Barriers and facilitators to social participation after driving cessation among older adults: A cohort study

Pellichero, Alice; Lafont, Sylviane; Paire-Ficout, Laurence; Fabrigoule, Colette; Chavoix, Chantal · 2021 · Crossref

DOI: 10.1016/j.rehab.2020.03.003

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Summary

This cohort study investigates the barriers and facilitators to social participation among older adults following driving cessation. The research addresses the challenge that losing driving privileges often leads to reduced mobility, loss of autonomy, and poor quality of life. Specifically, the authors sought to determine how driving cessation impacts out-of-home occupations (such as shopping, leisure, and visiting family) and to identify factors that either inhibit or facilitate the continuation of these activities, with a particular focus on the role of anticipating driving cessation. The study utilized data from the SAFE MOVE cohort, comprising 1,014 drivers aged 70 years or older recruited from two French administrative areas. Data were collected via home interviews at baseline and postal questionnaires at a two-year follow-up. Measures included socio-demographic information, self-rated health, cognitive performance (assessed via Trail-Making Tests and Digit Symbol Substitution Test), driving habits, and public transportation usage. The primary outcomes were driving status at follow-up and whether participants had considered driving cessation at baseline. Statistical analyses compared characteristics between those who stopped driving ("retired drivers") and those who continued, as well as between those who anticipated cessation and those who did not. Of the participants, 48 (5%) stopped driving during the study period, with a mean cessation age of 81.8 years. Medical reasons were the primary cause for cessation (73%). Seventy-one percent of retired drivers reported that stopping driving negatively affected their engagement in out-of-home occupations. Retired drivers were significantly older, had poorer health and cognitive abilities, and drove less at baseline compared to active drivers. Notably, only 4% of the cohort considered driving cessation at baseline, despite 85% predicting a negative impact on their quality of life if they stopped. However, those who did anticipate cessation were more likely to use public transportation at both baseline and follow-up and were less likely to expect a drastic decline in quality of life. Retired drivers also reported decreased access to public transportation and reduced use of buses after cessation, though they used on-demand transport more frequently. The findings indicate that while age, health decline, and cognitive impairment are inevitable barriers to maintaining social participation after driving cessation, other factors are modifiable. Anticipation of driving cessation and established habits of using public transportation facilitate adaptation and help maintain out-of-home activities. The authors conclude that interventions should focus on helping older adults anticipate driving cessation, improve awareness of their declining abilities, and develop familiarity with alternative transport systems before they stop driving. Additionally, public policy actions are needed to improve accessibility to public transportation to support sustainable mobility for older adults.

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• older drivers