Better Together: Social Contact and Loneliness Among U.S. Older Adults During COVID-19.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) resulted in older adults' greater reliance on technology to contact friends and families. However, less is known regarding the association between frequency of varying modes of communication and loneliness among older adults during COVID-19, and current findings are mixed. Therefore, this study aimed to advance this understanding. METHODS: Using the National Health and Aging Trends Study COVID-19 supplement data, multinomial regression analyses assessed how the frequency of four modes of contact (i.e., phone calls; electronic and social messaging such as e-mails/texts/social media messages; video calls; and in-person visits) during the COVID-19 pandemic was associated with feelings of loneliness among older adults compared to prepandemic (n = 2,564). RESULTS: Compared to never/less than once a week in-person visits, daily in-person visits were associated with lower odds of reporting more frequent loneliness during COVID-19 versus "about the same" as pre-COVID-19 while controlling for demographics, access to information and communication technologies (ICTs), digital literacy, and health covariates. Compared to those who reported never/less than once a week contact by electronic and social messaging, more frequent contact was associated with higher odds of reporting more frequent loneliness during COVID-19 versus "about the same" as pre-COVID-19 while controlling for other variables in the model. Phone calls and video calls were not significantly related to loneliness. DISCUSSION: Results suggest that ICTs may not decrease loneliness among older adults. This article discusses potential reasons and barriers, including digital exclusion, and provides recommendations to mitigate the negative effects of social isolation through technology for older adults.

With a Little Help From My Friends and Family: Transportation and Caregiving Hours.

OBJECTIVES: To better understand the associations between the driving status of the care recipient and caregiver with provided caregiving hours, more research on the relationships between contextual caregiving factors and driving-related behaviors is needed. METHOD: Using data from Round 7 of the National Health and Aging Trends Study (NHATS) and the linked National Survey of Caregiving (NSOC; n = 1054 dyads), this study explored how caregiver transportation assistance and care recipient driving frequency are associated with caregiving hours. RESULTS: Caregiving hours were highest among caregivers who provided transportation every day and among care recipients who had not driven in the last month. After controlling for covariates, negative binomial regression results indicated that greater caregiver transportation assistance was related to more caregiving hours, while greater care recipient driving frequency was related to less caregiving hours. CONCLUSION: Integrated supports and greater accessibility to transportation services may decrease time spent caregiving.

Planning for Driving Retirement: The Effect of Driving Perceptions, Driving Events, and Assessment of Driving Alternatives.

Most older adults will eventually stop driving, but few engage in planning for driving retirement. This study assessed whether driving stress, enjoyment, confidence, concerning driving events, and assessment of driving alternatives influence planning. Demographic factors were also included. Data were collected via a mailed transportation survey, with a final sample of 551 older adults who currently drive. Linear regression analyses revealed that more driving retirement planning was associated with greater driving stress, less driving confidence, and a more positive view of driving alternatives. Driving enjoyment and recent concerning driving events were not significantly related. Among the control variables, race and income were significantly related to planning, suggesting that lower income and identifying as Black race were associated with more planning. Gender only approached significance, suggesting that females may plan more than males. Overall, these findings suggest that more driving retirement planning is warranted. Some of the groups known to be at increased risk for driving reduction and cessation plan more for that eventuality than their counterparts. Implications of the study and suggestions for future research are discussed.

The Influence of Hearing Impairment on Driving Avoidance Among a Large Cohort of Older Drivers.

As people age, some of the commonly experienced psychomotor, visual, and cognitive declines can interfere with the ability to safely drive, often leading to situational avoidance of challenging driving situations. The effect of hearing impairment on these avoidance behaviors has not been comprehensively studied. Data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study were used to assess the effect of hearing impairment on driving avoidance, using three measures of hearing. Results indicated that hearing loss plays a complex role in driving avoidance, and that an objective hearing measure was a stronger predictor than hearing aid use and self-rated hearing. Greater hearing impairment was related to less nighttime and freeway driving, more trips farther than 15 mi from home, and lower odds of avoiding peak driving times. The moderating influence of hearing on both vision and cognition is also discussed, along with study implications and future research.

Family Satisfaction: Differences Between Nursing Homes and Residential Care Facilities.

This study compared differences in overall family satisfaction, specific satisfaction domains, and correlates of satisfaction between nursing homes (NHs) and residential care facilities (RCFs), using data from the 2016 Ohio Long-Term Care Family Satisfaction Survey. Satisfaction was higher for RCFs overall and within nearly every domain, with the largest difference observed in the environment domain. In both facility types, higher satisfaction was associated with male respondents, older respondent age, White race, less-frequent visitation, longer anticipated length of stay, less help provided during visits, smaller facilities, lower Medicaid-reliant resident percentage, and nonprofit status. Resident age, visitation frequency, perceived assistance required, and kinship tie were differentially related to satisfaction between facility types. NH administrators should focus on the environment and the moving in process. All administrators should address how residents spend time and should be aware that residents' and their family members' characteristics may affect satisfaction levels.

