Older Drivers’ Reasons for Reducing the Overall Amount of Their Driving and for Avoiding Selected Driving Situations

Abstract

Structured telephone interviews were conducted with 840 older drivers to explore their reasons for self-regulating their driving. The main reason for reduced driving was having fewer activities to drive to, and for avoidance of driving situations, reasons also included not liking or feeling insecure about driving in the situation. The lower-functioning participants, but still only a minority, were more likely to indicate decline in vision and reaction time as reasons for avoidance. Women were more likely to indicate lack of confidence as a reason for avoidance. The results suggest that the reduction in driving and avoidance of driving situations are separate types of self-regulatory behavior; that self-regulation of driving is an automatic process, in which older drivers are not aware that they are compensating for functional loss; and that it is important to acknowledge gender differences when designing interventions aimed at enhancing safe mobility.

Keywords

cognitive problems gender mobility compensation self-regulatory driving

Introduction

Mobility is important for the quality of life of older adults (Farquhar, 1995; Oxley & Whelan, 2008), and many older adults depend on the car to meet their mobility needs (Eberhard et al., 2006; Hakamies-Blomqvist & Wahlström, 1998). Yet research has shown that older adults generally tend to reduce the overall amount and modify their driving by avoiding various driving situations (Anstey & Smith, 2003; Baldock, Mathias, McLean, & Berndt, 2006; Ball et al., 1998; Charlton et al., 2006; D’Ambrosio, Donorfio, Coughlin, Mohyde, & Meyer, 2008; Donorfio, D’Ambrosio, Coughlin, & Mohyde, 2008b; Holland & Rabbitt, 1992; Molnar & Eby, 2008; Raitanen, Törmäkangas, Mollenkopf, & Marcellini, 2003; Rimmö & Hakamies-Blomqvist, 2002; Ruechel & Mann, 2005). These changes in driving patterns are referred to in the literature as the self-regulation of driving and regarded as a strategy for older drivers to continue to drive safely despite functional decline (Donorfio, Mohyde, Coughlin, & D’Ambrosio, 2008). However, the safety benefits of the self-regulation of driving have yet to be documented (Man-Son-Hing, Marshall, Molnar, & Wilson, 2007). The reduction in driving and avoidance of driving situations may, in fact, pose a greater limitation on mobility than it increases the safety of older drivers (Oxley & Whelan, 2008). Older drivers report that the modification of their driving has a negative impact on their lives (Ruechel & Mann, 2005) and often leads to driving cessation (Dellinger, Sehgal, Sleet, & Barrett-Connor, 2001).

A large amount of research has been carried out to gain a greater understanding of the self-regulation of driving. Factors predicting the self-regulation of driving have been identified, including functional decline, recognition of cognitive problems, age, gender, change in employment status (retirement), household income, the presence of other drivers in the household, driver confidence, and previous involvement in an accident (Ball et al., 1998; Charlton et al., 2006; Holland & Rabbitt, 1992; Meng & Siren, 2012; Ragland, Satariano, & MacLeod, 2004; Ross et al., 2009). Furthermore, women self-regulate their driving more than men (Charlton et al., 2006; D’Ambrosio et al., 2008; Hakamies-Blomqvist & Wahlström, 1998; Kostyniuk & Molnar, 2008; Molnar & Eby, 2008; Rimmö & Hakamies-Blomqvist, 2002) and are more likely to stop driving prematurely (Kostyniuk & Molnar, 2008; Siren, Hakamies-Blomqvist, & Lindeman, 2004). Other research has explored the role of awareness of functional decline in the self-regulation of driving, but no consensus has been reached. On one hand, it has been argued that older drivers need to be aware of their functional decline before they adjust their driving accordingly (Holland & Rabbitt, 1992) and that it is the drivers’ self-monitoring of their own driving capacity or ability that determines the extent to which the driving is regulated (Anstey, Wood, Lord, & Walker, 2005; Horswill, Anstey, Hatherly, Wood, & Pachana, 2011). On the other hand, it has also been argued that self-regulation of driving is an automatic process and that the driver may therefore not be aware that he or she is compensating for functional decline (De Raedt & Ponjaert-Kristoffersen, 2000).

When exploring the reasons older drivers give for self-regulating their driving, Ragland et al. (2004) found that the most common reasons for limiting or avoiding driving were problems with eyesight, concerns about having an accident, and having no reason to drive and that the women in the study reported concerns about crime. Women have been found to give up driving for various, less pressing reasons, whereas men tend to keep on driving until medical reasons make driving difficult (Hakamies-Blomqvist & Wahlström, 1998), which suggests that self-regulation of driving may lead to unnecessary loss of mobility to a greater extent among women. However, the mechanisms behind women’s tendency to self-regulate their driving more and stop driving prematurely are not yet fully understood (Donorfio, D’Ambrosio, Coughlin, & Mohyde, 2008a; Siren et al., 2004).

Moreover, the reasons older drivers give for regulating their driving depend on the self-regulatory behavior (Charlton et al., 2006). For example, the most common reason for reduction in overall driving is a change in lifestyle, such as retirement or moving house, rather than health-related reasons (Charlton et al., 2006; Raitanen et al., 2003), whereas avoidance of intersections, driving in rain, or when it is dark are explained by vision problems and safety concerns (Charlton et al., 2006). These findings suggest that the reduction in driving and the avoidance of specific driving situations may be two different types of self-regulatory behavior. The reduction in driving seems largely to reflect changes in mobility needs, whereas the avoidance of driving situations seems to reflect the traditional view of self-regulation of driving as a strategy for continuing to drive safely. Yet they are rarely treated separately in the literature. If the reduction in driving is a consequence of reduced need for mobility, it is less likely to be associated with functional decline and difficulties with driving, whereas if the avoidance of driving situations reflects a strategy for continuing to drive safely, it is likely to be associated with functional decline and experience of driving difficulty to a much greater extent. Consequently, because changes in mobility needs are mixed with the motivation to remain safe on the road, treating these two types of self-regulatory behavior as one may blur the results when exploring the role of self-regulation in the safe driving performance of older drivers and its impact on their mobility.

