An elder's transition from driver to passenger may be abrupt, as in the case of the sudden onset of a disabling medical condition (or legal revocation). Alternatively, the transition may be a gradual process of adapting to progressive functional declines, due to either a medical condition or normative aging processes, which affect driving abilities.
When elders stop driving, the common perspective shared by others is that "[horizontal ellipsis]well, they'll just take the bus." Unfortunately, this is seldom the case, and for many reasons. First, public transportation is generally available only in urban and suburban areas. Even when available, elders are often unlikely and/or unable to utilize this option. As a group, American elders rely on public transportation for less than 2% to 5% of their trips. In addition, without public transit experience in their younger days, elders are unlikely to use it once they have stopped driving. Moreover, many conditions that contribute to driving cessation (eg, diminishing vision, physical limitations, cognitive changes) may also preclude using alternatives to the car. Finally, elders often assign negative attributes to public transit (eg, dirty, unsafe).
Without financial resources (to purchase alternative transportation) and/or social resources (family/friends who can provide rides), an elder's loss of the driving privilege often precedes 1 or more associated negative consequences. These negative effects include decreased opportunities for participation in social activities, work and volunteering, shopping for goods and services (including food and medication), healthcare visits, faith-based activities, and other necessary and/or desired activities. With these effects come decreased independence and self-worth, increased incidence of depressive symptoms, and cognitive decline related to social isolation.
This situation is not likely to go away anytime soon and, in fact, is likely to worsen as developed nations' elder populations increase. Although we prepare for our financial retirement by saving money in retirement accounts, few of us plan for a time in our lives when we can no longer drive. This is evident in the communities we select to "age in place" that make us car-dependent, communities that lack sidewalks and acceptable transportation options.
This is the first of 2 special editions of TGR for which authors with potentially significant contributions were identified and asked to address the issues leading up to, and including, the transition from driver to passenger and the issues faced following transition, identifying potential avenues of intervention along the way. Authors were also asked to consider gender differences when possible. This edition contains 7 manuscripts from authors representing 3 continents and 6 countries. Methods include qualitative and quantitative designs and a comprehensive literature review.
Drs Siren and Hakamies-Blomqvist first address the relationship between aging and the meaning of mobility. This qualitative study, completed in Finland, highlights the adaptive process to age-related mobility restrictions and suggests enabling compensation to promote successful transitions.
Elder drivers who transition gradually to nondriver typically compensate for deficits that cause discomfort and decreased self-confidence in particular driving situations and, likely due to this compensatory behavior, improve their overall driving safety. Some commonly avoided situations include night driving, driving in rush hour, and making unprotected turns across traffic at intersections. These self-regulatory behaviors can be seen on the continuum of driver to nondriver as part of the transition process and, therefore, provide opportunities for intervention. Drs Friedland and Rudman examine the interpersonal aspects of self-regulation and identify potential barriers of, and facilitators to, discussions about driving and cessation among Canadian seniors, family, and physicians.
Families are commonly involved in the transition process. Kostyniuk, Molnar, and Eby examine adult children's comments about their parents' driving, noting the most commonly expressed concerns. In addition, they discover differences in the conversations adult children have with their mothers versus fathers with regard to regulation and cessation. Without recognition of the difficulties experienced while driving, persons with cognitive deficits often do not make compensatory adjustments and do not recognize the need to cease driving. D'Ambrosio, Coughlin, Mohyde, Carruth, Hunter, and Stern state the need for involvement by caregivers of drivers with dementia in the process of cessation and suggest educational interventions aimed at caregivers to assist them in the transition process.
Although much of the focus on driving cessation has been associated with the negative consequences, one study presented here suggests the presence of additional factors. Drs Oxley and Charlton, in an Australian project exploring the attitudes to and mobility impacts of driving cessation, found factors favorably associated with continued mobility after cessation. The results of this study illustrate the potential for improving mobility outcomes by, among other things, including these positive factors in training and educational programs.
Although one of the aims of this special edition was to gather information that could be useful in developing interventions to smooth the process of transitioning from driver to passenger, 2 articles describe interventions. Di Stefano, Lovell, Stone, Oh, and Cockfield report the development, implementation, and results of an Australian community-based health promotion education program aimed at assisting individuals in making informed choices about mobility transitions. In a Canadian project, Dobbs, Harper, and Wood describe the use and effectiveness of driver cessation support groups for persons with dementia and their caregivers. The results of this study suggest potential benefits of driving cessation support groups for other populations as well.
In summary, my goal as guest editor for these 2 special editions was to bring together a discussion about the transition from driver to passenger with the hope of initiating a conversation about the development of effective interventions to enable a smooth and successful transition. Given the diversity and quality of the work presented here, I believe that this conversation has started. I would like to sincerely thank the contributing authors not only for their submissions but also for their dedicated work in this area. I would also like to acknowledge the contribution of the reviewers for this special edition.
-Dennis P. McCarthy, PhD, OTR/L
Assistant Professor, Occupational Therapy, Department College of Nursing and Health Sciences Florida International University, Miami