Older Adults’ Attitudes About Future Mobility Changes and the Usefulness of Mobility Assessment Materials

Abstract

Objectives:

To understand older adults’ attitudes about future mobility and usefulness of mobility assessment materials.

Methods:

Data came from a telephone survey of 1,000 older adults aged 60–74 years. After answering baseline questions, respondents received mobility assessment materials, then completed follow-up interviews. Respondents were asked about future mobility challenges. During baseline and follow-up, subjects were asked four questions about their mobility as they aged which measured thinking about mobility, thinking about protecting mobility, confidence in protecting mobility, and motivation to protect mobility. Differences in percent of respondents’ attitudes between baseline and follow-up and 95% confidence intervals were calculated.

Results:

Driving (42%) was the most commonly reported challenge. Significant increases from baseline to follow-up in thinking about mobility (25%), thinking about protecting mobility (39%), and confidence in protecting mobility (29%) were reported.

Discussion:

Brief mobility assessment materials can encourage older adults to consider future mobility. Planning for changes can prolong safe mobility.

Keywords

older adult mobility mobility assessment tool

Introduction

As we age, our mobility or the ability to get where we want to go, when we want to go, might be reduced (Satariano et al., 2012). Driving and walking are the two most common modes of mobility for older adults (Collia et al., 2003) and aging is related to declines in both (Satariano et al., 2012). Most older adults will stop driving at some point in their lives with an average estimated nondriving lifespan of 7 years for men and 10 years for women (Foley et al., 2002). Driving cessation in older adults has been associated with poor psychological outlook, lower life satisfaction, community engagement, and quality of life, depression, isolation, declines in physical activity and health, and early death (Chihuri et al., 2016; Dickerson et al., 2019; Oxley & Charlton, 2009). Fear of falling is associated with travel limitations, avoidance of activities, loss of functional independence, reduced social activity, depression, and a decreased quality of life for older adults (Auais et al., 2017; Scheffer et al., 2008). In addition, mobility-associated injuries from falls and motor vehicle crashes are the leading causes of injury and injury death in older adults (Centers for Disease Control and Prevention, 2019).

Older adults might be reluctant to discuss or think about mobility issues due to the loss of independence associated with driving reductions and falls (Ambrose et al., 2013; Oxley & Charlton, 2009). However, in one study, older adults believed that planning for changes that might come with age could result in better future mobility outcomes (Harmon et al., 2018). Older adults who make the decision to stop driving on their own or with help were more satisfied with their mobility than those who had the decision made for them (Oxley & Charlton, 2009). While over half of middle-aged and older adults have not planned for driving cessation, more than 80% agreed that planning would help them to meet their transportation needs if they stop driving (Harmon et al., 2018). Planning can include using evidence-based interventions to reduce aging-associated risk factors (e.g., increasing medication use, decreasing muscle strength) that potentially reduce mobility (Dellinger et al., 2001; Gillespie et al., 2012). Further research on planning for mobility changes could inform interventions to improve older adults’ quality of life and allow for prolonged independence.

Materials were developed and evaluated to help older adults assess their mobility and plan for possible mobility changes as they age. The purpose of the current study is to describe older adults’ attitudes about their future mobility, mobility-related concerns, and the usefulness of these mobility assessment materials to increase planning.

Method

Materials to help older adults assess their mobility were developed based on a literature review and subject matter expert advice. The materials consisted of four pages that led older adults through an assessment of both their current mobility and areas that might be a problem in the future. The materials also gave suggestions for staying healthy, active, social, and connected, and a space to write in a brief plan. Different versions of the materials were tested with intercept interviews and focus groups to gauge their usability and acceptability among older adults aged 60–74 years. The resulting mobility assessment materials (Supplemental Material) were then pilot tested. Marketing databases for a nationwide list of telephone numbers were used to identify English speaking older adults aged 60–74 years. Potential respondents were first contacted by phone to obtain their consent for participation. Of the 2,872 people contacted, 1,000 (35%) met the additional criteria of self-reported good or very good mobility and agreed to participate. Older adults with less than good mobility were excluded as they are likely already aware of their mobility limitations and are receiving or seeking support. During the consent process, demographic data were collected (sex, race, marital status, education, household income). Respondents were asked to rate four attitude/belief questions on a scale of 1–5 with 1 being “not at all” and 5 being “very much.”

