Trajectories of cognitive decline by driving mobility: evidence from the Health and Retirement Study

Abstract

Objective The recent emphasis of the importance of “aging in place” has highlighted the role of transportation in health promotion over the life course. Driving cessation in later life is associated with numerous poor health outcomes including limitations in social and physical functioning and increased risk of mortality. However, little is known about the relationship between driving cessation and change in cognitive functioning in late life. This study examined the association between driving mobility and trajectories of cognitive functioning among older adults. Methods Using data from six waves [1998–2008] of the Health and Retirement Study, trajectories of cognitive functioning were estimated over a 10-year period using longitudinal mixed effects models [N = 9,135]. Cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Driving status and health characteristics were assessed by self-report. Results Older adults who did not drive (former and never drivers) at baseline had lower average cognitive scores compared with active drivers. Former drivers had accelerated cognitive decline over the subsequent 10 years compared with active drivers (β= −0.35, 95% Confidence Interval [CI] = −0.43 to −0.26) even after controlling for baseline cognitive functioning and health status. The transition to non-driving was associated with a faster cognitive decline among those who were driving at baseline (β = −0.31, 95% CI = −0.40 to −0.22). Conclusions Older adults without driving mobility had poorer cognitive functioning at baseline and experienced accelerated cognitive decline relative to active drivers over follow-up.

Seniors’ unmet mobility needs – how important is a driving licence?

“…Another reason for not renewing a licence is most likely related to the poorer health of ex-drivers. In line with previous research, ex-drivers showed poorer health, while neverdrivers had more limited socio-economic resources (Choi & Mezuk, 2013).…”

“…While the youngest cohorts of older women have almost caught up with men's licensing rates and there will be a lower share of non-licensed older people in the future (Hjorthol et al, 2010), recent research from the US has shown that the remaining unlicensed older people are a specifically disadvantaged group of which a high share are ethnic minority women (Choi & Mezuk, 2013). While these results cannot be directly transferred to a European context due to lower car dependence compared to the US, we expect a similar development even if less pronounced.…”

“…Furthermore, we expect health problems to be especially related to unmet mobility needs of ex-drivers as previous studies have shown that never-drivers tend to be in better health than exdrivers (Choi & Mezuk, 2013) and that, especially for male drivers, the decision to cease driving is often related to health-problems (Hakamies-Blomqvist & Siren, 2003;Hjorthol, 2013;Siren & Haustein, 2014).…”

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“…Driving cessation is associated with worsening health status, social and physical functioning limitations, and increased mortality risk [83][84][85]. However, less is known about the relationship between the driving cessation and the change on cognitive function in senior drivers [86]. For many seniors, driving cessation is a major life event and represents a significant loss of independence [87][88], causing negative social consequences that affect their psychological well-being [47,[89][90][91][92][93][94].…”

“…However, less is known about the relationship between the driving cessation and the change on cognitive function in senior drivers [86]. For many seniors, driving cessation is a major life event and represents a significant loss of independence [87][88], causing negative social consequences that affect their psychological well-being [47,[89][90][91][92][93][94]. Individuals with social, mobility and spatial restrictions are more likely to develop cognitive degenerations such as MCI and Alzheimer's disease [95][96].…”