Driving Cessation and Health Outcomes in Older Adults

Driving Cessation and Health Outcomes for Older Adults: A LongROAD Study

Background

• The number of older drivers on the road is continuing to increase in the United States.
  • The proportion of the population aged 65 years and older will increase from 13% in 2010 to 20% in 2040.
  • Of the 39.5 million adults aged 65 and older in the U.S., 81% hold a driver’s license.
• Declining health is known to be associated with driving cessation in older adults.
  • This is due to age-related declines in health, physical, and cognitive functions.
• It is less clear what impacts driving cessation may have on subsequent health and well-being in older adults.

Objective

• To better understand the research literature on the consequences of driving cessation in older adults.

Methods

• A systematic literature review, including a narrative and a metasynthesis was conducted on previously published studies pertinent to the health consequences of driving cessation.
  • Quantitative data for drivers aged 55 and older
  • Cross-sectional, cohort, or case-control design
  • Had a comparison group of current drivers
• Identified through a comprehensive search of bibliographic databases
• Sixteen studies met the inclusion criteria

Key Findings

Physical Health

• Former drivers had markedly low participation in outside activities and diminished productivity in daily life activities compared to current drivers.
• The association between driving cessation and reduced physical functioning was strong in longitudinal studies even after adjusting for socio-demographic factors and baseline health.

Depressive Symptoms

• Overall, driving cessation almost doubled the risk of increased depressive symptoms in older adults (OR= 1.91, 95% CI 1.61-2.27). Four of the studies reported significantly greater depressive symptoms in drivers who gave up their keys, after adjustment for potentially confounding factors.

Social Health

• Social health refers to the capacity to interact in society, which can be measured by social engagement, social contacts, and satisfaction with social roles and social support.
• One study found that driving cessation was associated with a 51% reduction in the size of social networks of friends and relatives over a 13-year period.

Cognitive Decline

• Several studies found that in general, former drivers had accelerated cognitive decline over a 10-year period compared with active drivers even after controlling for baseline cognitive function and general health.

Entry into Long-Term Care

• One study found that former drivers were nearly 5 times as likely as current drivers to be admitted to long-term care (LTC) facilities.
  • After adjusting for marriage or co-residence, there was still a strong association.

Increased Risk of Mortality

• A number of studies found that driving cessation was a strong predictor of 3-year mortality risk, as non-drivers were four to six times as likely to die as drivers, after adjusting for baseline psychological, general health, sensory, and cognitive abilities.

Implications

• Driving cessation in older adults appears to contribute to a variety of health problems, particularly depression.
• To mitigate the potential adverse effects of driving cessation on health and well-being in older adults, intervention programs ensuring safe mobility and social functions may be needed.