Safe

Mobility

for a

Maturing

Society:

Challenges

and

Opportunities

U.S. Department of Transportation

November 2003

Washington, DC

Safe Mobility for a Maturing Society: Challenges and Opportunities

Acknowledgements

i

The U.S. Department of Transportation wishes

to thank the many groups and individuals who

contributed extensively to this document. Input

came from participants in an array of local

and state activities, creating a report that represents the

knowledge of many professional and governmental

groups: transportation, social service, medicine and health

care, motor vehicle agencies, advocates, and others. Space

does not permit listing all who contributed to this effort.

We are grateful to those who organized and conducted

the forums: in Florida, Susan Samson, Selma Sauls, and

Mary Russell; in Michigan, Jennifer Evans and Betty

Mercer; in New York, Phil LaPore; and in California,

Jorge Lambrinos. The AAA Foundation for Traffic Safety

supported the focus groups conducted by the Beverly

Foundation under the direction of Helen Kerschner and

Rhonda Aizenberg; the Eno Transportation Foundation,

led by Damian Kulash, assisted with the forums and

early drafting of this report; and the Maryland Research

Consortium “Making Safe Mobility for Life a Reality,”

under Robert Raleigh, contributed much to the

report’s development.

At the national level, the Transportation Research Board

provided valuable contributions and review through its

international conference “Transportation in an Aging

Society: A Decade of Experience,” its staff representative

Richard Pain, and the chair of its Committee on Safe

Mobility of Older Persons, Richard Marottoli. The

Committee on Rural Public and Intercity Bus Transportation and its chair, Jon E. Burkhardt, the Committee on

Accessible Transportation and Mobility and its chair, S.

Ling Suen, and the Committee on Paratransit and its chair

Rosemary G. Mathias contributed understanding and

offered solutions as well. The chapter authors of the

report on “Transportation in an Aging Society: A Decade

of Experience” provided technical information and identified issues meriting further investigation. For technical and

fiscal support, we thank the National Institute on Aging,

particularly Jared Jobe, Robin Barr, and Daniel Foley, and

the Centers for Disease Control and Prevention, notably

Ann Dellinger. The Administration on Aging was consistently present throughout the development of the report,

represented by Lois Albarelli, Jeanette Takamura, and

Moya Thompson.

Many professional groups participated generously by

discussing their concerns in addressing the transportation

needs of older Americans. AARP has been always available

with valuable contributions and insights into refining

issues and solutions, led by Audrey Straight and Deborah

Alverez. We also wish to thank all those from AAA; the

American Association of Motor Vehicle Administrators,

led by Michael Calvin, Jason King, and Lori Cohen; the

Association for Driver Rehabilitation Specialists; the

American Medical Association, led by Joanne Schwartzberg; the American Occupational Therapy Association,

led by Anne Morris and Maureen Peterson; and the

automotive industry, including Jeffrey Pike at Ford

Motor Company and Kenneth Stack from General

Motors Corporation.

Many professionals within the Department of Transportation (past and present) have contributed to the report,

particularly the Aging America Intermodal Working

Group, whose members include:

Federal Transit Administration – Douglas Birnie, Sue

Masselink, Abby O’Donnell, John Spencer, Charlene

Wilder, Michael Winter

Federal Highway Administration – Elizabeth Alicandri,

Leverson Boodlal, Janet Coleman, John Fegan, Barbara

McMillen, Joseph Moyer

Federal Railroad Administration – Robert Martin

Federal Aviation Administration – Timothy Russo

Office of the Secretary – Donald Trilling (co-chair),

Jack Bennett, Rita Martin, Diane Wigle

National Highway Traffic Safety Administration – John

Eberhard (co-chair), NHTSA working group on older

drivers under Catherine Gotschall, with valuable input

from Joan Harris, Jenai Murtha, Jack Oates, Michael

Perel, Essie Wagner

Safe Mobility for a Maturing Society: Challenges and Opportunities

Table of Contents

iii

Acknowledgments ........................................................................................................................................................................................... i

Executive Summary ........................................................................................................................................................................................ v

I. Transportation for a Maturing Society.................................................................................................................................................1

Background ...............................................................................................................................................................................................1

Mobility: An Essential Ingredient of an Aging Society ................................................................................................................... 4

Aging in Place.......................................................................................................................................................................................... 5

A New Vision: Safe Mobility for Life................................................................................................................................................. 6

II. Safe Mobility for a Maturing Society: Challenges and Opportunities ........................................................................................... 9

1. Safer, Easier-to-Use Roadways and Walkways........................................................................................................................... 9

Improving Highways...................................................................................................................................................................... 9

Improving Pedestrian Facilities.................................................................................................................................................. 11

Better Land Use............................................................................................................................................................................ 11

2. Safer, Easier-To-Use Automobiles ............................................................................................................................................ 13

Improving Crash Protection....................................................................................................................................................... 13

Improving Crash Avoidance....................................................................................................................................................... 13

3. Assess and Improve Competency of Older Drivers and Pedestrians................................................................................. 14

Identifying Unsafe Drivers ......................................................................................................................................................... 14

Identifying Appropriate Settings for Regulating Unsafe Older Drivers ............................................................................. 15

4. Better, Easier-to-Use Public Transportation Services............................................................................................................ 16

Public Transportation .................................................................................................................................................................. 17

Mobility Managers........................................................................................................................................................................ 18

Rural Transportation for Older People .................................................................................................................................... 18

Interagency Coordination.......................................................................................................................................................... 18

Intercity Travel.............................................................................................................................................................................. 20

5. Targeted State and Local Safe Mobility Action Plans............................................................................................................ 21

6. Better Public Information .......................................................................................................................................................... 22

Identifying the Unsafe Driver .................................................................................................................................................... 22

The Professional Audience......................................................................................................................................................... 23

7. Basic and Social Research Needs............................................................................................................................................... 24

References ...................................................................................................................................................................................................... 27

Bibliography................................................................................................................................................................................................... 29

Abbreviations................................................................................................................................................................................................. 31

Safe Mobility for a Maturing Society: Challenges and Opportunities

Executive Summary

v

The United States faces a unique challenge in

transportation, driven by its growing senior

population. Health and medical advances make

it possible for people to live longer, and the

baby boomers are moving toward their retirement years.

Today, 35 million Americans are age 65 or older – about

13 percent of the population. By 2030, this number will

double, to 70 million people. One in five Americans will be

65 or older.

To date the nation has taken small steps to begin addressing the significant transportation needs of its changing

population. Without continued and additional attention to

these needs we could experience an increase in the number

of older people killed in crashes and leave some stranded

in their suburban or rural homes.

Without improvement in highways, vehicles, and user programs, the nation will face difficulty in providing safe

transportation for its older population. According to data

from the Fatality Analysis Reporting System (FARS) shown

in Figure ES-1, the nation’s safety efforts over the last two

decades have resulted in significant reductions in fatality

rates from highway crashes for all age groups under age

65. The rates for older persons, however, have declined far

more modestly, despite substantial reductions over the last

5 years. Continued safety improvements for our older drivers and pedestrians need to be implemented to counter the

potential for a major increase in older driver fatalities by

2030, as the elderly population doubles and drives far more

miles than the present older generation.

Older Americans, like their younger counterparts, depend

on the automobile for the bulk of their travel. For most, it

is the private automobile that provides them with independence, enables them to get to essential services, and

satisfies their need for social contact – it is pivotal to their

quality of life. Most older adults continue to live in the

same homes or locales where they lived when they retired,

close to family and friends, leading active lives, aging in

place in familiar surroundings. When physical or mental

limitations make it difficult to drive safely, most older

adults gradually and responsibly withdraw from driving. At

that point, many find themselves isolated from the activities that had filled their lives, especially if they live in suburban or rural areas where walking is difficult and nondriving transportation options scarce. Such isolation can

seriously undermine the quality of life for older people and

accelerate declines in health.

To provide safe mobility in the future, managers of our

transportation system must lead the nation on many

fronts: safer roadways, safer automobiles, better alternative

transportation services, and improved competency of

older drivers. Creative new partnerships are needed

between stakeholders, including government at all levels,

older persons themselves, their caregivers, social service

agencies, automakers, insurance companies, commercial

carriers, and local businesses. All of these groups need to

anticipate the coming era and become an integral part of

the response.

40

35

30

25

20

15

10

5

<6

Age

0

1981-

1985

1986-

1990

1991-

1995

1996-

2000

6-15 16-24 25-64 65-74 75+

Figure ES-1

Fata l i tyrates per 100,000 for selected Groups
Safe Mobility for a Maturing Society: Challenges and Opportunities

vi

Based on a series of regional forums, focus groups, conferences, and stakeholder roundtables held over the last

several years, the following vision of our future transportation system evolved:

A transportation system that offers safe mobility to all people and

allows older persons to remain independent and to age in place.

Investments in highway and pedestrian infrastructure and public

transportation services support independence. Medical and social

service communities, transportation managers, motor vehicle

administrators, and caregivers work together to extend safe driving

and to offer other convenient and affordable transportation options

when driving and walking must be curtailed. Public and private

organizations form new partnerships to enable all citizens to

enjoy safe mobility for life.

Fulfillment of this vision will require a concerted effort by

our political leaders and the community of professionals

who have an interest in the continued independence of

older adults. The nation’s transportation infrastructure

and vehicle fleet are massive and will require many years

to change.

To achieve this vision over the next 10 to 15 years progress

is needed in the following areas:

Safer, easier-to-use roadways and walkways

New roadway designs that better accommodate the

needs and limitations of older drivers and pedestrians,

including land use that minimizes auto dependence and

facilitates aging in place.

Safer, easier-to-use automobiles

More effective protection systems for fragile older occupants; better understanding of the interaction between

older drivers and vehicle systems that utilize new technologies to meet the needs and limitations of older drivers and occupants.

Improved systems for assessing competency

of older drivers and pedestrians

Better understanding of the characteristics that cause

older drivers to be at increased risk; more effective procedures for identifying, assessing, training, rehabilitating,

and regulating functionally limited drivers; better understanding of how to enable people with functional disabilities to walk safely.

Better, easier-to-use public transportation

services

Public transportation systems that facilitate wider use by

older people, including one-call-does-it-all mobility managers; evaluation and promulgation of best practices;

elimination of programmatic barriers to coordinated

delivery of transportation services; and intercity travel

that is more elder friendly.

Ta rgeted state and local action plans

Formation of state and local action plans that will provide safe transportation for an aging populace.

Better public information

A comprehensive campaign to educate older people and

their caregivers on how to identify unsafe older drivers;

information for health and social service groups to

equip them to address and extend the safe transportation needs of older people.

