RESEARCH BRIEF NUMBER 6 • SEPTEMBER 2012

Putting Data to Work for Older People

Use of Transportation Services among OAA Title III

Program Participants
 

by Kristen Robinson, Jennifer Lucado, and Claudia Schur, Social & Scientific Systems, Inc. 

Since passage of the Older Americans Act (OAA) in 1965, the Administration on Aging (AoA) has supported the delivery 

of services to elderly Americans, helping them maintain independence and remain in their own homes. Through 

its “Aging Services Network,” including State Units on Aging (SUAs), Area Agencies on Aging (AAAs), local service 

providers and tribal partners, AoA works to provide services designed to mitigate the effects of declining physical 

health and functioning experienced by frail older adults. This brief, the sixth in a series that presents findings from 

AoA’s National Survey of OAA Program Participants, explores the use of transportation services among OAA Title III 

program participants. 

Background 

While the majority of older Americans (97 percent) live 

in the community, their level of independence varies 

widely (Werner 2011). Primarily, independence is 

determined by a person’s ability to perform tasks and 

activities that allow them to care for themselves and 

maintain their household. One important activity older 

adults often associate with their ability to remain independent is being able to travel outside the home. Ready 

access to family, friends, health care, food stores, and 

social activities is vital to full participation in daily life 

(Coughlin 2001). For many older Americans, this means 

being able to drive their own cars. Yet, due to chronic 

conditions, poor vision, and other illnesses, it often 

becomes unsafe for older adults to continue driving 

(Edwards et al. 2009). Thus, access to alternative forms 

of transportation becomes crucial for older adults to 

remain independent. 

Family, friends, and neighbors often help fill this 

transportation gap for older adults once they can no 

longer drive. However, relying on others can be inconvenient and may not be an option for everyone. Mass 

transportation is another viable option for many older 

adults. While public transportation use among older 

adults has increased between 2001 and 2009, it still 

remained a small share (2.5 percent) of their overall 

travel (Lynott and Figueiredo 2011). Whereas lack of 

options for suburban and rural populations is often cited 

as the reason for low ridership rates, debilitating health 

What is the Aging Services Network? 

The Aging Services Network provides a range of 

community-based services—home-delivered and 

congregate meals, case management, transportation, and homemaker and caregiver support. Such 

services enhance both the quality of life and social 

interaction, and reduce the effects of disability for 

homebound and more active seniors. Funded under 

Title III of the OAA, services are available to all 

individuals age 60 and older, though delivery is 

targeted to the most vulnerable elderly. 

conditions and fear of the unknown are also contributing factors. In focus groups, people aged 75 and over 

reported that barriers to using public transportation 

included difficulty getting on/off the vehicle, trouble 

finding a seat, being jostled, time spent waiting, waiting 

in bad weather, inconvenient schedule, and a fear of 

teenage passengers (Coughlin 2001). 

To help older adults adapt to a life without personal 

vehicles, alternative means of transportation are 

necessary to improve access to health care, minimize 

social isolation, maintain social interaction, and reach 

community and social services (Cvitkovich and Wister 

2001). As part of the funding provided to states via the 

OAA, transportation services are offered to people age 

60 and older for a voluntary contribution. Typically, 

these services are arranged for or provided by AAAs 
Figure 1. Comparison of Title III Transportation Users 

to U.S. Population, 60 years and older 

75 and older 

85 and older 

Female 

Live alone 

Non-metro 

Fair/Poor

 health 

3 or more ADLs

 (needs help) 

61.5 

31.9 

26.0 

8.2 

84.7 

54.9 

67.7 

26.3 

52.9 

18.9 

40.7 

23.0 

5.8 

2.5 

0 20 40 60 80 100 

Title III Transportation Users 

(n=279,556) 

U.S Population, 60 years and older 

Sources: Fifth National Survey of OAA Program Participants (2009); 

National Health Interview Survey (2009); Medical Expenditure Panel 

Survey (2009). 