In the present study, the reduction in driving and the avoidance of driving situations were treated as two separate types of self-regulatory behavior. The aim of the present study was to gain a greater understanding of older drivers’ self-regulation of driving. More specifically, the present study explored older drivers’ reasons for reducing the overall amount of their driving and for avoiding selected driving situations by gender and self-rated cognitive problems.

Material and Methods

Participants

Six random samples of driving license holders aged 75 or older were extracted from the Danish driving license database. The samples were constructed so that they consisted of 550 people in 3 age groups: 75 to 79, 80 to 84, and 85 and older, with an equal number of women and men in each age group. A letter explaining the study was mailed out prior to the telephone interviews. To encourage participation, the letter said that there would be a lottery among participants and that five people would be randomly drawn to win a gift voucher each. Leaving aside cases where a telephone number was unavailable or the person was unable to be interviewed, a total of 1,332 people were contacted. Of these, 11% could not be reached and 19% refused to participate, which left a sample of 930 (70%). Of these, a further 42 (3%) drove a vehicle too seldom to fulfill the criteria for inclusion (driving a minimum of once a month).

In total, 888 older drivers completed the interview. They were aged 75 to 95 years, and their mean age was 82 years. Of these, 443 (49.9%) were women and 445 (50.1 %) men.

Participants were divided into four groups based on their gender and self-rated cognitive functioning (see Section 2.4. for details). An overview of the background information of the four groups is presented in Table 1. The proportion of women who reported being widows was larger than the proportion of men who reported being widowers, which represents the general trend for this age group. On average, women reported a lower annual mileage than men, F(1, 754) = 81.132, p < .001, partial η² = .097. On average, the lower-functioning group reported a few more symptoms and illness, F(1, 836) = 15.106, p < .001, partial η² = .018. The higher-functioning group was more likely to report problems with vision only rarely or very rarely, χ²(1) = 8.497, p < .001, OR = 2.5. Finally, the lower-functioning group on average had a significantly higher self-rated global cognitive score than the higher-functioning group, F(1, 836) = 1361.275, p < .001, partial η² = .620.

Table 1.

Characteristics of the Participants Divided by Gender and Cognitive Group.

	Women		Men
	Higher functioning	Lower functioning	Higher functioning	Lower functioning
N	196	215	222	207
Age
Mean	81.6	81.7	81.1	82.3
SD	4.2	4.4	4.4	4.4
Marital status
Married (%)	34.7	37.0	72.5	63.8
Single (%)	8.2	7.4	7.2	4.3
Widow(er) (%)	57.1	58.6	20.3	31.9
Objective health status
Mean number of symptoms/illnesses	1.6	1.9	1.6	2.1
SD	1.3	1.4	1.5	1.5
Subjective health status
“good or excellent” (%)	94.4	94.9	95.9	92.3
Problems with vision
“rarely or very rarely” (%)	97.9	93.5	95.9	91.3
Self-rated cognitive function
Mean score	7.7	13.1	7.8	12.9
SD	0.8	2.9	0.9	2.7
Annual mileage (km)
Mean	6392	5860	9473	9100
SD	3970	3944	4723	5995

Materials

Data for this study were collected by means of standardized computer-assisted telephone interviews (CATI) carried out by Synovate Denmark A/S. The interviews took an average of 30 to 35 min to complete. The telephone interviews were based on a questionnaire designed for this study.

The interview covered questions on background information, including age, gender, marital status, driving frequency, and annual mileage. Mileage outliers were excluded from analyses that included mileage. Outliers were defined as participants with an annual mileage of more than 3 standard deviations above the mean (Field, 2009).

Furthermore, questions on health and functioning were included. As an objective measure of health status, participants were presented with a list of 20 symptoms and illnesses and asked whether they suffered from any of these as confirmed by a physician. This list was derived from previous studies with similar settings and participants (Siren et al., 2004). In addition, participants were asked to assess their subjective overall health on a 4-point Likert-type scale where 1 = excellent, 2 = good, 3 = fair, and 4 = poor.

To get an indication of self-rated cognitive functioning, participants were asked how often they experienced difficulties with memory, concentration, orientating themselves, working out how to approach a task, making themselves understood during conversations, reacting too slowly, or saying or doing something that they afterwards regretted. They were asked to indicate how often they experienced these difficulties, on a 5-point Likert-type scale where 1 = very rarely, 2 = rarely, 3 = neither rarely nor often, 4 = often, and 5 = very often. In the analysis, the sum of these was calculated to obtain a global self-rated cognitive functioning score. The scores ranged from 7 to 35; the higher the score, the poorer the self-rated cognitive functioning. Cronbach’s alpha coefficient was calculated for this scale and showed that it had good internal reliability (α = .78).

Finally, participants were asked to indicate how often they experienced problems with their vision on the same 5-point Likert-type scale used for cognitive functioning.