Basic and social policy research

Research on the effect that loss of mobility can have on

the quality of life of older people, on potential, related

health-care costs, and on ways to reduce the transportation problems of older people through technological

and other solutions.

No single organization alone can assume the responsibility

of meeting the safety needs of our maturing society.
Safe Mobility for a Maturing Society: Challenges and Opportunities

vii

Responsibility must be shared, for success requires the

actions and resources of many diverse interests: federal

agencies, Congress, states, counties, municipalities, health

and social service professions, and the private sector.

Table ES-1 lists specific strategies in each of the seven

action areas. Implementation of these strategies will not

only improve safety for older adults, it will improve safety

for all road users.

Support for the implementation of the strategies presented

in this report may be available from existing federal aid

programs. These potential improvements must compete

with every other class of highway or transit improvement

and safety research. Careful evaluation of these strategies

and their potential contribution to provide safe mobility

for older Americans must be undertaken.
Safe Mobility for a Maturing Society: Challenges and Opportunities

viii

Table ES-1

Safe Mobility for a Maturing Society: Challenges and Opportunities

Strategies

1. Safer, Easier-to-Use Roadways and Walkways

Promote the use of guidelines and recommendations from FHWA Highway Design Handbook for Older Drivers and

Pedestrians through continued training of traffic engineers and highway department personnel and by ensuring this guidance

is incorporated into standard design manuals.

Promote the most effective guidelines for the accommodation of pedestrians.

Identify and promote effective land use approaches for accommodating older people’s transportation needs, and develop a

clearinghouse of best practices for planners and community developers.

2. Safer, Easier-to-Use Automobiles

Evaluate approaches to improve protection of older occupants in crashes.

Consider the need for new standards for exterior vehicle designs that are less injurious to pedestrians.

Evaluate older driver interactions with vehicle systems that affect the occurrence of crashes.

Continue work on specialized vehicle systems to extend the driving capabilities of persons with disabilities.

3. Improve Systems for Assessing Competency of Older Drivers and Pedestrians

Continue to identify the characteristics of older drivers who are at higher risk of crashing and those who self regulate.

Develop and evaluate procedures to identify referral, testing, rehabilitation, and regulation programs to improve older driver safety.

Develop and evaluate procedures to enable people with functional disabilities to drive, walk, and use transportation options

safely.

Provide materials to enable professional organizations to conduct in-service training on effective program guidelines.

4. Better, Easier-to-Use Public Transporta tion Services

Develop and evaluate public transportation best practices for older adults.

Develop comprehensive, one-call-does-it-all mobility managers to coordinate local providers and their services.

Conduct demonstration programs of innovative transit and supplemental transportation systems for underserved and rural

areas.

Strengthen the DOT/DHHS Interagency Coordinating Council to identify and remove programmatic barriers to the coordinated delivery of services for older adults.

Improve the ease of use of both transit and intercity transportation for older adults.

5. Ta rgeted State and Lo cal Safe Mobility Action Plans

Encourage formation of state and local consortia to address transportation needs of elderly people.

Encourage state and local communities to develop and implement action plans.

6. Better Public Information

Educate older people and their caregivers on how to identify unsafe older drivers and extend safe driving, walking, and use

of transit.

Train transportation, health, and social service personnel to enable safe mobility and well being of elderly people.

7. Basic and Social Policy Research

Determine the relationships between mobility and aging-related physical, cognitive, and functional limitations.

Establish the relationship between lost mobility, aging in place, and societal costs for older people.

Determine technology’s role in improving mobility and safety for functionally limited people as drivers, walkers, and public

transportation users.
Safe Mobility for a Maturing Society: Challenges and Opportunities

I. Transportation for a Maturing Society

1

Background

The United States will soon face a burgeoning population

of people aged 65 and older. As the older population

increases – expanded by the baby boomers, who will begin

turning 65 in 2011 – there will be new demands and

requirements on the nation’s transportation system. The

specialized needs of this older population present formidable problems. Enabling their continued safety and mobility

will require newly tailored programs, new approaches, new

forms of collaboration, and new investments. Some of

these changes are underway, such as improvements to the

highways. Many may take years to get into place.

Life expectancy has increased by 28 years since 1900.

During the twentieth century, the number of people 65

years of age and older in the United States increased

elevenfold as compared with only a threefold increase for

younger people. Those age 65 and older represent an ever

increasing proportion of the overall population – from

1 in 8 today (35 million) to 1 in 5 in 2030 (70 million).

Further, the number of people age 85 and older will

quadruple in the next 50 years.

This unprecedented social ach i evement is not a bl e s s i n g

without costs. As age incre a s e s, older people develop phy s ic a l , s e n s o ry, and cog n i t ive limitations that often re s t r i c t

their ability to drive, wa l k , or use public tra n s p o rt at i o n .

I l l n e s s e s, m e d i c at i o n s, and impairments make it difficult fo r

them to use the tra n s p o rt ation they need. Without mobility,

people may decrease their invo l vement in outside activ i t i e s,

and their health and well being may suffe r.1 While some

s e rvices exist to help people get to essential activities like

medical appointments and gro c e ry shopping, m a ny older

i n d ividuals have difficulty getting to social or re c re at i o n a l

a c t ivities that are an equally important part of their live s.2

The report presented here provides a vision of safe transportation for the future. It has been based on a national

dialogue concerning the transportation needs of an aging

population. Led by the U.S. Department of Transportation

(DOT) and begun in 1999, the process included regional

forums, workshops, professional society meetings, and

international conferences. These exchanges solicited the

broadest possible range of perspectives from those

practicing in the field – transportation professionals,

medical and social service providers, public officials and

agencies, and interest groups that deal with elderly people

on a day-to-day basis. Concurrent with the regional

forums, a series of focus group discussions was held with

older people and their lay caregivers (usually adult children)

to obtain their views on elderly driving, difficulties associated with driving cessation, and use of other transportation options. National telephone surveys of the general

population and of elderly individuals and their professional

and lay caregivers also contributed to this report.3 Finally,

extensive in-house analyses of the latest data aided in

refining the issues.

Discussions of ideas and innovations led to a comprehensive set of strategies and helped to identify the activities

needed to aid older people to be safe drivers, pedestrians,

and users of other transportation options. These strategies

were presented at the Transportation Research Board’s

(TRB) international conference, Transportation in an Aging

Society: A Decade of Experience, and in several workshops

since.4 Information obtained from these sources was also

reviewed in the context of industrialized countries through

a related effort of the Organization for Economic

Cooperation and Development.5 Strategies on key research

and implementation issues have been revised to reflect the

results of these meetings and reviews by many other professionals in the field. 1

Riter, Straight, & Evans. (2002).

2Kerschner & Aizenberg. (1999).

3

Eberhard & Murtha. (in press).

4

Transportation Research Board. (in press). Transportation in An Aging Society: A Decade of Experience (TRB Conference Proceedings 27). Washington, D.C.:

Transportation Research Board.

5Organization for Economic Cooperation and Development. (2001).
Safe Mobility for a Maturing Society: Challenges and Opportunities

2

Today, older adults constitute about 13 percent of the

population but represent 16 percent of all traffic deaths.

As pedestrians, drivers, or passengers, older adults experience over 6,600 fatalities a year.6

While traffic fatalities for younger Americans have

decreased significantly over the last 20 years, those for

older adults have not. Figure ES-1 (page v) shows the

fatality rates for six age groups during four periods that

span 1981 to 2000. It is evident from the graph that the

number of fatalities per 100,000 people has declined far

more sharply for those 64 and younger than for those

above 65.7 Thus, while our safety programs have been

markedly effective for younger persons, there has been less

of a reduction in fatalities for those 65 and older.

The picture from the immediate past is more reassuring,

however. After peaking in 1997, a significant downward

trend in older adult fatalities has become discernable over

the last five years, dropping from 7326 per 100,000 people

in 1997 to 6719 in 2001. This reduction is seen for both

the 65- to 74-year old age group, and for those over 75.

The National Highway Traffic Safety Administration

(NHTSA), the National Institute on Aging (NIA), and the

safety community are now trying to identify the basis for

these reductions, which is currently unknown.

Despite these reductions, the fatalities among older road

users represent, and will continue to represent, a significant

traffic safety problem, and one which will get worse as the

older adult population grows. This level of fatalities should

be generally unacceptable, particularly to those who manage the transportation system. But implementing solutions

to improve safety will take many years, as safer roads, safer

vehicles, safer pedestrian facilities, better driver programs,

and other improvements are made. This report attempts to

lay out strategies for evaluation that encompass a 10- to

15-year perspective.

Older Drivers as a Public Health and

SafetyIssue

From a public health point of view, this report needs to

address two key issues: (1) Do older drivers pose a significant risk to other motorists and pedestrians, and (2) To

what extent are older motor vehicle occupants at increased

risk of injury or death if they are in a crash?

Risk To Others

Contrary to popular belief, the older driver segment of

the population is not a significant risk to others. With

passing age, older persons often find driving more difficult

as a result of vision problems, cognitive limitations, side

effects of medications, slower reaction times, muscular

difficulties, diseases, and other conditions. Most older

people are aware of their limitations and responsibly discontinue or reduce their driving in difficult circumstances.

They have the lowest rate of alcohol involvement, and the

highest level of seat-belt use. They have fewer crashes per

licensed driver than any other age group, contrary to the

impression sometimes held by the public.8 Evans found

that renewing the license of a 70-year old male driver for

another year poses, on average, 40 percent less threat to

other road users than renewing the license of a 40-year

old male driver.9

Figure 1 shows the total number of fatalities to vehicle

occupants and to pedestrians by age of driver. It may be

seen that fatalities caused by the age groups over 65 are

lower than for drivers of any other age group shown.

6National Highway Traffic Safety Administration. (2001b).

7

Over the 20 years, the average rates declined 23% for the 16-24 year old

group, and 17% for those 25 to 64. The rate remained flat for those 65 to 74,

and rose 7% for those 75 and older.

8

Eberhard & Murtha. (in press).

9

Evans. (2000).
Safe Mobility for a Maturing Society: Challenges and Opportunities

3

Figure 1

Motor Vehicle Fatalities by Age of Driver

Figure 2 shows the number of occupant fatalities in vehicles other than that of the driver, for the year 2000. The

data are shown as a rate per 100,000 licensed drivers of

Figure 2

Other Vehicle Occupant Fata l i tyRate per 100,000

Drivers by Age of Driver

Source: Highway Safety Facts, 2000, Federal Highway Administration

and FARS 2001, National Highway Traffic Safety Administration, U.S

Department of Transportation, University of Michigan HRS/AHEAD

different age groups. As in Figure 1, older drivers are much

less likely to cause fatalities to occupants of other vehicles

than drivers of any other age group shown.