Note: Non-metro areas are not part of urbanized areas (UAs) or urban 

clusters (UCs). UAs and UCs are densely settled areas that have a 

center with at least 1,000 people per square mile, surrounded by areas 

with at least 500 people per square mile. 

or Aging and Disability Resource Centers (ADRCs) to 

older adults who are frail, disadvantaged, or “mobility 

impaired” (i.e., have no car; do not drive or do not live 

within 3⁄4 mile of fixed route stop) (National Center on 

Senior Transportation 2010). AoA data suggest that 

25.6 million rides were taken by transportation service 

users in 2010, and this brief offers information 

about who those individuals are, how often they use 

the services, and why they use them (AoA 2012). This 

information will help AoA better prepare for the large 

cohort of aging baby boomers who are likely to have 

more and different transportation needs than previous 

generations. 

Title III Transportation Users More 

Vulnerable than Overall Population 

There are approximately 54.6 million communitydwelling older adults in the U.S. (AoA 2012). Among 

these older Americans, persons who used the Title III 

transportation services tended to be more vulnerable— 

compared with the general population, they were more 

likely to be older, female, live alone, reside in a nonmetropolitan area, have fair or poor health, and need 

the help of another person to complete activities of daily 

living (ADLs) (Figure 1). 

These differences between users of Title III transportation services and the overall U.S. population indicate 

that the services are reaching those who need them 

most. As shown in Figure 1, transportation users 

were older than the overall population: they were 

almost twice as likely to be age 75 and older, and over 

3 times as likely to be age 85 and older. The vast 

majority (85 percent) of transportation users were 

female, compared with only 55 percent of the general 

population. Compared with older adults as a whole, 

transportation users were nearly 3 times as likely to 

reside outside a metropolitan area and more than 2.5 

times as likely to be living alone. 

The average health of transportation users was worse 

than the national average for those aged 60 years and 

older. About 2 in 5 transportation users said they had 

“fair” or “poor” health, while a little more than 1 in 5 

in the general population rated their health that way. 

ADLs are basic activities people complete to care for 

themselves, including: personal hygiene activities, such 

as bathing or using the toilet; dressing; eating; walking 

without an assistive device, such as a cane; and transferring from a seated to a standing position and getting in 

and out of bed. Needing the assistance of another person 

to complete 3 or more ADLs has been associated with 

an increased likelihood of nursing home placement in 

numerous studies (Gaugler 2007). In the U.S. population, 2.5 percent of people aged 60 and older need the 

assistance of another person to complete 3 or more ADLs 

(see Figure 1). Among AoA transportation users, that 

figure is more than twice as high. While not necessarily 

reporting that they needed assistance, an even greater 

proportion of AoA transportation users—17.2 percent— 

reported having difficulty with 3 or more ADLs (no 

national comparison data are available). Difficulty with 

ADLs is more common with increasing age: among the 

oldest users—those 85 years and older—25.3 percent 

reported having difficulty with 3 or more ADLs. 

2
Transportation Services Meet Varied 

Needs of Users 

Title III transportation services allow users to travel to 

different destinations, both to meet individual needs 

and to participate in community activities. As shown in 

Figure 2, visiting a physician to obtain medical care was 

the most commonly-cited reason for using transportation services, with two-thirds of participants using the 

services to reach a medical appointment. Approximately 

four in ten participants reported that transportation 

services allowed them to go shopping, take part in 

social events, and attend activities at a senior center 

(Figure 2). Almost three out of ten participants used 

transportation services solely for medical appointments, 

while about four of ten used services for healthcare as 

well as for other reasons (data not shown). 

Users were extremely satisfied with the transportation 

services provided; this satisfaction was reflected in their 

ratings of the services as well as in the longevity and 

frequency of use. Queried on seven different aspects 

of the transportation’s reliability and convenience, over 

70 percent of users were “always” satisfied and close 

to 20 percent reported that their needs were “usually” 

met (Figure 3). Most users of Title III transportation services (59%) had been using the transportation 

services for at least two years, and almost one-quarter 

of participants had been using the services for more 

than 5 years (data not shown). Over one-third of participants used the transportation services two or more 

times per week. 

