Driving Self-Regulation and Cessation
By Amy Horowitz, DSW
One of the most difficult issues faced by older persons, especially those with impaired vision, is whether to continue driving. More than simply a way to accomplish daily tasks, the ability to drive and maintain mobility in the community becomes associated with critical psychological and emotional meanings, including autonomy, independence and self-worth. For many, giving up driving is perceived as the first step toward a downward spiral of dependency. Thus, it is not surprising that some studies reported that depression and feelings of regret and isolation are common reactions to "giving up the keys."
Considerations for Remaining at the Wheel
Many factors contribute to the decision about whether or not to continue to drive. Limited empirical evidence suggests factors such as poor perceived general health, having an accident or "close call," the availability of alternate public transportation, and the opinions of family and physicians. The family or living situation can be an especially strong influence on the decision to stop driving. For example, the availability of other family members as drivers may make the decision to stop easier. On the other hand, having a non-driving spouse may prolong the need to continue.
In fact, most older people continue to drive as long as possible, even at very advanced ages. Preliminary data from a current Lighthouse study suggest that 15 percent of new applicants age 65 and older who apply for vision rehabilitation services are currently driving. And results of the Lighthouse National Survey on Vision Loss -- a telephone survey of a nationally representative sample of 1,219 persons age 45 and older -- indicate that 78 percent of all adults age 55 and older who self-reported moderate to severe vision impairment were current drivers.
There is also evidence, however, that older persons self-regulate driving behaviors long before they actually stop driving. The most common self-regulatory behaviors include: not driving at night, driving more slowly, driving shorter distances and/or only in the neighborhood, and not driving in bright sunlight.
A Dearth of Empirical Data
It is surprising how little research has been conducted on the psychosocial aspects of driving among older adults with physical disabilities, especially those with impaired vision. Two major questions need to be addressed. First, research is needed that focuses on the specific ways older people with vision impairments modify and/or regulate their driving behaviors. Although we have some preliminary data from samples of older people with various health conditions, we need more specific data on if, and to what degree, these driving behaviors are generalizable to the populations of older adults with impaired vision, and with different functional vision losses.
Second, research is needed regarding decision-making processes that people engage in as they weigh alternatives in terms of continuation, modification or cessation of driving. Specifically, we need to know more about how doctors or family members play roles in the process. Garnering this information will help with the design of interventions to assist older adults in their decision-making, and evaluate the efficacy of such interventions.
Amy Horowitz, DSW, is Senior Vice President for Research and Evaluation, and Director of the Arlene R. Gordon Research Institute, Lighthouse International.
Source: Lighthouse International's Aging & Vision newsletter (Summer-Fall 2001)
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