Ten Years Down the Road: Predictors of Driving Cessation
Ten Years Down the Road: Predictors of Driving Cessation
Purpose: Recent prospective studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults. However, these studies have been limited to 5 years of follow-up. The current study used data from the Maryland Older Drivers Project to examine predictors of driving cessation in older adults over a 10-year period.
Design and Methods: Participants (N = 1,248) completed baseline and 5-year assessments of physical and cognitive abilities. Driving status was ascertained at baseline and annually thereafter.
Results: Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic, physical, and cognitive predictors. The final model indicated three significant predictors of driving cessation, older age at baseline (hazard ratio [HR] = 1.12, p < .001), days driven per week (HR = 0.83, p = .05), and slower speed of processing as measured by the Useful Field of View Test (HR = 1.76, p < .01).
Implications: These results underscore the importance of cognitive speed of processing to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation. Further research is needed to determine the costs and potential benefits of such screening.
In 2004, more than 28 million licensed U.S. drivers were aged 65 years and older (Center for Disease Control and Prevention, 2006), and this number is projected to reach 40 million by the year 2020 (Dellinger, Langlois, & Li, 2002). Mobility is fundamental to successful aging with most older adults relying on driving for sustained mobility (Jette & Branch, 1992; O'Neill, 2000). Accordingly, many older adults view driving as a mark of independence and freedom (Gillins, 1990), and maintained driving mobility is increasingly recognized as being vital to health and quality of life for older adults (Oxley & Whelan, 2008).
Prospective studies have indicated that driving cessation results in many negative consequences for older adults (Edwards, Perkins, Ross, & Reynolds, 2009; Freeman, Gange, Munoz, & West, 2006; Marottoli et al., 1997, 2000; Mezuk & Rebok, 2008; Windsor, Anstey, Butterworth, Luszcz, & Andrews, 2007). Seniors who do not drive diminish their contact with outside stimuli that is necessary for a healthy and robust existence (Marottoli et al., 2000). As an example, social isolation occurs following driving cessation (Mezuk & Rebok) and leads to subsequent increases in depression (Azad, Byszewski, Amos, & Molnar, 2002; Marottoli et al., 1997; Windsor et al.). Of further concern, even after considering health status, driving cessation is prospectively associated with increased risk for nursing home placement as well as mortality (Edwards et al.; Freeman et al.).
Most studies of driving cessation have been retrospective comparing older drivers with older adults who have ceased driving. Such studies have found that older drivers tend to have fewer physical limitations, and better health, vision, and cognitive function than do older nondrivers (Brayne et al., 2000; Campbell, Bush, & Hale, 1993; Ragland, Satariano, & MacLeod, 2004). Older adults who have ceased driving also tend to have less education, less income, and more medical conditions compared with drivers (Campbell et al.; Dellinger, Sehgal, Sleet, & Barrett-Connor, 2001). Typically, retrospective studies have revealed that women have been more likely to cease driving than men (Brayne et al., 2000; Campbell et al.; Freund & Szinovacz, 2002). Whether or not one lives with other drivers may also be related to the decision to stop driving (Freund & Szinovacz). However, when such demographic factors were prospectively considered in concert with cognitive and physical performance variables among participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, cognitive and everyday functional abilities emerged as stronger predictors (Ackerman, Edwards, Ross, Ball, & Lunsman, 2008; Edwards et al., 2008).
More than 15 years ago, a longitudinal study across 10 years was conducted to identify patterns of driving among older adults (Jette & Branch, 1992), but until fairly recently, driving habits among modern cohorts of older adults have not been longitudinally examined. Recent analyses have prospectively examined predictors of driving cessation across 3 and 5 years among U.S. and Australian older drivers (Ackerman et al., 2008; Anstey, Windsor, Luszcz, & Andrews, 2006; Edwards et al., 2008; Freeman, Munoz, Turano, & West, 2005). These longitudinal studies have indicated that increasing age, poor vision, poor health, less than ideal physical functioning, diminished cognitive speed of processing, and problems with instrumental functional abilities contribute to the decision to cease driving (Ackerman et al.; Edwards et al., 2008; Freeman et al.). Similarly, among Australian older adults, poor grip strength, subjective feelings of health and well-being, and poor cognition as indicated by memory and reasoning were associated with increased rates of driving cessation (Anstey et al.). The purpose of these analyses was to examine the relationship of performance-based measures of cognitive and physical abilities, administered in a state motor vehicle administration setting, to subsequent rates of driving cessation among a modern cohort of older drivers from a population-based sample across a 10-year period.
