Giving Up Driving May Be Express Lane To Long-term Care

The Hopkins study findings, published in the July issue of the American Journal of Public Health, included extensive interviews conducted over a 10-year period with 1,593 seniors between 65 and 84 years of age who live in the small, Eastern Shore town of Salisbury, Md.

"We are not recommending continuation of driving for seniors who are a threat to themselves or others on the road," said Ellen Freeman, Ph.D., an epidemiological researcher now working with the Johns Hopkins Wilmer Eye Institute and the study's lead author. "Instead, we hope that understanding the very real health impact that losing the ability to drive has on seniors will encourage families to plan contingencies to assist elderly members with transportation issues."

The researchers also pointed out that losing the ability to drive poses an especially significant hardship to seniors living in isolated rural areas or any place without good, accessible public transportation for the elderly.

"We set out to learn whether or not the loss of driving ability played a measurable role in an older person's eventual need for long-term care," said Sheila West, Ph.D., a professor of ophthalmology at the Johns Hopkins School of Medicine. "The independence that accompanies a driver's license and car has long been linked anecdotally to a better quality of life for seniors."

Freeman and others on the Hopkins team stressed that from both a personal and public policy standpoint, the need is greater than ever to figure out what best and safely helps older people keep an independent lifestyle. "The average annual cost of nursing home admission is $69,000, and the price tag associated with entry into assisted living is roughly $30,000," she noted. "That's a public policy issue of huge dimensions as our population ages."

"This probably isn't so much about the process of driving but rather the larger issue of mobility as it relates to a person's independence," added Freeman. "When someone becomes a shut-in due to the loss of their primary transportation, the likelihood that they will require living assistance categorically increases."

Non-drivers across the entire age group studied had four times the risk of long-term care entry compared to drivers, and the absence of other drivers in the home doubled the risk of entering long-term care. Nine percent of those studied entered long-term care for three months or more. By the end of the study, 29 percent of men and 58 percent of women had no other drivers in the household, and 22 percent of people who were driving at the beginning of the study reported that they stopped driving during the study.

Freeman and her colleagues said their study methods took into account and factored out many other causes of "long-term care entry," including age, race, marital status and such health problems as frailty, dementia and stroke damage. There were no significant differences in outcomes between men and women.

"These findings point to the importance of research into how to keep seniors driving and independent as long as is safely possible," said West, director of the Johns Hopkins Initiative for Translational Research on Driving and the study's senior author.

Salisbury, the site of the 10-year study, is a semirural town of about 40,000 people. Freeman cautioned that because no formal public transportation system was available to the residents of the town, the findings of the study should only be interpreted as meaningful for communities of similar size that also lack public transportation infrastructure.

Previous research done by Freeman showed that the same group of people studied reported driving more than 3,000 miles per year when they entered the study, with some already reporting changing the way they drove, such as avoiding driving at night and to unfamiliar places.

This study was funded by the National Institute on Aging. The study's co-authors were: Stephen T. Gange, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, and Beatriz Muòoz, M.S., of the Johns Hopkins School of Medicine.