To assess reasons for self-regulation of driving, participants were asked whether they drove more, the same, or less today compared to 15 years ago, both with regard to annual mileage and driving frequency. If the participants reported they had reduced their driving, they were presented with a list of 21 possible reasons for this and asked to indicate to what extent each reason applied to them on a 5-point Likert-type scale, where 1 = not at all, 2 = poorly, 3 = neither poorly nor well, 4 = well, and 5 = very well (see Table 2 for list of reasons).

Table 2.

Percentage of Participants in Total and for Each of the Four Groups Reporting That Each Reason for Reducing Driving Applied to Them.

		Women		Men
	All	Higher functioning	Lower functioning	Higher functioning	Lower functioning
N	666 (%)^a	160 (%)^a	161 (%)^a	178 (%)^a	167 (%)^a
Reason for reduced driving
I have fewer activities I drive to	69.8	61.4	70.9	65.4	78.3
I no longer drive just for the drive	44.8	42.7	45.1	34.0	53.5
Petrol is expensive	19.2	11.9	18.6	18.8	27.8
The traffic has become more complex	18.6	21.1	28.3	6.4	20.4
Family members or friends have moved closer	18.3	18.4	20.4	12.4	22.0
I have moved house	14.2	13.5	15.1	10.4	17.9
The other road users have become more reckless	9.6	9.2	13.4	4.2	11.3
I do not like driving any longer	9.2	9.6	12.0	5.8	9.4
Driving takes too much concentration	8.6	7.7	11.5	4.0	11.3
I now have better access to public transport	8.5	4.5	12.7	7.8	10.4
I am scared of having an accident	8.2	8.8	13.6	2.9	9.1
My vision has declined	8.1	5.2	11.1	4.7	11.6
My reaction time has declined	7.8	4.6	12.1	5.3	9.8
A member of my family/or other person thinks it is best if I drive less	5.9	3.8	4.3	4.6	11.3
Driving pollutes	4.3	2.6	6.2	1.8	7.2
I do not feel confident in my own driving	4.2	2.5	5.8	1.1	8.1
There are too many cyclists	4.2	2.5	5.8	4.0	3.7
I feel insecure about driving	3.3	1.9	6.0	0	6.3
My GP or other doctor has recommended that I drive less	2.3	1.3	3.0	1.7	3.6
I have difficulties orienting because of stiffness of the neck	2.3	0.6	2.5	0.6	6.2
I feel physical discomfort when driving	1.6	0	1.8	1.1	3.0

The absolute frequencies relating to these percentages vary because of omitted responses on individual items.

In addition, participants were asked whether they avoided, whenever possible, driving when feeling unwell, motorway (highway) driving, driving when it is dark, or times and places with many cyclists. The situations were based on the literature on older drivers or are common driving situations. The situation times and places with many cyclists was included because of the large cyclist population in Denmark. An estimated 17% of all trips are made by bicycle in Denmark (DTU, 2011). Participants who reported avoiding one or more of these driving situations were presented with a list of possible reasons for avoiding each situation and asked to indicate to what extent each reason applied to them on the same 5-point Likert-type scale as above (see Tables 3, 4, 5, and 6 for the list of reasons for avoiding each situation).

Table 3.

Percentage of Participants in Total and for Each of the Four Groups Reporting That Each Reason for Avoiding Driving When Feeling Unwell Applied to Them.

		Women		Men
	All	Higher functioning	Lower functioning	Higher functioning	Lower functioning
N	630 (%)^a	156 (%)^a	175 (%)^a	150 (%)^a	149 (%)^a
Reason for avoiding driving when feeling unwell
I do not like to drive when feeling unwell	84.6	81.6	88.9	80.2	85.7
I have no reason to drive when feeling unwell	81.1	80.0	84.6	74.8	80.5
I feel insecure about driving when feeling unwell	67.0	62.5	70.4	61.2	70.2
It takes too much concentration to drive when feeling unwell	60.2	52.8	66.0	56.5	63.9
I do not feel confident in my own driving, when I am feeling unwell	53.4	51.8	62.6	44.2	50.8
It is difficult to keep an overview of the traffic when feeling unwell	50.8	42.9	62.9	40.8	55.2
I am scared of having an accident	47.3	43.4	58.6	34.9	51.2
A member of my family/or other person thinks it is best if I avoid driving when feeling unwell	24.0	24.0	22.3	20.9	29.9

The absolute frequencies relating to these percentages vary because of omitted responses on individual items.

Table 4.

Percentage of Participants in Total and for Each of the Four Groups Reporting That Each Reason for Avoiding Driving When It Is Dark Applied to Them.

		Women		Men
	All	Higher functioning	Lower functioning	Higher functioning	Lower functioning
N	332 (%)^a	76 (%)^a	132 (%)^a	50 (%)^a	74 (%)^a
Reason for avoiding driving when it is dark
I do not like driving when it is dark	84.5	86.6	86.9	72.7	83.3
I might as well move my activities to when it is light	81.3	86.6	75.6	81.4	81.5
I have no reason to drive when it is dark	77.9	84.5	76.7	68.9	73.4
I feel insecure about driving when it is dark	62.8	61.8	70.0	51.2	56.4
It takes too much concentration to drive when it is dark	60.2	56.7	61.9	55.8	63.6
The roads I typically drive on have poor lighting	46.4	48.6	45.5	35.9	50.0
I do not feel confident in my own driving, when I drive when it is dark	43.8	36.2	57.5	30.2	35.7
I am scared of having an accident	42.6	42.9	51.2	21.4	43.1
My vision has declined	35.4	22.5	42.9	35.0	39.0
There are so many cyclists who drive without lights on	27.9	25.4	34.2	22.7	21.7
My reaction time has declined	24.9	11.8	30.6	18.6	35.2
I have good access to public transport which I prefer to use when it is dark	20.4	20.5	19.8	22.4	21.7
A member of my family/or other person thinks it is best if I avoid driving when it is dark	16.9	16.0	11.3	17.0	25.4

The absolute frequencies relating to these percentages vary because of omitted responses on individual items.