The point can be raised that older people have often

retired from driving, but continue to hold their licenses.

To resolve this, data from the University of Michigan

Health and Retirement Study (HRS) survey were reviewed

to determine the proportion of people over 65 who

viewed themselves as still able to drive.10 The rightmost

bars in Figure 2 labeled able drivers show modified fatality

rates based on applying those proportions to the numbers

of drivers holding licenses for each age group. There are

no comparable data for those younger than 65. It can be

seen from the figure that the fatality rates per 100,000 able

drivers for those aged 65 to 84 are lower than the rates per

100,000 licensed drivers of any other age group. The rate

for those over 85 is comparable to drivers age 55 to 64,

and lower than any other age group. Together, Figures 1

and 2 demonstrate that older drivers pose less of a public

health risk to other road users than younger age groups.

Risk To Themselves

Figure 3 illustrates the fatality rate for drivers of different

ages, as a rate per 100 million miles driven. The U-shaped

curve indicates that the fatality rate of older drivers begins

to increase after age 60. Recent analysis by the Insurance

Institute for Highway Safety (IIHS) and Johns Hopkins

University indicates that most of the increased fatalities for

older people can be attributed to their increased fragility.11

Figure 3

Driver Fata l i tyRate per 100 Million VMT, 1996

Source: Crash Data and Rates for Age-Sex Groups of Drivers, 1996

(NHTSA Research Note)

14,000

12,000

10,000

8,000

6,000

4,000

2,000

0

13,037

9,265

8,093

5,783

3,634 3,112

2,623

770

MV Occupants

Pedestrians, etc.

16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Driver Age Groups Source: FARS 1999

1,308 1,215 1,030 656 424 214 136 26

10 University of Michigan. (2000). The question asked was, “Are you

able to drive?” 11 Li, Braver, & Chen. (2001).

20

15

10

5

16-24

Age

0

25-34 35-44 45-54 75-84 85+ 55-64 65-74

Licensed Drivers

Able Drivers

8

7

6

5

4

3

2

1

16

Age

0

17 18 19 20-

24

25-

29

30-

34

35-

39

50-

54

55-

59

40-

44

45-

49

60-

64

65-

69

70-

74

75-

79

80-

84

85

+
Safe Mobility for a Maturing Society: Challenges and Opportunities

4

As drivers, passengers, and pedestrians, older people are

far more fragile than younger ones. This fragility is

exemplified by their fatality rate in crashes. For passenger

vehicle crashes reported by the police, the rate of driver

deaths begins to rise after age 60 and grows sharply as

age increases. For those ages 75 to 79, the rate of driver

deaths per crash is almost triple the rate for those ages

30 to 59. For ages 80 and above (our fastest growing age

group), the rate is over four times that for drivers in the

30–59 age group

These fatality rates will present an ever more critical safety

problem as the 65-and-older group continues to expand.

The doubling of this population, in combination with the

fact that more older people will be licensed drivers, will live

further from social services, and will drive more miles than

the present older generation means that their involvement

in fatal crashes could increase substantially by 2030.

Some indication of the growth in overall fatalities for this

age group may be gained by noting projections of the

involvement of drivers in fatal crashes. In the year 2000

about 6200 drivers over 65 were involved in fatal crashes.12

Two estimates of the projected number of fatal crashes

for these drivers are provided in Figure 4. Ecosometrics,

Inc. projects more than a tripling of today’s number by

2030.13 The Insurance Institute for Highway Safety estimate is about double today’s number.14 In contrast, IIHS

provides an estimate of fatal crash involvement for the

other segment of the driving population, those aged 16 to

64. These projections are relatively flat over the same time

period.

Figure 4

Projected Involvemments in Fatal Crashes for

Drivers Over 65 and Drivers 16 to 64

Source: Burkhardt, Berger Creedon, McGavock (1998). Lyman,

Furguson, Williams, & Braver (2001).

According to these projections, without corrective action,

the number of older persons killed in automobile crashes

could increase two- to threefold by 2030.

Mobility: An Essential Ingredient of an

Aging Society

Older people enjoy a significantly better quality of life

today than in the past.15 They are more active and more

involved, and they look forward to many more active years

in retirement than earlier generations experienced. The use

of various modes of transportation by three age-groupings

of older adults is shown in Figure 5. The private vehicle is

the dominant mode, with walking a distant second. Not

only do most older people drive or ride in a private vehicle,

they can be expected to continue doing so throughout the

remainder of their lives as they seek to preserve this convenience in getting to friends, services, and activities and to

enjoy self-sufficiency and independence.

50000

2010

0

IIHS 16-64 IIHS 65+ Ecosometrics 65+

2020 2030

40000

30000

20000

10000

Year

12 National Highway Traffic Safety Administration. (2001). 13 Burkhardt, Berger, Creedon, & McGavock. (1998). 14 Lyman, Furguson, Williams, & Braver. (2001). 15 Hobbs & Damon. (1996).
Safe Mobility for a Maturing Society: Challenges and Opportunities

5

Figure 5

Transporta tion Modes of Older Persons

Source: Bureau of Transportation Statistics 2003 National Household

Travel Survey, U.S. Department of Transportation

Many people remember the feeling of freedom that came

after they first got their driver’s license – the rich array of

destinations and activities that came into reach. Losing the

ability to drive reverses that expansion of possibilities. The

loss is intensified by years of habit and entrenched by location and activity decisions that were based on the ability to

travel independently. Many middle-aged people observe

this loss in their own parents, who are reluctant to stop

driving or lose interest in their former activities once they

are unable to drive themselves. Many older people who are

considered unfit to drive refuse to quit in spite of efforts

by their children or health providers to keep them from

driving. The tenacity with which some older people cling

to the wheel is evidence of the value they place on their

mobility and independence.

Mobility is essential to personal health and social well

being. Surveys indicate that many older people cherish

their independence and are reluctant to call upon others

for transportation.16 But when people are unable to drive,

they can find themselves isolated. If they do not have

access to family members and neighbors to drive them,

they may find it very difficult to get to shops, friends and

family, health-care facilities, recreational spots, religious

activities, or community events. When people are deprived

of these normal forms of social interaction, health and

mental well being deteriorate.17

Aging in Place

The value of familiar surroundings and maintaining

contact with one’s network of activities and friends, as

well as reduced cost of living, has led to increased public

support for programs that facilitate aging in place. Most

people, in fact, do age in place and continue to live active

and productive lives. For many who retire in familiar

neighborhoods, automobile access is taken for granted.

Few people plan for the time when they can no longer

drive. Unless individuals plan far ahead for possible

changes in transportation needs, they may find themselves

literally stranded in their homes, inconveniently located

with respect to public transportation services, and unfamiliar with or incapable of using other alternatives to the

private car. They may find that they need special help

carrying packages or getting to buses or taxis safely. The

success of aging-in-place programs hinges on having the

requisite transportation capabilities.

In the future, effects of reduced mobility may be mitigated

by use of the personal computer, the Internet, and other

advanced technologies. More and more older people are

computer literate, and this percentage will increase as computers become more universal and as computer-literate

persons grow older. As more older people are able to

order food, medicine, and other goods via their computers,

essential goods and services may become more available,

but their social isolation may increase.

80

70

60

50

40

30

20

10

POV Driver

Modes of Transportation

0

65-74

75-84

85+

POV Passenger Walking Transit/Taxi

16 Burkhardt, Berger, Creedon, & McGavock. (1998). 17 Marottoli, Mendes de Leon, Glass, Williams, Cooney, Berkman,

& Tinetti. (1997).
Safe Mobility for a Maturing Society: Challenges and Opportunities

6

A NewVision: Safe Mobility for Life

From the concerns expressed by older people, their family

members, caregivers, and a wide range of professionals

familiar with these issues, the vision to which we aspire is

as follows:

A transportation system that offers safe mobility

to all people and allows older persons to remain

independent and to age in place. Investments in

highway and pedestrian infrastructure and public transportation services support independence. The medical and social service communities, transportation managers, motor vehicle

administrators, and caregivers work together to

extend safe driving and to offer other convenient

and affordable transportation options when driving and walking must be curtailed. Public and

private organizations form new partnerships to

enable all citizens to enjoy safe mobility for life.

Fulfilling this vision will require dedicated leadership and

long-term commitment. The result will be safer, more convenient transportation for all older people – transportation

that will extend safe mobility further into the aging years.

Start Immediately

If the nation is to meet the challenge of safe mobility as

its people age, it must be kept in mind that the transportation infrastructure and vehicle fleet are massive and require

many years to change. Even changes that appear relatively

simple in concept, such as enlarging the size of the letters

and improving the visibility of traffic signs, take several

decades to accomplish: appropriate new standards must be

proposed and evaluated, results debated, new standards

passed, and signs manufactured and installed. Because

infrastructure improvement is an incremental process

spread over several decades, it is important to begin preparing today for needs that will be widespread 20 or so

years hence.

Create Broad Public Understanding

Public education programs are needed to dispel misconceptions about the safety risks and mobility needs of older

adults. The crash data cited in Figure 2 indicate that as a

group older drivers do not place an undue safety burden

on the public. Further, mobility is an indispensable basic

need of older persons. It is vital for aging in place and a

healthy society. This requires a fundamental change in how

the public, the media, the community, older people, and a

wide range of professionals approach the issues.

Build Partnerships of Many Diverse Interests

Fundamental changes in perception are also needed if all

citizens are to have safe mobility for life. The issue cannot

be resolved if it is seen solely as a safety problem or solely

as a transportation problem. Rather, it must be recognized

as a public health and wellness problem that involves safety

and mobility. Governments do many things that affect the

mobility of older persons, as do vehicle manufacturers,

community developers, health insurers, auto insurers, taxi

operators, public transportation agencies, health-care

providers, older individuals themselves, family members,

and caregivers. Effective solutions to the transportation

needs of older persons are complex and are often beyond

the ability of any one of these groups to address by itself.

In government, coordination will be required among agencies within large departments as well as across departmental jurisdictions. New levels of coordination and cooperation will be called for to successfully integrate these strategies into an environment of social, health, and transportation programs carried out by multiple organizations with

unique missions.
Safe Mobility for a Maturing Society: Challenges and Opportunities

7

Stay Customer Oriented

Older people, like everyone else, want mobility that is safe

and convenient. The aging process varies widely from person to person, however, and differences in capabilities

become greater as age increases. The specific features of

safe mobility that are most important to individuals also

vary widely. Improvements to serve people with visual

impairments may be of no use to those suffering from

dementia, and vice versa. Older people are key to understanding and developing solutions that will meet their

needs, and their voices are essential in shaping effective

policies. For example, older people and their caregivers

can bring unique insights to local public transportation

boards, zoning boards, highway commissions, and the

like. Appointing them or their advocates to these bodies

can help communities better address the needs of an

aging society.

