In recent years, the discussion of safe transportation for older people has expanded beyond driving to include a range of options for providing out-of-home mobility. In this context, the term “mobility” is not a synonym for ambulation but is used in a broader sense to mean how a person gets from one place to another outside the home. Many factors have influenced this paradigm shift. One of the most important was that limiting the discussion to who could still drive safely and how those who were no longer safe drivers should be evaluated and de-licensed addressed only part of the issue and left the larger, looming question of “what now” unanswered. For people who have to limit or stop driving, there is a large void to be filled to mitigate the negative practical and psychological effects of no longer being able to drive. A detailed discussion of this issue, including research developments, practical applications, and future directions, can be found in Transportation in an Aging Society: A Decade of Experience (TRB, 2004) and a companion document, Safe Mobility for Older Americans: Report of the Committee for the Conference on Transportation in an Aging Society (TRB, 2005). Still, the traditional emphasis on risk was understandable. Motor vehicle crashes are a leading cause of “accidental” injury and death in people 65 years of age and older, a group that is growing rapidly as the general population ages. Coupled with the increased susceptibility of older persons to injury because of their decreased reserve capacity, safety concerns are understandable. However, the importance of driving to a person’s sense of independence and well-being must also be taken into account, particularly for people in North America. Older persons depend on cars far more than other modalities for transportation, either as drivers or passengers. Moreover, in our society out-of-home mobility provided by driving is a key factor in being able to participate in social and productive activities, which in turn have been associated with lower risk of mortality and better functional status (Glass et al., 1999). Indeed, the cessation of driving has been linked to a number of negative outcomes, including a decrease in participation in out-of-home activities, an increase in depressive symptoms, and possibly an increase in the likelihood of nursing home placement (Freeman et al., 2006; Marottoli et al., 1997, 2000). A sense of these negative consequences, which has long been evident in clinical practice, has led to reluctance on the part of both patients and clinicians to discuss the topic or to assess the underlying risk factors of driving difficulties. In an early survey, many physicians reported that they were reluctant to address the issue because of the potential negative consequences for their patients and the lack of options in many locations to fill the mobility gap if people had to stop driving (Drickamer and Marottoli, 1993). Increasing awareness of the need to provide transportation options and make people aware of those options have been major contributors to the paradigm shift in thinking described above. Although much of the early research in this area was on medical conditions and functional impairments that might contribute to safety risks, recent efforts have focused more on determining whether interventions to improve drivers’ functions or adapt to impairments might improve driving performance and safety. It is hoped that a combination of the availability of interventions, and evidence of their effectiveness, coupled with the availability and awareness of transportation options, will encourage drivers, families, and clinicians to engage in discussions of this sensitive topic and ultimately lead to a better balance between safety, autonomy, mobility, and participation in out-of-home activities. (Author/publisher)
Abstract