amenity buildings and promote the occurrence and continuation of social interactions. In order of highest to lowest impact on elderly activities, the following factors were identified and scored: amenity building scale, lighting, comprehensive surrounding environment, surrounding amenities, water features, and vegetation. This research also reveals that among existing amenity buildings, there is insufficient support for certain activities and therefore, parks need to be improved to address this deficiency. Overall, this study indicates that under China's current aging trends, amenity buildings have become an especially important infrastructure within urban public space, and their design trend is to incorporate the dual characteristics of "recreation + society".

Coming Out of "Retirement"-Predictors of Driving Resumption Among Older Drivers

Background and Objectives

Predictors and consequences of driving cessation in older adults have been studied extensively. This study sought to establish the extent to which former drivers resume driving and identify associated factors.

Research Design and Methods

Descriptive analysis of the 2011–2015 National Health and Aging Trends Study data (Round 1: n = 6,680; Round 5: n = 3,409) characterized the extent of driving resumption through 2015 by baseline driving status (driver, former driver, never driver). Weighted multivariate logistic regression and multilevel longitudinal models examined predictors of driving resumption.

Results

Among drivers who stopped driving during the study, 17%–28% resumed driving. Age, vehicle ownership, stroke, hospitalization, memory, and perceived transportation barriers were associated with resumption in regression analysis. In multilevel analysis stratified by baseline driving status, poor word recall (OR = 0.62; 95% CI = 0.40, 0.95) and use of public transportation (OR = 9.74; 95% CI = 1.54, 61.77) were significantly associated with driving resumption for baseline drivers, while use of taxi (OR < 0.001; 95% CI = <0.001, 0.02) was negatively associated with resumption for baseline former drivers.

Discussion and Implications

This study highlights several factors associated with driving resumption. Uncertainty about the underlying causes for resumption remains, so results should be interpreted with caution. However, predictive factors may help to identify individuals in need of additional mobility transition counseling. Ongoing transportation assessment may be warranted among former drivers.

Risk and safety perception on urban and rural roads: Effects of environmental features, driver age and risk sensitivity

OBJECTIVE

The ability to detect changing visual information is a vital component of safe driving. In addition to detecting changing visual information, drivers must also interpret its relevance to safety. Environmental changes considered to have high safety relevance will likely demand greater attention and more timely responses than those considered to have lower safety relevance. The aim of this study was to explore factors that are likely to influence perceptions of risk and safety regarding changing visual information in the driving environment. Factors explored were the environment in which the change occurs (i.e., urban vs. rural), the type of object that changes, and the driver's age, experience, and risk sensitivity.

METHODS

Sixty-three licensed drivers aged 18-70 years completed a hazard rating task, which required them to rate the perceived hazardousness of changing specific elements within urban and rural driving environments. Three attributes of potential hazards were systematically manipulated: the environment (urban, rural); the type of object changed (road sign, car, motorcycle, pedestrian, traffic light, animal, tree); and its inherent safety risk (low risk, high risk). Inherent safety risk was manipulated by either varying the object's placement, on/near or away from the road, or altering an infrastructure element that would require a change to driver behavior. Participants also completed two driving-related risk perception tasks, rating their relative crash risk and perceived risk of aberrant driving behaviors.

RESULTS

Driver age was not significantly associated with hazard ratings, but individual differences in perceived risk of aberrant driving behaviors predicted hazard ratings, suggesting that general driving-related risk sensitivity plays a strong role in safety perception. In both urban and rural scenes, there were significant associations between hazard ratings and inherent safety risk, with low-risk changes perceived as consistently less hazardous than high-risk impact changes; however, the effect was larger for urban environments. There were also effects of object type, with certain objects rated as consistently more safety relevant. In urban scenes, changes involving pedestrians were rated significantly more hazardous than all other objects, and in rural scenes, changes involving animals were rated as significantly more hazardous. Notably, hazard ratings were found to be higher in urban compared with rural driving environments, even when changes were matched between environments.

CONCLUSION

This study demonstrates that drivers perceive rural roads as less risky than urban roads, even when similar scenarios occur in both environments. Age did not affect hazard ratings. Instead, the findings suggest that the assessment of risk posed by hazards is influenced more by individual differences in risk sensitivity. This highlights the need for driver education to account for appraisal of hazards' risk and relevance, in addition to hazard detection, when considering factors that promote road safety.