Figure 2. Percentage of Title III Transportation Users 

Using Services to Reach Each Destination, 2009 

Medical

 appointments 

Social events* 

Shopping* 

Senior center 

Congregate 

meal program 

68 

40 

40 

38 

28 

0 20 40 60 80 100 

Source: Fifth National Survey of OAA Program Participants (2009). 

* Social events include volunteer activities; clubs and meetings; visits 

to friends and relatives; recreational activities; and religious services. 

Shopping might include shopping for groceries, clothing, and other 

necessities. 

There are almost 10 million older women nationally 

who live alone. In terms of Title III transportation 

services, approximately 85 percent of users were 

women, and about 68 percent of all users lived alone. 

The transportation services provided under Title III 

appear to serve a particularly important function 

for these very vulnerable older adults. Living alone 

has been shown to be a predictor of nursing home 

admission (McCann, Donnelly, and O’Reilly 2011; 

Miller and Weissert 2000). While females living alone 

represent almost 1 in 5 older adults nationally, they 

accounted for 3 in 5 transportation users. Older adults 

who live alone used the transportation services more 

Figure 3. Title III Transportation Users’ Ratings of Services, 2009 

How often do the drivers pick you up when

 they are supposed to? 

How often are the drivers polite? 

How often are the vehicles easy to get into

 and out of? 

How often are the vehicles comfortable? 

How often do you arrive at your destination

 on time? 

How often can you get to the places you

 want or need to go? 

How often do you get rides at the times and

 on the days you need them? 

0% 20% 40% 60% 80% 100% 

Always Usually Sometimes Seldom Never 

Source: Fifth National Survey of OAA Program Participants (2009). 

3
Figure 4: Differences in Title III Transportation Service 

Use among Females Living Alone, by Health Rating, 2009 

Medical 
 79

appointments

 64 

Congregate

 28

meal program

 26 

42 Senior center 

36 

44 Shopping* 44 

36 Social* 

44 

32 

times/week 

2 or more 

32 

28 Once/week 

29 

40 

once/month 

Less than 

40 

0 20 40 60 80 100 

Frequency of transportation Percentage in subgroup using transportation

service use within subgroup services to reach each destination 

Poor health Good health 

Source: Fifth National Survey of OAA Program Participants (2009). 

* Social events include volunteer activities; clubs and meetings; visits 

to friends and relatives; recreational activities; and religious services. 

Shopping might include shopping for groceries, clothing, and other 

frequently than those who live with others for doctor 

visits, social activities, and shopping. One out of three 

participants who live alone used transportation services 

at least twice a week. 

Figure 4 shows use of transportation services 

among females living alone, with differences across 

those in good versus poor health. Of females living 

alone, approximately 28 percent were in poor health, 

defined here as having 2 of the following 4 indicators: 

self-reported “fair” or “poor” health status, 5 or more 

medical conditions, 3 or more ADL difficulties, or 

5 or more instrumental activities of daily living (IADL) 

difficulties. IADLs are complex skills needed to live 

independently, including going outside the home, 

managing finances, managing medications, preparing 

meals, doing light housework, using the telephone, and 

driving a car or using public transportation. These users 

were more likely to use transportation services to visit 

their doctor—almost 8 in 10 females living alone who 

were in poor health used the transportation services to 

obtain medical care, compared to over 6 in 10 of those 

in better health. Persons in better health still relied 

on transportation services for other, more sociallyoriented but still vital interactions. Although persons 

in better health appeared to use the service to reach 

social activities more than those in poor health, these 

differences were not statistically significant. 

hile women accounted for the vast majority of transportation users, men made up 15 percent of those using 

these services. Compared with female users, men were 

more likely to use the service 2 or more times a week 

and to use the service to reach medical appointments; 

men were less likely to use the service to attend a 

congregate meal program or go shopping, which might 

include buying groceries, clothing, and other necessities. 