Experiment Aggressively

Consortia of local and state organizations are developing

action plans to create local methods to ensure safe mobility. As their experience grows, they can provide model

solutions on which others can build. Experimentation

with a wide range of approaches will offer communities a

variety of options to consider. In other venues, such as

research on improved vehicle crashworthiness for frail

occupants or the development of improved screening and

rehabilitation programs, the federal government can target

research and development on topics that have the highest

potential to improve safety and mobility for older users.

Accelerate the Pace of Deployment

While the mobility of an older society may seem like a

remote problem that is still decades away, 35 million persons in the United States are already age 65 or older. In

anticipation of their growing numbers, the nation must

accelerate the pace at which transportation improvements

are made. The research community is now in the vanguard

in recognizing this problem, and research will be a critical

part of any solution strategy. Programmatic changes can

be made in parallel with research as long as such strategies

are evaluated to ensure their effectiveness as national

investments are made. For example, the Federal Highway

Administration (FHWA) published the Highway Design

Handbook for Older Drivers and Pedestrians,

18 which lists thirty

recommendations that can make roads safer for older road

users. Federal and state grants for transportation system

improvements could be structured to encourage upgrading

facilities now, with full awareness that the efficacy of alternative treatments should be continually reassessed as experience accumulates.

Finance Realistically

Many of the strategies in this report are eligible for existing federal-aid programs. These potential improvements

must compete with every other class of highway or transit

improvement and safety research. Careful evaluation of

these strategies and their potential contribution to provide

safe mobility for older Americans must be undertaken.

16 Federal Highway Administration. (2001c).

Safe Mobility for a Maturing Society: Challenges and Opportunities

II. Safe Mobility for a Maturing Society:

Challenges and Opportunities

9

Many federal agencies, state and local governments, and

some private sector organizations have initiated programs

to begin to prepare the nation’s transportation system for

older Americans. But these programs will not be sufficient

to mitigate the high fatality level projected for the coming

decades or the need to provide transportation options.

There is no simple solution to these complex problems,

nor is responsibility vested in a single organization.

Responses to these needs must be undertaken by governmental agencies at all levels, by the private sector, and by

the public, who have a shared responsibility. Coordinated

action by many is required. The following provides a

framework for managing safe transportation for our aging

population in the first decades of the new century.

To provide safe mobility for older adults, progress is needed in the following categories:

1. Safer, easier-to-use roadways and walkways

2. Safer, easier-to-use automobiles

3. Improved systems to assess competency of older drivers

4. Better, easier-to-use transportation services

5. Targeted state/local safe mobility action plans

6. Better public information

7. Basic and social policy research

Major issues in each of these areas are discussed in the

following seven sections. They represent strategies to be

considered which encompass the next 10-15 years. Some

of them are already under way, some can be initiated in

the near future, some call for further development and

evaluation, and some must await funding availability. The

strategies are summarized in Table ES-1, at the end of

the Executive Summary.

1. Safer, Easier-to-Use Roadways

and Walkways

Older persons are highly auto-dependent. As shown in

Figure 5 (see page 5), approximately 90 percent of all trips

by those between the ages of 65 and 84 are now by auto.

The automobile is likely to remain the dominant mode of

travel among older persons. Because older persons are

more easily injured and killed in crashes, roads need to be

safer and easier for them to use. Pedestrian trips are the

second most widely used mode and adequate and safe

facilities must be provided for walking.

Improving Highways

Crash rates for older drivers are not evenly distributed

across the various types of crashes. The sharpest increases

with age involve intersection and crossing-path situations,

where older drivers must make complex maneuvers and

decisions as they interact with opposing traffic. These

include turning crashes (right turns and especially left

turns), particularly in urban areas, and lane changing

crashes on two-lane rural freeways.19 Older drivers are

also disproportionately involved in crashes at stop signs,

where the driver has stopped at the sign and then proceeds

to pull out in front of another vehicle. This may be

because older drivers have more difficulty perceiving and

judging the dynamics of traffic movement and performing

cognitive tasks within time constraints. Situations requiring

peripheral vision may present the greatest risk to older

drivers. Deterioration of vision, diminished cognition,

increased perception-reaction time, and reduced muscular

agility can affect an individual’s ability to drive safely.

Roadways can be designed, however, to help compensate

for such changes.

19Cerreli. (1989).
Safe Mobility for a Maturing Society: Challenges and Opportunities

10

Highway improvements and upgrades are a never-ending

part of maintaining the transportation infrastructure.

These projects may be initiated in response to adverse

crash experience or as part of a totally new facility associated with development of previously empty land. When

planners, decision makers, and highway engineers are

developing and deciding on these projects, they can better

accommodate the needs and limitations of older road

users by utilizing existing guidelines and recommended

designs. These are found in a series of FHWA handbooks,

particularly the recently revised (2001) Highway Design

Handbook for Older Drivers and Pedestrians and a new companion publication: Guidelines and Recommendations to

Accommodate Older Drivers and Pedestrians.

20 These documents

are collectively referred to as the FHWA handbooks. While

applying these recommendations can extend the period

during which driving is safe for older people, design

improvements will also make the system safer for all road

users.

Strategy 1.A.

Promote the use of guidelines and

recommendations from the FHWA

Highway Design Handbook for Older

Drivers and Pedestrians through continued

training of traffic engineers and highway

department personnel and by ensuring

that this guidance is incorporated into

standard design manuals.

Upgrading the nation’s highway infrastructure to include

the long list of specific improvements identified in the

FHWA handbooks is a massive challenge. Improvements

include better nighttime visibility of signs and pavement

markings, intersection design, lighting, and other safety

enhancements. Innovative approaches made possible by

new technologies are potential candidates for roadway

improvements in addition to traditional features described

in the FHWA handbooks. With many hundreds of millions

of traffic signs across the nation, replacement will be an

incremental process. New signs will be phased in over

years, as physical deterioration requires and as financial

resources allow. This process is slow, taking 10 to 20 years,

not because of lack of concern, but because design standards involve consideration of many separate features and

user attributes, and because any change affecting the entire

highway infrastructure is a massive undertaking.

The nation needs to phase in these changes more rapidly

in anticipation of an aging society. First, this requires

increasing highway engineers’ familiarity with and acceptance of the guidelines and recommendations in the FHWA

handbooks. To that end, traffic and highway engineers

should participate in training programs, such as those

developed by FHWA, to ensure that they understand and

can apply design standards to accommodate older people.

Second, these recommended designs need to be incorporated into the standard design manuals used by roadway

designers, such as the Manual on Uniform Traffic Control

Devices,

21 and A Policy on Geometric Design of Highways and

Streets (The Green Book),22 of the American Association of

State Highway and Transportation Officials (AASHTO).

Moving the design recommendations from the handbooks

into the manuals demands priority attention from standard-setting bodies and transportation agencies because

this is a time-consuming process. The various professional

and government groups that are responsible for different

aspects of highway design apply rigorous procedures to

evaluate changes to standards, and it can take them many

years to review and act on possible changes. While it is

important to preserve the quality that they assure, the

process can be accelerated if standard-setting groups are

provided with analytic, evaluative, drafting, and communication assistance. Substantial progress has been made in

getting these guidelines into the design manuals, and that

work needs to continue.

20 Federal Highway Administration. (2001c). 21 Federal Highway Administration. (2000). 22 American Association of State Highway Transportation Officials. (2001).
Safe Mobility for a Maturing Society: Challenges and Opportunities

11

Improving Pedes trian Facilities

Following driving, walking is the second most frequent

mode of transportation among older persons, as shown in

Figure 5. Older adults account for 21 percent of total

pedestrian fatalities, but only 13 percent of the total population. Walking is a key component of almost every trip

taken. People walk between the different segments of most

trips. The pedestrian death rate for those 75 and older is

nearly double that of all other ages.23

Walking access is important for many local businesses.

Land use policies that encourage walking can create concentrations of pedestrian traffic that lure additional business activity and can also reduce the amount of time people are on the road as drivers. Finally, walking contributes

to improved health through physical exercise, and those

who continue to walk into old age are more able to walk as

a means of transportation.

In spite of possible physical limitations and safety concerns, older adults make a higher percentage of their trips

by walking than do younger ones. As it becomes difficult

for older persons to drive or use public transportation,

walking also may become increasingly difficult due to

declining functional ability. Overcoming design shortcomings or facility barriers may enable older people who have

disabilities to walk to nearby services.

Strategy 1.B.

Promote the most effective guidelines for

the accommodation of pedestrians.

Promising pedestrian facility improvements have been

identified in the FHWA handbooks and in FHWA’s

Designing Sidewalks and Trails for Access (Parts 1 and 2),

24

Pedestrian Facilities Users Guide: Providing Safety and Mobility,

25

and in its brochure, A Walkable Community.

26 Promoting

and evaluating the pedestrian infrastructure is a responsibility shared by agencies at all levels of government, who

must select among competing priorities for limited

resources. Older persons and advocates working on their

behalf can help their communities establish priorities for

better pedestrian facilities and bring increased attention

and coordination to pedestrian issues.

Better signaling, signing, speed management, and markings

should be implemented to protect pedestrians. Pedestrian

crosswalk signals need to be bright and clear to accommodate the reduced visual acuity common among the elderly.

Pedestrian signal timing should be adjusted to reflect the

often slower walking pace and slower “start up” time of

older pedestrians. Greater use should be made of “smart”

signals that detect when pedestrians are in the crosswalk

and adjust the timing of the walk phase to give them

time to cross safely. In addition, pedestrian refuge islands

should be provided on wide, busy streets. In locations

with high volumes of elderly pedestrians, additional

roadway signing in advance of pedestrian crossings

could be appropriate.

A range of other improvements would be helpful, including adding sidewalks, benches, and covered areas; widening

sidewalks and maintaining them in good condition;

providing additional curb cuts; and upgrading signing

and markings to make walking a safer and more attractive

alternative for older persons. Introducing traffic calming

approaches can reduce speed and lessen the opportunity

for serious conflict with vehicles. As above, there is a need

for the guidelines and recommendations for pedestrian

improvements in the FHWA handbooks to be incorporated into the standard design manuals. This work is underway and should continue.