Predictors of driving outcomes including both crash involvement and driving cessation in a prospective study of Japanese older drivers

The first aim of this study was to investigate predictors of future traffic crash involvement, taking into account bias in the handling of data for former drivers. The second aim was to compare characteristics of former drivers and crash-involved drivers in order to gain an understanding of appropriate driving cessation among older drivers. In all, 154 drivers aged 70 years or older participated in the baseline interview and the follow-up survey conducted two years later. In the baseline interview, participants were asked to respond to a questionnaire, take the Useful Field of View test^® (UFOV), and complete the Mini-Mental State Examination. In the follow-up survey, participants were asked by mail or telephone whether they had stopped driving. Participants reporting that they still drove were invited to participate in a subsequent interview. Based on the information obtained in the follow-up survey, participants were classified as follows: driving cessation group (n=26); crash-involved group (n=18); and crash-free group (n=110). A multinomial logistic regression was then used to analyse the data. Contrary to the results of previous studies, we found older age to be associated with crash involvement but not with driving cessation. The cessation group had more decreased cognitive processing speed than the crash-involved and crash-free groups. Crash history was also predictive of crash involvement. Participants who were subject to license renewal between baseline and follow-up had a greater tendency to continue driving. Results suggested that age and crash history could potentially identify high-risk older drivers. The predictive power of cognitive processing speed is reduced under certain conditions. License-renewal procedures may induce Japanese older adults to continue driving. Future studies should use a large national sample to confirm the results of the present study.

Driving SAFE

The purpose of this study was to develop a screening test of driving knowledge for use with dementia patients and other older drivers. Seventy-five drivers with dementia and 80 non-demented elderly drivers completed a 39-item questionnaire concerning the rules-of-the-road and a Mini-Mental State Examination (MMSE). Using item analysis, 15 items were selected for a screening test.The internal consistency reliability of the test was 0.74, while that of all 39 questions was 0.79. Patient and control means on the test differed significantly ( p < 0.001). MMSE scores accounted for only 16 percent of the variance in driving knowledge scores in the dementia patients. Results suggest that it is possible to develop a knowledge-based driving instrument that can successfully be administered to patients with diagnoses of mild to moderate dementia. Drivers with dementia demonstrated significantly poorer knowledge of driving regulations than the control group. However, the final score on the driving instrument was not well predicted by the MMSE, suggesting that direct assessment of driving knowledge is important to driving assessment.

Meaning and Management of Food Security Among Rural Elders

Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. This study uses fixed response and textual data obtained through in-depth interviews with adults 70 years and older from a multiethnic population in rural North Carolina to examine the incidence of food insecurity and how older adults experience food insecurity and maintain food security. We interviewed 145 elders up to five times over the course of 1 year. Responses to standard food insecurity questions indicate that only 12% of older adults experience food insecurity. However, analysis of textual data reveals common themes concerning food insecurity that suggest that these questions may underestimate the number of rural elders who are food insecure and not tap the potential vulnerability of others who are dependent on precarious nutritional self-management strategies to meet their needs.

Driving Cessation and Health in Older Women

To study the association of health and driving cessation in older female drivers, a mail survey was sent to all Finnish women born in 1927 who gave up their driver license at the age of 70 (n = 1,476) and to a corresponding random sample of women who renewed their license at the age of 70 (n = 1,494). The ex-drivers had poorer overall health status than the drivers, but the health conditions related to driving cessation were in general not of the type impairing driving ability but rather decreasing overall well-being and physical mobility. The results suggest that there is a significant number of older women giving up their license while still fit to drive; hence, for many women, driving cessation may imply a voluntary but unnecessary resignation from an active and independent life.

Racial and Ethnic Differences in the Likelihood of Vaginal Birth After Cesarean Delivery

BACKGROUND

A major contributor to the increase in cesarean deliveries over recent decades is the decline in vaginal births after cesarean (VBAC). Racial and ethnic disparities in other perinatal outcomes are widely recognized, but few studies have been directed toward racial/ethnic differences in VBAC rates.

METHODS

We used the population-based Massachusetts Pregnancy to Early Life (PELL) database to investigate racial/ethnic differences in rates of VBAC for Massachusetts residents with one prior cesarean from 1998 to 2008.

RESULTS

The overall VBAC rate was 17.3 percent. After adjusting for demographic, behavioral, and medical risk factors, non-Hispanic Asian mothers had a greater likelihood of VBAC than non-Hispanic white mothers (adjusted risk ratio 1.31 [95% CI 1.23-1.39]). No other racial/ethnic group was significantly different from non-Hispanic whites in adjusted analyses. The likelihood of VBAC also decreased with increasing maternal age.

DISCUSSION

Non-Hispanic Asian women are significantly more likely to have VBAC than non-Hispanic white women. Efforts to reduce cesarean delivery rates in the United States should address these disparities. Future research should investigate factors underlying these differences to ensure that all women have access to appropriate maternity care services.

Meta-analysis of best corrected visual acuity after treatment for myopic choroidal neovascularisation

AIM

To compare the best corrected visual acuity (BCVA) between Verteporfin with photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in patients with myopic choroidal neovascularization (CNV).

METHOD

Published literature from Medline, Premedline, Embase and the Cochrane Library from inception until November 2013 were retrieved. All studies evaluating the BCVA between Verteporfin with PDT and intravitreal anti-VEGF for myopic CNV were included. The results were pooled using mean difference (MD), a corresponding 95% confidence interval (CI).

