This study investigates factors that may be related to dependency on driving and decisions to continue or ceased riving in older age. Some older drivers may be unsafe to drive (Drachman & Swearer, 1993), but are unwilling to cease, this can result in referrals to mental health services. The potential influence of attitudes towards driving on driving behaviour has been highlighted (O'Neill, 1996) but as yet has not been fully investigated. A questionnaire was developed, based on the Theory of Planned Behaviour, to elicit factors which might predict older drivers' intentions to drive more or less often. Reliability was demonstrated for the questionnaire, which was completed by 99 older drivers. The results indicated that the majority of older drivers used their car frequently. Two components of the Theory of Planned Behaviour were demonstrated to predict 73% of the variance in driving behaviour, namely, perceived behavioural control and attitude towards driving. Those drivers who perceived more positive outcomes for driving and less negative outcomes were likely to intend driving more often. Also those drivers with higher levels of perceived behavioural control were likely to intend to drive more often. A self-report measure of actual driving behaviour two to three months later, suggested that behavioural intention was highly related to subsequent driving behaviour. Methodological issues, future research and clinical implications of the findings are discussed. In particular, interventions based on attitude change and problem solving to decrease perceived dependency on the car, may facilitate the process of giving up driving.

Introduction: Mobility is critical for independence, social engagement and quality of life, which for many seniors equates with driving. Driving cessation has been associated with depression, isolation and decreased social and community engagement. However, apart from a few studies in the United States, research on the impacts of driving cessation and transportation use in general has been restricted to community dwelling seniors. It is estimated that 40,000 seniors in Ontario alone currently live in retirement facilities; a number expected to increase. Purposes: The aim of the wider project is to gain a better understanding of the transportation patterns and needs of older adults living in retirement homes. The specific aims of this study, which focused on residents who recently stopped driving (in the past two years), were to examine: 1) events leading to driving cessation, impacts (including depression), and possible associations with relocation; 2) transportation use, including how frequently they left the Village; and 3) connections with family and friends, and activity engagement in and outside the Villages. Methods: A survey of residents from four retirement Villages in Southern Ontario was conducted to examine driving status and use of other modes of transportation. An in-depth study was then conducted with a sample of 20 residents (9 men and 11 women, age 86.45 ± 5.16), recruited via letters, pamphlets, booths and door-to-door. The study involved both quantitative (questionnaires, scales on depression and balance confidence, activity checklists) and qualitative methods (small group discussions). Participants were also asked to complete travel diaries over two weeks for all trips outside the Village (purpose and mode of travel). Results: The transportation survey (N=407; 56% response rate) showed that 68% of residents had stopped driving (N=273), over half within 12 months of relocation. In the in-depth study, 36.8% had stopped driving before the move (average of 3.43±1.72 months, range 1 to 6), 42.1% after the move (average of 27.38±13.51 months, range 2 to 46), and 21.2% within the same month. While the quantitative data indicates a relationship between these transitions, this connection was often not made by residents themselves. Several mentioned health problems as the main reason they quit driving; two had lost their licenses. Regardless, most felt the decision to quit driving was voluntary and done at the “right time”. Except for a few people, this sample did not have depression symptoms and had adjusted to no longer driving. The majority (85%) had relatives in the area and most stayed connected to relatives and friends living outside the Village through visits and phone calls. Nearly all the residents (90%, n=18) received rides from others, most commonly from their daughters (70%), followed by friends outside the Village (60%). Half the sample said they used public buses occasionally, and those who did had significantly higher balance confidence scores on the ABC scale (73.33±18.50) compared to those who did not (49.44±21.02) (t=-2.69 p=0.015). Confidence scores, however, did not differ for those who used the Village shuttle (80%) and those who did not (20%). Based on their travel diaries, 76.5% of the residents (13/17) made at least one trip outside the Village over a two week period (average of 7.00±4.93, range 1 to 18), most often as a passenger in a private vehicle (58%). Recreation and social trips were the most common (44.2%), followed by: medical appointments (18%), shopping (17%), errands (15.3%) and religious activities (5.4%). The sample also took advantage of services and amenities inside the Village, including: meals in the dining room (95%), the café (90%), general store (80%), salon (65%), library (65%), laundry facilities as well as services of health professionals. They also participated in Village programs, including: music, concerts, movies (80%), physical activities (65%), games (55%) and religious services (50%). Conclusions: Seniors who can afford to live in upscale retirement homes may not suffer the adverse effects of driving cessation often found in community seniors. Despite advanced age and mobility restrictions (85% used a walker outdoors), these individuals remained connected to the outside community. This sample, at least, took advantage of the services and amenities in their Villages which may reduce their need for travel outside the Village. They do not appear to have unmet transportation needs, given that most had relatives in the area as well as other people to drive them when needed. More studies are needed on this growing segment of the senior population, particularly on other types of retirement facilities which may not offer as many services (such as shuttle buses or vans) for residents.