As the majority of older adults are not planning for mobility changes that may come with age (Harmon et al., 2018), the precontemplation stage of the Transtheoretical Stages Model (Glanz) was used to design questions to measure attitudes. This stage is characterized as unaware and older adults in this stage may not be thinking about their mobility or protecting it, may not be motivated, and may not be confident that they know what to do. The following questions were developed and are listed below with the attitude being measured.

Research Question 1 (RQ1): “How much have you been recently thinking about your ability to get around your home and community as you age?” (thinking about mobility).

Research Question 2 (RQ2): “How much have you been recently thinking about protecting your ability to get around your home and community as you age?” (thinking about protecting mobility).

Research Question 3 (RQ3): “How confident do you feel that you know what to do to protect your mobility as you age?” (confidence in protecting mobility).

Research Question 4 (RQ4): “How motivated are you to protect your ability to get around your home and community as you age?” (motivation to protect mobility).

In addition, interviewers asked an open-ended response question: “What is the first thing that comes to mind when you think about challenges you might face in getting to the places you need to go, as you get older?”

After the verbal consent was completed and the above questions asked (hereafter referred to as baseline), mobility assessment materials were mailed to participants. Participants were asked to review and complete the assessment section on Page 2 and the plan section on Page 4 (refer Supplemental Material) prior to the follow-up interview 1 week later. At follow-up, the respondents were asked to confirm that they received the assessment materials, they still had the materials, and they had read and completed them. If they indicated no to either of the first two questions, another copy of the assessment was mailed and the respondent was rescheduled for follow-up interview. If they indicated no to completing the assessment, they were instructed to take a moment to read and complete the assessment now before any interview questions were asked. This approach allowed for none of the respondents to be lost to follow-up.

The follow-up telephone interview (100% of those who consented completed the interview) asked participants the same four attitude/belief questions as the baseline interview.

Analysis

Respondents who answered the open-ended question in a way that implied they had less than good mobility (currently used assistive devices or currently had trouble getting around) were excluded (45 participants) from analysis leaving a sample of 955 older adults aged 60–74 years.

In the survey, race/ethnicity was categorized into White non-Hispanic, Black non-Hispanic, American Indian/ Alaska Native, Asian/Pacific Islander, and Hispanic. For analysis, due to small sample size, race ethnicity was grouped into White non-Hispanic, Black non-Hispanic, and other. The quantitative data were categorized for each of the four attitude/belief questions with RQ1 measuring “thinking about mobility,” RQ2 “thinking about protecting mobility,” RQ3 “confidence in protecting mobility,” and RQ4 “motivation to protect mobility.” Scores of 4–5 were considered “high” and scores of 1–3 were considered “low.” For brevity, respondents who reported a score of 4–5 for thinking about their future mobility or protecting future mobility are described as reporting “thinking” or “thinking about protecting.” Similarly, those reporting a score of 4–5 for confidence in or motivation to protect their mobility are described as being “confident” or “motivated.” The baseline responses were compared across groups (i.e., comparing males to females) using a difference of proportions test and alpha level of .05, as were the follow-up responses after receiving the mobility assessment materials.

The percent differences in the percent of respondents reporting thinking/thinking about protecting/confidence/motivation at baseline and follow-up and the corresponding 95% confidence intervals were calculated using standard errors based on the discordant pairs to account for the dependency between responses. An adjusted Wald confidence interval was used when the cell counts were less than 10 (Agresti & Min, 2005). If the 95% confidence interval for the percent difference contained zero, respondents’ attitudes were considered to have not significantly changed after receiving, reviewing, and completing the mobility assessment materials. To compare the percent differences across groups (i.e., comparing male to female, percent differences from baseline to follow-up), 95% confidence intervals (not reported) and corresponding p values were calculated by combining the estimated within group standard errors assuming independence across groups. For the groups with more than two categories (e.g., income) a reference group was selected and each group was compared with the reference group using 95% confidence intervals.