How Accumulated Wealth Affects Driving Reduction and Cessation.

BACKGROUND AND OBJECTIVES: Older adults can expect to live between 6 and 10 years after they give up driving, but driving reduction and cessation (DRC) are not equally experienced by all groups. Individual characteristics such as poor health, impaired vision, older age, and female gender are known to affect DRC. Using cumulative disadvantage theory as a guide, this study assessed the role played by wealth in DRC among older adults. RESEARCH DESIGN AND METHODS: Data from the National Health and Aging Trends Study were analyzed using multinomial logistic regression techniques. This allowed for the effect of each predictor on the odds of engagement in a given driving status (full driving, driving reduction [DR], and driving cessation [DC]) to be compared to each of the others. RESULTS: The final sample included 6,387 participants. After controlling for the effect of covariates, less wealth was associated with higher odds of DR compared to full driving, DC compared to full driving, and DC compared to DR. Confirming previous research, several other factors were also significantly related to driving status including age, health, vision, gender, race, education, relationship status, household size, and work status. DISCUSSION AND IMPLICATIONS: The influence of wealth on driving status among older adults represents another disadvantage unequally distributed to some in older adulthood. Those with less wealth will have fewer resources to meet their mobility needs using alternatives and may already be facing additional financial constraints due to worse health and other challenges associated with lower socioeconomic status.

Differences in Driving Outcomes Among Cognitively Normal African American and Caucasian Older Adults.

OBJECTIVE: To examine the effect of race in driving performance and behavior prospectively among cognitively normal older adults. METHODS: Cognitively normal participants (Clinical Dementia Rating 0), ≥ 65 years of age (n = 177) were selected from prospective, longitudinal studies at the Knight Alzheimer Disease Research Center at Washington University. Self-reported driving behavior (Driving Habits Questionnaire) and driving performance (road test) were annually assessed. Daily driving behavior data were collected using the Driving Real World In-Vehicle Evaluation System (DRIVES). Baseline differences between African Americans and Caucasians were tested using t tests and general linear models. Amyloid imaging and cerebrospinal fluid Alzheimer disease (AD) biomarkers were compared across groups. Linear mixed models examined change in daily driving behavior over time. Survival analyses tested time to a marginal or fail rating on the road test. RESULTS: There were no differences between African Americans (n = 34) and Caucasians (n = 143) in age, sex, education, or vascular risk factors. Baseline self-reported driving behavior and road test performance were largely similar for both races. Longitudinal analyses using the DRIVES data aggregated monthly showed that African Americans had a greater reduction in number of trips made per month, miles driven per month, and trips with aggressive behavior compared to Caucasians. These effects remained after controlling for AD biomarkers, age, education, and sex. CONCLUSIONS: In this sample of cognitively normal older adults, African Americans had a greater reduction of daily driving behavior compared to Caucasians. Observed racial differences may reflect differences in environmental/social factors, changes in cognition, and/or physical functioning.

Older Adults' Expectations about Mortality, Driving Life and Years Left without Driving.

People are living and driving longer than ever before, with little preparation for transitioning to being non-drivers. We investigated driving expectations among drivers age 65 and older, including sociodemographic and driving context predictors. Cross-sectional data from 349 older drivers were explored to determine variation in how many years they expected to continue driving. General linear models examined predictors of both expectations. In this predominantly Black/African American sample, 76% of older drivers (mean age = 73 ± 5.7 years) expected a non-driving future, forecasting living an average of 5.75 ± 7.29 years after driving cessation. Regression models on years left of driving life and years left to live post-driving cessation predicted nearly half of the variance in older drivers' expectations with five significant predictors: income, current age, age expected to live to, self-limiting driving to nearby places and difficulty, visualizing being a non-driver. Many older drivers expect to stop driving before end of life.

Planning for a Nondriving Future: Behaviors and Beliefs Among Middle-Aged and Older Drivers.