RESULTS

Finally, five studies enrolled 349 eyes were included in the meta-analysis. We inferred that the BCVA of myopic CNV after the treatment of anti-VEGF was significantly better compared with Verteporfin with PDT (MD=0.25, 95%CI:0.17-0.33, Z=5.97, P<0.00001).

CONCLUSION

This meta-analysis suggests that intravitreal anti-VEGF could have a better BCVA after treatment than Verteporfin with PDT for myopic CNV.

Biopsychosocial Risk Factors for Driving Cessation

Objective: This study aims to identify social, psychological, and biomedical risk factors for current and future driving cessation in older adults. Method: Data from six waves (1998-2008) of the Health and Retirement Study (HRS) were pooled. Participants aged 65 and above were included in the study ( N = 17,349). Results: Multivariate logistic regression models to identify risk factors for current and future driving cessation were consistent (age, gender, education, race, marital status, income, cognitive function, limits in activities of daily living and instrumental activities of daily living, vision, health, diabetes, stroke, arthritis, and hip fracture). Only one variable, falls, was associated with future driving cessation (odds ratio [OR] = 0.92; confidence interval [CI] = [0.85, 1.0]), but not current driving cessation. Discussion: Older age, female gender, and minority race were risk factors for current and future cessation. Adults with arthritis were more likely to keep driving compared with those without arthritis.

The impact of transportation support on driving cessation among community-dwelling older adults

OBJECTIVES

This study longitudinally examines the impact of transportation support on driving cessation among community-dwelling older adults residing in retirement communities.

METHOD

Data came from 3 waves of the Florida Retirement Study (1990-1992), a population-based cohort study. Analysis was limited to participants who drove at baseline and were reinterviewed in 1992 (N = 636). Transportation support from a spouse, family members, friends/neighbors, agencies/organizations (e.g., church), or hired assistants was included. Discrete-time multivariate hazard models were estimated to examine the impact of transportation support on driving cessation while controlling for demographic and health characteristics.

RESULTS

Participants were more likely to stop driving if they had received at least some transportation support from friends/neighbors (Hazard Ratio = 2.49, p = .001) as compared with those with little or no support. Transportation support from organizations/agencies or hired assistants was also significantly associated with the likelihood of driving cessation, but only a small number of participants reported to have received such support. Receiving some or more transportation support from a spouse or family members did not have a statistically significant relationship with driving cessation.

DISCUSSION

The findings suggest that available nonkin transportation support, particularly support from peer friends, plays an important role in driving cessation for older adults living in retirement communities.

Walking the tightrope: developing a systems approach to balance safety and mobility for an aging society

In an aging population, safety and mobility are often viewed as being in conflict, when in fact they are two values that must be reflected equally in transportation policy. The challenge for policy makers and for society is to emphasize and optimize both. To achieve this, a comprehensive systems approach to driver health, personal decision-making and planning, community and transportation systems construction, vehicle design, and licensing regulations is needed. Such an approach requires crafting policies based on conceptualizing the issue as a continuum of resources facilitating safety and mobility regardless of driving status. The discussion that follows reviews components of the issue and suggestions for developing a comprehensive approach.

Examining the aging process through the stress-coping framework: application to driving cessation in later life

The aging process is marked by a series of transitions that influence multiple domains of well-being. One important transition for older adults is the process of driving cessation. Numerous studies have examined risk factors for driving cessation among older adults to identify at-risk older drivers for road safety. Recent research has focused on the consequences of driving cessation in later life for health and well-being. However, these reports have been largely empirical and are not drawn from a defined conceptual framework. Establishing a theoretical model of 'how driving cessation interacts with other processes and domains of aging' will promote synthesis of seemingly disparate findings and also link the empirical research on cessation to the broader field of gerontology. This article describes a conceptual model for articulating and examining the components of the driving cessation process based on the stress-coping paradigm. This model situates driving cessation within the context of exogenous stressors, individual vulnerabilities and coping strategies, and environmental hazards and buffers over the lifespan. This model could assist in guiding intervention strategies aimed at reducing premature driving cessation in older drivers with ameliorable impairments while assisting at-risk older drivers to reduce or stop driving in a less stressful way.

Multiple chronic medical conditions and associated driving risk: a systematic review

BACKGROUND

Numerous medical conditions can affect one's ability to operate a motor vehicle. The likelihood of having multiple medical conditions increases with advancing age; however, the interplay of the associated impairments has not been previously addressed in the literature.

OBJECTIVE

To identify the incremental risks for the effects of multiple chronic medical conditions on driving ability and crash risk.

METHODS

A comprehensive English-language literature search using the keywords driving, motor vehicle crashes, accidents, multiple medical conditions, and chronic medical conditions was completed. To be included, the article had to address the effects of the combination of multiple chronic medical conditions on driving and include a relevant outcome, such as crashes, driving violations, on-road driving assessment, driving simulator assessment, or driving cessation/avoidance patterns.