Table 5.

Percentage of Participants in Total and for Each of the Four Groups Reporting That Each Reason for Avoiding Motorway Driving Applied to Them.

		Women		Men
	All	Higher functioning	Lower functioning	Higher functioning	Lower functioning
N	150 (%)^a	49 (%)^a	54 (%)^a	19 (%)^a	28 (%)^a
Reason for avoiding motorway driving
I have no reason to drive on motorways	81.0	85.1	78.7	72.2	87.5
I do not like to drive on motorways	80.7	75.0	83.7	86.7	80.8
I prefer to drive another and prettier route	77.4	69.6	81.3	66.7	92.3
The speed is so high on motorways	73.6	67.4	75.5	77.8	77.8
I feel insecure about driving on motorways	51.9	51.2	65.1	41.7	33.3
It takes too much concentration to drive on motorways	51.1	46.5	57.1	60.0	43.5
The other drivers drive recklessly on motorways	50.0	54.5	52.6	43.8	53.8
I am scared of having an accident	35.5	37.0	37.5	25.0	36.0
I do not feel confident in my own driving, when I drive on motorways	32.1	34.9	39.5	20.0	19.2
My reaction time has declined	21.7	13.3	37.2	6.3	25.0
A member of my family/or other person thinks it is best if I avoid driving on motorways	16.8	17.4	19.6	11.1	13.0
My vision has declined	10.5	6.3	16.3	5.6	11.5

The absolute frequencies relating to these percentages vary because of omitted responses on individual items.

Table 6.

Percentage of Participants in Total and for Each of the Four Groups Reporting That Each Reason for Avoiding Driving at Times and in Places With Many Cyclists Applied to Them.

		Women		Men
	All	Higher functioning	Lower functioning	Higher functioning	Lower functioning
N	172 (%)^a	32 (%)^a	60 (%)^a	24 (%)^a	56 (%)^a
Reason for avoiding times and places with many cyclists
I do not like to drive when there are many cyclists	62.8	57.1	73.5	42.9	59.5
I have no reason to drive where there are many cyclists	61.8	58.6	74.1	50.0	52.3
It takes too much concentration to drive when there are many cyclists	50.7	55.2	56.6	52.6	41.9
Cyclists ride recklessly	48.2	51.7	56.3	45.0	36.6
I feel insecure about driving when there are many cyclists	45.0	50.0	59.6	38.1	31.9
I am scared of having an accident	44.6	53.3	50.0	42.9	35.3
My reaction time has declined	25.3	16.7	41.3	18.2	19.1
I do not feel confident in my own driving, where there are many cyclists	21.2	26.7	28.0	13.6	14.3
A member of my family/or other person thinks it is best if I avoid driving when there are many cyclists	14.3	12.9	16.7	4.5	18.4
My vision has declined	9.8	6.7	13.3	4.5	9.8
I have difficulties orienting because of stiffness of the neck	4.8	9.4	3.6	8.7	1.9

The absolute frequencies relating to these percentages vary because of omitted responses on individual items.

In the analysis, the answers “not at all” and “poorly” were combined to indicate that the reason suggested did not apply to the participant, and the answers “well” and “very well” were combined to indicate that the reason did apply to the participant. The answer “neither poorly nor well” was excluded from the analysis because, in most cases, very few participants chose this option.

Group differences were not explored in the case of reasons that less than 10% of participants reported as applying to them.

To avoid any systematic sequence-dependent effect in the results, the sequence in which various driving situations and suggested reasons for self-regulating driving were presented to respondents was randomized from participant to participant.

Analysis

To explore gender trends and the trends in self-rated cognitive functioning, as well as interactions between these two factors, participants were divided into four groups: higher- and lower-functioning women, and higher- and lower-functioning men. The division into the higher- and lower-functioning groups was based on each participant’s self-rated cognitive score. The cutoff score was determined by identifying the 50 percentile score, which was 10. Participants scoring below 10 were assigned to the higher-functioning group, and participants scoring 10 or more, to the lower-functioning group. It was possible to calculate the self-rated cognitive score for a total of 840 out of 888 participants; the score could not be calculated in all cases, due to missing values.

To test the statistical significance of the differences between the groups, log-linear analysis was used to analyze categorical variables and ANOVA for continuous variables.

Results

Reasons for Reduced Driving

Of the 840 participants, 666 participants reported having reduced their driving compared to 15 years ago. They were presented with a list of possible reasons for this and asked to indicate to what extent each reason applied to them. For all the suggested reasons except one, a large majority of participants reported that the reason did not apply to them. The exception was, “I have fewer activities I drive to” (see Table 2).

Three-way log-linear analysis revealed that there was a significant three-way interaction in the case of the two reasons: “I no longer drive just for the drive,” χ²(1) = 4.44, p < .05, and “the traffic has become more complex,” χ²(1) = 4.21, p < .05. Odds ratios indicated that the lower-functioning group was more likely to agree with the reasons than the higher-functioning group, but this trend was much more pronounced among men (OR 3.6 and 3.7 for the respective reasons) than among women (OR 1.1 and 1.5 for the respective reasons).