Despite the reality of older adults living many years after driving cessation, few prepare for the eventuality; empirically, planning for a nondriving future has not been directly quantified or explored. The following study quantifies 1) the extent of current drivers' planning, 2) specific planning behaviors, 3) beliefs about benefits of planning, 4) drivers' intention to plan more for future transportation needs, and 5) group differences associated with planning. In a predominantly female, black, urban sample of current drivers ages 53-92, fewer than half (42.1%) had planned at all for a nondriving future, with correspondingly low levels of planning behaviors reported. However, over 80% believed planning would help them meet their needs post-cessation and transition emotionally to being a nondriver. Most (85%) intended to plan more in the future as well, indicating further potential openness to the topic. Drivers who planned were older, drove less frequently, limited their driving to nearby places, reported less difficulty believing they would become a nondriver, and expected to continue driving three years less than non-planners. These findings suggest that drivers' perceived nearness to driving cessation impacts planning for future transportation needs, and existing perceived benefits of planning may provide leverage to motivate action.

E-hail (Rideshare) Knowledge, Use, Reliance, and Future Expectations among Older Adults.

The goals of this study were to explore e-hail (e.g., Uber/Lyft) knowledge, use, reliance, and future expectations among older adults. Specifically, we aimed to identify factors that were related to e-hail, and how older adults view this mode as a potential future transportation option. Data were collected from a sample of older adults using a pencil-and-paper mailed survey. Univariate, bivariate, and regression techniques were used to assess the relationships among e-hail and several demographic and other factors. Almost three-quarters of the sample (74%) reported no e-hail knowledge. Only 1.7% had used e-hail to arrange a ride,andonly 3.3% reported that they relied on e-hail for any of their transportation needs. Younger age, male gender, more education, higher transportation satisfaction, and discussing transportation options with others were all independently associated with greater e-hail knowledge. Male gender also predicted e-hail use. E-hail was the mode least relied upon by older adults. Current e-hail knowledge was the biggest predictor of anticipated future use. E-hail may be a viable future option for older adults who have limited or stopped driving. More exposure to e-hail and continued evolution of these services is required to overcome older adults' lower internet/smartphone use. Policies could be implemented at departments of motor vehicles to pair information or training on transportation alternatives (like e-hail) with elimination of driving privileges, or at doctors' offices, senior centers, or hospitals. Potential underlying reasons for the findings are also discussed.

The Influence of the Transportation Environment on Driving Reduction and Cessation.

Purpose of the Study: Driving is by far the most common mode of transportation in the United States, but driving ability is known to decline as people experience age-related functional declines. Some older adults respond to such declines by self-limiting their driving to situations with a low perceived risk of crashing, and many people eventually stop driving completely. Previous research has largely focused on individual and interpersonal predictors of driving reduction and cessation (DRC). The purpose of this study was to assess the influence of the transportation environment on DRC. Design and Methods: Data were combined from the Health and Retirement Study, the Urban Mobility Scorecard, and StreetMap North America (GIS data). Longitudinal survival analysis techniques were used to analyze seven waves of data spanning a 12-year period. Results: As roadway density and congestion increased in the environment, the odds of DRC also increased, even after controlling for individual and interpersonal predictors. Other predictors of DRC included demographics, relationship status, health, and household size. Implications: The current study identified an association between the transportation environment and DRC. Future research is needed to determine whether a causal link can be established. If so, modifications to the physical environment (e.g., creating livable communities with goods and services in close proximity) could reduce driving distances in order to improve older drivers' ability to remain engaged in life. In addition, older individuals who wish to age in place should consider how their local transportation environment may affect their quality of life.

Cellular phone use while driving at night.

OBJECTIVE: Use of a cellular phone has been shown to negatively affect one's attention to the driving task, leading to an increase in crash risk. At any given daylight hour, about 6% of US drivers are actively talking on a hand-held cell phone. However, previous surveys have focused only on cell phone use during the day. Driving at night has been shown to be a riskier activity than driving during the day. The purpose of the current study was to assess the rate of hand-held cellular phone use while driving at night, using specialized night vision equipment. METHODS: In 2006, two statewide direct observation survey waves of nighttime cellular phone use were conducted in Indiana utilizing specialized night vision equipment. Combined results of driver hand-held cellular phone use from both waves are presented in this manuscript. RESULTS: The rates of nighttime cell phone use were similar to results found in previous daytime studies. The overall rate of nighttime hand-held cellular phone use was 5.8 +/- 0.6%. Cellular phone use was highest for females and for younger drivers. In fact, the highest rate observed during the study (of 11.9%) was for 16-to 29-year-old females. CONCLUSIONS: The high level of cellular phone use found within the young age group, coupled with the increased crash risk associated with cellular phone use, nighttime driving, and for young drivers in general, suggests that this issue may become an important transportation-related concern.

A direct observation study of nighttime safety belt use in Indiana.

