Americans value their mobility, and especially the level of personal mobility afforded by travel in an automobile, van, or other private vehicle. According to 1995 Nationwide Personal Transportation Survey (NPTS) data, nearly nine of every ten trips taken in the U.S. are by private vehicle (Hu and Young, 1999). Since 1983, the percentage of private vehicle trips has increased, while the percentage of public transit and walking trips has actually decreased. This trend likely reflects the increasing percentage of Americans living in the suburbs rather than in central cities, and the corresponding increase in travel distances and decrease in public transit availability. Age does not diminish the need for mobility. At the first White House Conference on Ageing held in 1971, transportation was identified as the third issue of greatest concern for seniors, preceded only by income and health. Although most seniors are no longer in the work force, they still rely heavily on their private vehicles to get them to the grocery store, the bank, the doctor’s office, church, and other needed destinations. Based on available NPTS data, between 77 and 90 percent of all urban trips and 86 to 95 percent of all rural trips by drivers age 65 or above are by private vehicle (with the lowest percentages for drivers age 85+). At the same time, a number of studies have linked access to personal mobility to overall satisfaction and quality of life among older persons (Burkhardt et al., 1998; Johnson 1995; Eisenhandler, 1990; Cutler, 1975; Gianturco et al., 1974). Despite the obvious importance of driving for maintaining mobility and independence, older adults as a group greatly reduce the amount that they drive, and many discontinue driving altogether. Drivers age 65 and older travel only about half that of drivers aged 25-64 (Hu and Young, 1999). Part of this reflects their reduced presence in the work force and the absence of work-related travel. Older adults may also have fewer needs and simply prefer to travel less. Declining functional abilities, medical conditions, medication use, and economic concerns also contribute to reduced travel. Certainly, poor health and declining functional abilities are reasons for some older adults to curtail their driving -- those with poor night-time vision often stop driving at night, others uncomfortable in new situations may only drive to familiar places, etc. However, many older adults may, at least from a safety standpoint, be curtailing their driving unnecessarily. For these persons, finding ways to help them continue driving safely can have large benefits in terms of increased independence and improved self-esteem and overall quality of life. A number of studies have examined factors associated with driving cessation and/or reduction by the elderly (Hakamies-Blomqvist and Wahlstrom, 1998; Chipman 1998; Koepsell et al., 1994; Kington et al., 1994; Marottoli et al, 1993; Persson 1993; Campbell et al., 1993; Jette and Branch, 1992). Commonly cited factors include poor vision (especially night-time), medical conditions including arthritis, and a general “lack of confidence” or feeling that one is “too old to be driving.” Economic factors may also be a concern for many of the nation’s elderly, especially women living in rural areas and in single family households. The goal of the current project was to move beyond these studies to focus more specifically on those factors associated with a premature reduction or cessation of driving that might be remediated through education or training, exercise and wellness, adaptive devices, rehabilitation, and vehicle design. The project also sought to gather information on older persons’ attitudes about driving and the impact of driving reduction or cessation on mobility and quality of life. A final goal of the project was to explore potential interventions for counteracting the premature reduction or cessation of driving and extending the period during which older adults are able to provide for their own mobility needs with safety and confidence. The work was carried out in several phases, with each phase building on the results of the previous phase. Initially, focus groups were conducted with older adults who had either recently stopped driving or who might be stopping driving in the near future. Parallel groups were held with family members (usually adult children) concerned about an older adult’s driving. The focus group findings provided input to a national telephone survey of older drivers and former drivers to gather quantitative data on factors influencing older adults’ decisions about driving. The initial focus groups also suggested a potential target population along with a potential intervention for further study. The target population was a subset of older women who appeared to be stopping driving prematurely, while the potential intervention was an on-road driving evaluation by a licensed driving instructor, with the possibility of follow-up lessons. Both were further explored in a separate phase of the project. As a final phase of the project, focus groups were held with three potential stakeholders in the process: driving school instructors, physicians, and occupational therapists. A mail survey was also conducted of driving schools nationwide to determine their knowledge and interest in working with the older driver population. The results of these efforts are documented in the chapters that follow. Chapter 2 summarises the results of the focus groups with older adults and family members of older adults, while Chapter 3 documents the results of our initial investigation of on-road driving evaluations as a potential intervention for persons who may be stopping driving prematurely. Chapter 4 highlights findings from the national telephone survey of older drivers and former drivers, and Chapter 5 summarises the results of our follow-up contacts with driver educators, occupational therapists, and physicians. The final chapter draws conclusions from the overall project and makes recommendations for future studies and activities to help older adults make responsible decisions about continuing or stopping driving. (Author/publisher)
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