Part XI:

Transportation

Relevance to Centers for Independent Living (CILs)

This section discusses issues that make driving more challenging for an older adult including driving situations that are most hazardous, alternative transportation systems, and what an older adult needs or may look for in an alternative transportation system.

Consider:

1. Most older adults who do not drive were able to drive safely.

2. Loss of the ability to drive often limits range of activities outside the home.

3. Unless assisted in finding and using alternatives, older adults, who have stopped driving, may become depressed and isolated.

4. CILs can identify alternative transportation options and counsel older consumers in ways to remain active in their communities.

Transportation is an important part of being able to get around a community and participate in activities. Older adults may drive to social engagements, errands, visits to family, and to work or to volunteer. However, when it is no longer safe for an older adult to drive, they may find it difficult to locate alternative transportation or they may be reluctant to use an unfamiliar public transportation system. CILs may assist in helping older consumers to meet their transportation needs.

Part XI: Transportation

Driving

Driving is a daily task for many of us. We drive to work, to socialize, to get our groceries, to appointments, and for many other reasons. We come and go as we please. And most of us do so safely. Driving is considered a complex task requiring that the driver be able to process and respond to many different stimuli at the same time. The purpose of this chapter is to introduce the reader to challenges an older driver may encounter and alternative modes of transportation that an older driver may need help accessing.

Driving is visually demanding and requires:

• Acuity

• Depth perception

• Figure/ ground ability

• Tracking

• Contrast sensitivity

• Peripheral vision

• Central vision

• Color perception

Adequate hearing is also necessary for safe driving.

Driving is demanding cognitively and requires:

• Alertness

• Orientation- to time, place, and person

• Memory- immediate, short term, and long term

• Attention- attention span, selective attention, multi-tasking

• Recognition

• Learning

• Generalization

• Problem solving

• Processing

Driving is demanding physically and requires:

• Strength

• Coordination

• Endurance

• Visual- motor integration

• Motor control

• Range of motion

As people age, their abilities in some of these performance components decline. Most people experience visual changes beginning at 40-50 years of age.¹ The ability to distinguish detail at rest and in motion decreases with age, which affects ability to read road signs. The ability to change focus quickly decreases with age, which affects ability to look at something close up like the dashboard and then focus on something at a distance like other cars, pedestrians, and road signs. The field of vision also decreases with age making objects off to the side more difficult to see and making right of way situations more difficult.² Sensitivity to bright light may make it difficult for the older driver to see when sunlight shines in their eyes during the day or headlights shine in their eyes during night driving. Decreased depth perception may make it difficult for the older adult to park and to make a left turn. Nearsightedness may make it difficult for the older driver to pick out road signs and pedestrians. This may be especially challenging at cluttered intersections.

Visual disorders commonly associated with increasing age may interfere with the ability to drive safely. They include macular degeneration, cataracts, glaucoma, and visual changes that result as a secondary complication from diabetes.

Macular degeneration results in decreased central vision and usually results in the older adult ceasing driving³. Most people with macular degeneration maintain their peripheral vision.

Cataracts may interfere with driving at night. Headlights may seem too bright and glare may be severe or vision may seem blurry.

Glaucoma may interfere with right of way situations.

People with diabetes are at an increased risk of developing glaucoma, cataracts, and retinopathy. Glaucoma and cataracts were described earlier. Retinopathy involves damage to the small blood vessels in the retina and the growth of new fragile blood vessels that break easily, bleed into the middle of the eye, and cloud vision.⁴ Severe vision loss may occur or blindness. The person may not have symptoms, but if symptoms are present the person may experience blurred vision, floaters or flashes of light, vision loss, or eye pain.⁵

There are some techniques that may be used to compensate for visual changes associated with aging while driving.²⁶ These techniques include:

• Wear sunglasses to eliminate glare

• Avoid looking directly into the headlights of oncoming traffic

• Use sunglass lenses that flip up and down to help with lighting problems upon entering and exiting tunnels

• Limit night driving

• Avoid eyeglass frames that block peripheral vision

• Turn head to compensate for decreased peripheral vision

• Drive in familiar locations

• Avoid rush hour

• Avoid driving during bad weather

• Keep headlights clean and properly adjusted

Another sensory system that drivers rely heavily on is their auditory system. Hearing alerts the driver to sirens, horns, and other vehicles.⁷ According to an AARP report, about 20% of people over 55 and 30% of people over 65 have a hearing impairment.