Older adults who responded none or nothing when asked about future mobility challenges (11% of respondents) were considered to be not thinking about their future mobility and removed from analysis of this question. For older adults who gave a response for future mobility challenges, two of the authors analyzed their responses to develop a list of themes. The two lists of themes were reconciled to create one list and themes were grouped into categories based on similarity of themes and number of responses in each (Table 1). All three authors independently classified each response using the final theme list. Respondents could have reported more than one theme. All three authors then reconciled the three sets to create final themes for each respondent and calculated the percent of respondents who mentioned each theme in their response.

Table 1.

Definition of Themes Reported by Adults Aged 60–74 Years When Asked “What Is The First Thing That Comes to Mind When You Think About Challenges You Might Face in Getting to the Places You Need to Go, as You Get Older?”

Category	Definitions and labels used
Driving	Car, driving, driving nighttime, driving safety, nighttime, physical ability to drive, time, traffic, distance (when answer pertains to driving distance), parking (sometimes)
Ability	Assistive device, falling, injury, mobility, physical, physical mobility, arthritis, climb stairs, strength
Alternative transportation	Biking, public transportation, transportation
Health	Cognitive, health, hearing, vision, energy, stroke
Don’t know/none/don’t think about it	Don’t know, Don’t think about it, none
Cost/financial	Health insurance, money, maintenance
Walking	Walking, distance (when answer pertains to walking distance)
Burden/help/independence	Burden, help, family help, independence, support
Other	Ability, directions, distance (when not clearly pertaining to driving or walking), faith, home, medical, miscellaneous, motivation, move, nursing home, other, safety, schedule, scheduling, slow, travel, weather, rural, stressful

Results

Most respondents were female (54.8%), White (90.3%), married (59.1%), and reported very good current mobility (72.7%) (Table 2). Compared with the U.S. population, the sample was more likely to report their race as White and less likely to report being Black or other race.

Table 2.

Demographic and Other Characteristics of Adult Respondents Aged 60–74 Years, 2014, Compared With the July 1, 2014 U.S. Census Projections.

Characteristic	Respondents			U.S. Census
Characteristic	n	%	95% CI	N	%
Sex
Female	523	54.8	[51.6, 57.9]	23,737,483	52.8
Male	432	45.2	[42.1, 48.4]	21,226,939	47.2
Race
White	862	90.3	[88.4, 92.1]	34,020,703	75.7
Black	63	6.6	[5.0, 8.2]	4,422,133	9.8
Other^a	30	3.1	[2.0, 4.2]	6,521,586	14.5
Marital status^b
Married	564	59.1	[55.9, 62.2]
Divorced, widowed, single	391	40.9	[37.8, 44.1]
Education
High school or less	194	20.3	[17.8, 22.9]
Some college	287	30.1	[27.1, 33.0]
College degree or more	474	49.6	[46.5, 52.8]
Household income
<35,000	346	36.2	[33.2, 39.3]
35,001–75,000	356	37.3	[34.2, 40.3]
>75,000	253	26.5	[23.7, 29.3]
Current mobility^c
Good	261	27.3	[24.5, 30.2]
Very good	694	72.7	[69.8, 75.5]
Thinking about mobility^d
Not at all or rarely	523	54.8	[51.6, 57.9]
Occasionally	192	20.1	[17.6, 22.7]
Moderate to very much	240	25.1	[22.4, 27.9]
Thinking about protecting mobility^e
Not at all or rarely	507	53.1	[49.9, 56.3]
Occasionally	198	20.7	[18.2, 23.3]
Moderate to very much	250	26.2	[23.4, 29.0]
Confidence in protecting mobility^f
Not at all or rarely	186	19.5	[17.0, 22.0]
Occasionally	242	25.3	[22.6, 28.1]
Moderate to very much	527	55.2	[52.0, 58.3]
Motivated to protect mobility^g
Not at all or rarely	72	7.5	[5.9, 9.2]
Occasionally	152	15.9	[13.6, 18.2]
Moderate to very much	731	76.5	[73.9, 79.2]

Other includes Asian, Pacific Islanders/Hawaiian Natives, American Indian/Alaskan Native, and Hispanic. ^bMissing cells were not available by the 60- to 74-year age group in the U.S. Census. ^cOnly respondents with good or very good current mobility were included in this study. ^d“How much have you been recently thinking about your ability to get around in your home and community as you age?” ^e“How much have you been recently thinking about protecting your ability to get around your home and community as you age?” ^f“How confident do you feel that you know what to do to protect your mobility as you age?” ^g“How motivated are you to protect your ability to get around your home and community as you age?”