W

Transportation Services Important 

Lifeline for Community-Based Elderly 

A major goal of the AoA and the Title III programs is to 

provide services that help older Americans to function 

independently and thus remain living in the community. 

The percentage of different types of participants reporting 

that the service helps them to continue living at home 

is shown in Figure 5. Those with multiple indications of 

poor health were most likely to feel that the transportation service was useful: 94 percent said that the service 

helps them to continue living at home, compared with 

82 percent of those with multiple indicators of good 

health. Transportation participants who used the service 

to go to medical appointments or to attend a congregate 

meal program were more likely to feel that the service 

helped them to continue living at home compared with 

those not using the service to reach those destinations 

(94 percent vs. 76 percent and 93 percent vs. 86 percent, 

respectively) (congregate meal program data not shown). 

These findings highlight the integral role transportation 

services are fulfilling by providing access to essential 

destinations, such as medical appointments and congregate meals. 

necessities. 

4
Figure 5. Percentage of Title III Transportation 

Participants Who Believe That the Service Helps Them 

Continue to Live at Home 

Less than

 once/month 

Once/week 

2 or more

 times/week 

No 

Yes 

No 

Yes 

Good health 

Poor health 

All participants 

Health

Status 

Lives 

Alone 

Uses service to 

reach medical 

appointments 

Frequency of 

transportation

service use

83 

87 

94 

76 

94 

84 

90 

82 

94 

88 

0 20 40 60 80 100 

Source: Fifth National Survey of OAA Program Participants (2009). 

Implications 

The ability to travel from one’s home to routine destinations is a critical element of overall life satisfaction, 

both for the daily necessities of life and for maintaining social ties with family, friends, and community 

(Coughlin 2001). Once an older person begins to have 

difficulty travelling in their usual ways, it becomes vital 

that they have other options available to them to retain 

their independence and reduce any feelings of isolation. 

As this brief shows, transportation services funded by 

the OAA, through the AoA, meet the needs of a diverse 

group of community-dwelling older adults. As was 

intended by the OAA, the transportation services play 

a key role in maintaining independence for older adults 

and, in particular, for those frail and vulnerable adults 

who are most in need of the service. 

Acknowledgment 

We would like to thank the Office of Performance and 

Evaluation, Center for Disability and Aging Policy, 

Administration for Community Living for their guidance and feedback while completing this Research Brief. 

Our thanks also go to Cynthia Saiontz-Martinez of 

Social & Scientific Systems, Inc. for her programming 

support. 

Data 

Information on Title III participants was drawn from 

the Fifth National Survey of OAA Program Participants. 

Westat Inc. conducted the telephone survey in 2009, 

administering it to 5,495 people who reported receiving 

Title III services. This brief includes data for the 

824 participants who were surveyed about their experiences with transportation services. The survey used 

a two-stage sample design, first selecting a sample of 

AAAs and then randomly sampling participants from 

each selected AAA by service type. The number of 

participants selected from each AAA was proportional 

to the number of participants served in that particular 

service by the sampled AAA. All analyses in this 

brief apply sample weights to account for this design. 

Additional data from and more detailed documentation for the Fifth National Survey and other AoA data 

sources are available on the new interactive AGing 

Integrated Database (AGID) at http://data.aoa.gov. 

5
About This Series 

This series is funded by AoA, and presents 

analyses conducted by Social & Scientific 

Systems using data from AoA’s National Surveys 

of Program Participants. These surveys collect 

information from Title III participants about their 

demographics, socioeconomic status, health, 

and functioning, as well as their service use and 

client-reported service impact and quality. For 

more information about this study, please contact 

Kristen Robinson at Social & Scientific Systems, 

krobinson@s-3.com. 

6

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