Driving Cessation and Risk of Institutionalization

Background and Purpose: Driving is necessary for mobility and independence to many older adults in the US. Private vehicles are the primary mode of transportation for older adults as making 89% of their trips in a private vehicle either as a passenger or a driver. In this cultural context, driving cessation leads to a major life transition from an independent driver to a dependent passenger and can be accompanied by negative social and health consequences. Driving cessation might be an independent risk factor for institutionalization among older adults. This study aimed to examine the relationship between driving cessation and risk of institutionalization in later life.

Methods: Data came from the 1998-2008 waves of Health and Retirement Study (N=9,347; 58.6% female; Mean age=74.3). Driving status and health characteristics were assessed by self-report. Institutionalization was assessed by entering into a nursing home. Respondents who had moved to nursing homes after the baseline were retained in the study and interviewed. A series of logistic regression and discrete-time multivariate hazard models were used to estimate the risk for institutionalization associated with driving cessation.

Results: About 7.2% of respondents were institutionalized during follow-ups. Logistic regression results showed that non-drivers (former and never drivers) at baseline were more likely to enter into long-term care as compared to active drivers (OR=1.42, 95% CI=1.01–1.99) after accounting for baseline sociodemographic and health characteristics.  Discrete-time hazard model results indicated that driving cessation was significantly associated with the likelihood of institutionalization (HR=7.7, 95% CI=5.9–10.04) after accounting for sociodemographic characteristics and health status.

Conclusions and Implications: The findings imply that driving cessation is an independent risk factor for institutionalization even after accounting for health status. Approximately 90% of older Americans want to stay in their home for as long as possible (referred to as “aging in place”). The findings of this study suggest that independent transportation is essential for aging in place. Social workers working with older adults need to develop and provide effective community-based services to meet the growing needs of alternative transportation; so older adults can remain independent and living in their own homes and communities regardless of their driving status.