Thinking Moderately to Very Much About Mobility

At baseline, a quarter (25.1%) of respondents reported thinking moderately to very much about their mobility (Table 3). A higher proportion of women reported thinking (28.5%) compared with men (21.1%) (p = .009). A lower proportion of those with household incomes between US$35,001 and 75,000 (22.5%) compared with those with incomes <US$35,000 (29.2%) (p = .042), and those with very good current mobility (18.9%) compared with those with good current mobility (41.8%) (p < .001) reported thinking about their mobility.

Table 3.

Proportion of Older Adults Aged 60–74 Years Who Answered “Moderately to Very Much” to Mobility Questions at Baseline and Follow-Up by Selected Characteristics, 2014.^a

Characteristic	Thinking^c				Thinking about protecting^d				Confident^e				Motivated^f
	Baseline		Follow-up		Baseline		Follow-up		Baseline		Follow-up		Baseline		Follow-up
	%	p value	%	p value	%	p value	%	p value	%	p value	%	p value	%	p value	%	p value
Sex
Male	21.1	—	44.9	—	21.5	—	57.2	—	56.5	—	80.8	—	74.8	—	71.1	—
Female	28.5	.009	54.9	.002	30.0	.003	72.1	<.001	54.1	.463	86.2	.023	78.0	.239	81.5	<.001
Race
White (Ref)	24.0	—	48.4	—	24.7	—	63.3	—	54.2	—	82.8	—	75.3	—	75.9	—
Black	33.3	.098	76.2	<.001	44.4	<.001	92.1	<.001	69.8	.016	92.1	.077	92.1	.008	90.5	.008
Other	40.0	.046	53.3	.593	30.0	.51	66.7	.71	53.3	.927	93.3	.21	80.0	.556	73.3	.75
Marital status
Married	24.8	—	50.5	—	26.1	—	65.3	—	56.4	—	86.0	—	77.5	—	75.4	—
Single/divorced/widowed	25.6	.792	50.1	.902	26.3	.923	65.5	.943	53.5	.371	80.6	.025	75.2	.411	78.8	.219
Education
High school or less (Ref)	28.9	—	60.3	—	28.9	—	69.6	—	52.6	—	87.6	—	73.2	—	78.9	—
Some college	25.8	.455	55.1	.253	28.9	.99	71.1	.725	55.8	.493	87.1	.866	73.5	.937	79.4	.879
4-year degree or higher	23.2	.124	43.5	<.001	23.4	.14	60.1	.022	55.9	.432	80.2	.022	79.8	.064	74.3	.209
Income
<US$35,000 (Ref)	29.2	—	56.9	—	31.2	—	68.8	—	55.5	—	82.1	—	72.5	—	79.8	—
US$35,001–US$75,000	22.5	.042	48.0	.018	23.0	.015	65.7	.389	55.3	.967	85.7	.195	75.8	.318	76.4	.282
>US$75,000	23.3	.109	44.7	.003	23.7	.044	60.1	.027	54.6	.818	83.4	.674	83.0	.003	73.1	.056
Current mobility^b
Good	41.8	—	64.4	—	41.0	—	71.3	—	49.4	—	77.4	—	75.9	—	79.7	—
Very good	18.9	<.001	45.1	<.001	20.6	<.001	63.1	.018	57.4	.028	86.2	.001	76.8	.76	75.7	.187
Total	25.1		50.4		26.2		65.3		55.2		83.8		76.5		76.8

Respondents who reported a score of 4–5 (moderately to very much) for thinking about their future mobility or protecting future mobility are described as reporting “thinking” or “thinking about protecting.” Similarly, those reporting a score of 4–5 (moderately to very much) for confidence in or motivation to protect their mobility are described as being “confident” or “motivated.” ^bOnly respondents with good or very good current mobility were included in this study. ^c“How much have you been recently thinking about your ability to get around in your home and community as you age?” ^d“How much have you been recently thinking about protecting your ability to get around your home and community as you age?” ^e“How confident do you feel that you know what to do to protect your mobility as you age?” ^f“How motivated are you to protect your ability to get around your home and community as you age?”