Abstract and Introduction
Abstract
Purpose: Recent prospective studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults. However, these studies have been limited to 5 years of follow-up. The current study used data from the Maryland Older Drivers Project to examine predictors of driving cessation in older adults over a 10-year period.
Design and Methods: Participants (N = 1,248) completed baseline and 5-year assessments of physical and cognitive abilities. Driving status was ascertained at baseline and annually thereafter.
Results: Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic, physical, and cognitive predictors. The final model indicated three significant predictors of driving cessation, older age at baseline (hazard ratio [HR] = 1.12, p < .001), days driven per week (HR = 0.83, p = .05), and slower speed of processing as measured by the Useful Field of View Test (HR = 1.76, p < .01).
Implications: These results underscore the importance of cognitive speed of processing to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation. Further research is needed to determine the costs and potential benefits of such screening.
Introduction
In 2004, more than 28 million licensed U.S. drivers were aged 65 years and older (Center for Disease Control and Prevention, 2006), and this number is projected to reach 40 million by the year 2020 (Dellinger, Langlois, & Li, 2002). Mobility is fundamental to successful aging with most older adults relying on driving for sustained mobility (Jette & Branch, 1992; O'Neill, 2000). Accordingly, many older adults view driving as a mark of independence and freedom (Gillins, 1990), and maintained driving mobility is increasingly recognized as being vital to health and quality of life for older adults (Oxley & Whelan, 2008).
Prospective studies have indicated that driving cessation results in many negative consequences for older adults (Edwards, Perkins, Ross, & Reynolds, 2009; Freeman, Gange, Munoz, & West, 2006; Marottoli et al., 1997, 2000; Mezuk & Rebok, 2008; Windsor, Anstey, Butterworth, Luszcz, & Andrews, 2007). Seniors who do not drive diminish their contact with outside stimuli that is necessary for a healthy and robust existence (Marottoli et al., 2000). As an example, social isolation occurs following driving cessation (Mezuk & Rebok) and leads to subsequent increases in depression (Azad, Byszewski, Amos, & Molnar, 2002; Marottoli et al., 1997; Windsor et al.). Of further concern, even after considering health status, driving cessation is prospectively associated with increased risk for nursing home placement as well as mortality (Edwards et al.; Freeman et al.).
Most studies of driving cessation have been retrospective comparing older drivers with older adults who have ceased driving. Such studies have found that older drivers tend to have fewer physical limitations, and better health, vision, and cognitive function than do older nondrivers (Brayne et al., 2000; Campbell, Bush, & Hale, 1993; Ragland, Satariano, & MacLeod, 2004). Older adults who have ceased driving also tend to have less education, less income, and more medical conditions compared with drivers (Campbell et al.; Dellinger, Sehgal, Sleet, & Barrett-Connor, 2001). Typically, retrospective studies have revealed that women have been more likely to cease driving than men (Brayne et al., 2000; Campbell et al.; Freund & Szinovacz, 2002). Whether or not one lives with other drivers may also be related to the decision to stop driving (Freund & Szinovacz). However, when such demographic factors were prospectively considered in concert with cognitive and physical performance variables among participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, cognitive and everyday functional abilities emerged as stronger predictors (Ackerman, Edwards, Ross, Ball, & Lunsman, 2008; Edwards et al., 2008).
More than 15 years ago, a longitudinal study across 10 years was conducted to identify patterns of driving among older adults (Jette & Branch, 1992), but until fairly recently, driving habits among modern cohorts of older adults have not been longitudinally examined. Recent analyses have prospectively examined predictors of driving cessation across 3 and 5 years among U.S. and Australian older drivers (Ackerman et al., 2008; Anstey, Windsor, Luszcz, & Andrews, 2006; Edwards et al., 2008; Freeman, Munoz, Turano, & West, 2005). These longitudinal studies have indicated that increasing age, poor vision, poor health, less than ideal physical functioning, diminished cognitive speed of processing, and problems with instrumental functional abilities contribute to the decision to cease driving (Ackerman et al.; Edwards et al., 2008; Freeman et al.). Similarly, among Australian older adults, poor grip strength, subjective feelings of health and well-being, and poor cognition as indicated by memory and reasoning were associated with increased rates of driving cessation (Anstey et al.). The purpose of these analyses was to examine the relationship of performance-based measures of cognitive and physical abilities, administered in a state motor vehicle administration setting, to subsequent rates of driving cessation among a modern cohort of older drivers from a population-based sample across a 10-year period.
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