RESULTS

The overall trend was for increasing number of chronic medical conditions to be associated with higher crash risk and higher likelihood of driving cessation. Although there is some evidence that impaired functional abilities are associated with poorer driving outcome, most of the studies do not support this. No studies were identified that evaluated compensation techniques for drivers with multiple chronic medical conditions with the exception of driving avoidance or self-restriction.

CONCLUSIONS

The evidence supports the view that drivers with more chronic medical conditions tend to cease driving or engage in driving avoidance. The myriad combinations of diseases and disease severity present a level of complexity that complicates making informed decisions about driving with multiple chronic medical conditions.

Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years

PURPOSE

The purpose of this study was to prospectively examine the role of cognitive and instrumental functional performance in driving cessation while simultaneously accounting for any contributions of demographics, vision, physical performance, and health among a sample of older adults without dementia.

DESIGN AND METHODS

Included in the analyses were 1,838 participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were drivers at baseline and completed the third-year assessment. Participants completed baseline assessments of sociodemographic characteristics, health, sensory function, physical function, cognitive abilities, instrumental functional performance, and depressive symptoms. Driving status was again ascertained 3 years later.

RESULTS

We used Cox proportional hazard analyses to examine prospective predictors of driving cessation over a 3-year period. The final model indicated four significant risk factors for driving cessation: older age (hazard ratio [HR] = 1.06, p = .009), poorer balance as measured by the Turn 360 degrees test (HR = 1.17, p = .002), slower cognitive speed of processing as measured by the Useful Field of View test (HR = 1.37, p = .004), and poorer instrumental functional performance as assessed by the Everyday Problems Test (HR = 1.59, p < .001).

IMPLICATIONS

Although vision, health, and physical abilities are commonly considered when determining driving capacity, cognitive speed of processing and instrumental functional performance may be better indicators of subsequent likelihood of driving cessation across 3 years among older adults. Poor health and vision may only impact driving cessation to the extent that cognitive speed of processing and instrumental functioning are affected.

Driving status and three-year mortality among community-dwelling older adults

BACKGROUND

Driving cessation can lead to myriad negative consequences for older adults. The purpose of these analyses was to examine driving status as a predictor of mortality among community-dwelling older adults.

METHODS

This prospective cohort study included 660 community-dwelling adults ranging in age between 63 and 97 years. Between 2000 and 2004, participants completed performance-based assessments of vision, cognition, and physical abilities and indexes of health, depression, self-efficacy, and driving habits. Follow-up telephone interviews were completed approximately 3 years later.

RESULTS

Among community-dwelling older adults, older age, health, poor near visual acuity, depressive symptoms, compromised cognitive status, and being a nondriver are associated with increased risk for a 3-year mortality. Nondrivers were four to six times more likely to die than drivers during the subsequent 3-year period.

CONCLUSIONS

The ability to drive represents both a sign of cherished independence and underlying health and well-being for older adults. Retaining this ability is an important health concern in the United States.

Evidência de validade de construto para o teste de atenção sustentada

O objetivo do estudo foi verificar evidência de validade de construto para o Teste de Atenção Sustentada. Participaram da pesquisa 127 indivíduos, que passaram pelo processo de avaliação psicológica para a obtenção da carteira Nacional de Habilitação em clínicas credenciadas pelo DETRAN. Os resultados mostraram correlações negativas e significativas entre as medidas de concentração e de velocidade com qualidade do Teste de Atenção Sustentada e a idade. Nas análises de variância, o agrupamento das diferentes idades apresentou diferenças estatisticamente significativas tanto em relação à concentração como à velocidade com qualidade. com base nesses resultados, concluiu-se que houve evidência de validade de construto, a partir da análise das idades, para essas medidas.

Self-Reported Health and Driving Cessation in Community-Dwelling Older Drivers

BACKGROUND

Stopping driving has significant negative consequences for older adults, but there is no simple, reliable screening tool to predict driving cessation. We sought to determine if self-rated health (SRH) was an independent predictor of driving cessation among older adults.

METHODS

Data on SRH (poor, fair, good, very good, or excellent), medical diagnoses, physical performance, visual acuity, driving status, and other relevant covariates were collected from 649 community-dwelling older Alabama drivers during in-home interviews. Using multivariable logistic regression analyses, we estimated the association of SRH with driving cessation 2 years later.

RESULTS

Participants had a mean age of 74 years; 43% were women, 41% African American, and 48% rural. Overall, 36% reported poor to fair SRH at baseline, and 11% had stopped driving after 2 years. Compared to 8% of drivers with good to excellent SRH, 17% with poor to fair health stopped driving (adjusted odds ratio [OR], 1.93; 95% confidence interval [CI], 1.09-3.41; p=.025). Lower Short Physical Performance Battery (SPPB) scores (adjusted OR, 0.86; 95% CI, 0.78-0.95; p=.001) and older age (adjusted OR, 1.06 per year; 95% CI, 1.01-1.11; p=.010) were also associated with driving cessation. Receiver operating characteristics curves documented similar predictive discrimination (c statistics) for SRH (0.72), the SPPB (0.70), and a count of comorbidities based on the Charlson Comorbidity Index (0.73).

