Safe mobility a key concern as the nation ages

How to safely serve the transportation needs of a radically larger and significantly more mobile older population was one of the themes sounded in "Advances in Aging: Mobility and Transportation Safety," a semester-long course offered by the UC Berkeley Traffic Safety Center and the Academic Geriatric Resource Program in spring 2001.

Experts in the fields of transportation and urban planning, transportation engineering, public health, neurology, gerontology, and other disciplines from the UC campus and across the country delivered lectures. They also took part in colloquia and participated in interviews with Traffic Safety Center staff as part of the center's mandate to create a bank of traffic safety expertise.

What emerged from the presentations was the sense that any successful program of safe transportation options for older transportation users must be shaped by the fact that there are more older drivers than ever before, and that they are logging more miles than ever before. In addition, despite clichéd perceptions, they pose less risk to others and themselves than younger drivers do. However, while there have been major improvements in reducing fatalities in younger age age groups, the improvement has not been as great among older transportation users, recent statistics show. This suggests that the transportation system is not serving older users as well in terms of providing them with safe mobility.

Today's older drivers travel nearly twice as far in a typical day as
their counterparts 20 years ago.
—Martin Wachs, Institute of Transportation Studies, Berkeley

They are also driving more. Today's older drivers travel nearly twice as far in a typical day as their counterparts 20 years ago, according to Martin Wachs, Director of the Institute of Transportation Studies at UC Berkeley and Professor of Civil and Environmental Engineering and City and Regional Planning. About 90% of the trips taken by adults 65 and older are made in cars, he said.

Part of the reason for these increases is that there are more women on the road. "Up until 20 or 30 years ago, it was quite common for men to drive and women not to," Wachs said. "With women outliving men, when they lose their mate, women also lose their mobility." In recent years, though, women became as likely as men to drive and, since 1996, they have outnumbered men drivers.

For many older people, feasible alternatives to cars are not available because they are aging in place, which means they tend to live in the same low-density suburban communities where they moved to raise their families as younger adults, Wachs said.

"As people get into these far-flung suburbs and rural areas, there's frequently no transportation other than the private automobile. And to provide services in those communities is really, really costly and may not be practical," said John Eberhard, Senior Research Psychologist for the National Highway Traffic Safety Administration. 
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Staying Mobile Means Staying Healthy

Traffic safety research traditionally emphasized how people's health affected their ability to drive, explained Patricia Waller, Senior Research Scientist at the Texas Transportation Institute at Texas A&M. Instead, she said, researchers should emphasize the reverse: how the ability to drive enhances the older person's health and sense of well-being.

"The strongest predictor of premature death among older people is social isolation," Waller said. Safe, accessible transportation gives people opportunities to engage in social contacts and forestall being cut off from others prematurely.

Widespread automobile dependence among older travelers is based on rational decisions, noted many of the speakers. First, older drivers are generally safe, Wachs noted, because they tend to self-regulate. They avoid hazardous situations by restricting their driving to daylight or high-visibility conditions and stay away from unfamiliar or congested routes. They also have the highest rate of seatbelt use and are least involved in alcohol-related fatalities, according to Eberhard.

According to Sandra Rosenbloom, Director of the Roy P. Drachman Institute for Land and Regional Development Studies and Professor of Planning at the University of Arizona, by driving into old age, older adults are saying: "'I'd rather take the increased risk of the car crash than sit in my home for three weeks without getting out. I'd rather take the risk of a car crash than call up my daughter yet again and ask her to bring me groceries or take me to the store. I'd rather take the risk of the crash than not see my friends or not go to church.' That's what they're implicitly doing, and that's rational."

The relationship between driving and self-sufficiency and quality of life was buttressed by what Eberhard found in focus groups conducted with older adults, who expressed the sense that, "If you don't drive, you're out of luck."

Under the current transportation system, cars are often the safest, most practical way for the older transportation user to get around. "People who stop driving actually show an increase in overall road fatalities because they're much more likely to be killed as pedestrians than they are when protected by 4,000 pounds of structure," Eberhard said.

Older respondents reported in surveys that they avoided transit because they feared being victimized by criminals, Wachs found—an impression that is supported by statistics. In transit settings, "older people are more likely to be victimized than people of other age groups," Wachs said. 
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Extending the Driving Life of the Older Driver

Because driving is so important, there is a great need to help older adults extend their safe driving years and to present opportunities for a gradual transition to other modes—before they are forced to give up their cars completely.

