Mobility and Driving: Public Health Perspectives

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Mobility and Driving Public Health
Perspectives

• Jeffrey W. Elias, Ph.D.

National Institute on Aging
Listening Session for the White House Conference
on Aging January 8, 2005
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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)
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Driving and Aging as a Risk Factor
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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

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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)

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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

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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.

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Driving and Population Trends
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Trends in Cognition, Disability, and
Vulnerability as an older driver
continued..http//cta.ornl.gov/cta/One_Pagers/Mob
ility_Safety.pdf
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10.0
If disability rate did not
change since 1982
8.3
8.0
7.5
7.1
7.0
6.4
6.0
Based on declining
disability rate since 1982
4.0
1989
1982
1994
Total Population
Total Population
Total Population
Age 65
Age 65
Age 65
26.9 million
30.8 million
33.7 million
Source National Long Term Care Survey 1982-1994
(Kenneth Manton, Ph.D.)
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Current training takes place within the framework
of cohort/generation experiences and exposures
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Verbal Meaning
57
55
Space
Mean T-Scores (mean 50, sd 10)
Reasoning
53
Number
51

Word Fluency
49
47
Time 1
Time 2
Time 1
Time 2
Occasion
Adult Offspring
Parents
Generation
Source Schaie, 2000
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Trends in Cognition, Disability, and
Vulnerability as an older driver
continued..http//cta.ornl.gov/cta/One_Pagers/Mob
ility_Safety.pdf
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Trends in Cognition, Disability, and
Vulnerability as an older driver
continued..http//cta.ornl.gov/cta/One_Pagers/Mob
ility_Safety.pdf
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Trends in Cognition, Disability, and
Vulnerability as an older driver
continued..http//cta.ornl.gov/cta/One_Pagers/Mob
ility_Safety.pdf
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Trends in Cognition, Disability, and
Vulnerability as an older driver
continued..http//cta.ornl.gov/cta/One_Pagers/Mob
ility_Safety.pdf
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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.

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Trends in Cognition, Disability, and
Vulnerability as an older driver
continued..http//cta.ornl.gov/cta/One_Pagers/Mob
ility_Safety.pdf
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Driving as a Higher Order IADL
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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).

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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.

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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.

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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.

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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.

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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.

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Driving as an IADL continued..

• Maintenance or loss of the driving
• IADL is no trivial matter.

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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.
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