At follow-up, after receiving the mobility assessment materials, the percent of respondents who reported thinking about their mobility doubled to 50.4% (Table 3). Significant differences in thinking about mobility remained by gender (p = .002), household income (p = .018), and current mobility (p < .001). In addition, a lower proportion of those with an income >US$75,000 reported thinking (44.7%) compared with those with an income <US$35,000 (56.9%) (p = .003), those with a 4-year degree or higher (43.5%) compared with those with a high school education or less (60.3%) (p < .001), and Black older adults (76.2%) compared with White older adults (48.4%) (p < .001).

All groups, with the exception of other race, had significant increases in thinking about mobility ranging from 20.3% points to 42.9% points after receiving the mobility materials (Table 4). Larger increases were reported among Black respondents (42.9% points) when compared with White respondents (24.4% points) (p = .014) and those with less than high school education (31.4% points) compared with those with at least a 4-year degree (20.3% points) (p = .022; data not shown).

Table 4.

Percentage Point Difference From Baseline to Follow-Up in Proportion of Older Adults Aged 60–74 Years Who Answered “Moderately to Very Much” to Mobility Questions by Selected Characteristics, 2014.

Characteristic	Thinking^a		Thinking about Protecting^b		Confident^c		Motivated^d
Characteristic	Percentage point difference	95% CI	Percentage point difference	95% CI	Percentage point difference	95% CI	Percentage point difference	95% CI
Sex
Male	23.9	[18.6, 29.1]	35.7	[30.5, 40.8]	24.3	[18.9, 29.7]	−3.7	[−9.0, 1.5]
Female	26.4	[21.5, 31.3]	42.1	[37.3, 46.9]	32.1	[27.5, 36.7]	3.4	[−1.1, 8.0]
Race
White (Ref)	24.4	[20.6, 28.1]	38.6	[34.9, 42.2]	28.7	[24.9, 32.4]	0.6	[−3.1, 4.2]
Black	42.9	[28.5, 54.6]	47.6	[33.0, 59.4]	22.2	[11.1, 32.0]	−1.6	[−12.0, 8.9]
Other	13.3	[−10.8, 35.8]	36.7	[14.8, 54.0]	40.0	[17.7, 57.3]	−6.7	[−26.4, 13.9]
Marital status
Married	25.7	[21.0, 30.4]	39.2	[34.8, 43.6]	29.6	[25.1, 34.1]	−2.1	[−6.5, 2.2]
Single/divorced/widowed	24.6	[18.9, 30.2]	39.1	[33.4, 44.8]	27.1	[21.4, 32.8]	3.6	[−1.9, 9.1]
Education
High school or less (Ref)	31.4	[23.3, 38.9]	40.7	[33.4, 48.1]	35.1	[27.5, 41.9]	5.7	[−1.4, 12.7]
Some college	29.3	[22.6, 35.9]	42.2	[35.5, 48.2]	31.4	[25.0, 37.3]	5.9	[−0.5, 12.3]
4-year degree or higher	20.3	[15.2, 25.3]	36.7	[31.6, 41.8]	24.3	[19.0, 29.5]	−5.5	[−10.4, −0.6]
Income
<US$35,000 (Ref)	27.8	[21.8, 33.7]	37.6	[31.6, 43.6]	26.6	[20.7, 32.5]	7.2	[1.4, 13.1]
US$35,001–$75,000	25.6	[19.5, 31.6]	42.7	[37.0, 47.9]	30.3	[24.6, 36.1]	0.6	[−4.7, 5.8]
>US$75,000	21.3	[14.7, 28.0]	36.4	[29.4, 43.3]	28.9	[22.0, 35.7]	−9.9	[−16.7, −3.1]
Current mobility^e
Good	22.6	[15.3, 29.9]	30.3	[23.5, 37.0]	28.0	[20.8, 35.1]	3.8	[−2.8, 10.4]
Very good	26.2	[22.1, 30.4]	42.5	[38.4, 46.6]	28.8	[24.8, 32.9]	−1.1	[−5.2, 2.9]
Total	25.2	[21.6, 28.8]	39.2	[35.7, 42.7]	28.6	[25.1, 32.1]	0.2	[−3.2, 3.6]

“How much have you been recently thinking about your ability to get around in your home and community as you age?” ^b“How much have you been recently thinking about protecting your ability to get around your home and community as you age?” ^c“How confident do you feel that you know what to do to protect your mobility as you age?” ^d“How motivated are you to protect your ability to get around your home and community as you age?” ^eOnly respondents with good or very good current mobility were included in this study.

