Getting Rides From Others As a Coping Mechanism in the Transition to Non-Driving

OBJECTIVES

To characterize the effect of the actual and potential ability to get rides from others on older adults' driving reduction at 3-year follow-up in the United States.

METHODS

We analyzed National Health and Aging Trends Study data from community-dwelling drivers in 2015 (unweighted n = 5,102). We used weighted logistic regression models to estimate whether getting rides from others in 2015 was associated with older adults increasing the number of driving behaviors they avoided, decreasing the frequency with which they drove, or not driving at 3-year follow-up after adjusting for biopsychosocial variables. We also measured presence of social network members living nearby including household and non-household members and estimated associated odds of driving reduction at 3-year follow-up.

RESULTS

Older adults who got rides from others in 2015 had greater odds of reporting no longer driving at 3-year follow-up compared to those who did not get rides (adjusted odds ratio [aOR] = 1.53, 95% confidence interval [CI]: 1.11-2.11). We found no statistically significant association between older adults living with others or having more nearby confidantes outside their household and their odds of reducing driving at 3-year follow-up.

DISCUSSION

These findings suggest that getting rides from others plays an important role in the transition to non-driving for older adults. Future research should examine whether other aspects of social networks (e.g., type, quality, and closer proximity) might also be key modifiable coping factors for older adults transitioning to non-driving.

PREDICTORS OF INDIVIDUAL TRANSPORTATION ALTERNATIVES IN THE TRANSITION TO NON-DRIVING

For older adults who transition to non-driving, successful coping includes maintaining mobility. Individual transportation alternatives, e.g. rides from friends and family, are important coping factors in the transition to non-driving. However, it is unclear to what extent social network composition predicts the accessibility of these individual transportation alternatives. We examined whether various aspects of social networks (including living with a spouse/partner; having a child; living with a child; having other household members; having anyone to talk to about important things) were associated with the actual receipt of rides from family and friends. Using the National Health and Aging Trends Study (NHATS), a nationally representative cohort of Medicare beneficiaries ages 65 and older, we conducted a cross-sectional analysis using a subsample of community-dwelling older adults whose driving status was known at the baseline interview in 2015 (n = 5,889). We used logistic regression to estimate the association between social network indicators with the odds of receiving a ride from a family member or friend. When adjusting for biopsychosocial characteristics and current driving status, we found that having a spouse or partner was associated with a significant odds of having received a ride (adjusted OR, 95% CI = 1.41, 1.05–1.90) as was being able to name at least five people the participant could talk to about important things (adjusted OR, 95% CI = 1.65, 1.14–2.38). Our findings support previous evidence that marital status and support from social network members outside one’s household may be particularly important for accessible individual transportation alternatives.

MEASURING AGE-FRIENDLINESS OF TRANSPORTATION, MOBILITY COMMUNITY CHARACTERISTICS: A SCOPING REVIEW

Age-friendly community initiatives seek to identify and develop infrastructure and services that promote active aging. Inclusive characteristics of transportation and outdoor spaces can improve everyone’s mobility around their communities but are particularly important to adults who are transitioning to non-driving. In this study, we aimed to identify and describe age-friendly community indicators that evaluate characteristics most associated with community-level mobility, specifically transportation and outdoor spaces. We conducted a scoping review of peer-reviewed and gray literature to find records describing the development of age-friendly community indicators and then to identify indices with measures of transportation and outdoor spaces resources. We searched PubMed, Scopus, Ebsco, and Web of Science in August 2022 for literature published since 2005. Our search resulted in 1,012 unique records; screening for relevance by title and abstract resulted in 33 records that received full text reviews. We identified 9 final indicators for inclusion and reviewed records to describe the source of the indices, development methodology, and specific indicators used to measure transportation and outdoor spaces. Included indicators were sponsored by governmental or non-profit public health organizations (n=4) and academic researchers (n=5), including one academic partnership with a for-profit insurance company. Most indices (n=6) described measures drawn from subjective data collected during community assessments. Age-friendly indicators were not developed specifically for investigating older adults’ transition to non-driving, a missing focus that represents a significant gap. Aligning indicators with this common life transition will facilitate research into the interventions promoting mobility at the community level for all.

Understanding and Improving Arterial Roads to Support Public Health and Transportation Goals

Arterials are types of roads designed to carry high volumes of motorized traffic. They are an integral part of transportation systems worldwide and exposure to them is ubiquitous, especially in urban areas. Arterials provide access to diverse commercial and cultural resources, which can positively influence community health by supporting social cohesion as well as economic and cultural opportunities. They can negatively influence health via safety issues, noise, air pollution, and lack of economic development. The aims of public health and transportation partially overlap; efforts to improve arterials can meet goals of both professions. Two trends in arterial design show promise. First, transportation professionals increasingly define the performance of arterials via metrics accounting for pedestrians, cyclists, transit riders, and nearby residents in addition to motor vehicle users. Second, applying traffic engineering and design can generate safety, air quality, and livability benefits, but we need evidence to support these interventions. We describe the importance of arterials (including exposures, health behaviors, effects on equity, and resulting health outcomes) and make the case for public health collaborations with the transportation sector.

Are rural places less safe for motorists? Definitions of urban and rural to understand road safety disparities

The objectives of the study are to understand road safety within the context of regional development processes and to assess how urban-rural categories represent differences in motor vehicle occupant fatality risk. We analysed 2015 motor vehicle occupant deaths in Wisconsin from 2010 to 2014, using three definitions of urban-rural continua and negative binomial regression to adjust for population density, travel exposure and the proportion of teen residents. Rural-Urban Commuting Area codes, Beale codes and the Census definition of urban and rural places do not explain differences in urban and rural transportation fatality rates when controlling for population density. Although it is widely believed that rural places are uniquely dangerous for motorised travel, this understanding may be an artefact of inaccurate constructs. Instead, population density is a more helpful way to represent transportation hazards across different types of settlement patterns, including commuter suburbs and exurbs.

How do the definitions of urban and rural matter for transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes

Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural. We use three different definitions of urban-rural continua to quantify and compare motor vehicle occupant fatality rates per person-trip and person-mile for the state of Wisconsin. The three urban-rural continua are defined by: (1) popular impressions of urban, suburban, and rural places using a system from regional economics; (2) population density; and (3) the intensity of commute flows to core urbanized areas. In this analysis, the three definitions captured different people and places within each continuum level, highlighting rural heterogeneity. Despite this heterogeneity, the three definitions resulted in similar fatality rate gradients, suggesting a potentially latent "rural" characteristic. We then used field observations of urban-rural transects to refine the definitions. When accounting for the presence of higher-density towns and villages in rural places, we found that low-density urban places such as suburbs and exurbs have fatality rates more similar to those in rural places. These findings support the need to understand road safety within the context of regional development processes instead of urban-rural categories.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.