Research That Matters (January 17 - 20, 2008)

Purpose: Mobility is key to older adults' ability to maintain independence and well-being. Losing one's ability or privilege to drive can severely impair mobility and increase risk for social isolation, depression and residential home placement (Ragland et al., 2005). For personal and public safety, persons with dementia must eventually retire from driving. Little is known about driving retirement and its impact on personal mobility and well-being. This study explores driving retirement of older patients diagnosed with dementia in a university-based neurology clinic. Methods: Using clinic referrals, 564 caregivers of older drivers diagnosed with dementia in the past three years were mailed a survey (adapted from the Driving Habits Questionnaire (Owsley et al., 1999)). Demographic data was obtained through a review of medical charts. Non-parametric tests were used to explore the relationship between indicators of well-being and participation in critical activities of living (shopping, seeing people, church and health-related visits). Results: Surveys were completed by 120 family caregivers (21% response rate—65% spouse, 25% child, 10% other). Of the 120 older adults, 84 were retired drivers whose average age was 73 years and who were primarily male (52%) and well educated (13.6 years). The majority (71%) were diagnosed with Dementia of the Alzheimer's Type (DAT) at CDR 0.5 or 1 levels (very mild – mild, MMSE 21.2+6.3). Driving retirement occurred as a result of diminishing cognition (54%), family (42%) or physician (40%) recommendation or a traffic incident (17%). Few caregivers reported using community/educational resources to support driving retirement. Many reported that out-of-home activities stopped or decreased after driving retirement. Of concern was the observed negative impact on driver well-being (increased depression (44%), anxiety (31%), decreased motivation (38%), social engagement (44%) and a reduction in activities (49%). Half of the retired drivers stopped participating in one or more of the previously-designated four critical activities. In exploring the relationship between the four critical activities, participation in activities was the only statistically significant outcome variable. Findings also suggest that males experience more anxiety and higher rates of a reduction in activities. Implications: As many older adults with dementia experience a negative impact when retired from driving, implications occur for research, policy and practice. Further study is needed to understand the long-term impact of driving retirement on well-being to enable the development of appropriate mobility interventions. Opportunities for educating older drivers, caregivers and professionals and developing viable forms of alternative transportation options can result.