There are cognitive changes associated with aging that may interfere with the ability to drive safely. Cognitive processing slows with age, which affects how fast an individual can respond to a situation. If it takes longer to process, it will also take longer to react. The ability to remain focused on driving while other things are happening may be a problem if the older adult is experiencing difficulty with selective attention. On the other hand, the older adult may be experiencing difficulty in multi-tasking. Both of these types of attention are used and necessary for safe driving. A driver has to process a variety of information, attend to what is important, and then react to the situation appropriately.⁸

Dementia is a cognitive impairment that becomes more prevalent as people age. In dementia, there are memory deficits. The older driver with dementia may start getting lost when they are driving or forgetting their destination.⁸ As the disease progresses the driver is less and less able to drive safely. Short-term memory loss interferes with the ability to merge and change lanes safely among many other tasks associated with driving. If a stressful situation arises when driving, the cognitive impairment may appear more pronounced and the driver may have increased difficulty with the task.⁹ Another problem with dementia is that the older driver does not recognize that they are unsafe and should stop driving. When dementia has reached the point where the driver is no longer safe, it may be necessary to involve outside assistance in transitioning the older adult to the role of non-driver.

The older adult experiences musculoskeletal changes with age that may interfere with driving. Joints may stiffen, muscles may weaken, movements may be slower, coordination may decrease, and reflexes may be slower.⁸ Between the ages of 35 and 65, reaction time decreases by 40%.⁹ Older drivers respond more slowly in a crisis and may instinctively compensate for this by driving slower. A decrease in mobility is linked to increased reaction time. Decreased mobility may interfere with the ability to turn the steering wheel, to turn the head to see what is behind when backing up, to move the foot from pedal to pedal in an effective manner, or to push on the brakes or honk the horn fast enough to avoid an accident.

Some medical conditions that are more prevalent in the older population also interfere with driving. Eighty percent of the population over 70 has arthritis, which may interfere with mobility and reaction time necessary for safe driving. Parkinson's disease may also interfere with a driver's ability to move in a manner necessary to drive safely. Diabetes may cause decreased sensation in hands and feet, which can interfere with steering and using the pedals effectively.

Another issue older drivers have is how medication may affect their driving. Older adults take more medications than any other age group. They may take several different types of medication at once. They may be more sensitive to medications that act on the central nervous system and medications may stay in their system longer.⁸ Some of the medications that may interfere with the operation of a motor vehicle include sleep aids, depression medications, anti-histamines, strong painkillers, and diabetes medications.

Even though there are declines in physical, cognitive, and sensory abilities with age, it is important to understand the statistics associated with older drivers rather than assume problems associated with driving due to decline. An AARP article reported that drivers age 65 and over have fewer car accidents than any other age group per 1,000 licensed drivers.⁹ This may be due to self-limiting driving time. Older drivers drive fewer miles and do not drive as often at night, during rush hour, or during bad weather.¹⁰ There are some older drivers that are not aware of the decline in their driving abilities and therefore do not self-limit their driving time.

One study compared adults age 69 + to adults 30-39 and found that "older adults are more likely to receive citations for failure to yield and disregarding traffic signals or signs, twice as likely to be involved in left-hand turn crashes, and seven times mores likely to be killed and hospitalized when wearing seatbelts".¹¹ Another study found that the most common errors associated with older adults' involvement in traffic accidents were failure to yield and not responding appropriately to stop signs and traffic lights.⁹ Other research has found that older drivers have difficulty judging correct speed and judging timing for merging and turning corners.¹² They also have difficulty braking quickly and using fluid motion when steering.

Motor vehicle accidents claimed the lives of 7,780 people over 65 in 1999 and injured 209,000 people over 65 in 2000.13 In 2000, the majority of the accidents involving people over 65 happened in the daytime on a weekday and involved another vehicle. An AARP report also uncovered the deadly affects of traffic accidents on older adults, reporting drivers age 80 to 84 were 4 times as likely to die in a crash than those 65 to 69 and drivers over age 85 were 6 times more likely to die in a crash as drivers age 65 to 69.9 This is most likely due to increased frailty with age.

Transportation Alternatives

If an older driver is having difficulty with driving safely, there may be some alternative methods of transportation available. A study by Kerschner and Aizenberg came up with the five A's of transportation based on what older adults desired in a transportation system.¹⁴ They state older adults want:

• Availability- available to them when needed, including evenings and weekends

• Accessibility- they can get to it, get in it, ride in it, and get out of it

• Affordability- this relates to cost and ability to use vouchers and coupons to decrease out of pocket expense

• Acceptability- clean, safe, and easy to use

• Adaptability- meets special needs like transporting a person with a wheelchair or the ability to stop for several errands

Some alternative forms of transportation include:

• Walking- second most common form of transportation, with driving being number one

• Carpooling with family and friends

• Taxi cab

• Personalized driver service

• Bus

• Train

• Subway

• Shuttle buses or vans

• Special services like those offered by senior centers, churches, Area Agencies on Aging, independent living centers, or other local organizations

• Public door to door paratransit service

Some of the alternative transportation solutions available currently do not meet the transportation needs of the older adult.¹⁵ Some of these problems include:

• The transportation is not available on weekends or evenings¹⁶

• It is too difficult for the older adult to get to the transportation stops- important to have door-through-door service option

• The vehicles are too difficult for the older adult to board and exit

• The climate is harsh making it hard for the older adult to sit and wait for the vehicle

• Feeling unsafe waiting at a transportation stop, especially in the evening

• Many places do not have public transportation, especially in rural areas

• Problems that interfere with the older adults' ability to drive are often the same problems that interfere with their ability to learn a new transportation system

Even in areas where public transportation is available, it is not typically the mode of transportation the older adult can or will use. Older drivers use private vehicles over 90% of the time for their transportation needs.⁹ Less than 5% of the older population uses public transportation. If the older adult grew up using public transportation, they are more likely to use it later in life. If transportation is not available, many older adults continue to drive even if they are not safe. With the loss of their mode of community mobility, when older people no longer drive, they are at high risk of social isolation.