CONCLUSIONS

Poor to fair SRH predicted incident driving cessation after 2 years in a cohort of older adults. SRH can be easily obtained during clinic visits to identify at-risk drivers.

Social isolation, support, and capital and nutritional risk in an older sample: ethnic and gender differences

This study examines the relationships that exist between social isolation, support, and capital and nutritional risk in older black and white women and men. The paper reports on 1000 community-dwelling older adults aged 65 and older enrolled in the University of Alabama at Birmingham (UAB) Study of Aging, a longitudinal observational study of mobility among older black and white participants in the USA. Black women were at greatest nutritional risk; and black women and men were the groups most likely to be socially isolated and to possess the least amounts of social support and social capital. For all ethnic-gender groups, greater restriction in independent life-space (an indicator of social isolation) was associated with increased nutritional risk. For black women and white men, not having adequate transportation (also an indicator of social isolation) was associated with increased nutritional risk. Additionally, for black and white women and white men, lower income was associated with increased nutritional risk. For white women only, the perception of a low level of social support was associated with increased nutritional risk. For black men, not being married (an indicator of social support) and not attending religious services regularly, restricting activities for fear of being attacked, and perceived discrimination (indicators of social capital) were associated with increased nutritional risk. Black females had the greatest risk of poor nutritional health, however more indicators of social isolation, support, and capital were associated with nutritional risk for black men. Additionally, the indicators of social support and capital adversely affecting nutritional risk for black men differed from those associated with nutritional risk in other ethnic-gender groups. This research has implications for nutritional policies directed towards older adults.

Driving habits and patterns in older men with glaucoma

Glaucoma, an eye disorder that gradually decreases peripheral vision, affects millions of older adults. Consequences of glaucoma can mean changes in the ability to perform familiar tasks, including driving an automobile. We surveyed older drivers with glaucoma and a control comparison group in order to learn more about their driving habits and expectations about driving cessation. Findings indicate that compared to the control group, drivers with glaucoma are significantly more likely to change their driving habits with regard to driving at night (p=0.003), on freeways (p=0.05), and in unfamiliar areas (p=0.01). Drivers with glaucoma were also significantly more likely to report family concern about their driving (p=0.01). However, the drivers with glaucoma did not anticipate that their disease would force them to discontinue driving. Social workers play a pivotal role in coordinating the complex care needs of visually impaired elders. When driving skills are affected, social workers must address transportation, housing as well as quality of life concerns.

Reasons Given by Older People for Limitation or Avoidance of Driving

PURPOSE

To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance.

DESIGN AND METHODS

Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one medical and nonmedical reasons for limiting or avoiding driving were examined by age and gender.

RESULTS

Most older people continue to drive; however, many, especially older women, report one or more reasons to limit or avoid driving. Among medical reasons, problems with eyesight are by far the most often cited; no other health problem was identified as a major reason for limitation. Among nonmedical reasons, being concerned about an accident, being concerned about crime, and having no reason to drive were often cited. Important predictors of reported driving limitations were low income, limited functional status, and self-report of poor vision.

IMPLICATIONS

Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.

A randomized clinical trial to assess the benefit of offering on-site mobile mammography in addition to health education for older women

OBJECTIVE

We conducted a cluster randomized clinical trial to compare the benefit of offering on-site mobile mammography in addition to an outreach program designed to increase mammography use by educating patients.

SUBJECTS AND METHODS

We recruited a consecutive volunteer sample of 499 women ranging in age from 60 to 84 years who had not undergone mammography in the previous year to participate in a cluster randomized clinical trial about the benefit of on-site mobile mammography. Subjects were recruited from 60 community-based sites where seniors gather. The intervention included a structured on-site multicomponent educational program with or without available on-site mobile mammography. The primary outcome measure was self-reported receipt of mammography within 3 months of the intervention.

RESULTS

Women in the group offered access to on-site mammography and health education were significantly more likely than those in the group offered health education only to undergo mammography within 3 months (55% vs 40%, p = 0.001; adjusted [for clustering] odds ratio, 1.83; 95% confidence interval, 1.22-2.74). Gains from offering on-site mammography were shown for several ethnic and sociodemographic subgroups and were especially large for Asian American women.

CONCLUSION

Offering on-site mammography at community-based sites where older women gather is an effective method for increasing breast cancer screening rates among older women and may be particularly effective for some subgroups of women who traditionally have had low screening rates.

Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities

PURPOSE

This study explored the impact of cognition and the availability of other drivers on driving restriction and cessation among older adults.

