The overall population of the United States is ageing, as is the driver population. In 1977, 10% of all drivers were over age 65 (FHWA, 1978). By 1997, this portion had increased to 14% (FHWA, 1998) and by 2020, 20% of licensed drivers are expected to be 65 or older (Chu, 1994). The growing number of ageing drivers presents a particular problem to American society because mobility, an important element in maintaining quality of life, is often equated with the ability to drive. The dispersed land-use patterns in the United States, the growth of suburbs, and the present transportation system have made Americans so dependent on the automobile that it has become not only a mode of transportation, but also a perceived necessity for maintaining independence, autonomy, and in some cases, self-esteem. As people age, however, driving an automobile safely can become more difficult, with the physical changes associated with ageing and disease often affecting a person’s ability to see, hear, process information, and react in a timely manner. Because of these changes, older drivers become increasingly faced with decisions about reducing or even stopping driving, and because of the large size of this cohort, their mobility decisions will have a profound effect on the transportation system as a whole. Understanding the process people go through as their driving abilities decline will facilitate efforts to help older drivers continue driving as long as it is safe, and to make appropriate and acceptable decisions regarding reduction or stopping driving. Such an understanding will also help facilitate efforts to provide acceptable ways to meet older drivers’ mobility needs when they can no longer drive. There is little historical data on the driving reduction and cessation process among older drivers. Earlier cohorts of older drivers were much smaller and the land-use patterns and transportation systems were not as automobile-oriented as they are now. Many older persons of previous generations never held driving licenses, and lived in areas served by transit which they used and continued to use as they aged. However, the present cohort of older drivers in the United States matured with the automobile, became dependent on it, and is very reluctant to give it up in favour of public transportation services. A number of studies have identified factors associated with driving reduction and cessation. For example, driving reduction and cessation has been associated with declining health and functional status (Campbell et al., 1993; Marottoli et al., 1993), age (Forrest et al., 1997; Jette and Branch, 1993), gender (Rosenbloom, 1988), avoidance of driving under certain conditions, avoidance of specific driving manoeuvres, and discomfort or nervousness in various driving situations (Benekohal et al., 1994; Lonero et al., 1994; Kington, et al., 1994; Persson, 1993; Stewart et al., 1993). Little, however, has been done to develop a comprehensive theoretical framework that might lead to a model of driving reduction and cessation. Observations of the process can provide a starting point for this. For example, an interesting observation of the driving reduction and cessation process among older drivers is that some drivers continue to drive even though their physical skills have diminished, while others, with the same physical skills, appear to stop driving voluntarily. This observation leads one to speculate that perhaps drivers first have to acknowledge that they are having problems with their driving abilities before they can contemplate stopping driving. The degree to which drivers recognise or anticipate problems may well be an underlying factor in the driving reduction and cessation process. Some older drivers may be experiencing few driving-related problems, do not anticipate any in the near future, and continue to drive. Some drivers may have experienced age-related declines in driving ability, have restricted driving under some conditions, and can anticipate a time when they may have to stop driving. Others may be experiencing so many age-related problems that they can clearly anticipate a time when they will have to stop driving. Still others may be reluctant to admit that they have problems or simply assume that they will die before they have to make the decision to stop driving. Because the process of driving reduction and cessation is fundamentally a process of behaviour change, it makes sense to examine older driver decisions related to reducing and stopping driving within a framework of behaviour change. This paper takes the first steps toward adapting a theoretical behaviour change model to the driving reduction and cessation process among older drivers by testing a critical assumption about the process. The assumption is that the anticipation of driving ability problems is an essential factor in the driving reduction and cessation process. The intent of the paper is to increase understanding of the process and to start developing a behavioural framework that can be used in identifying intervention opportunities to help design and plan programs, options, and services for the mobility of the anticipated new cohort of older drivers. (Author/publisher)
Samenvatting