In addition, there was a significant two-way interaction between functional group and reason, where the lower-functioning group was more likely to agree with the reasons, in the case of the following two reasons: “I have fewer activities I drive to,” χ²(1) = 8.86, p < .01, OR = 1.7, and “Petrol is expensive,” χ²(1) = 5.84, p < .05, OR = 1.6.

Furthermore, there was a significant two-way interaction between gender and reason in the case of the reason, “Petrol is expensive,” χ²(1) = 6.12, p < .05, where odds ratios indicated that women were 1.7 times more likely to agree than men.

Reasons for Avoiding Driving When Feeling Unwell

Of the 840 participants, 630 reported avoiding driving when feeling unwell. They were presented with a list of possible reasons for this and asked to indicate to what extent each reason applied to them.

The participants were most likely to report that the reasons, “I do not like to drive when feeling unwell,” and “I have no reason to drive when feeling unwell,” applied to them, followed by, “I feel insecure about driving when feeling unwell” (see Table 3).

Three-way log-linear analysis revealed a statistically significant two-way interaction between cognitive group and reason, where the lower-functioning group was more likely to agree with the reasons in the case of the following six reasons: “I do not like to drive when feeling unwell,” χ²(1) = 4.63, p < .05, OR = 1.7; “I feel insecure about driving when feeling unwell,” χ²(1) = 4.27, p < .05, OR = 1.5; “It takes too much concentration to drive when feeling unwell,” χ²(1) = 5.84, p < .05, OR = 1.6; “I do not feel confident in my own driving, when I am feeling unwell,” χ²(1) = 4.57, p < .05, OR = 1.4; “I am scared of having an accident,” χ²(1) = 13.91, p < .001, OR = 1.9, and finally, “It is difficult to keep an overview of the traffic when feeling unwell,” χ²(1) = 15.68, p < .001, OR = 2.0. In addition, women were significantly more likely to agree with the reason, “I do not feel confident in my own driving, when feeling unwell,” χ²(1) = 4.94, p < .05, OR = 1.5.

Reasons for Avoiding Driving When It Is Dark

Of the 840 participants, 332 reported avoiding driving when it is dark. The reasons participants were most likely to report as applying to them, when avoiding driving when it is dark, were, “I do not like driving when it is dark,” “I might as well move my activities to when it is light,” and “I have no reason to drive when it is dark” (see Table 4).

There was a statistically significant two-way interaction between cognitive group and reason, where the lower-functioning group was more likely to agree with the reasons in the case of the following four reasons: “I am scared of having an accident,” χ²(1) = 5.38, p < .05, OR = 1.8; “I do not feel confident in my own driving when it is dark,” χ²(1) = 7.78, p < .01, OR = 2.0; “My vision has declined,” χ²(1) = 6.27, p < .05, OR = 1.7; and finally, “My reaction time has declined,” χ²(1) = 11.58, p < .01, OR = 2.8.

In addition, women were more likely to agree with the following two reasons: “I am scared of having an accident,” χ²(1) = 5.44, p < .05, OR = 1.8, and “I do not feel confident in my own driving when it is dark,” χ²(1) = 7.2, p < .01, OR = 2.0; men were more likely to agree with the reason, “ a member of my family/or other person thinks it is best if I avoid driving when it is dark,” χ²(1) = 3.88, p < .05, OR = 1.9.

Reasons for Avoiding Motorway Driving

Of the 840 participants, 150 reported avoiding driving on motorways. The reasons for avoiding motorway driving that participants were most likely to agree with were, “I have no reason to drive on motorways,” and “I do not like to drive on motorways,” followed by, “I prefer to drive another and prettier route,” and “The speed is so high on the motorways” (see Table 5).

There was a significant two-way interaction between cognitive group and reason, where the lower-functioning group was more likely to agree with the reason, in the case of the following two reasons: “I prefer to drive another and prettier route,” χ²(1) = 5.13, p < .05, OR = 2.6, and “My reaction time has declined,” χ²(1) = 8.69, p < .01, OR = 3.8.

In addition, women were more likely to agree, in the case of the following two reasons: “I do not feel confident in my own driving, when I drive on motorways,” χ²(1) = 4.24, p < .05, OR = 2.4, and “I feel insecure about driving on motorways,” χ²(1) = 5.26, p < .05, OR = 2.4.

Reasons for Avoiding Driving at Times and in Places With Many Cyclists

Finally, 172 of the 840 participants reported avoiding driving at times and in places with many cyclists. When exploring the reasons for avoiding driving times and places with many cyclists, the reasons participants were most likely to agree with were, “I have no reason to drive where there are many cyclists,” and “I do not like to drive when there are many cyclists” (see Table 6).

There were no statistically significant differences between the cognitive groups, but there was a tendency for women to be more likely to agree with the suggested reasons than is the case with men and the two-way interaction between gender and reason reached the level of statistical significance in the case of the following three reasons: “I have no reason to drive where there are many cyclists,” χ²(1) = 4.46, p < .05, OR = 2.1; “I feel insecure about driving when there are many cyclists,” χ²(1) = 7.14, p < .01, OR = 2.5; and finally, “I do not feel confident in my own driving, where there are many cyclists,” χ²(1) = 4.15, p < .05, OR = 2.3.

Discussion

The aim of the present study was to gain a better understanding of older drivers’ self-regulation of driving. More specifically, the present study explored older drivers’ reasons for reducing the overall amount of their driving and for avoiding selected driving situations by gender and self-rated cognitive problems.