DESIGN AND METHODS

Survey data from the first wave of the Asset and Health Dynamics Among the Oldest Old data were analyzed, using multinomial logistic regressions.

RESULTS

Cognitive impairment is associated with driving restriction and cessation, although a noteworthy minority of mildly and severely cognitively impaired individuals continue to drive. Partner's driving and involvement and presence of other drivers in the household moderated the effect of cognition on driving restriction and cessation.

IMPLICATIONS

The decision processes surrounding an individual's restricting or stopping driving are complex and may include consideration not only of competence, but also of sense of self-worth and relationship with a partner.

Aging, driving and vision

Older people constitute the fastest growing sector of the driving population and are believed to represent a high risk to road safety, given their high crash rate per distance travelled. The crash characteristics of the elderly also differ from those of younger drivers and generally involve multiple vehicles and more complex driving situations. Although the reasons for this deterioration in driving performance are multi-factorial, the age-related changes in vision are likely to be a significant factor, given the important role of vision in driving. This paper provides an overview of some of the complex issues associated with older drivers and considers how the aging changes in visual function might impact on driving performance. Particular emphasis is placed on the literature linking vision to driving, with emphasis on more recent research. The implications of this research for driver licensing and self-regulation of older drivers are also discussed.

The effects of driving cessation on the elderly with dementia and their caregivers

This research explores how the loss of driving privileges by impaired drivers affects households. The particular focus is on the travel behavior and preceptions of people living in households where an elderly driver has had his or her license revoked due to Alzheimer's disease or a related dementia. The data for this analysis were drawn from a 1996 survey of households in California which queried the caregivers of people with dementia on how the former drivers access necessary destinations once they can no longer drive, and on the difficulties faced by other household members in seeking alternative means of transportation. After losing their license, the vast majority of people surveyed depended on informal support systems for transportation, such as rides from family and friends. Although such arrangements were not reported to be a problem for the majority of households, certain groups of non-drivers reported difficulty accessing services, particularly social and recreational destinations. The most commonly reported problem was a lack of available licensed drivers to chauffeur non-drivers. Importantly, no increase was observed in the number of people walking, using public transit, taxis, or van services following license revocation. People who did not live with at least one licensed driver and those who were younger and healthier reported the greatest mismatch between their need and desire to travel and the availability of transportation. In addition, some caregivers reported that they frequently missed work or stopped working entirely in order to care for and chauffeur people in the former drivers' household. Overall, these findings reinforce the importance of both developing transportation policies to support the functioning of informal transportation structures and in improving the range of alternative transportation options for those individuals with particular disabilities--like dementia--who are not well served by either informal arrangements or by formal transportation services for the disabled.

Impaired vision and other factors associated with driving cessation in the elderly: the Blue Mountains Eye Study

The aim of present study was to review vision and other factors associated with the cessation of driving. As part of the Blue Mountains Eye Study, detailed demographic information, driving status and medical history were taken. Visual acuity was measured during a standardized refraction and visual fields documented. Potential risk factors were decided a priori. Among the 3654 Eye Study participants, 2831 (77.5%) had driven a motor vehicle in the past, of whom 2379 (84.0%) were current drivers and 452 (16.0%, 95% CI 14.6-17.4%) said they had stopped driving. Older persons and women were more likely to have stopped driving. After adjusting for age and sex, sensory impairment affecting vision and hearing, plus chronic medical conditions and benzodiazepine use were significantly associated with cessation of driving. The study found that sensory impairment, particularly visual parameters, was associated with the decision to stop driving by older subjects.

Factors related to driving difficulty and habits in older drivers

OBJECTIVES

To evaluate the association between chronic medical conditions, functional, cognitive, and visual impairments and driving difficulty and habits among older drivers.

DESIGN

Cross-sectional study.

SETTING

Mobile County, Alabama.

PARTICIPANTS

A total of 901 residents of Mobile County, Alabama aged 65 or older who possessed a driver's license in 1996.

MEASUREMENTS

Information on demographic characteristics, functional limitations, chronic medical conditions, driving habits, and visual and cognitive function were collected via telephone. The three dependent variables in this study were difficulty with driving, defined as any reported difficulty in > or = 3 driving situations (e.g. at night), low annual estimated mileage, defined as driving less than 3000 miles in 1996, and low number of days ( < or = 3) driven per week.

RESULTS

A history of falls, kidney disease or stroke was associated with difficulty driving. Older drivers with a history of kidney disease were more likely to report a low annual mileage than subjects without kidney disease. Low annual mileage was also associated with cognitive impairment. In general, older drivers with a functional impairment were more likely to drive less than 4 days per week. Older drivers with a history of cataracts or high blood pressure were more likely to report a low number of days driven per week, while subjects with visual impairment were at increased risk of experiencing difficulty driving as well as low number of days driven per week.

CONCLUSIONS

The results underscore the need to further understand the factors negatively affecting driving independence and mobility in older drivers, as well as the importance of improved communication between older adults and health care professionals regarding driving.