Better Land Use

Some 50 years of suburbanization and choices of home

sites dispersed across the community and beyond can

leave those aging in place completely auto-dependent and

23 National Highway Traffic Safety Administration. (2002). 24 Federal Highway Administration. (1999 and 2001b). 25 Federal Highway Administration. (2002). 26 Federal Highway Administration. (2001a).
Safe Mobility for a Maturing Society: Challenges and Opportunities

12

stranded when they can no longer drive. Nevertheless,

today few older people adequately anticipate the transportation implications of old age when they are deciding

where to live. Certainly, young people facing the possibility

of having a family and making future career changes would

not be expected to pay much attention to their mobility in

old age as they choose a home or apartment. But even

older persons and their adult children caregivers tend not

to think far enough ahead about future transportation and

mobility concerns when making housing decisions – such

as moving out of the family house because it is too big

and cumbersome to maintain, or relocating to a different

climate or to an assisted living facility. The availability of

activities and services within walking range and access to

public transportation can become very important to older

persons, yet most people make location decisions many

years before they become dependent on these features.

Strategy 1.C.

Identify and promote effective land use

approaches for accommodating older

people’s transportation needs and develop

a clearinghouse of best practices for planners and community developers.

New land use approaches can result in patterns that facilitate neighborhood-based living, minimizing dependency on

automobiles. Thoughtful future zoning and land use planning could lead to communities in which housing options

are integrated with a variety of services needed by older

adults (medical services, houses of worship, shopping,

social centers, assisted living facilities, etc.). These communities could be served by access roadways where older

drivers can safely interface with a network designed to

allow older pedestrians, cyclists, users of motorized wheelchairs, scooters, and other unlicensed low-speed vehicles to

proceed with a full sense of security.

Land use planners need to be informed about their role in

accommodating the increasing numbers of older people

who will reside in their communities in the near future. All

who are concerned about safe mobility for the elderly –

consumer advocates, health-care organizations, citizen

groups, and local governments – can help draw attention

to this planning need and encourage decision makers to

anticipate it as they plan their development. A clearinghouse on innovative programs and best practices on land

use planning and reengineering access patterns for the elderly needs to be established.

Land use policy is generally the purview of local officials,

whose decisions must balance diverse social, economic,

neighborhood, developmental, and individual rights issues.

Metropolitan Planning Organizations (MPOs) and other

agencies that plan public buildings, public transportation,

pedestrian, and road facilities should adapt their work to

reflect the changing needs of the increasingly older population. As plans are modified to address the needs of an

aging population, local governments should include older

persons or their caregivers on planning boards and other

bodies responsible for planning, zoning, and programming

street and pedestrian improvements.

Action Summary:

1. Safer, Easier-to-Use Roadways and Walkways

Recommended designs from the FHWA handbooks for

making roadway use easier and safer for older drivers and

pedestrians need to be promoted. Training of highway and

traffic engineers on these guidelines and recommendations

should be continued. Efforts to incorporate the FHWA

guidelines and recommendations into standard design

manuals should receive continuing priority. Projects that

address the needs of older pedestrians, especially around

sites heavily frequented by senior citizens, need to be promoted. Land use patterns that maximize the safe mobility

of older adults need to be encouraged and recognized in

state or local community and transportation improvement

plans. A clearinghouse of best design standards and land

use should be established, and planners and community

developers should be informed of the most effective new

community, highway, and pedestrian designs.
Safe Mobility for a Maturing Society: Challenges and Opportunities

13

2. Safer, Easier-To-Use Automobiles

Improving Crash Protection

Older persons are less able than most persons to withstand

and recover from the trauma of crashes, and they face a

much higher likelihood that a crash will prove fatal. When

they are involved in crashes, occupants over age 80 are

more than four times as likely to die than those under 60.27

This vulnerability leads to the following strategies.

Strategy 2.A.

Evaluate approaches to improve protection

of older occupants in crashes.

As part of the continuing development of countermeasures that protect all occupants in crashes, strategies for

the better protection of older occupants that take into

account their increased fragility may be evaluated.

Evaluation of the injury-saving potential of existing technologies and research into potential improvements could

benefit the growing number of older persons buying cars.

These investigations may examine the feasibility and practicability of crash dummy enhancements and/or revised

injury tolerance criteria for existing dummies to replicate

the features of older motorists. These might then be used

to design and test improved air bag systems, inflatable

belts, force-limiting safety belts, side air bags, knee bolsters,

and other occupant protection systems to maximize protection for older users. Future revisions of the Federal

Motor Vehicle Safety Standards should consider the needs

of older occupants.

Strategy 2.B.

Consider the need for new standards

for exterior vehicle designs that are less

injurious to pedestrians.

Pedestrian fatalities are disproportionately high for older

adults. The National Highway Traffic Safety Administration (NHTSA), through its participation in the International Harmonization Research Activities pedestrian working

group, is a beneficiary of the test procedures and costbenefit estimates being developed for pedestrian safety.

Continued work through the U.N. WP 29, Working Party

on Passive Safety (GRSP), would allow it to explore the

feasibility of developing a Global Technical Regulation

for pedestrian safety.

Improving Crash Avoidance

Crash statistics show that older drivers have a higher

percentage of their fatal crashes in angle collisions than

drivers of other ages.28 More than half of their crashes

are angle collisions, while among younger drivers the

proportion is only a quarter. Industry has been working

to develop crash avoidance systems that can reduce these

angle collisions as well as other collision types.

Strategy 2.C.

Evaluate older driver interactions with

vehicle systems that affect the occurrence

of crashes.

To ensure new technologies such as navigation systems,

brake assist systems, collision warning and avoidance systems are beneficial, careful evaluation with special emphasis on the demands placed on older drivers needs to be

performed. Many older drivers’ ability to focus attention

and process information is impaired; therefore, the potential benefits of the new technologies must be established.29

Revisions to the crash avoidance Federal Motor Vehicle

Safety Standards should consider the needs of older occupants. As an example, glare and nighttime vision issues

regarding older drivers ought to be kept in mind in assessing and promulgating vehicle lighting standards. It should

be recognized that technological advances in vehicles could

result in problems as well as benefits. The success and

practicality of all of these systems depends in large measure on designing them to help drivers with special needs

without distracting or confusing them. Industry, government, and universities need to cooperate in research, development and evaluation of these designs.

27 Li, Braver, & Chen. (2001). 28 Hakimes-Blomquist. (in press). 29 Caird. (in press).
Safe Mobility for a Maturing Society: Challenges and Opportunities

14

Strategy 2.D.

Continue work on specialized vehicle

systems to extend the driving capabilities

of persons with disabilities.

Vehicle designs can be changed to compensate for the special needs of drivers with disabilities. Companies produce

specialized vehicle controls to accommodate people with

disabilities and make it possible for them to drive, such as

brakes and accelerators designed for left foot operation for

people with paralysis on the right side of the body.

Ongoing public and private work with disabled populations can further develop and evaluate advanced technologies to improve the ability of those with disabilities to

drive. One area for investigation would be the potential for

original equipment manufacturers (OEM) to accommodate

the needs of people with disabilities by incorporating

features into new vehicles rather than depending on items

added at a later date. Steering and braking levels of effort

could be easily adjustable in the vehicle’s electronics rather

than modified after the fact. While this would improve

equipment reliability, it would be important to evaluate

problems in the field to establish the costs and benefits

of building in such specialized systems.

In the meantime, professionals involved in driver rehabilitation can continue to provide educational material to

increase awareness of how available technology can

help persons with specialized requirements continue to

drive safely.

Action Summary:

2. Safer, Easier-to-Use Automobiles

Means to better protect frail older occupants and pedestrians need to be evaluated. Older driver interactions with

vehicle systems that affect the occurrence of crashes and

promote effective solutions need to be studied, to provide

a basis for developing vehicles that are easier and safer for

older people to drive. The continuing development of specialized vehicle systems can extend the driving capabilities

for the physically challenged older population.

3. Assess and Improve Competency

of Older Drivers and Pedestrians

Evidence to date indicates that older people prefer to drive

in a private vehicle as late in life as possible and generally

do so safely.30 Additionally, there is evidence that some

older people drive longer than they can walk or use transportation options.31 To enable people to have safe mobility

it is necessary to design programs that can enable older

people to drive, walk, and use alternatives safely.

Identifying unsafe older drivers has been the focus of a

number of studies.32 These studies indicate that some older

drivers who may be at higher risk of crashing may continue to hold licenses and drive.

Iden tifying Unsafe Drivers

Older drivers place less of a safety burden on the public

because they drive less and reduce their exposure to higher-risk circumstances.33 Some older drivers, however, particularly those with cognitive deficits and other diminished

functional abilities, may not recognize their condition and

may not properly reduce or cease driving.

Strategy 3.A.

Continue to identify the characteristics of

older drivers who are at higher risk of crashing and those who correctly self regulate.

Research needs to be conducted to better identify the characteristics that cause older drivers to be at increased risk of

crashing.34 There is also a need to better understand the

extent to which older people appropriately self-regulate,

since less than 5 percent of older people lose their licenses

due to action by state licensing authorities.35 Based on these

findings guidance to States on the particular needs to regulate and reexamine older drivers is warranted.

30 Hakimes-Blomquist. (in press). 31 Riter, Straight, & Evans. (2002). 32 Staplin, Lococo, Stewart, & Decina. (1999). 33 Hakimes-Blomquist. (in press). 34 Transportation Research Board (Ed.). (in press). 35 Kington, Reuben, Rogowski, & Lillard. (1994).
Safe Mobility for a Maturing Society: Challenges and Opportunities

15

Iden tifying Appropriate Settings

for Regu la ting Unsafe Older Drivers

Most people support programs that assess the overall

driving population without regard for age.36 Unfortunately,

to test everyone on all the functional disabilities that could

affect safe driving is impractical, particularly in a driver

licensing setting because of costs and personnel considerations. Since functional disabilities associated with increased

crashes are found more frequently in older people, agebased testing is often recommended. However, such testing should be advocated only if research determines that

it can correctly identify unsafe drivers.

States need to know whether renewal testing should be

based on age or on other ways of identifying potentially

higher risk drivers such as crashes, moving violations, or

reports by law enforcement, physicians, or family members. To date, none of these approaches has been very successful in effectively identifying those who cannot safely

drive.37 Traditional tests currently used in driver reexaminations have not been found to be predictive of crash

involvement. Incidents of crashes and moving vehicle violations are generally low among the overall older population, and those who are most likely to observe the characteristics indicative of unsafe driving are often reluctant to

report the need to reexamine.

Strategy 3.B.

Develop and evaluate procedures to identify

referral, testing, rehabilitation, and regulation programs to improve older driver safety.