INTRODUCTION: Nearly all direct observation studies of safety belt use are conducted exclusively during daylight hours. Recent work has suggested that safety belt use at night may differ from daytime belt use. METHODS: An observational study of nighttime safety belt use, utilizing specialized night vision equipment, was conducted in Indiana surrounding the Click It or Ticket 2006 safety belt mobilization activities. A pre- and a post-mobilization statewide direct observation survey was conducted at night coinciding with daytime safety belt use data collection conducted by the state of Indiana. Daytime and nighttime belt use rates were compared. RESULTS: The comparisons across the mobilization period revealed a significant increase during the day, but a significant decrease at night. Comparisons between daytime and nighttime belt use revealed no overall difference during the pre wave, but a significant difference during the post wave. Finally, many common daytime trends in belt use were also found at night, with the exception of the typical age and seating position effects. DISCUSSION: The mobilization activities had a positive effect on daytime belt use, but no effect on nighttime belt use, likely resulting in the differences between daytime and nighttime belt use observed during the post wave. IMPACT ON INDUSTRY: The findings of this study suggest that safety belt mobilizations implemented only during the day do not influence nighttime safety belt use. Changes to how these programs are implemented or additional programs specifically targeting belt use at night should be considered, along with continued monitoring of nighttime belt use.

Driver hand-held cellular phone use: a four-year analysis.

INTRODUCTION: The use of hand-held cellular (mobile) phones while driving has stirred more debate, passion, and research than perhaps any other traffic safety issue in the past several years. There is ample research showing that the use of either hand-held or hands-free cellular phones can lead to unsafe driving patterns. Whether or not these performance deficits increase the risk of crash is difficult to establish, but recent studies are beginning to suggest that cellular phone use elevates crash risk. METHODS: The purpose of this study was to assess changes in the rate of hand-held cellular phone use by motor-vehicle drivers on a statewide level in Michigan. This study presents the results of 13 statewide surveys of cellular phone use over a 4-year period. Hand-held cellular phone use data were collected through direct observation while vehicles were stopped at intersections and freeway exit ramps. Data were weighted to be representative of all drivers traveling during daylight hours in Michigan. RESULTS: The study found that driver hand-held cellular phone use has more than doubled between 2001 and 2005, from 2.7% to 5.8%. This change represents an average increase of 0.78 percentage points per year. The 5.8% use rate observed in 2005 means that at any given daylight hour, around 36,550 drivers were conversing on cellular phones while driving on Michigan roadways. The trend line fitted to these data predicts that by the year 2010, driver hand-held cellular phone use will be around 8.6%, or 55,000 drivers at any given daylight hour. CONCLUSIONS: These results make it clear that cellular phone use while driving will continue to be an important traffic safety issue, and highlight the importance of continued attempts to generate new ways of alleviating this potential hazard.

Using personal digital assistants (PDAs) for the collection of safety belt use data in the field.

From 1975 through 2003, because of the use of safety belts, an estimated 180,000 deaths from traffic crashes have been prevented. In order to assess the gains that have been made in safety belt use across the U.S., in individual states, and in communities, belt use surveys are conducted at regular intervals to determine use rates. The most valid method for surveying safety belt use is through direct observation. Direct observation surveys are conducted along roadways by trained researchers looking into passing vehicles and recording safety belt use. This method of data collection has been effective in the past through the use of paper-and-pencil data recording, yet it could be improved through the use of electronic and communication technology. Reported here is a study designed to compare electronic data collection, using personal digital assistants (PDAs), with collection using the traditional paper-and-pencil method during the annual statewide survey of safety belt use in Michigan that we have been conducting since 1984. The goals of the study were to develop a PDA database program for data entry in the field, to directly compare the PDA data collection process with the paper-and-pencil method on both accuracy and speed, and to assess mechanical and environmental factors, such as battery life, screen visibility, and reaction to adverse weather, that may act as limitations to the PDA method, in comparison with the paper-and-pencil method. In a direct comparison of methods, two observers collected data at the same roadway intersections, one using paper and a pencil and one using a PDA equipped with our custom software. The study showed that the PDA method was as fast and as accurate as the paper-and-pencil method. There were no adverse effects on the PDA caused by environmental conditions. The PDA was superior to the paper-and-pencil method in rainy weather and for data collector supervision. In addition, the use of the PDA obviated the need for entry of paper-recorded data into an electronic format. We conclude that the use of PDAs for safety belt field data collection is superior to the paper-and-pencil method. A Web address is given where the custom PDA safety belt data collection software can be obtained free of charge.

Use of booster seats by Michigan children 4-8 years of age.

