# Presentation: 346037

## Social and Economic Impacts of Driving Cessation in the United States

**Mary D. Stearns,  Don Sussman, **
**David Skinner**
**RSPA / Volpe Center**** **
**NHTSA**
**US DOT/**** ****Office of the Secretary**

## Background

- Automobile travel is the primary source of out-of-the home mobility in the US
- Driving cessation likely to curtail older Americans’ mobility
- At the 1999 TRB meeting on transportation and aging, the impact of loss of mobility on health was identified as a Key Issue
- Need methodology to quantify
- Contribution of mobility to health
- Other costs of lost mobility

## In 2030 One Out of Five Americans Will Be 65 or Older (70 Million) 

- Number of Americans 65 and older (in millions) by year

- Age Distribution of the United States Population, 2000

**In 2000 there were 143 women for every 100 men age 65 and older, **
**(21 million women vs.14 million men)**** **

## Issue

- Research suggests
- Lost out-of-the-home-mobility
- Leads to isolation, depressive symptoms, illness
- Diminished quality of life
- Relationship between driving status and sense of autonomy and health hypothesized
- Insufficient data to validate

## What We Know

**What We Know**

- The US population is aging
- Driving declines with age
- Major/minor depression
- Widespread public health problems
- Risk of automotive injury and fatality increases with age

## Driving Cessation 

- More likely due to self-perceived physical incapacitation than diagnosis
- Is episodic
- Decision to cease can depend on life requirements (e.g. employment)
- Men postpone cessation longer than women
- Hu, Lu & Trumble DOT HS 1997

## Driving Cessation: A Socially Induced Disability? 

- Disablement** - **gradual and nonlinear process of decline
- Decision to cease driving has consequences
- For many areas of life
- Embedded in life choices
- Driving cessation can be considered a disability
- Broad range of effects if residence location doesn’t offer transportation alternatives
- Robin Barr, NIA

## What Does Driving Cessation Mean?

- If driving is ...  [a] resource
- ...It is possible to replace that resource with alternative forms of transportation
- And the alternative services may also reduce the risk of a crash that injures or kills the affected older adult ... a net reduction in health risk
- If driving is itself part of independence
- ...The loss represents part of a cascade towards increasing dependence and death
- Robin Barr, NIA

## Cessation - “Sentinel Event”

- Driving reduction/cessation worsens depression
- Having a spouse or relative who drives often does not mitigate depression following driving cessation
- Driving cessation (not loss of mobility) is a key link to depressive symptoms
- Driving cessation suggests loss of control and dependency, affecting self-image
- Fonda, Wallace, Herzog. Journal of gerontology: SOCIAL SCIENCES 2001

## Driving Cessation and Depressive Symptoms

- Driving cessation:
- Restricts access to economic, social, and health care services
- Reduces ability for self-care
- Brings on depressive symptoms:
- Because is symbolic to identity

## Methodology- Background

- We need to understand:
- Reasons for driving cessation
- The impact of residence on mobility
- Location and living arrangements
- Available mobility options
- Access to public transport, affordability of private transportation
- Different expectations among current and future cohorts

## Five Step Methodology: Estimating Social and Economic Costs 

- Define the temporal course of driving cessation
- Identify substitutions for driving cessation (“prototypes”)
- Estimate the magnitude of the population by prototype
- Identify costs for each prototype
- Acquire cost information

## Mobility and Its Substitutes

- Mobility prototypes
- “Base Case:”* Status quo*,” self-provided mobility
- Prototype 1: lives in residence, informal provision of  mobility through friends and family
- Prototype 2: lives in residence, can afford to purchase mobility
- Prototype 3: lives in residence, limited ability to purchase mobility, lacks mobility substitutes
- Prototype 4: residential facility; mobility substitutes provided and services “brought in”

## Slide 14

## Estimates of Population Age 65 and Older, by Mobility Prototype, by Help Required

## Costs By Prototype

- Costs:
- Direct or ‘out-of-pocket’ costs.
- Opportunity costs, e.g., volunteer caregiver foregoes employment earnings for time spent in volunteer caregiving.
- Indirect costs. Person loses mobility and experiences illness because of the loss of social interaction bestowed by external mobility.

## Allocating Loss of Mobility Costs

- Costs associated with mobility loss can fall on:
- Individual
- Family and friends
- Private enterprises, e.g., social services and medical sector
- Community
- Local government
- State
- Nation (social costs)
- Others

## Data Needs 

- Data must provide:
- driving and mobility status
- health status
- income and consumption expenditures
- Propose reanalysis of HRS/AHEAD
- national sample
- estimate distribution of functional capability and living arrangements

## HRS/AHEAD

- NIA - sponsor, conducted by University of Michigan
- National** **longitudinal sample; 1992, 1994, 1996, 1998, 2000, anticipate 3 more waves
- Measures: financial resources, retirement, health, ADLs, IADLs, cognitive information, physical ailments, income and consumption expenditures
- Records driving reduction, cessation, spouse driving

## HRS/AHEAD

- Demographically representative, national sample. By using HRS/AHEAD...
- Estimates can be ‘ratcheted’ up to national population segments.
- We can determine point estimate of costs as well as confidence interval (precision of estimate)

## Considerations

- Loss of mobility costs could be short or long run
- Short-run cost occurs by paying a premium for goods/ services delivery
- Long-run costs occurs if health declines due to loss of mobility
- Should costs be net of any benefits that might accrue from a person *not* having external mobility?
- If driver is at a *very high* risk of a crash due to age-related deficits
- Are costs recoverable?
- While costs are incurred from mobility loss, can public and/or private investment recover those costs