Surveys have indicated that neither professionals (physicians, other health and social service staff, or law enforcement personnel) nor family think they have sufficient

information to adequately address the competency of

older people to drive.38 Development of better ways to

insure that only safe drivers are on the road needs to continue. As a first step in this process it would be advantageous to evaluate the various programs being developed or

recently developed. These include:

1. The American Medical Association (AMA) Physicians

Guide to Assessing and Counseling Older Drivers,

39 needs

to be made available to physicians or health care groups.

2. Promising programs need to be identified to assist lay

caregivers or family members on how to deal with

unsafe older drivers or bring them to the attention of

the motor vehicle department. The recently developed

Model Driver Screening and Evaluation Program: Guidelines for

Motor Vehicle Administrators40 would best be evaluated in

one or more states to see which elements of these

guidelines are effective in assessing the older driver.

Guidelines are also needed for traffic law enforcement,

traffic court judges, social workers, and, possibly,

religious groups that deal with issues facing older people

and who can play a role in identifying those who may

be unsafe drivers.

Strategy 3.C.

Develop and evaluate procedures to enable

people with functional disabilities to drive,

walk, or use transportation options safely.

Determination of which functional limitations are

amenable to rehabilitation needs to continue. Research is

needed to develop a broad base of experience with various

diagnostic instruments and practices, develop norms and

counseling procedures based on these norms, and develop

ways to promote and pay for these programs. Though

designed primarily as a means to rehabilitate or counsel

older drivers, when remediation is not possible, test findings could help to get unsafe drivers off the road by

providing valuable information to older people and caregivers regarding the need to stop driving and by helping

to identify which mobility alternatives the aging driver is

capable of using.

36 Eberhand & Murtha. (in press). 37 Staplin, Lococo, Stewart, & Decina. (1999). 38 Sterns, Sterns, Aizenberg, & Anapole. (2001). 39 Wang, Kosinski, Schwartzberg, & Shanklin. (July 2003). 40 National Highway Traffic Safety Administration. (May 2003).
Safe Mobility for a Maturing Society: Challenges and Opportunities

16

Available tools such as self-assessment materials to enable

older people to correctly gauge their ability to drive safely

need to be evaluated, to determine if the subpopulations

with higher crash risks can correctly self regulate.

It is important to conduct an analysis of the potential of

education and training to extend the safe driving and walking potential of older people. Attention should be given to

how information can enable older people to make appropriate judgments about their driving ability.

Training programs that are available for older drivers need

to be evaluated. Most are classroom-only programs, and

their effectiveness has yet to be determined. Researchers

should look into who takes these training courses and if

they are the drivers who can best benefit from the information. The role that behind-the-wheel evaluation and

training can have in enhancing the driving skills of older

drivers with different functional disabilities needs to be

determined. Similar activities that encourage safe walking

also need investigation.

Strategy 3.D.

Provide materials to enable professional

organizations to conduct in-service training

on effective program guidelines.

As more appropriate systems and programs are identified,

the Safe Mobility for Older People Notebook developed by

NHTSA needs to be updated and widely distributed to

state and local groups. Health, social service, and public

service personnel who deal with these issues must then be

trained and, if necessary, certified by the appropriate

national organization. The approach used by the

Association for Driver Rehabilitation Specialists (ADED)

to certify driver rehabilitation specialists could serve as one

example of such training. Attempts to help ensure that

there are adequately trained personnel to enable

older people to be correctly assessed, such as the current

activity by the American Occupational Therapy

Association (AOTA), should be encouraged.

Action Summary:

3. Assess and Improve Competency of Older

Drivers and Pedestrians

Federal, State, and national organizations need to work

together to develop cost-effective programs that enable

older people to experience safe mobility longer in life. The

organizations need to support evaluations of programs

for identifying, assessing, training, rehabilitating, and regulating functionally limited drivers in State Departments of

Motor Vehicles (DMV) and in medical and social service

settings. They can determine the most cost-effective ways

of identifying potentially higher risk drivers and the role

that education and training have in enabling older people

to drive or walk safely later in life. Personnel who deal

with these issues need to be appropriately trained.

4. Better, Easier-to-Use Public

Transporta tion Services

As Figure 5 shows, about 90 percent of all trips made by

individuals between the ages of 65 and 84 are in private

vehicles. For many of these trips, the older adult is not

driving. The percentage of those who are passengers

rises constantly with age, from 21 percent for those ages

65-69 years old, to 36 percent for those ages 80-84, to

40 percent for 85 and older. This indicates the significant

role of the informal support system that provides the bulk

of the transportation for older adults unable to drive

themselves. For many older people, family, friends, and

neighbors are the key to mobility. Nearby friends, available

at all hours, can often provide transportation for an

unplanned or last-minute trip. Many places of worship,

senior centers, hired drivers, and voluntary organizations

also provide transportation services, but most elderly

people with special needs who are not in institutions are

transported in family automobiles.
Safe Mobility for a Maturing Society: Challenges and Opportunities

17

In future years, older people may be more transportationdisadvantaged because they will lack the help now provided by adult children. Relying on family as mobility

providers may become less possible. Spouses and adult

children, who have been the traditional caregivers, may be

less able to take on transportation and care duties due to

smaller family sizes, geographic separation, and a greater

proportion of families where both husband and wife

work.41 As a result, public transportation will become

increasingly important to the elderly community.

Public Transportation

The potential of public transportation is not being fully

realized by older people, accounting for only about

3 percent of their trips. For some older people, this may

be so because they are more able to drive than walk or

use public transportation. Public transportation needs to

be designed to better respond to the needs of America’s

growing elderly population. This is true for both conventional fixed-route public transportation and paratransit

services (but not for the supplemental transportation

systems, discussed below). Having a viable alternative to

the automobile is important if older adults are to maintain

true independence once driving becomes unsafe or they

choose not to drive.

Strategy 4.A.

Develop and evaluate public transportation

best practices for older adults.

Public transportation systems need to be made more

elder-friendly – easier to use and more convenient to reach

safely. They must offer better connectivity from where

older persons live to where they need to go, and better

pedestrian access to and from public transportation facilities. The physical and functional impairments that may

limit or inhibit an older person’s driving must be considered in the design and operation of public transportation.

Impairments may affect the older individual’s abilities to,

for example, walk to the public transportation stop, wait

for a vehicle outside in bad weather, climb aboard the

vehicle, pay for the ride, stand in a vehicle while it is in

motion, and recognize entry and departure points. Routes,

schedules, and operating procedures must be simplified.

Paratransit services should be tailored more to the needs

of older customers. These services address many of the

barriers preventing the use of public transportation by

older individuals. Most of these services provide door-todoor service from the passenger’s home to their destination, eliminating the need to gain access to a bus stop.

There are limitations to the effectiveness of paratransit

services, however. Many systems have a narrow geographic

service area. Many offer limited hours of operation, and

customers cannot use them for evening or weekend activities. Paratransit services also lack the flexibility in scheduling that many grew accustomed to when driving.

Appointments may need to be scheduled 24 hours or more

in advance, and the passenger must know in advance what

time a return trip is needed. Advance scheduling can cause

problems – for example, when a medical appointment runs

very late. Further, many older adults do not meet the

Americans With Disabilities Act (ADA) definitions of eligibility and do not have access to ADA paratransit. For

those who do, paratransit services tend to be fractionalized

and are not coordinated to address the full range of transportation needs of older, functionally limited Americans.

It is important public transportation operators become

well acquainted with the special needs of their elderly customers to best take advantage of the growing market they

represent. Marketing to this group of customers poses new

challenges. Research should focus on their capabilities,

functional limitations, and special customer needs so that

public transportation providers are able to develop tailored

training and marketing campaigns to attract older patrons.

41 Hobbs & Damon. (1996).
Safe Mobility for a Maturing Society: Challenges and Opportunities

18

Mobility Managers

Older adults may use a number of public and private

modes to meet their travel requirements. Consequently,

public transportation operators need to integrate their

services into a network of diverse, ancillary providers of

service in their region so they can become more responsive

to customer needs.

Strategy 4.B.

Develop comprehensive, one-call-does-it-all

mobility managers to coordinate local

providers and their services.

Mobility managers may be put in place by a variety of

organizations that serve the elderly, from public transportation operators, to Area Agencies on Aging, to faithbased or community-provided services. For public transportation operators, mobility managers will work through

the network of services offered by different organizations,

from providers of fixed-route bus and rail services to

shared service on flexible routes with dynamic dispatching.

They also may interface with taxis or other providers

offering more individualized trips that accommodate

special preferences or the functional limitations of the

trip-maker. Mobility managers take more time to understand customer needs and functions, acting almost as a

travel agent to connect the customer to appropriate

services and service providers. They can coordinate the

different programs, eliminate duplication of service, and

provide continuity among services.

In the forums and focus groups conducted to develop this

report,42 a recurring suggestion was to have a single, userfriendly source of personalized information about transportation options. An older person could dial a one-calldoes-it-all number, describe the specific trip he or she

wanted to take, and get detailed help in arranging it. The

mobility manager would counsel the elderly customer,

family member, or caregiver on exactly how to accomplish

all portions of the desired trip until the route becomes

routine for the traveler. The mobility manager might also

recommend alternative modes, list options, schedule

pickups, provide contacts for service providers, arrange

training to use the transportation services, or provide

additional information.

The mobility manager’s success in arranging the desired

trip will depend in part on the information base they are

using: how up to date, how comprehensive, and how well

the transportation services are known to match the needs

and abilities of the individual customer. For the mobility

manager the database could be manual, with individual

effort spent to stay up to date, or computerized using

advanced information technology. Service could be provided in various languages and made accessible for those with

disabilities. In some areas, mobility managers should eventually be able to provide guidance to users on how they

could access the needed information in their own homes

through an easy-to-use telephone service or the Internet,

so users can make their own choices.

Rural Transportation for Older People

The isolation of older people in rural and outer suburban

areas is particularly troublesome. Traffic fatalities for

motor vehicle occupants age 65 and above are higher in

rural areas (60%) than urban areas (40%).43 Elderly people

in rural areas face transportation challenges that are unique

to the geographic and socioeconomic conditions of their

communities. Often there are vast distances between destinations. Some rural communities are as far as 200 miles

away from inpatient medical facilities or the nearest airport. Even though most elderly people travel by private

vehicle as drivers or passengers, car ownership and use

declines with age. Although transportation options become

increasingly important with age, 38 percent of rural counties have no public transit service, and many have only

negligible services (fewer than 25 trips per year for each

household without a car).