This study reports the results of a statewide survey of restraint use by 4-8-year-old children in Michigan conducted between July 13 and 29, 2004. In this study, 3420 4-8-year-old children were observed traveling in passenger cars, vans/minivans, sport-utility vehicles, and pickup trucks. Restraint use was estimated for children traveling in all vehicles combined, as well as for each vehicle type separately. Children's restraint use was also calculated by the sex, age, and belt use of the driver. Separate estimates were also made of the restraint use of 4-8-year-old children by the combination of sex and belt use of the driver. Overall, 8.6 +/- 5.9% of 4-8-year-old children were seated in a booster seat, 48.8 +/- 10.3% were wearing a safety belt, 5.1 +/- 3.4% were seated in a child safety seat, and the remaining 37.5 +/- 11.5% were traveling completely unrestrained. When examining the rates by vehicle type, booster seat use was highest among children riding in sport-utility vehicles and lowest for those in pickup trucks. Surprisingly, children riding in passenger cars were more likely to be completely unrestrained than those in any other type of vehicle. While the sex of the driver did not seem to influence the restraint use of target-aged children, the driver's age did seem to have an effect. Booster seat use was quite low (0.6%) for children traveling with a driver over the age of 60, compared to 7.0 and 9.1% for those riding with drivers 16-29 and 30-59 years of age, respectively. The safety belt use of the driver also had a substantial influence on children's restraint use. Irrespective of driver sex, children riding with belted drivers were traveling in booster seats about 10% of the time, while those riding with unbelted drivers were only in booster seats 1-2% of the time.

Differences in safety belt use by race.

The purpose of the study was to identify daytime differences in safety belt use by race. Safety belt use was investigated in a direct observation survey of drivers and front-outboard passengers throughout Michigan. Data were weighted to calculate statewide safety belt use rates by race. Race was assessed visually by trained observers. The study showed that motor vehicle occupants identified as Black had significantly lower safety belt use than those occupants identified as White or Other.

The effect of changing from secondary to primary safety belt enforcement on police harassment.

The purpose of the study was to investigate whether changing Michigan's safety belt law from secondary to primary (standard) enforcement resulted in police harassment. The study investigated safety-belt-enforcement-related harassment by considering three measures: citizen complaints arising from enforcement of the safety belt law; citation over-representation, that is, a statistical determination of whether certain groups received more citations than would be expected based upon their presence in the driving population and their rate of violating the safety belt use law; and self-reported harassment among the population of people who receive safety belt citations. Safety-belt-related harassment complaints were very uncommon both before and after primary enforcement. Implementation of primary enforcement did not lead to an increase in citation over-representation, and, therefore, safety-belt-related harassment by sex, race, or age. The vast majority of people receiving safety belt citations reported officer behavior as professional and did not feel that they were singled out for their citation. However, a sizeable minority of Blacks and young people report perceptions of safety-belt-related harassment. Results suggest that states with secondary enforcement should continue their efforts to change to primary enforcement, but should also make a strong effort to educate both law enforcement and the public about the harassment issue.

Improving older driver knowledge and self-awareness through self-assessment: the driving decisions workbook.

PURPOSE: This study aims to assess whether the Driving Decisions Workbook, a self-assessment instrument for older drivers, increased self-awareness and general knowledge. This study also assessed perceptions regarding its usefulness, particularly as a tool for facilitating discussions within families of older drivers. A secondary purpose of the study was to determine if problems identified by drivers in the workbook related to problems they had with actual driving. DESIGN AND METHODS: The Driving Decisions Workbook was administered along with a questionnaire and a road test. A convenience sample of 99 licensed drivers aged 65 and above was used. RESULTS: After completing the workbook, about three fourths of the participants reported being more aware of changes that could affect driving. Fourteen percent reported that they had discovered a change in themselves of which they had not been previously aware. All respondents found the workbook to be at least a little useful and thought the workbook could help facilitate family discussions. Workbook responses were positively correlated with overall road test scores. Significant correlations were also noted between the road test and a majority of workbook subsection responses. IMPLICATIONS: This study indicates that the workbook may be a useful first-tier assessment instrument and educational tool for the older driver. It may encourage an older driver to drive more safely and/or to seek clinical assessment, and help in facilitating discussions about driving within their families.

Driver hand-held mobile phone use and safety belt use.

The purposes of the study were to identify hand-held mobile phone use trends for Michigan and to compare safety belt use between users and nonusers. Mobile phone and safety belt use was investigated by a direct observation survey of drivers at intersections in Michigan. Data were weighted to calculate mobile phone use and safety belt use rates statewide. The study showed 2.7% of Michigan drivers were using a mobile phone at any given daylight time. Safety belt use of current mobile phone users was significantly lower than those not using mobile phones.