In a study of older drivers in Tucson, Rosenbloom found that a significant percentage of older people had no plans for getting around after the time when driving ceased to be feasible. As a result, when that time came, they suffered a dramatic, sudden drop in trips.

"If we offered people alternatives, they might very well give up driving sooner or in dangerous situations, and we would also address the problem of people who were self-regulating in ways that really restricted their mobility and lifestyles."

—Sandra Rosenbloom, the Drachman Institute

"We should stop taking the loss of driving as the moment we start getting worried about people," Rosenbloom said. "Not only would we deal with their mobility problems, we would also address the crash and safety problems. If we offered people alternatives, they might very well give up driving sooner or in dangerous situations, and we would also address the problem of people who were self-regulating in ways that really restricted their mobility and lifestyles."

Two distinct issues are raised by the growing presence of older drivers, said Leonard Evans, President of Science Serving Society: the risks they face and the risks they pose to others. Older adults pose far less risk on the road than younger drivers do, he said. A 70-year-old driver is less likely than a 20-year-old driver to cause a driving-related fatality or suffer one, he explained.

Nonetheless, drivers begin experiencing genuine problems of performance as they age, Evans said. Per mile driven, the risk of crashing begins to rise as drivers reach their mid-50s, and increases dramatically around the ages of 65-70, he said.

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Testing Falls Short

One commonly proposed solution, which would use licensing and testing to remove unsafe older drivers, is politically unpopular and, many of the speakers noted, likely to be impractical and ineffective.

"Licensing an older driver does not pose a greater threat to other road users than licensing other drivers," Evans said.

"Most tests that we have are much more likely to take safe people off the road and make them unsafe pedestrians than they are to identify those few people who are unsafe and need to be drawn out of the road system," Eberhard said.

A major challenge is the difficulty in determining who is no longer a safe driver. Chronological age is not a reliable indicator of functional age, Waller noted. Even in the case of individual drivers, a single driver may perform differently at different times.

"There is actually very little relationship between testing or what you find in the laboratory and someone's crash rates," Rosenbloom said. There is also not much evidence that widely promoted "refresher" courses for older drivers reduce their risk of accidents, Wachs said. "Statistically, there is a very poor correlation between completing the course and increased safety," he said.

"I think more and more the traffic safety community is recognizing that you can talk about harder tests and stricter rules and stricter licensing, but you also have to be realistic and talk about options for people whose licenses you take away," Rosenbloom said. "People are already suffering loss of independence, loss of flexibility, loss of convenience, and we have to do something."

Waller called for more gradual measures that complement each other. "The norm should be a graduated exiting from the licensed population. There is a desperate need for community-based programs that will provide transportation for those who can no longer drive. These should be coordinated with licensing programs so that older persons may be transitioned from full-fledged licensure to users of alternative transportation.

"Licensure of older drivers involves legal, political, insurance, medical, public health and safety, and economic dimensions, as well as others. Licensing policy should be based on solid input from a very broad variety of agencies and people," Waller said.
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Changing the Environment

Existing roadways, cars, public transportation services, and pedestrian facilities were generally not designed with the older person in mind. "In traffic engineering, highway design, and the high technology sector, they need to have a better understanding of the characteristics of older people. One size doesn't fit all is an underlying theme that needs to be presented to the engineers," Eberhard said.

Slower reaction times, less acute vision and hearing, difficulty with physical movement such as turning one's head, and the effects of medication, or of health conditions such as a recent stroke are among the factors that designers of transportation facilities and cars need to consider.

The majority of people with some type of impairment or disability in relation to transportation are older people, Wachs noted. And any improvements made on their behalf would also rebound to the benefit of other disabled users and, most likely, the general population.

Examples include larger road signs with better illumination, improved edge delineation on the road, longer crosswalk signals, repaired sidewalks, and safe and available public transportation. There is no "single, simple answer," Wachs said.

Whether looking at improving the safety and ease of use of roads, automobiles, community design, public transportation, or pedestrian facilities, improving transportation for older adults will require the efforts of many disciplines, groups, and individuals. Health care providers, city planners, senior advocates, media, transportation engineers, government, the automobile industry, and older adults themselves are all potential partners.

The U.S. Department of Transportation is currently undertaking such an effort, bringing together policy makers, practitioners, older adults, and their caregivers to create a National Agenda related to mobility and aging. The agenda addresses how to improve roads, pedestrian facilities, automobile design, driver assessment and rehabilitation, and other transportation services.

"I think the solutions go way beyond the DOT. This is a major, major social problem and program. And the solutions have to be created jointly with the private sector and with those interest groups that support the aging issues," Eberhard said.

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