42 Kerschner & Aizenberg. (1996). 43 National Highway Traffic Safety Administration. (2001a).
Safe Mobility for a Maturing Society: Challenges and Opportunities

19

Left unresolved, these challenges will be exacerbated as the

elderly population in rural areas increases. Rural retirement

communities will see higher proportions of older persons,

due not only to aging in place, but also to immigration of

older people from metropolitan are a s. By 2020, some stat e s

(including Alaska, Arizona, Colorado, Idaho, Montana,

Nevada, New Mexico, Oregon, Utah, Washington, and

Wyoming) will see up to a 100 percent increase of their

elderly and oldest old (85 and over) populations.44

Adequate transportation also benefits rural communities

that aim to attract retirees. Research shows that rural retirement destination communities (those with 15 percent or

more net immigration of people age 60 and older) experience population gains, increased family incomes, greater

economic diversification, and reduced unemployment rates.

State transportation planners should include solutions that

address the need for safer rural roads and new or expanded transportation services for their older populations. It is

necessary they work to get better information to communities so they can understand what is available to them.

Without adequate transportation access, older people in

rural areas will experience greater isolation and receive

less health care. In economic terms, the medical costs of

inadequate transportation will remain high if people enter

institutions and nursing care facilities prematurely due to

inability to drive or lack of transit services.

Strategy 4.C.

Conduct demonstration programs of innovative transit and supplemental transportation

systems for underserved and rural areas.

It is important for communities around the country to

experiment with different kinds of systems to provide

alternative transportation for older adults. Some of the

best such systems have grown out of creative partnerships

among a variety of interests: elder advocates, governments,

religious organizations, and care providers. For the most

part, such partnerships rely on local leadership and meet a

need that is recognized at the grassroots level. Opportunities and needs vary widely from one community to

another, and what works in one area may or may not

work in another. Nevertheless, many areas have been

successful in building partnerships that combine services

in innovative ways or that tap into unconventional sources

of financial support. These transportation systems can

encompass a variety of paratransit and shared-ride services, sometimes operated jointly by local public transportation agencies and social service organizations, sometimes

taking advantage of volunteers. Such systems often provide a level of flexibility, convenience, and security that

traditional public transportation service cannot match. It

is important to determine which combinations of transportation arrangements work best in different settings.

Some attempts are being made to address this question.

Through the Transit Cooperative Research Program, the

Federal Transit Administration (FTA) supported a project

by Westat, Inc., to identify best practices and assist public

transportation providers to improve options for older

adults.45 The AAA Foundation for Traffic Safety

(AAAFTS) and the Beverly Foundation have recently

completed a study identifying best practices among

supplemental or informal transportation programs (STPs)

for elderly people.46 They have identified over 300 STPs

that provide senior-friendly service – most targeted at

those 85 and older, the fastest growing segment of the

population. Those 85 and older often have special needs

because of cognitive, visual, and hearing impairments and

difficulties walking and climbing inclines. Almost half

of the STPs provide or can provide escort service. Local

governments and public transportation operators should

review and conduct demonstration projects of those best

practices appropriate to their communities.

Experimentation will be needed to see which new

approaches providing alternative transportation for older

44 Burkhardt, Hedrick, & McGavock. (1997). 45 Burkhardt, McGavock, Nelson, & Mitchel. (2002). 46 Beverly Foundation. (2001).
Safe Mobility for a Maturing Society: Challenges and Opportunities

20

adults could be adapted on a broader scale to address

particular local conditions. It should be determined which

requirements – particularly innovative use of volunteers,

Intelligent Transportation Systems (ITS) applications, and

public-private financing mechanisms – are most effective

in different settings. They should continue identifying the

advantages to be gained through using the latest technology to coordinate services at the local, regional, and multiagency levels for the purposes of job training, employment,

medical service, nutrition trips, rehabilitation, and other

life-sustaining functions. The value of ITS technologies

should be established, including automated scheduling, dispatching, traveler information systems, and billing software, as well as automatic vehicle location systems to facilitate dynamic dispatching. The utility for mobility management in one-call-does-it-all applications can be proven over

a variety of community settings.

Interagency Coordination

Many forms of specialized transportation service for older

people are based on support from federal programs. Many

acts govern the various services that are provided, including the Transportation Equity Act for the 21st Century

(TEA-21), the Older Americans Act, the Americans With

Disabilities Act, the Civil Rights Act, and the Clean Air

Act. Federal agencies involved with these programs include

DOT, Department of Health and Human Services

(DHHS), Department of Veterans Affairs, Department of

Education, Department of Agriculture, and the Joint

Council on Human Resources. The distributions of funds

for these specialized services are frequently fragmented,

uncoordinated, and not universally available. Developing

partnerships among providers, often combined with private-sector interests, allows for a reduction in inefficiencies, overlaps, and gaps, resulting in a better overall level of

service for the elderly population. For example, dedicated

paratransit and public transportation services serving individual medical institutions might be melded to save money

and increase overall coverage. A coordinated information

and reservation center could allow a single vehicle to pick

up elderly and other eligible individuals and deliver them to

nearby destinations, rather than having each institution

send a separate vehicle to virtually the identical location.

DOT and DHHS have been working on improving the

coordination between their agencies through the

DOT/DHHS Coordinating Council on Access and

Mobility (Interagency Coordinating Council). The FTA

and Administration on Aging (AoA) recently signed a

memorandum of understanding that builds on the collaborative process between DHHS and DOT.

Strategy 4.D.

Strengthen the Interagency Coordinating

Council to identify and remove programmatic barriers to the coordinated delivery of

services for elderly people.

At the federal level, the Interagency Coordinating Council

needs to review the barriers that prevent building cooperative systems and minimize the dissonance in the regulatory

requirements for the use of federal funds. Information

needs to be promulgated on the best systems among communities, which barriers are amenable to mitigation, and

what performance measures it can use to demonstrate

progress in coordinating services. This information could

lead to improvements in the coordination of public

transportation and specialized services offered by DOT,

DHHS, and others. Better coordination will result in better

overall service to elderly customers and lower overall costs.

Intercity Travel

Many older persons have the desire and the wherewithal to

make intercity trips. But in many cases, intercity transportation presents barriers to older adult customers, particularly

at airport, train, bus, and marine terminals, which are often

difficult for older patrons to use. Older travelers report

difficulty with long walks through airports with no place to

sit down as well as problems finding gates, reaching storage bins, using lavatories that are hard to access, climbing
Safe Mobility for a Maturing Society: Challenges and Opportunities

21

difficult stairways, getting assistance with luggage, negotiating awkward floor or platform heights, and the like.

Strategy 4.E.

Improve the ease of use of both transit and

intercity transportation for older adults.

The reasons why older adults are so reluctant to use transit

need to be identified and remedies developed to mitigate

obstacles. A national dialogue is needed to identify barriers

that the elderly face in using intercity passenger services

and to assess the costs and benefits – including additional

business – associated with removing these barriers. These

findings would also help companies market to this growing

set of customers. For example, electric passenger carts are

usually available to provide rides to those who experience

difficulty walking through air terminals, but many older

persons who would use this service do not know how and

where to request it. Additional customer information in

this area could be helpful.

Action Summary:

4. Better, Easier-to-Use Public

Transportation Services

Better-designed public transportation facilitating wider use

by older people needs to be developed. Transit should be

integrated with the services of other local providers

through mobility managers who tie these services together

for older users and mitigate the complexity that often

deters them. Demonstration projects should be supported

to test how new systems that provide alternative transportation for older adults can be adapted on a broader

scale to suit particular local conditions and requirements

in other communities. There is a need for the Interagency

Coordinating Council to evaluate the presence of programmatic barriers to coordinating delivery of transportation services. The reasons why older adults are so

reluctant to use transit need to be studied and remedies

developed. Barriers that deter many older people from

intercity travel need to be identified and ways to mitigate

them determined.

5. Targeted State and Lo cal

Safe Mobility Action Plans

Transportation is but one of a number of issues associated

with elderly needs (e.g., health care, retirement security)

that compete for public resources and attention. This

holds at the state and local level, as well as nationally. To

give safe transportation the priority it warrants will require

leadership, activism, and consensus building, both political

and institutional.

To define safe mobility for their older populations, states

and local communities must ensure that applicable areas

covered in this report are addressed by community leaders,

business executives, older people, care providers, concerned citizens, and researchers. The federal government

can support, assist, and inform the process, but meeting

the mobility needs of an aging society must first and foremost be a key priority of state and local leaders.

Strategy 5.A.

Encourage formation of state and local

consortia to address the transportation

needs of elderly people.

Some states – including Arizona, California, Florida, Iowa,

Maryland, Michigan, and New York – have already developed task forces or consortia over the last 10 years to

address the mobility of their aging population. These consortia or task forces provide a means to define what must

be done and develop plans to proceed with implementation. Such task forces are a call to action to state offices

(transportation, aging, motor vehicle, health, and housing),

planning organizations, and community-based institutions

to learn about transportation issues and develop a plan of

action. In order to be fully effective, extensive cooperation

is required among a broad array of groups with different

perspectives: social service, medical, and transportation

organizations, as well as the private sector. Solutions will

typically lie outside the purview of any single organization.

Only a full dialogue among interested groups can assure

detailed knowledge of the many government mobility
Safe Mobility for a Maturing Society: Challenges and Opportunities

22

programs available to draw upon and of the state of the

art in research and development. This knowledge will

provide the basis upon which consortia can consider

potential policy changes and formulate new strategies for

their long-range plans.

Strategy 5.B.

Encourage states and local communities

to develop and implement safe mobility

action plans.

States and local communities need to start immediately to

determine what needs to be done to provide safe mobility

for their aging population. They need to consider not only

what they can do to make their infrastructure safer, but

also other ways to make their drivers, walkers, and transportation users safer. Maryland, for example, has created a

broad-based consortium to develop better techniques for

identifying drivers at risk, assessing their capabilities, rehabilitating them when possible, educating them about their

limitations and the resultant implications of each, and transitioning them to alternatives. Arizona, California, Florida,

Iowa, Maryland, and Michigan have developed broad plans

to address all the issues covered in this report.

Once consortia or task forces have been established and

their plans developed, it is critical that there be an ongoing

group to help ensure the continued development and

implementation of the programs recommended in the

plan. Furthermore, states should evaluate the effectiveness

of the programs that are initiated (successes and failures)

on some regular basis. Assistance should be provided to

states establishing these groups, developing their plans, and

sharing their programs with other localities.

Action Summary:

5. Targeted State and Local Safe Mobility

Action Plans

There is a need for states and local communities to organize consortia to develop and put in place long-term plans

for maintaining the safe mobility of their older citizens.

The consortia should include representatives of key state

and local groups with an ongoing interest in continued

independence of the elderly population, as well as older

people themselves. National organizations and federal

agencies that have a role in this area need also be members. As states and local communities implement and evaluate their programs, it is important that the results be

shared with other states and communities.

