Mobility and Driving: Public Health Perspectives

Jeffrey W. Elias, Ph.D.

National Institute on Aging

Listening Session for the White House Listening Session for the White House Conference on AgingConference on Aging

January 8, 2005January 8, 2005

Mobility and Driving: Public Health Perspectives

1) Driving as a risk factor

2) Trends in mobility, disability, cognition, and driving

3) Driving as a higher order activity of daily living (IADL)

Driving and aging as a risk factor

A major focus for research on driving is on determining risk factors for an accident.

Individual risk is assessed by:

• Health conditions

• Health treatment/medications (much more needed)

• Driving Conditions

Driving and aging as a risk factor cont..

Individual risk is assessed by (cont..):

• Cognition – attention – multi-tasking (cell phone)

• Motor function – flexibility – strength

• Vision – acuity, contrast, field of vision (UFOV)

• Perception – visual, auditory, tactile, smell, (taste)

Driving and aging as a risk factor cont..

In-Car assessments and simulation assessment allows assessment of individual risk by:

• Responses to conditions

• Tactics to detect or avoid danger

• Driving patterns – planning -strategy

Driving and aging as a risk factor cont..

The ultimate goal of this research would be to provide:

the risk for this driver,

in this vehicle,

at this time of day,

for this trip,

and suggested ways to reduce risk.

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

http://cta.ornl.gov/cta/One_Pagers/Mobility_Safety.pdf

Source: National Long Term Care Survey 1982-1994 (Kenneth Manton, Ph.D.)

Number of Chronically Disabled Americans Age 65 and Over

(in millions)

7.07.1

6.4

7.5

8.3

4.0

6.0

8.0

10.0

Based on declining disability rate since 1982

If disability rate did not change since 1982

1982 1989 1994Total Population

Age 65+26.9 million

Total PopulationAge 65+

30.8 million

Total PopulationAge 65+

33.7 million

Adult OffspringParents

Occasion:

59

57

55

53

51

49

47

Generation:

Current training takes place within the framework of cohort/generation experiences and exposures

Source: Schaie, 2000

Time 1 Time 2 Time 1 Time 2

Verbal Meaning

Number

Space

Word Fluency

Mea

n T

-Sco

res

(mea

n=

50,

sd

= 1

0)

Reasoning

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

http://cta.ornl.gov/cta/One_Pagers/Mobility_Safety.pdf

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

http://cta.ornl.gov/cta/One_Pagers/Mobility_Safety.pdf

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

http://cta.ornl.gov/cta/One_Pagers/Mobility_Safety.pdf

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

http://cta.ornl.gov/cta/One_Pagers/Mobility_Safety.pdf

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

The growing size of the older population accounts for 82% of the projected fatality increases from 1995-2025.

The decreasing crash risk helps to reduce the rate of increase by 33%.

Trends in Cognition, Disability, and Vulnerability as an older driver continued..

http://cta.ornl.gov/cta/One_Pagers/Mobility_Safety.pdf

Driving as an IADL

Under the greater schema of mobility,

driving can be usefully conceptualized

as a higher order instrumental activity of daily living (IADL).

Driving as an IADL continued ..

As an IADL driving is much more complex than other IADLS.

Driving as an IADL is a form of mobility within a complex context.

Driving as an IADL continued..The context for driving as an IADL is:

One or more persons in a vehicle;

On a roadway;

In a highway system;

Guided by rules and expectations for the utility and safety of the driver and others.

Driving as an IADL cont..

Legal driving requires a license with procedure and policy determined by the individual states.

The roadway rules for driving differ from state to state and locality to locality.

Insurance companies are interested in driving performance across the lifespan.

Driving as an IADL continued .. The ability to drive safely differs by

conditions.

Some components of driving are almost automatic and can resist decline for a long time, while others are sensitive to age-related changes in vision, physical health, motor control, and cognitive function.

Some drivers quit before they need to, others continue to drive beyond safe capacity to do so.

Driving as an IADL continued ..

The loss of the IADL, based on the situation, can have serious consequences for self-concept, access to services, access to socialization, access to recreation, physical, mental, and cognitive health.

Driving as an IADL continued..

Maintenance or loss of the driving

IADL is no trivial matter.

Mobility and Driving: Public Health Perspectives

The challenge is to take the information we have, the information we will have, and translate that into appropriate policy that can keep up with changing culture, demographics, technology, trends in physical and cognitive function, and financial capabilities.