Who's Going to Drive Miss Daisy?

Questions Arise as More Older Americans Outlive Driving Privilege

As people live longer and more older drivers give up their driving
privileges, family, friends and public officials may find themselves asking,
as it was in a popular film, "who's going to drive Miss Daisy?" The question
could become a critical one as America ages, according to a new study*,
which finds older men and women who outlive their ability or willingness to
drive may be dependent on alternative transportation for more than a decade
in later life.

"Hundreds of thousands of older people quit driving each year and must turn
to alternative transportation. This change in status can create unforeseen
economic and social burdens that need to be addressed in the same way we
have encouraged people to think about planning for retirement and
end-of-life care. I don't think sufficient attention has been paid to the
transition from driver to non-driver in the aging population," says Dan
Foley, M.S., a biostatistician at the National Institute on Aging (NIA) and
lead author of the study, published in the August 2002 issue of the
"American Journal of Public Health."

Almost 10 percent of the nation's drivers are older than 65, and that
percentage could increase rapidly in the next decade as the post-World War
II "baby boom" generation begins to reach that milestone. In addition, a
greater proportion of women age 65 or older is driving than in the past. By
2030, projections suggest one in five Americans will be 65 or older, and the
number of people aged 85 and older -- currently the fastest growing segment
of the older population -- could exceed 10 million. But in Foley's study,
driving cessation peaked at about age 85, suggesting more of the oldest old
may be dependent on other forms of transportation in the future.

The investigators analyzed data gathered in 1993 and 1995 as part of the
NIA-supported Asset and Health Dynamics Among the Oldest Old (AHEAD) study.
From this nationwide sample of people ages 70 or older, they assessed
follow-up data on 4,996 men and women who were able to drive and had access
to a car. Based on a statistical analysis, these drivers represented
approximately 13.7 million Americans aged 70 or older who were driving in
1993, the baseline year. Overall, 82 percent of men and 55 percent of women
in this age group drove that year. Driving prevalence declined with age,
ranging from 88 percent of men in their early 70s to 55 percent of those 85
or older. Among women, about 70 percent drove in their early 70s compared to
22 percent still driving at age 85 or older.

Two years later, 7 percent of the drivers had died. Another 9 percent were
alive, but had quit driving for other reasons.  Overall, these findings
suggest that more than 600,000 people age 70 or older stop driving each year
and become dependent on others to meet their transportation needs. About
400,000 older drivers die of all causes annually. Other than death, poor
vision, memory impairment and an inability to perform one or more activities
of daily living (bathing, dressing, eating, transferring between bed and
chair, toileting, and getting around inside the home) were common reasons
older people stopped driving.

"Driving skills are dependent on three areas of wellness: physical fitness,
thinking clearly and seeing well," Foley says. "Whether a person can
continue driving hinges on the severity of the disability or functional loss
in one or more of these three areas. Over time, people seem to reach
thresholds where they believe they can no longer safely drive."

Statistical analysis showed that the average number of years a person
continued to drive -- the driving expectancy -- was significantly less than
overall life expectancy. For instance, men and women who were still driving
at ages 70 to 74 were expected to drive, on average, another 11 years. But
these men were expected to live about 17 more years, and the women nearly 21
more years. This gap between driving expectancy and overall life expectancy
means men in this age group who stopped driving were dependent on
alternative transportation for an average of six years. For women, the gap
translated into about 10 years dependence on other transportation modes.

At age 85, those still driving had a driving expectancy of about two years.
But even at this age, men would have 4 non-driving years of life remaining
and women nearly 6 years. Researchers found no differences in driving
expectancy between urban and rural areas.

"Driving has an essential role in helping older men and women live
independently. However, with age, a person's competence and confidence
behind the wheel may erode to the point that quitting becomes an unfortunate
necessity and dependence on other means of transportation becomes an
inevitable reality," Foley says. "If we, as a society, fail to take steps to
help older people prepare for and cope with this transition, then the goal
of improving the quality of life in old age will be greatly compromised,
both now and in the foreseeable future."

The NIA, a component of the National Institutes of Health, leads the federal
effort in supporting and conducting basic and clinical research on aging and
the special needs of older people. For information about the NIA, visit the
website at http://www.nia.nih.gov/. For a free copy of "Older Drivers," an
Age Page, and other free brochures and booklets about aging and health
topics of interest to older people, call the NIA Information Center at (800)
222-2225.

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*Foley, DJ, Heimovitz HK, Guralnik JM, Brock DB, "Driving Life Expectancy of
Persons Aged 70 Years and Older in the United States," 'American Journal of
Public Health,'  vol. 92, no. 8 pp. 1284-1289. DJ Foley, JM Guralnik, and DB
Brock are with the laboratory of Epidemiology, Demography, and Biometry at
the National Institute on Aging., Bethesda, Maryland. HK Hemovitz is with
Sytel, Inc., Rockville, Maryland.