Introduction: Mobility is critical for independence, social engagement and quality of life, which for many seniors equates with driving. Driving cessation has been associated with depression, isolation and decreased social and community engagement. However, apart from a few studies in the United States, research on the impacts of driving cessation and transportation use in general has been restricted to community dwelling seniors. It is estimated that 40,000 seniors in Ontario alone currently live in retirement facilities; a number expected to increase. Purposes: The aim of the wider project is to gain a better understanding of the transportation patterns and needs of older adults living in retirement homes. The specific aims of this study, which focused on residents who recently stopped driving (in the past two years), were to examine: 1) events leading to driving cessation, impacts (including depression), and possible associations with relocation; 2) transportation use, including how frequently they left the Village; and 3) connections with family and friends, and activity engagement in and outside the Villages. Methods: A survey of residents from four retirement Villages in Southern Ontario was conducted to examine driving status and use of other modes of transportation. An in-depth study was then conducted with a sample of 20 residents (9 men and 11 women, age 86.45 ± 5.16), recruited via letters, pamphlets, booths and door-to-door. The study involved both quantitative (questionnaires, scales on depression and balance confidence, activity checklists) and qualitative methods (small group discussions). Participants were also asked to complete travel diaries over two weeks for all trips outside the Village (purpose and mode of travel). Results: The transportation survey (N=407; 56% response rate) showed that 68% of residents had stopped driving (N=273), over half within 12 months of relocation. In the in-depth study, 36.8% had stopped driving before the move (average of 3.43±1.72 months, range 1 to 6), 42.1% after the move (average of 27.38±13.51 months, range 2 to 46), and 21.2% within the same month. While the quantitative data indicates a relationship between these transitions, this connection was often not made by residents themselves. Several mentioned health problems as the main reason they quit driving; two had lost their licenses. Regardless, most felt the decision to quit driving was voluntary and done at the “right time”. Except for a few people, this sample did not have depression symptoms and had adjusted to no longer driving. The majority (85%) had relatives in the area and most stayed connected to relatives and friends living outside the Village through visits and phone calls. Nearly all the residents (90%, n=18) received rides from others, most commonly from their daughters (70%), followed by friends outside the Village (60%). Half the sample said they used public buses occasionally, and those who did had significantly higher balance confidence scores on the ABC scale (73.33±18.50) compared to those who did not (49.44±21.02) (t=-2.69 p=0.015). Confidence scores, however, did not differ for those who used the Village shuttle (80%) and those who did not (20%). Based on their travel diaries, 76.5% of the residents (13/17) made at least one trip outside the Village over a two week period (average of 7.00±4.93, range 1 to 18), most often as a passenger in a private vehicle (58%). Recreation and social trips were the most common (44.2%), followed by: medical appointments (18%), shopping (17%), errands (15.3%) and religious activities (5.4%). The sample also took advantage of services and amenities inside the Village, including: meals in the dining room (95%), the café (90%), general store (80%), salon (65%), library (65%), laundry facilities as well as services of health professionals. They also participated in Village programs, including: music, concerts, movies (80%), physical activities (65%), games (55%) and religious services (50%). Conclusions: Seniors who can afford to live in upscale retirement homes may not suffer the adverse effects of driving cessation often found in community seniors. Despite advanced age and mobility restrictions (85% used a walker outdoors), these individuals remained connected to the outside community. This sample, at least, took advantage of the services and amenities in their Villages which may reduce their need for travel outside the Village. They do not appear to have unmet transportation needs, given that most had relatives in the area as well as other people to drive them when needed. More studies are needed on this growing segment of the senior population, particularly on other types of retirement facilities which may not offer as many services (such as shuttle buses or vans) for residents.