There are programs around the country that teach people to use public transportation or provide public transportation. For example, the Independent Transportation Network in Portland, Maine provides 24 hour service 7 days a week that is safe, easy, and reliable according to the company.¹⁶ Local CILs may offer training in use of public transportation.

There are many different sources of funding for alternative transportation. The federal government has over 50 different sources alone. Because there are so many funding sources for transportation and so many different programs, there is a new initiative called "United We Ride" by the Department of Transportation, Department of Health and Human Services, and Department of Labor and Department of Education to coordinate the various programs and deliver better service to the consumers.¹⁷ This initiative will hopefully make it easier for people to use alternative transportation and meet the transportation needs of older adult with disabilities.

Local Area Agencies on Aging keep track of transit services available in the area. CILs are encouraged to become aware of transportation options in their area.

For more information on the types of alternative transportation available in your area, contact:

• Your local Area Agency on Aging by using ElderCare Locator 1-800-677-1116 and ask for your local Office on Aging

• Easter Seals Project ACTION (Accessible Community Transportation In Our Nation) at 1-800-659-6428 or go to their website at www.projectaction.org.

References

¹American Automobile Association Foundation for Traffic Safety. (2000). How to Help an Older Driver, A Guide for Planning Safe Transportation. Washington, DC.

²American Association of Retired Persons. (1995). Frequently asked questions: answer to question two. Driver Safety Program. Retrieved January 21, 2004 from http://www.aarp.org/drive/faq2.html

³WebMD- Healthwise, Inc. (2002). Age-related Macular Degeneration, Retrieved January 21, 2004 from http://my.webmd.com/hw/healthy_seniors/hw176041.asp

⁴WebMD- Healthwise, Inc. (2002). Diabetic Retinopathy: Topic Overview, Retrieved January 21, 2004 from http://my.webmd.com/hw/diabetes_1_2/tf1311.asp

⁵WebMD- Healthwise, Inc. (2002). Diabetic Retinopathy: Symptoms, Retrieved January 21, 2004 from http://my.webmd.com/hw/diabetes_1_2/tf1323.asp

⁶Lighthouse International. (2004). Tips from Lighthouse International for Older drivers with Vision Problems, Retrieved January 21, 2004 from http://www.lighthouse.org/tips/old_people_driving.htm

⁷American Association of Retired Persons. (1995). Frequently asked questions: answer to question three. Driver Safety Program. Retrieved January 21, 2004 from http://www.aarp.org/drive/faq3.html

⁸National Institute on Aging. (2002). Older drivers. Age Page, Retrieved January 21, 2004 from http://www.niapublications.org/engagepages/drivers.asp

⁹Straight, A. & Jackson, A.M. (1999). Older Drivers, Retrieved January 21, 2004 from http://research.aarp.org/consume/fs51r_older_drivers.html

¹⁰Carr, D.B. (2000). The older adult driver. American Family Physician, Retrieved January 21, 2004 from http://www.aafp.org/afp/20000101/141.html

¹¹Cook, L., S. Knight, Olson, L.M., Nechodom, P.J., & Dean, J.M. (2000). Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995. Annals of Emergency Medicine, 35(6): 585-591.

¹²Green, M. (2004). Visual forensic of older drivers. Visual Expert: Human Factors, Retrieved January 21, 2004 from http://www.visualexpert.com/Resources/olderdrivers.html

¹³National Center for Injury Prevention and Control. (2003). Older Adult Drivers Factsheet, Retrieved January 21, 2004 from http://www.cdc.gov/ncipc/factsheets/older.htm

¹⁴Kerschner, H & Aizenberg, R. (November, 1999). Transportation in an aging society: focus group project. Senior Driver Research, Retrieved January 21, 2004 from http://www.seniordrivers.org/research/index.cfm?selection=1

¹⁵European Conference of Ministeries of Transport. (April 24, 2001). Policies to increase accessibility and safety for older people. Report on Transport and Ageing of the Population, Retrieved January 22, 2004 from http://www.seniordrivers.org/clearinghouse/pdf/ECMT2001.pdf6 Independent Transportation Network. Dignified Transportation for Seniors: Your Community-based Alternative, Retrieved January 22, 2004 from http://www.itninc.org/index.asp

¹⁷Coordinating Council on Access and Mobility. (2003). United We Ride: Building the Fully Coordinate Human Service Transportation System, Retrieved January 22, 2004 from http://www.fta.dot.gov/CCAM/www/index.html

Transportation Resources