THE ELDERLY AND MOBILITY: A REVIEW OF THE LITERATURE by Michelle Whelan Jim Langford Jennifer Oxley Sjaanie Koppel Judith Charlton November 2006 Report No. 255 II MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE REPORT DOCUMENTATION PAGE Report No. Date ISBN Pages 255 November, 2006 0 7326 2325 1 118 Title and sub-title: The Elderly and Mobility: A Review of the Literature Author(s): Michelle Whelan, Jim Langford, Jennifer Oxley, Sjaanie Koppel & Judith Charlton Sponsoring Organisation(s): Swedish Road Administration (SRA) _______________________________________________________________________________ Abstract: The ability to travel is associated with freedom, activity and choice and driving offers an important mobility option for most elderly. Driving cessation is linked to an increase in depressive symptoms and a decline in out-of-home activity levels and community mobility. Further, for at least some people, the same health conditions and functional impairments that cause a change in driving patterns will also limit access to other transport options (walking, cycling, public transport), thereby further contributing to restricted community mobility and its consequences. Driving status thus plays a critical role in the complex interactions between ageing, physical and psychological health, community mobility and use of health services. A good understanding of these relationships is required in order to enable older people to maintain economic and social participation and quality of life. This report provides a comprehensive review of international literature to assess the current state of knowledge with regard to the complex relationships between changing driving and travel patterns, ageing, health status, and reduced mobility and the impact of poor mobility on quality of life. The findings from the literature review were used to compile a set of ‘best-practice’ recommendations to effectively manage the safe mobility of elderly road users. It is recommended that a co-ordinated approach that encompasses innovative strategies and initiatives to manage the mobility of older road users be adopted. Such an approach should include measures that focus on safer road users (appropriate management of ‘at-risk’ older drivers through appropriate licensing procedures and development of targeted educational and training programs), safer vehicles (improved crashworthiness of vehicles, raising of awareness amongst older drivers of the benefits of occupant protection, and development of ITS technologies), safer roads (creating a safer and more forgiving road environment to match the characteristics and needs of older road users), and improvements to alternative transport options (provision of accessible, affordable, safe and co-ordinated transport options that are tailored to the needs of older adults and promotion and awareness of alternative transport options amongst older drivers and their families/caregivers). Options for further research are also highlighted. Poor mobility places a substantial burden on the individual, families, community and society and there is a real need for policy makers, local governments and communities to consider the transportation needs of the elderly to support ongoing mobility. Key Words: Older Road Users; Mobility; Travel Needs; Driving; Quality of Life; Crash Risk; Safety; Education; Road Design; Vehicle Design; Public Transport. Reproduction of this page is authorised Monash University Accident Research Centre, Building 70, Wellington Road, Clayton, Victoria, 3800, Australia. Telephone: +61 3 9905 4371, Fax: +61 3 9905 4363 THE ELDERLY AND MOBILITY: A LITERATURE REVIEW iii IV MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE Preface Project Manager Dr. Jennifer Oxley, Senior Research Fellow Research Team Mr. Jim Langford, Senior Research Fellow Ms. Michelle Whelan, Research Assistant Dr. Sjaanie Koppel, Research Fellow Dr. Judith Charlton, Senior Research Fellow THE ELDERLY AND MOBILITY: A LITERATURE REVIEW v VI MONASH UNIVERSITY ACCIDENT RESEARCH CENTRE Contents EXECUTIVE SUMMARY ............................................................................................XIII 1 INTRODUCTION ....................................................................................................... 1 1.1 METHOD................................................................................................................. 2 1.2 STRUCTURE OF THE REVIEW ................................................................................... 2 1.3 OLDER PEOPLE’S NEED FOR MOBILITY .................................................................... 3 1.3.1 Findings from the OECD Working Group .................................................... 3 1.3.2 Findings from the research............................................................................ 4 1.3.2.1 Mobility is more than travel ...................................................................... 4 1.3.2.2 Travel needs............................................................................................... 5 1.3.2.3 The impact of driving reduction and cessation on QoL ............................ 6 1.3.2.4 Older adults in the next two decades....................................................... 11 1.4 SUMMARY ............................................................................................................ 12 2 ASSESSING AND MANAGING OLDER DRIVER SAFETY: THE FACTS AND MYTHS..................................................................................................................... 13 2.1 CRASH INVOLVEMENT .......................................................................................... 13 2.1.1 Findings from the OECD Working Group .................................................. 13 2.1.2 Findings from the research – the frailty bias .............................................. 15 2.1.3 Findings from the research – the low mileage bias..................................... 17 2.1.3.1 Explaining the low mileage bias.............................................................. 19 2.1.4 Conclusions ................................................................................................. 20 2.2 VULNERABILITY.................................................................................................... 20 2.2.1 Findings from the OECD Working Group .................................................. 20 2.2.2 Findings from the research – older drivers as a crash risk to others ......... 21 2.2.3 Conclusions ................................................................................................. 23 2.3 MEDICAL CONDITIONS AND FUNCTIONAL DECLINE............................................... 23 2.3.1 Findings from the OECD Working Group .................................................. 23 2.3.2 Findings from the research – the link between ageing and medical conditions..................................................................................................................... 25 General Condition.................................................................................................... 26 2.3.3 Findings from the research – the link between ageing and vision .............. 28 2.3.4 Findings from the research – the link between ageing and cognition......... 29 2.3.5 Findings from the research – the link between ageing, medical conditions, functional impairments and crash risk ........................................................................ 29 2.3.6 Findings from the research – the role of self-regulation in countering changes in functional performance. ............................................................................ 30 2.3.7 Findings from the research – using crash epidemiology to explore unfitness to drive and crash responsibility. ................................................................................ 32 2.3.8 Conclusions ................................................................................................. 34 2.4 FITNESS TO DRIVE ................................................................................................. 34 2.4.1 Findings from the OECD Working Group .................................................. 34 2.4.2 Age-based mandatory assessment programs as part of general licensing procedures to identify at-risk drivers. ......................................................................... 36 2.4.3 Review of the evidence showing the validity of the individual assessment protocols. ..................................................................................................................... 37 2.4.3.1 On-road assessment ................................................................................. 37 2.4.3.2 Off-road assessment ................................................................................ 38 THE ELDERLY AND MOBILITY: A LITERATURE REVIEW vii 2.4.4 Conclusions ..................................................................................................41 2.4.4.1 Age-based mandatory assessment programs............................................41 2.4.4.2 On-road and off-road assessment.............................................................42 2.5 LICENCE REMOVAL ................................................................................................43 2.5.1 Findings from the OECD Working Group ...................................................44 2.5.2 Findings from the research: premature cessation of driving.......................45 2.5.3 Findings