Background: The rise in the total number of seniors will lead to a considerable increase in the prevalence of persons with dementia (PWD), the number of senior drivers and the amount of drivers with dementia. Understanding how this life event is experienced by PWD and their caregivers is paramount to policy development and planning. Methods: Descriptive qualitative study using secondary data. There were 25 participants over the age of 65, whose monthly phone call conversations were analyzed using analytic induction, to find links and create a theoretically based hypothesis regarding the experience of driving cessation. A standardized questionnaire was used to guide the telephone data collection. Results: PWD may experience emotions of anger when they don’t understand why they are no longer allowed to drive. When PWD understand why they are no longer allowed to drive, they seem to accept and self-regulate their driving cessation. Cognitive tests and physicians instructing PWD they have to cease driving, are not perceived to be helpful in this understanding. Public transportation and alternate means of personal transportation are potentially associated with the acceptance of driving cessation. Conclusions: PWD might not understand the link between cognitive assessments, their memory, and their driving performance. A systems level approach to improved access to transportation and on-road driving tests might make it easier for PWD to understand and accept the lifestyle changes that come with driving cessation.

Doctor of Philosophy / Department of Family Studies and Human Services / Karen Myers-Bowman / Due to health conditions, the average 70 year old will outlive the ability to drive by 6 years for men and 10 years for women (Foley et al., 2002). Driving loss has a significantly negative impact on the quality of life of an older adult. For this reason, some continue to drive despite concerns about safety. Midlife family members of older adults often feel social pressure to intervene in driving decision-making and social pressure to refrain from intervening. The goal of this study was to understand the experiences of midlife family members from the time that someone first noticed a concern with the older relative’s driving until the time the older adult stopped driving. A qualitative, multiple embedded case study approach was used to gather information from two midlife family members from 7 families with an older driver who had recently retired from driving. The family processes that influenced communication about driving and choice of strategies for intervening were examined. Findings indicated that the midlife family members became aware of safety issues at different times. Awareness prompted conversations with other relatives, and the majority of family conversations about driving did not include the older adult. Many family members reported a respect for the autonomy of the older relative and a reluctance to initiate conversations without permission from the older adult to do so. Intervention strategies reported by participants included (1) wait and worry, (2) nudging, (3) attempted conversation, (4) ending requests for driving assistance, (5) requesting assistance from physicians, (6) requesting assistance from the DMV, (7) requesting assistance from law enforcement, and (8) accepting the inability to end an older adult’s driving career. Participants reported many factors that both helped and hindered efforts to encourage driving retirement. Based on these findings, an Ecological Model of Later-Life Decision-Making was proposed. The model reflects that the participants’ efforts to encourage driving retirement were not simply a matter of intra-family communication, but were influenced by processes occurring at multiple levels, both within and outside of the family. Processes occurring at multiple levels both helped and hindered family members’ efforts to encourage driving retirement.

Research has revealed a variety of negative health consequences for older adults who stop driving, and with the "graying of America," this will be a frequently encountered issue for healthcare providers. The purpose of this study was to determine if there are differences in quality of life and depressive symptoms between former drivers who made the decision to stop driving voluntarily and former drivers who made the decision involuntarily (either in a resistant or in a reluctant manner). In this cross-sectional cohort comparison study, community dwelling older adults were asked to complete questionnaires of depression (using the Geriatric Depression Scale), and quality of life (QOL) (using the Short Form Health Survey-36 questionnaire). Descriptive statistics include data for each individual group separately; separate analysis of variance (ANOVA) was used to analyze the data to determine if differences in QOL and depression exist between the groups. Results: the small sample (n=18) was predominantly comprised of women (15/18), most were widowed, and the age of participants was 81 years. No differences were detected between the three group means for the GDS, F(2, 15) = .782 (p = .47). Results for the SF-36 revealed differences between the group means in the mental health component summary was F(2,13) = 4.209, (p = .039). Conclusions: There are few differences between involuntary and voluntary former drivers demographics, but differences may exist between involuntary and voluntary former drivers' quality of life.