There were four main findings: First, only one reason for reduced driving, “I have fewer activities I drive to,” was reported to apply to the majority of participants. Second, the reasons for avoiding driving in the four driving situations that participants were most likely to agree with were, “I do not like driving in the situation,” “I have no reason to drive in the situation/might as well move my activities,” followed by, “It takes too much concentration to drive in the situation,” and “I feel insecure about driving in the situation.” Third, the lower-functioning group was more likely than the higher-functioning group to agree with decline in vision and reaction time as reasons for avoiding motorway driving and driving when it is dark, but it was only a minority who indicated functional decline as a reason for avoiding the driving situations. Fourth, women were more likely than men to agree with lack of confidence as a reason for avoiding all four driving situations.

The results suggest that the reduction in driving largely appears to relate to a reduced need for mobility whereas the avoidance of driving situations is associated with not liking to drive in the situation and feeling insecure about driving in the situation and may thus to a larger extent reflect strategies to continue to drive safely. These findings support previous literature suggesting that the reasons for the self-regulation of driving vary depending on the self-regulatory behavior (Charlton et al., 2006; Ragland et al., 2004; Raitanen et al., 2003) and suggest that the overall reduction in driving indeed is a qualitatively different type of self-regulatory behavior than the avoidance of driving situations.

Although the reduction in overall driving may be a natural consequence of lifestyle changes, it is not likely to increase the safety of older road users. If the reduction in driving results in older drivers changing their mode of transport to less safer ones such as walking or cycling, it may have a negative impact on their overall traffic safety (Hakamies-Blomqvist, Johansson, & Lundberg, 1996: Siren & Meng, 2012). In addition, the reduction in overall driving may lead to a reduction in older driver’s driving routine and thereby lead to an increased risk. It should be noted though that particularly the lower-functioning men were more likely to agree with the traffic having become more complex as a reason for having reduced their driving, indicating that, in some cases, the reduction in driving may also reflect motivations to continue to drive safely.

It was only a minority of the lower-functioning group who pointed toward functional decline as reasons for avoidance. Previous research suggest that older drivers may not be aware of their functional decline (Holland & Rabbitt, 1992); however, participants in the present study were divided into the higher- and lower-functioning groups on the basis of their self-rated cognitive functioning and, thus, differed in the number of cognitive problems they recognized. The fact that they to a large extent did not indicate functional decline as a reason for avoiding driving situations but rather indicated the more abstract feeling of not liking to drive in the situation as a reason for avoiding the driving situations indicate, therefore, that their self-regulation of driving was largely an unconscious response to their functional decline, as proposed by De Raedt and Ponjaert-Kristoffersen (2000).

When the lower-functioning participants did indicate functional decline, reduced vision and reaction time were indicated as the reasons for the avoidance, supporting previous research that has identified decline in vision as an important reason for the avoidance of driving situations (Charlton et al., 2006; Ragland et al., 2004).

A study by Meng & Siren (2012) found that avoidance of driving situations was associated with driving-related discomfort and that older drivers who recognize cognitive problems were more likely to report driving-related discomfort. On the basis of these results, they argue that this feeling of driving-related discomfort may function as an indirect self-monitoring of driving ability. The most common reason for avoidance of the driving situations in the present study was not liking to drive in the situation, perhaps reflecting this driving-related discomfort. However, the lower-functioning participants in the present study were not more likely to report not liking to drive in a situation, except for when avoiding driving when feeling unwell. Therefore, although the feeling of not liking to drive in a particular driving situation may reflect driving-related discomfort, the results suggest that the feeling of not liking to drive in a situation extends somewhat beyond driving-related discomfort. Nevertheless, taken together, these findings suggest that to a large extent older drivers avoid driving situations because of abstract negative feelings. Further research into what lies behind these negative feelings associated with the avoidance of driving situations may shed further light on whether they relate to actual driving ability, and thus contribute to the safe driving performance of older drivers, or whether they just lead to unwarranted mobility restrictions.

Finally, women were more likely to indicate lack of confidence as a reason for avoidance in all four driving situations, which supports previous findings that older women are less confident as drivers (D’Ambrosio et al., 2008) and literature proposing a link between lack of confidence and self-regulation of driving (Baldock et al., 2006; Charlton et al., 2006). Women were also more likely to report feeling insecure about driving in the situation when avoiding motorway driving and avoiding times and places with many cyclists. Taken together, these results suggest that older women’s avoidance of driving situations is to a larger extent motivated by lack of confidence and insecurity about their own driving. Given that the self-regulation of driving often leads to driving cessation (Dellinger et al., 2001), these findings lend support to the suggestion by Rimmö and Hakamies-Blomqvist (2002) that lack of confidence leads to premature driving cessation among women and may be part of the explanation for why older women give up driving for less pressing reasons and, thereby, their greater vulnerability toward unwarranted mobility loss. On the other hand, women were not more likely to indicate lack of confidence as a reason for having reduced their overall amount of driving, which might indicate that the reduction in driving is largely a consequence of reduced need for mobility rather than a response to negative feelings.