Visual risk factors for driving difficulty among older drivers

This study sought to evaluate associations between visual function and self-reported difficulty with driving tasks. Drivers (N = 384) between the ages of 55 and 85 were selected from ophthalmology practices and optometry clinics; three out of four of the sample had cataracts and the remaining were cataract-free. Information on driving exposure and difficulty was obtained via self-report. Visual functional status of all participants was measured with respect to acuity, contrast sensitivity, disability glare and useful field of view. Cognitive impairment was evaluated using the Mattis Organic Mental Syndrome Screening Examination. The results show a pattern of difficulty in high-risk driving situations among those with decreased visual acuity and contrast sensitivity, even after adjustments for age, gender, weekly mileage, and cognitive impairment.

Consequences of driving cessation: decreased out-of-home activity levels

OBJECTIVES

Increasing age, socioeconomic factors, and declining function and health have been linked to driving cessation, but little is known about the consequences of stopping driving. This study was designed to test the hypothesis that driving cessation leads to a decline in out-of-home activity levels.

METHODS

In 1989 a survey of driving practices was administered to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1,316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and 722 never drove or stopped before 1982. Information on sociodemographic and health-related variables came from in-home EPESE interviews in 1982, 1985, and 1988, and from yearly phone interviews. Activity was measured at all three in-home interviews, and an activity measure was created based on self-reported participation in nine out-of-home activities. A repeated measures random-effects model was used to test the effect of driving cessation on activity while controlling for potential confounders.

RESULTS

Driving cessation was strongly associated with decreased out-of-home activity levels (coefficient-1.081, standard error 0.264, p < .001) after adjustment for sociodemographic and health-related factors.

DISCUSSION

The potential consequences of driving limitations or cessation should be taken into account when advising older drivers and developing alternative transportation strategies to help maintain their mobility.

Very old drivers: findings from a population cohort of people aged 84 and over

BACKGROUND

Increases in longevity will involve a significant increase among the number of drivers in the very old, who are at greater risk of being involved in road accidents. Data are thus needed from studies of older populations to characterize those still driving, the reasons for giving up and to help formulate appropriate policies for dealing with the problems faced and created by an increase in older drivers.

METHODS

A driving questionnaire was administered to surviving members of a cohort comprising a representative sample of individuals aged >/=84, the Cambridge City over 75 Cohort. Out of 546 survivors 404 completed the driving questionnaire at the 9-year follow-up. In addition, subjects were assessed, at baseline and at each follow-up, for cognitive performance using the Mini-Mental State Examination (MMSE) and for physical impairment using the Instrumental of Activities in Daily Living (IADL) scale.

RESULTS

Of the sample, 37% had driven in the past, and 8.4% were still driving, the majority regularly. The drivers tended to be younger (mean age 86.6 years), men (71%) and to be married (67.7%). Although physical disability and cognitive impairment are common in this age group, current drivers had few physical limitations on their daily activities and were not impaired on MMSE. None of the current drivers had visual impairment and 22.6% had hearing loss. Of those who had given up driving, 48.5% had given up at the age of >/=80. The commonest reasons for giving up driving were health problems (28.6%), and loss of confidence (17.9%). One-third reported giving up driving on advice.

CONCLUSION

A process of self-selection takes place among older drivers. People over the age of 84 who are still driving have generally high levels of physical fitness and mental functioning, although some have some sensory loss. Given the likely increase in the number of older drivers over the next decades, safety will be improved most by strategies aimed at the entire driving population with older drivers in mind, rather than relying on costly screening programmes to identify the relatively small numbers of impaired older people who continue to drive.

The driving habits of adults aged 60 years and older

OBJECTIVES

We describe the driving habits of adults aged 60 years and older who were interviewed in the context of a community survey focused on mental disturbances. Our goal was to identify clinical cues that might signal driving difficulty in older adults who might present to the primary care physician for health care.

DESIGN

A population-based survey.

SETTING

Continuing participants in a follow-up study of community-dwelling adults who were living in East Baltimore in 1981.

PARTICIPANTS

Subjects were 1920 continuing participants of the Baltimore sample of the Epidemiologic Catchment Area Program; 589 were aged 60 years and older and provided information on driving habits.

MEASUREMENTS

Respondents were asked about their driving status: had they made adaptations to driving and had they experienced any adverse driving events in the 2 years before the interview. Driving behaviors were assessed in relation to chronic disease, sensory impairment, functional status, and mental status.

RESULTS

Former drivers were more likely to be older, female, and nonwhite. Diabetes, vision impairment, functional impairment, and making an error on the copy design task of the Mini-Mental State Examination (MMSE) were associated with no longer driving. Women were more likely to report having made adaptations to driving, as were persons with heart disease, arthritis, vision impairment, and those who made an error on the copy design task of the MMSE. Heart disease and hearing impairment were associated with report of an adverse driving event. In multivariate models that included terms for potentially influential characteristics such as age, gender, and miles driven, only the copy design task was associated with driving status, and only heart disease was associated with driving adaptation and adverse driving events.