The projected growth of persons ages 65 and older in the U.S. over the next few decades will usher in an era of unprecedented numbers of seniors licensed to drive. For some members of this group, there will come a time where driving will have to cease due to a variety of factors. At that juncture in their lives, these seniors may have to consider transportation alternatives other than the personally operated vehicle. The objective of this study is to evaluate potential changes in transit market share arising from travel behavior changes of seniors who lose their driving privileges. This includes determining seniors interest in, ability to, and subsequent use of public transit. First, a literature review of developments that have impacted senior travel behavior is presented. Developments such as the changing demographics of seniors, senior socio-economic status, the process of driving retirement, and factors influencing transit use by seniors are presented. Estimates of the numbers of licensed and former drivers are derived for the year 2030 using several methodological approaches. Trip rates are applied to the predicted non-driving population to derive estimates of the potential demand for transit and subsequent market share. Discussion of the estimated market share results also incorporates a descriptive overview of senior travel behavior as derived from analyses of publicly available datasets followed by focus group results illustrating the experiences of seniors and their transportation choices.Recommendations range from transit agencies engaging in direct "generational" marketing to seniors in order to understand their transportation needs as well as perceptions about transit, promoting the use of transit, and demonstrating the viability of transit for specific trip purposes and partner with rideshare providers. Despite the predicted increase in transit market shares attributable to the senior population, transit providers have extensive work to do to change the perceptions of transit service provision and subsequently encourage the use of such services by senior populations in forthcoming generations if transit is to become a viable transportation alternative for those seniors ceasing to drive.

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The older adult population and the number of older adults who rely primarily on driving as their means of transportation in later life are increasing. Older adults experience changes due to aging and age-related diseases that may put them at increased risk of crashes and other unsafe driving behaviours. Considerable evidence has demonstrated that some older adults compensate for their declining abilities by voluntarily restricting their own driving to limit exposure to risky driving situations or by stopping driving altogether. Since mobility is critical for maintaining the independence and quality of life of the older adult, it is important to examine factors that influence driving behaviours of older adults and to promote their safe driving for as long as possible. It has been suggested that driving cessation might occur in discrete stages of driving restriction culminating in driving cessation. Yet, the application of TM to older driver behaviour has not been explored in detail. Thus, the purpose of this research was to explore older adults’ perceptions and experiences of the process of older driver behaviour change within the TM framework. Drivers and former drivers (both men and women) aged 71-94 years of age completed a health and demographic questionnaire and participated in either a digitally recorded semi-structured individual interview or a group discussion. Participants were asked a series of pre-determined questions and probes tailored for either current or former drivers to examine this process. The recordings were transcribed and reviewed for themes related to driving behaviour change. The participants exhibited a wide variety of perceptions and experiences related to the process of driving behaviour change in aging. Their driving behaviour in aging could be divided into 2 general classes: those who changed their driving with age and those who did not. The spectrum of experiences ranged from those who gradually imposed restrictions on their driving with age (“the gradual restrictors”) or made plans for stopping (“the preparers”) to those who always employed driving restrictions throughout their driving history (“the consistent”) or those who made no or only minor changes to their driving behaviour with age (“the non-changers”). Some preliminary support for TM within the driving context was found and recommendations for extensions to the TM model were suggested. Further exploration of driving behaviour change within the TM framework is warranted. The findings from this study may be appropriate for use in designing educational strategies and interventions aimed at helping older adults remain on the road safely longer or stop driving, if needed.