Strengths and Limitations of the Study

The strengths of the present study are the large random sample and the high response rate, making the results valid for the general population of Danish older drivers. One limitation of the study is that participants were presented with lists of reasons for the reduction in driving and avoidance of driving situations. These lists are obviously not exhaustive; therefore, it cannot be ruled out that we missed out relevant reasons. Likewise, we only explored reasons for avoidance of four driving situations and general reduction in driving. Previous research has shown that the reasons for self-regulation depend on the self-regulatory behavior (Charlton et al., 2006; Ragland et al., 2004; Raitanen et al., 2003). Future research into the reasons older drivers give for avoiding a larger range of driving situations may reveal further differences as well as similarities in motivations for the self-regulatory behavior of older drivers. Furthermore, we did not assess participants’ need for mobility and changes in these and therefore cannot rule out that the reduction in driving may, in some cases, reflect decline in driving ability and that older drivers pointing toward reduced mobility need as explanation may in fact reflect self-denial. Therefore, although it is an advantage methodologically to treat the avoidance and reduction of driving separately, one should keep in mind that there is overlap between the motivations behind these two types of self-regulatory behaviors and that they are both part of the driving cessation process.

All participants were 75 years or older; therefore in order to be able to include changes occurring at the earlier stages of the aging process a time frame of 15 years was used. The participants may, however, have experienced difficulties recalling changes occurring that long ago or exactly when the changes occurred. Therefore, the results should be interpreted as changes occurring in fairly recent years without applying a specific time frame.

One aim of the study was to explore how older drivers who report cognitive problems explain their self-regulation of driving. Therefore, the study categorized participants’ cognitive status on the basis of self-reported problems with cognitive functions. Objective measures of cognitive functioning designed for phone interviews have been developed (Ofstedal, Fisher, & Herzog, 2005; Regula Herzog & Wallace, 1997). However, such elaborate measures could not be applied in the present study due to time constraint in the interviews and the focus of the questionnaire was on driving rather than on health and cognitive functioning per se. Nevertheless, it can reasonably be assumed that in general the group reporting more cognitive difficulties also actually had lower cognitive functioning. Nevertheless, it is recognized that our results cannot be generalized to subgroups of older drivers with various medical diagnoses. For example, Alzheimer’s disease is often associated with anosognosia, or lack of insight into one’s impairments (Starkstein, Jorge, Mizrahi, & Robinson, 2006). Thus, it is unknown whether older drivers who experience cognitive problems, but do not recognize them, would show the same pattern of results.

Conclusion

In conclusion, the results suggest that the reduction in driving and the avoidance of selected driving situations are best treated as separate types of self-regulatory behavior; the reduction in driving seems primarily to be a consequence of a reduced need for mobility, whereas the avoidance of driving situations largely appears to be motivated by negative feelings associated with driving in the situations. The reduction in driving is not likely to increase the safety of the older road users because it may lead to an increased use of less safe modes of transport and a reduction in driving routine and, thus, is not the self-regulatory behavior that should be encouraged. Further research may help assessing the balance between safety benefits and unwarranted mobility restrictions related to avoidance as a self-regulatory strategy.

Moreover, the results showed that even though older drivers recognize visual and cognitive problems, only a minority indicated functional decline as a reason for avoiding driving situations, indicating that their self-regulation of driving is largely an automatic process in which they are not aware that they are compensating for functional loss.

Finally, the results lend further support to the suggestion that older women’s greater vulnerability to premature driving cessation and unwarranted mobility loss are linked to lack of confidence and insecurity about their own driving. This finding stresses the importance of acknowledging gender differences when designing interventions aimed at enhancing safe mobility.

Footnotes

Acknowledgements

The authors would like to acknowledge Dr. Tom Teasdale for his constructive comments on the statistical analyses.

Authors’ note

The project has been approved by the Danish Ethical Committee (De Videnskabsetiske Komiteer for Region Hovedstaden) Protocol Number: H-1-2010-094.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received financial support from the TRYGFoundation for the research, authorship, and/or publication of this article.

Author Biographies

Annette Meng has earned her MSc Psychology degree from the University of Copenhagen in 2006. She is currently completing her PhD thesis at the University of Copenhagen, Department of Psychology. Her areas of interest are transport psychology, older drivers, cognitive impairment and driving, and mobility.

Anu Siren, PhD, is a psychologist and an Associate Professor at the Technical University of Denmark, Department of Transport. Her areas of interest include ageing and transport, safety and mobility issues of older road users, and gender and transport.

References

Anstey

K. J.

Smith

G. A.

(2003). Associations of biomarkers, cognition and self-reports of sensory function with self-reported driving behaviour and confidence. Gerontology, 49, 196-202.

Anstey

K. J.

Wood

Lord

Walker

J. G.

(2005). Cognitive, sensory and physical factors enabling driving safety in older adults. Clinical Psychology Review, 25, 45-65.

Baldock

Mathias

McLean

Berndt

(2006). Self-regulation of driving and its relationship to driving ability among older adults. Accident Analysis and Prevention, 38(5), 1038-1045.

Ball

Owsley

Stalvey

Roenker

D. L.

Sloane

M. E.

Graves

(1998). Driving avoidance and functional impairment in older drivers. Accident Analysis and Prevention, 30(3), 313-322.

Charlton

J. L.

Oxley

Fildes

Oxley

Newstead

Koppel

O’Hare

(2006). Characteristics of older drivers who adopt self-regulatory driving behaviours. Transportation Research. Part F: Traffic Psychology and Behaviour, 9, 363-373.

D’Ambrosio

L. A.

Donorfio

L. K. M.

Coughlin

J. F.

Mohyde

Meyer

(2008). Gender Differences in self-regulation patterns and attitudes toward driving among older adults. Journal of Women & Aging, 20, 265-282.

Dellinger

A. M.

Sehgal

Sleet

D. A.

Barrett-Connor

(2001). Driving cessation: What older former drivers tell us. Journal of the American Geriatric Society, 49, 431-435.

