The Impact of Transportation Support on the Decision Making of Driving Cessation among Community-Dwelling Older Adults

PURPOSE: Driving cessation is a stressful transition for many older adults given that in the United States, mobility is primarily based on traveling in private vehicles. Previous studies have shown that driving cessation among older adults caused negative consequences on social and psychological wellbeing such as increased depressive symptoms and decreased out-of-home activity levels (Fonda, Wallace, & Herzog, 2001; Marottoli, Mendes de Leon, Glass, & Williams, 1997; Marottoli et al., 2000). In this social context, some older drivers tend to be reluctant to give up their car keys despite concerns such as visual or cognitive impairments. For social safety and individual mobility, transportation support for older adults is quite critical. Despite this importance, very few studies have examined the role of transportation support in the driving cessation process in later life. Therefore, this study aims to explore how formal and informal transportation support influences decision making about driving cessation among community-dwelling older adults.

METHODS: Data were obtained from three waves of the Florida Disability Study (1990-1992). The study population consists of generally healthy community-living old-old persons residing in Florida retirement communities. We restricted our sample to those who were driving at baseline (N = 604). Respondents had a mean age of 78.3 at baseline, and 62% of older drivers were female. A discrete-time multivariate hazard model was used to examine the impact of transportation support on driving cessation while controlling sociodemographic characteristics (age, gender, and education) and health conditions (comorbidity, hospitalization history, functional impairment, and vision impairment). Transportation support from spouse, family members, friends and neighbors were categorized into informal transportation support. Formal transportation support included transportation support that respondents had received from organizations and hired assistants.

RESULTS: The results showed that both formal and informal transportation support influenced older adults to cease their driving even after controlling sociodemographic factors and health conditions The statistically significant transportation support influencing driving cessation was from friends and neighbors (OR = 1.81, p < .001), hired assistants (OR=1.65, p <.01), and spouse (OR=1.39, p <.01). Transportation support from other family members and organizations was not statistically significant. Among sociodemographic factors, older age was significantly associated with driving cessation (OR=1.18, p <.001), supporting previous studies. Regarding health conditions, functional impairment, which was measured with self-reported difficulty with IADL, was significantly associated with higher risk of driving cessation (OR = 1.27, p < .001).

IMPLICATIONS: These results imply that accessibility of alternative transportation is important in older adults' decisions to stop driving given the limited routes of transportation provided by organizations and the restricted availability of rides offered by family members. When geriatric social workers assess elderly clients' difficulty in driving, they need to be knowledgeable about accessibility of alternative transportation, not only its availability. The findings of this study could also contribute to developing and improving adequate transportation services for older adults in community.