6. Better Public Information

The public, and the elderly in particular, need more current

information on how older people can maintain safe mobility as late in life as possible. Transportation is frequently

fundamental to independence, happiness, and health.

Elderly individuals cherish an independent existence, and

act safely and responsibly. A national social marketing program could provide information on corrective strategies

that can enable older people to drive safely longer and on

available resources that can enable them to have mobility.

It can also serve an ill-informed general public by providing facts that counter often-held views that older drivers

are unsafe.

Identifying the Unsafe Driver

Older persons themselves need better information on the

issues they face and the resources available to assist them.

For most older people, driving will remain their primary
Safe Mobility for a Maturing Society: Challenges and Opportunities

23

means of transportation, and informational materials are

needed to explain and encourage ways in which the safe

driving years can be extended. The transition from driving

to other forms of transportation is an extremely sensitive

process. Loss of driving can be so debilitating that some

social workers have established self-help groups to assist

older people who have stopped driving.

Strategy 6.A.

Educate older people and their caregivers

on how to identify unsafe older drivers

and extend safe driving, walking, and use

of transit.

A campaign to identify unsafe older drivers needs to be

developed. It is important for the campaign to communicate to older people how they can evaluate their skills,

improve their safe driving, and learn when to transition to

other public transportation options. The campaign needs

to also communicate with families of older drivers and the

professional care-giving groups that interact with older

people: doctors, extended caregiver networks, legislators,

and law enforcement personnel and motor vehicle department personnel. Messages for each segment need to be

consistent with that group’s interests and responsibilities

and focus on the overriding objective: ensuring safe mobility for life.

Programs are needed to help older adults and their caregivers plan effectively for lifelong mobility so that the need

to reduce or cease driving can be anticipated. If mobility

planning has taken place, a safe, effective, and satisfying

transition from driving to the use of other options can

occur. Since older people are reluctant to plan for

stopping driving, social service agencies need to be in a

position to enable those who do stop to readily use other

transportation options. It is necessary to design and test

information materials that emphasize the most satisfactory

ways of making this change and advise older people and

their families of the various transportation and life-style

options available.

National campaigns exploring the broad impacts of aging

on driving, how to extend the safe driving years, and the

wisdom of thinking about alternatives even before they

become necessary are needed. Providing media with an

accurate description of older drivers could be an important

element of a national campaign. How older persons – and

their loved ones – deal with the transition from driving to

other transportation options can be handled best at the

local or regional level, where specific descriptions of various services, routes, and assistance available can be collected and publicized extensively. It is here where creative

partnerships will be particularly advantageous to enable

one-call-does-it-all and mobility manager services. National

campaigns encouraging expanded public awareness of the

relationship between advancing age and declining driver

skills and the importance of preparing for possible cessation of driving are important.

The Professional Audience

In addition to providing information to older drivers,

family members, and caregivers, it is essential to develop a

system to share information among the professional, state,

and local communities involved in these issues. Older

people today (as evidenced by their comments at regional

forums and focus groups) do not feel that their needs and

concerns are understood by many of the professionals that

they deal with on matters involving driving or mobility. A

common suggestion was to train professionals – highway

designers, medical providers, public transportation managers and drivers, police, taxi operators, driver licensing

personnel, urban planners, or social service agency staff –

to be sensitive to and informed about the safe mobility

needs of senior citizens.

Strategy 6.B.

Train transportation, health and social

service personnel to enable safe mobility

and well being of elderly people.

Professional groups should be made aware of the need to

ensure that their members are able to address safe mobility
Safe Mobility for a Maturing Society: Challenges and Opportunities

24

for tomorrow’s older people. Far more information and

training is needed to equip the many more professionals

who should be in service to address these matters as the

senior population continues to grow. Training programs

stressing how these professional specialties can assist older

people in remaining safely mobile are needed.

It’s important that medical research, engineering innovations, testing and evaluation protocols, and other data be

readily available to academics and practitioners nationally

and internationally. Existing or new web pages can be

linked to assist in the general provision of information to

both general and specialized publics (e.g., doctors, therapists) at both the national and local level. These web pages

can serve as clearinghouses for government, private, and

not-for-profit efforts to improve accessibility, mobility, and

safety for older people. They should be linked to organizations providing information to older people on driving and

transportation, such as AARP, AAAFTS, and the Association for Driver Rehabilitation Specialists (ADED) and others. These organizations can also be linked with toll-free

numbers that provide immediate access to key information

in a format understandable to older adults. State and local

agencies that deal with aging constituents need to become

knowledgeable about transportation issues.

Action Summary:

6. Better Public Information

A comprehensive campaign needs to be developed and

implemented to educate older people and their caregivers

on how to evaluate and extend their abilities to safely drive,

walk, and use transit. Members of service and other professions involved in the well being of the aging population

need to be trained on how they can assist the elderly in

remaining mobile.

7. Basic and Social Research Needs

There are many proposals for ways to improve safe mobility for older persons, and additional research is needed to

develop and evaluate them. In addition to the specific

strategies presented in this report, there is a need for basic

and social policy research. Worldwide experts have updated

the requirements for new research and development in

TRB’s 2003 report, Transportation for an Aging Society –

Initiatives Drawn from a Decade of Experience, cosponsored by

DOT, the Centers for Disease Control and Prevention

(CDC), and the National Institute on Aging (NIA).47 A

similar effort of the Organization for Economic

Cooperation and Development provided the broader perspective of the industrial world in the report Mobility Needs

and Safety Problems of an Ageing Society, published in

November 2001.48

Strategy 7.A.

Determine the relationships between

mobility and aging-related physical,

cognitive, and functional limitations.

Additional research is needed to better understand the role

mobility (or more specifically, lack of mobility) plays in key

issues surrounding the aging process and its effect on successful aging. Better understanding is needed as to how comorbid medical conditions affect driving and using other

transportation options. For instance, the effects of early

Alzheimer’s dementia on driving capabilities need to be

better understood. There is a need to determine at what

stage in this disease, together with any other co-morbid

conditions, a person may no longer drive safely or get

around independently. As we learn more about the role of

functional abilities on mobility, we should also determine

the influence these abilities have on the ability to age in

place. There is also a need to determine ways to reduce or

eliminate functional limitations. With old age frequently

comes more medications, and many older people are tak47 Transportation Research Board. (in press). 48 Organization for Economic Cooperation and Development. (2001).
Safe Mobility for a Maturing Society: Challenges and Opportunities

25

ing multiple medications. Continued research on the

positive and negative effects of short- and long-acting

medications and multiple medications on driving

capabilities is needed.

As more research confirms which physical and cognitive

deficiencies impair driving performance, cost-effective

ways to identify individuals with these deficiencies must

continue to be developed. In addition, we need to develop

more effective ways for doctors, health-care practitioners,

social workers, rehabilitation specialists, law enforcement,

judges, and others to identify and deal with potentially atrisk drivers.

One key consideration regarding mobility needs is to

understand how the lack of mobility translates into

social costs.

Strategy 7.B.

Establish the relationships between lost

mobility, aging in place, and societal costs

for older people.

Research needs to be conducted on the societal costs and

benefits of increasing mobility to older persons. This

research should provide a basis to evaluate the economic

impacts of mobility and nonmobility on the individual,

family, and community, and eventually provide estimates of

the value to society of supporting life-long mobility. It

could provide indications of whether and where additional

private investment in mobility solutions might be stimulated from health, automobile, and life insurance companies,

health-care providers, and others.

Future senior citizens will introduce new patterns of travel

demand. Travel surveys need to track changes in the type,

length, and frequency of trips made by older individuals in

order to make new demand forecasts, inform public policymakers, and be responsive to changing needs of the

older population. The key resource in developing these

data is the Nationwide Household Travel Survey (NHTS).

An over sampling of older persons is needed as NHTS

tracks travel trends, and the survey could also include additional information on functional ability and transportation

options to identify special groups needing tailored transportation. In addition to evaluating specific programs, a

national survey could provide insights into changing issues

faced by older drivers.

Strategy 7.C.

Determine technology’s role in improving

mobility and safety for functionally limited

people as drivers, walkers, and public

transportation users.

Increased application of technology and ITS holds great

promise for helping functionally limited people overcome

their limitations and take corrective actions. Research

should be conducted to identify, design, and evaluate the

additional systems needed by the anticipated larger population of older persons with functional limitations.

Action Summary:

7. Basic and Social Research Needs

Research is needed to increase our understanding of how

loss of mobility affects older people. The impact of diminished mobility on the ability of the elderly population to

age in place, on their quality of life, and on potential

increases in the costs of health and nursing home care

needs to be established. Research is also needed to better

determine how the transportation problems of functionally limited people as drivers, walkers, and transit users can

be reduced by technology and other solutions.

Safe Mobility for a Maturing Society: Challenges and Opportunities

References

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Beverly Foundation. (2001). Supplemental Transportation

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Traffic Safety.

Burkhardt, J.E., Berger, A.M., Creedon, M., & McGavock,

A.T. (1998). Mobility and Independence: Changes and Challenges

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Burkhardt, J., Hedrick, J., & McGavock, A. (1997).

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Abbreviations

31

AAA – formerly American Automobile Association

AAAFTS – AAA Foundation for Traffic Safety

AAMVA – American Association of Motor

Vehicle Administrators

AARP – formerly American Association of

Retired Persons

AASHTO – American Association of State Highway and

Transportation Officials

ADA – Americans With Disabilities Act

ADED – Association for Driver Rehabilitation Specialists

AMA – American Medical Association

AoA – Administration on Aging, DHHS

AOA – American Optometric Association

AOTA – American Occupational Therapy Association

CDC – Centers for Disease Control and

Prevention, DHHS

DHHS – Department of Health and Human Services

DMV – Department of Motor Vehicles

DOT – U.S. Department of Transportation

DMV – Department of Motor Vehicles

DOT – U.S. Department of Transportation

FARS – Fatality Analysis Reporting System

FARS – Fatality Analysis Reporting System

FHWA – Federal Highway Administration

FTA – Federal Transit Administration

HRS – Health and Retirement Study

ITS – Intelligent Transportation Systems

MPO – Metropolitan Planning Organization

NHTS – Nationwide Household Travel Survey

NHTSA – National Highway Traffic Safety

Administration

NIA – National Institute on Aging, NIH/DHHS

NIH – National Institutes of Health, DHHS

OST – Office of the Secretary, DOT

STPs – Supplemental Transportation Programs

TEA - 21 – Transportation Equity Act for

the 21st Century

TRB – Transportation Research Board