The Potential Impact of Driving Cessation for Rural and Urban Older Adults: AAA LongROAD Study

Sean Mebust; Melinda Robinson; Ida Baker; Andrew Johnson; George W. Rebok

This research brief examines whether there are urban-rural differences in how older adults rate the potential impact that driving cessation would have on their lives.

Introduction

The influence of driving on the well-being of older adults has been documented in multiple studies demonstrating the declines in social engagement, cognitive and physical function and survival following driving cessation (Choi, et al., 2013; Curl et al., 2014; Doebler, 2016; O’Connor et al., 2013; Tyrovolas et al., 2017). The motivation to continue driving may be especially pronounced for older adults in rural areas because of limited options for public and other alternative sources of transportation as well as the longer distances between regular destinations such as grocery stores, pharmacies, health care providers and locations for social activities (Byles & Gallienne, 2012; Donorfio et al., 2009; Johnson, 2002, Payyandadan et al., 2018). Thus, investigators speculate that older rural drivers may be more likely than urban drivers to continue driving despite various physical and cognitive limitations (e.g. Byles & Gallienne, 2012). This study examines whether there are urban-rural differences in how older adults rate the potential impact that driving cessation would have on their lives. Results confirm that older drivers from a rural area rate the prospect of driving cessation as more impactful on their lives and that these perceptions may influence their decision to continue driving despite health decline.

Key Findings

Results confirm that older drivers from a rural area rate the prospect of driving cessation as more impactful on their lives and that these perceptions may influence their decision to continue driving despite health decline.

Methodology

AAA LongROAD is a prospective, multisite cohort study of personal, vehicular and environmental factors that predict the driving behaviors, patterns and outcomes (e.g. crashes, convictions) of older adults. A total of 2,990 women and men 65-79 years of age were recruited from health systems at five study sites (Ann Arbor, MI; Baltimore, MD; Cooperstown, NY; Denver, CO; and San Diego, CA). Details regarding the study design and methods are described in Li et al., (2017).

The data for these analyses were collected at the baseline visit for all participants. The potential impact of driving cessation was based on responses to the following questions: “If you could not drive, how much would it affect what you want to do” and “If you could not drive, how much would it affect what you need to do”.

The response options for these questions ranged from 1 to 7, with 1 labeled as “not at all” and 7 labeled as “completely.” For each of these questions, “completely” was the modal response. In the analyses, high potential impact of driving cessation was classified as “yes” (response option 7) or “no” (response options 1-6). The designation of urban or rural residence was based on the Rural Urban Commuting Area (RUCA) values for ZIP codes of study participants (Hall et al., 2006).

Sociodemographic characteristics recorded at the baseline visit and included in the analyses were age, gender, marital status, race and ethnicity, educational attainment, household income and whether the participant was employed. In addition to the questions about potential impact of driving cessation, participants were asked how many days they drove in a typical week; how many miles they drove on most trips out and back from home; the other forms of transportation recently used (in addition to driving oneself); whether a friend or family member was available to give them rides; and whether there was someone who depended on them for driving.

Results

Residents of urban areas were more likely to be college graduates and have higher levels of income. The race and ethnicity of the study population was predominantly white and non-Hispanic, especially beyond the urban areas. The percentage of participants who reported normally driving each day of the week was approximately similar across the three RUCA categories. Residents of the suburban and rural areas had a higher percentage of most trips from home being longer than 15 miles. Recent use of alternative forms of ground transportation was more common in urban areas. Virtually all participants, regardless of area of residence, indicated that a friend or family member was available to give them a ride.

For both survey questions on the potential impact of driving cessation, there was an increase across categories of urbanicity, with older adults living in rural areas being especially much more likely to perceive a major impact on their lives.