Mental Health Consequences of “Giving up the Keys:” Driving Cessation among Older Adults

Background and Purpose: For older adults, driving is more than simply an activity to accomplish daily tasks. Rather, driving is a means to maintain one's socialization, and is imbued with a host of psychological meanings, including a sense of autonomy, independence, and self-worth. As a result, older adults with health problems typically resist giving up driving as long as possible, although many self-regulate their driving (e.g., avoid night driving) in what has been called a “driving cessation continuum.” Evidence is also emerging which suggests that driving cessation is associated with the onset of significant depressive symptomatology as well as persistence in depression over time. However, little is known about why some older adults are better able than others to make driving transitions with relatively less psychological distress. There has been surprisingly little research addressing the psychosocial influences on this decision. Decisions about driving are especially salient for the growing numbers of older adults who experience age-related vision problems, especially since poor vision is the most commonly cited reason given for driving cessation. The purpose of this presentation is to examine the relationships between driving self-regulation, driving cessation and mental health among visually disabled older adults.

Methods: The baseline sample was recruited from community-based older adults, age 55+ (mean age =74.8 years), with varying levels of functional vision problems (n=381). Data were collected via in-depth interviews at baseline and at 6, 12, 18, and 24 month follow-ups. This paper presents preliminary results from the 1-year follow-up, at which time 17% of the 204 participants to date had stopped driving. Hierarchical regression analyses were conducted to identify: 1) significant correlates of baseline depression; and 2) baseline predictors of change in depression from baseline to Year 1. Depression was measured with the 20-item CES-D.

Results: At baseline, the mean CES-D score was 8.4 (SD 9.2) and 16.8% scored at 16 or greater, indicating clinically significant depressive symptomatology. Greater depression was independently associated with younger age, more functional vision problems (p=.074), having ADL difficulty, lower autonomy values, lower self-regulatory coping, lower perceived emotional support from family/friends, not living with another driver, and using more forms of alternate transportation (total R2=.40). Self-regulatory driving behaviors were not significantly related to depressive symptoms in the multivariate analyses. At Year 1, the mean CES-D score was 8.1 (SD 8.6) and 15.4% scored at 16 or higher. An increase in depression from baseline to Year 1 was significantly predicted by baseline depression, older age, having ADL difficulty, rating oneself as a poorer driver (p=.06), lower perceived emotional support from family/friends (p=.06), and being an ex-driver (total R2=.57).

Conclusions and Implications: Older adults who stop driving are at greater risk for increased depression within the year following driving cessation. Findings highlight the importance of developing services to both prevent and treat the mental health consequences of driving cessation.