CONCLUSION

Simple tests that tap visuospatial ability, such as the copy design task of the MMSE, may warrant additional study for use in driving assessment of older adults in primary care. The results underscore the importance of making an inquiry about driving as a separate and independent component of functional assessment.

Do older drivers with visual and cognitive impairments drive less?

OBJECTIVE

To determine whether older drivers with poorer cognitive and/or visual function drive fewer miles or avoid driving in situations that pose higher crash risks, such as at nighttime, in rush hour traffic, or when weather conditions are bad.

DESIGN

A cross-sectional data analysis conducted as part of a larger prospective study.

SUBJECTS

A total of 3238 drivers aged 65 and older applying for renewal of their driver's license at one of eight participating North Carolina driver's license offices.

MEASUREMENTS

Subjects were administered a battery of brief tests of cognitive and visual function, which included the Trail Making Test Parts A and B, the Short Blessed Orientation-Memory-Concentration test, and measures of high and low contrast visual acuity, contrast sensitivity, and peripheral vision. Participants were also asked to complete a brief driving survey containing questions about the number of miles they drove and whether they avoided driving under certain conditions, such as after dark or on busy, multi-lane roadways. Driver age and gender were covariates in the analyses.

RESULTS

Results of multivariate logistic regression models show a clear pattern of reduced driving exposure--lower annual miles and greater avoidance of high-risk driving situations--associated with lower levels of cognitive and visual function. In general, the prevalence odds of reduced driving exposure were higher for the cognitive function variables than for the visual function variables, and higher for males than for females. Men who scored in the lowest quartile of performance on one of the cognitive tests were six to seven times more likely to report driving fewer than 3000 miles a year than were men scoring in the highest quartile, and women with low scores were one-and-one-half to two times more likely to report driving less than 3000 miles than women with higher scores.

CONCLUSIONS

While the findings of this study are reassuring, they do not guarantee that all drivers with cognitive and visual impairments are limiting their driving exposure appropriately, and geriatricians and other health professionals should be encouraged to evaluate their patients' cognitive and visual fitness for driving and provide counsel where indicated.

Driving patterns and medical conditions in older women

OBJECTIVES

To describe driving patterns (e.g., driving frequency) in older women drivers and to evaluate the impact of medical conditions and comorbidity on driving patterns.

DESIGN

Cross-sectional examination of the association between medical conditions and driving patterns.

SETTING

Population-based cohort from the Pittsburgh Center of the Study of Osteoporotic Fractures (SOF).

PARTICIPANTS

A total of 1768 women aged 71 years or older.

MAIN MEASUREMENTS

Driving information was obtained through a driving questionnaire, including driving status, weekly mileage, longest trip in the past year, etc. Data for demographics, lifestyle behavior, and medical conditions were collected through the SOF study.

RESULTS

Among the participants, 1103 (62.3%) were current drivers, 337 (19.1%) had stopped driving, and 329 (18.6%) had never driven in their lifetime. The proportion reporting driving cessation and decline in driving amount increased with age. The prevalence of most medical conditions was higher among former drivers than in current or never drivers. Even after controlling for age and other demographic variables, fractures, heart disease, diabetes, self-reported poor vision or hearing, as well as comorbidity were found to be associated independently with decreased driving amount, including driving cessation, decline in mileage, and avoiding long trips.

CONCLUSION

Both individual medical conditions and comorbidity influence driving patterns in older drivers. Because it is common for older people to have several medical conditions simultaneously, comorbidity might be a more comprehensive measure of medical impact on driving.

Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly

OBJECTIVES

The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped.

DESIGN

Cohort study.

SETTING

Urban community.

PARTICIPANTS

A driving survey was administered in 1989 to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and the remainder had either never driven or had stopped before 1982.

MEASUREMENTS

Information about independent and dependent variables other than driving status came from the in person EPESE interviews in 1982, 1985, and 1988, except for medical conditions, which were updated yearly. Depressive symptoms were assessed by the Centers for Epidemiologic Studies-Depression (CES-D) scale. Analyses focused on the changes in depressive symptoms before and after driving cessation. Repeated measures multivariable analysis accounted for the effect of cessation on the outcome adjusting for the potential confounding due to sociodemographic and health-related factors.

RESULTS

Individuals who stopped driving exhibited substantial increases in depressive symptoms during the 6-year interval. Driving cessation was among the strongest predictors of increased depressive symptoms (Coefficient 2.464, SE 0.758, P = .001) even when adjusting for sociodemographic and health-related factors.

CONCLUSIONS

Driving cessation was associated with an increase in depressive symptoms even when accounting for sociodemographic and health-related factors. These consequences need to be taken into account when advising older drivers and when developing alternative transportation strategies.