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.

Feasibility and Validity of a Low-Cost Racing Simulator in Driving Assessment after Stroke.

There is a myriad of methodologies to assess driving performance after a stroke. These include psychometric tests, driving simulation, questionnaires, and/or road tests. Research-based driving simulators have emerged as a safe, convenient way to assess driving performance after a stroke. Such traditional research simulators are useful in recreating street traffic scenarios, but are often expensive, with limited physics models and graphics rendering. In contrast, racing simulators developed for motorsport professionals and enthusiasts offer high levels of realism, run on consumer-grade hardware, and can provide rich telemetric data. However, most offer limited simulation of traffic scenarios. This pilot study compares the feasibility of research simulation and racing simulation in a sample with minor stroke. We determine that the racing simulator is tolerated well in subjects with a minor stroke. There were correlations between research and racing simulator outcomes with psychometric tests associated with driving performance, such as the Trails Making Test Part A, Snellgrove Maze Task, and the Motricity Index. We found correlations between measures of driving speed on a complex research simulator scenario and racing simulator lap time and maximum tires off track. Finally, we present two models, using outcomes from either the research or racing simulator, predicting road test failure as linked to a previously published fitness-to-drive calculator that uses psychometric screening.

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.

Predictors of Readiness for Mobility Transition in Older Drivers.

We administered the Assessment of Readiness for Mobility Transition (ARMT) to 301 older drivers and compared total scores with participant characteristics. Overall, 18% of participants were not attitudinally ready for mobility transition, while 19% were very ready. Notably, participants with hospitalizations in the past year were either very ready for mobility transition (20% vs 14% without hospitalizations) or not ready at all (30% vs 17%). Significant health events may polarize reactions towards mobility transition. Individualizing communication about driving cessation readiness could help address such differing views. To further consider its effectiveness, ARMT could be utilized in mobility transition counseling interventions.

Assessment of Readiness for Mobility Transition (ARMT): a tool for mobility transition counseling with older adults.

Individualized assessment is important when counseling older adults concerning the transition from driving to nondriving mobility. This study validated a measure of emotional and attitudinal readiness in support of mobility transition counseling (MTC). Items derived from a mixed-methods approach were administered by mailed questionnaire to community-dwelling adults (n = 297; ages 57-95). Factor analysis was employed to form the 24-item Assessment of Readiness for Mobility Transition (ARMT). The ARMT-Total Score (ARMT-TS) demonstrated sound internal consistency and split-half reliability (.88 each). The ARMT-TS correlated as hypothesized with validity measures, including self-reported physical functioning, mental health, and openness to experience. High scorers, who evidenced strong self-reliance and an unwillingness to be a burden on others, are considered to be at risk when faced with a significant mobility transition. An appreciation for such differences can allow for personalized, tailored discussion and planning for when it is time to "hang up the keys."

Older adults' driving reduction and cessation: perspectives of adult children.

PURPOSE OF THE STUDY: Adult children are often directly affected by aging parents' decision to limit or stop driving. This qualitative study examined the process of driving reduction and cessation (DRC) from the perspective of adult children, with a focus on family communication. DESIGN AND METHODS: Four focus group interviews were conducted with 37 adult children (29/37 female; mean age = 45.5) of older parents using a structured protocol. Transcripts were analyzed by two independent coders to identify major themes. RESULTS: Themes represented three aspects of the DRC process: family communication and dynamics (i.e., discussion, negotiation, and planning; avoidance and side stepping; resignation and refusal), taking action to end a parent's driving career (i.e., engaging a third party; taking away the car), and post-cessation reflection (i.e., relief; social benefits; resentment and guilt). IMPLICATIONS: Despite the potential benefits of planning for DRC, families are unsure about how best to approach this topic. Adult children worry about assuming responsibility for their parents' transportation needs and their parents' reactions to restricted mobility. Despite a reluctance to communicate openly about DRC, adult children and their parents share similar and significant concerns that merit increased attention.

Physician input and licensing of at-risk drivers: a review of all-inclusive medical evaluation forms in the US and Canada.

This article details a systematic review of medical evaluation forms in support of licensing decisions for medically at-risk drivers. Comparisons were made between all-inclusive forms utilized by 52 State and Provincial Departments of Motor Vehicles (DMVs) in the US and Canada. Comparisons focused on length, format, content, instructional quality, medical coverage, ease of use, and other qualitative characteristics. Median page length was 2 (range 1-10), and mean word count was 1083 (494-3884). Common response options included open-ended (98%), forced choice (87%), and check box (81%). While the majority of forms (77%) required driver consent, only 24% requested information from the driver. Less than half (46%) included text on confidentiality protection. While all forms requested general medical information, just over half included specific sections for vision (54%) and cognitive/neurological conditions (56%). Most forms (81%) required that a judgment be made concerning driver safety, and half prompted for possible license restrictions. Criterion-based quality ratings were assigned on a five-point Likert scale by group consensus. One third of forms were rated as marginal or poor in comprehensiveness and utility, and just two garnered an excellent overall rating. Findings are discussed relative to current research on driver fitness and elements of a proposed model form. Best practice recommendations include a page length limitation, emphasis on in-person evaluation (i.e., as opposed to a records-only review), prompts to collect crash and other driving history information, clear instructions and stepwise format, content prompts across relevant medical categories, documentation of functional status and impairment levels, options for driving with restrictions in lieu of de-licensing, and emphasis on relative (vs. absolute) clinical judgments of overall driver safety.

Decoding the Miss Daisy Syndrome: an examination of subjective responses to mobility change.

The subjective responses associated with personal life space and mobility status were explored. Thirty individuals participated in focus groups based on self-rated disability status, current places visited, and availability. Qualitative analyses revealed that most participants equated personal mobility with driving a vehicle. Attitudes concerning mobility status and preparedness for change varied based on disability level and personal experience. Fear of dependence from future mobility loss was prominent in all groups. Few participants acknowledged significant planning for future retirement from driving or other mobility challenges. An understanding of common attitudes, perceptions and meanings can inform professionals who intervene and support older adults experiencing mobility changes.