De Raedt

Ponjaert-Kristoffersen

(2000). Can strategic and tactical compensation reduce crash risk in older drivers? Age and Ageing, 29, 517-521.

Donorfio

L. K. M.

D’Ambrosio

L. A.

Coughlin

J. F.

Mohyde

(2008a). Health, safety, self-regulation and the older driver: It’s not just a matter of age. Journal of Safety Research, 39, 555-561.

10.

Donorfio

L. K. M.

D’Ambrosio

L. A.

Coughlin

J. F.

Mohyde

(2008b). To drive or not to drive, that isn’t the question—The meaning of self-regulation among older drivers. Journal of Safety Research, 40, 221-226.

11.

Donorfio

L. K. M.

Mohyde

Coughlin

J. F.

D’Ambrosio

L. A.

(2008). A qualitative exploration of self-regulation behaviours among older drivers. Journal of Aging and Social Policy, 20, 323-339.

12.

DTU. (2011). TU-rapport for hele Danmark, dataperiode 2011. (Danish Travel Survey Report, 2011). Lyngby, Denmark: Author.

13.

Eberhard

J. W.

Stutts

Burkhardt

Finn

Hunt

Staplin

McCarthy

D. P.

(2006). Strategies and tools to enable safe mobility for older adults. Topics in Geriatric Rehabilitation, 22(1), 3-17.

14.

Farquhar

(1995). Elderly people’s definitions of quality of life. Social Science and Medicine, 41, 1439-1446.

15.

Field

(Ed.). (2009). Discovering statistics using SPSS. London: Sage.

16.

Hakamies-Blomqvist

Johansson

Lundberg

(1996). Medical screening of older drivers as a traffic safety measure—A comparative Finnish-Swedish evaluation study. Journal of the American Geriatrics Society, 44, 650-653.

17.

Hakamies-Blomqvist

Wahlström

(1998). Why do older drivers give up driving? Accident Analysis and Prevention, 30, 305-312.

18.

Holland

C. A.

Rabbitt

P. M. A.

(1992). People’s awareness of their age-related sensory and cognitive deficits and the implications for road safety. Applied Cognitive Psychology, 6, 217-231.

19.

Horswill

M. S.

Anstey

K. J.

Hatherly

Wood

J. M.

Pachana

N. A.

(2011). Older drivers’ insight into their hazard perception ability. Accident Analysis and Prevention, 63(6), 2121-2127.

20.

Kostyniuk

L. P.

Molnar

L. J.

(2008). Self-regulatory driving practices among older adults: Health, age and sex effects. Accident Analysis and Prevention, 40, 1576-1580.

21.

Man-Son-Hing

Marshall

S. C.

Molnar

F. J.

Wilson

K. G.

(2007). Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. Journal of the American Geriatric Society, 55(6), 878-884.

22.

Meng

Siren

(2012). Cognitive problems, self-rated changes in driving skills, driving-related discomfort and self-regulation of driving in old drivers. Accident Analysis and Prevention, 49, 322-329.

23.

Molnar

L. J.

Eby

D. W.

(2008). The relationship between self-regulation and driving-related abilities in older drivers: An exploratory study. Traffic Injury Prevention, 9, 314-319.

24.

Ofstedal

M. B.

Fisher

G. G.

Herzog

A. R.

(2005). Documentation of cognitive functioning measures in the health and retirement study (HRS Documentation Report DR-006). Ann Arbor: Survey Research Center, University of Michigan.

25.

Oxley

Whelan

(2008). It cannot be all about safety: The benefits of prolonged mobility. Traffic Injury Prevention, 9(4), 367-378.

26.

Ragland

D. R.

Satariano

W. A.

MacLeod

K. E.

(2004). Reasons given by older people for limitation or avoidance of driving. The Gerontologist, 44(2), 237-244.

27.

Raitanen

Törmäkangas

Mollenkopf

Marcellini

(2003). Why do older drivers reduce driving? Findings from three European countries. Transportation Research. Part F: Traffic Psychology and Behaviour, 6, 81-95.

28.

Regula Herzog

Wallace

R. B.

(1997). Measures of cognitive functioning in the AHEAD study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 52, 37-48.

29.

Rimmö

P. A.

Hakamies-Blomqvist

(2002). Older drivers’ aberrant driving behaviour, impaired activity, and health as reasons for self-imposed driving limitations. Transportation Research. Part F: Traffic Psychology and Behaviour, 5, 47-62.

30.

Ross

L. A.

Clay

O. J.

Edwards

J. D.

Ball

K. K.

Wadley

V. G.

Vance

D. E.

Joyce

J. J.

(2009). Do older drivers at-risk for crashes modify their driving over time? Journal of Gerontology: Psychological Sciences, 10, 1-8.

31.

Ruechel

Mann

W. C.

(2005). Self-regulation of driving by older persons. Physical and Occupational Therapy in Geriatrics, 23, 91-102.

32.

Siren

Hakamies-Blomqvist

Lindeman

(2004). Driving cessation and health in older women. Journal of Applied Gerontology, 23(1), 58-69.

33.

Siren

Meng

(2012). Cognitive screening of older drivers does not produce safety benefits. Accident Analysis and Prevention, 45, 634-638.

34.

Starkstein

S. E.

Jorge

Mizrahi

Robinson

R. G.

(2006). A diagnostic formulation for anosognosia in Alzheimer’s disease. Journal of Neurology Neurosurgery and Psychiatry, 77, 719-725.