Thinking Moderately to Very Much About Protecting Mobility

About a quarter (26.2%) reported thinking about protecting their mobility at baseline (Table 3). A higher proportion of females (30.0%) compared with males (21.5%) (p < .001), and Black respondents (44.4%) compared with White respondents (24.7%) (p < .001) reported thinking about protecting their mobility. A lower proportion of those with household incomes of US$35,001–US$75,000 (23.0%) and >US$75,000 (23.7%) when compared with <US$35,000 (31.2%) (p = .015 and .044, respectively) and those with very good current mobility (20.6%) compared with those reporting good current mobility (41.0%) (p < .001) reported thinking about protecting their mobility (Table 3).

At follow-up, the percentage who reported thinking about protecting their mobility increased to 65.3% (Table 3). The groups that differed at baseline were the same at follow-up with the exception of those with an income of US$35,001–US$75,000 who no longer differed from those with an income <$35,000. In addition, at follow-up, a lower proportion of those with a 4-year degree or higher education (60.1%) compared with high school or less education (69.6%) (p = .022) reported thinking about protecting their mobility.

All groups had significant increases in thinking about protecting their mobility after receiving the mobility assessment materials ranging from 30.3% points to 47.6% points (Table 4). A larger increase was reported among those with very good current mobility (42.5% points) when compared with good current mobility (30.3% points) for protecting their mobility (p = .002; data not shown).

Confident Moderately to Very Much in Protecting Mobility

At baseline, 55.2% of respondents were confident in knowing how to protect their mobility as they aged (Table 3). A higher proportion of Black respondents (69.8%) compared with White respondents (54.2%) (p = .016), and those with very good current mobility (57.4%) compared with those with good current mobility (49.4%) (p = .028) reported being confident (Table 3).

At follow-up, the percentage who were confident in protecting their mobility increased to 83.8% (Table 3). A higher proportion of females (86.2%) compared with males (80.8%) (p = .023), and those with very good current mobility (86.2%) compared with those with good current mobility (77.4%) (p = .001) reported being confident (Table 3). A lower proportion of those who are single (80.6%) compared with married (86.0%) (p = .025), and those with a 4-year degree or higher education (80.2%) compared with high school or less education (87.6%) (p = .022) reported being confident.

All groups had significant increases ranging from 22.2% points to 40.0% points in being confident in protecting their mobility (Table 4). A larger increase was reported among females (32.1% points) when compared with males (24.3% points) confidence in protecting mobility (p = .032); while the increase among those with a 4-year degree or higher education (24.3% points) was less than that of those with high school or less education (35.1% points) for confidence in protecting mobility (p = .021; data not shown).

Motivated Moderately to Very Much to Protect Mobility

At baseline, 76.5% of respondents were motivated to protect their mobility (Table 3). A higher proportion of Black respondents (92.1%) compared with White respondents (75.3%) (p = .008) and those with household incomes >US$75,000 (83.0%) compared with <US$35,000 (72.5%) (p = .003) reported being motivated (Table 3).

At follow-up, 76.8% of respondents were motivated, which was not a significant increase from baseline (Table 4). A higher proportion of females (81.5%) compared with males (71.1%) (p < .001), and Black respondents (90.5%) compared with White respondents (75.9%) (p = .008) reported being motivated (Table 3).

Those with income <US$35,000 were the only group to have a significant increase in motivation (7.2% points) from baseline to follow-up (Table 4). Those with an income of >US$75,000 decreased 9.9% points and those with a four year degree or higher education decreased 5.5% points in motivation.

Challenges to Mobility

About 89% of respondents reported thinking about how their mobility might change with age. The most commonly reported theme was driving which was reported by 42% of those who were thinking about mobility changes (Figure 1). Respondents expressed concern about many facets of driving including ability to drive, fear of injuring someone, and cost as shown in these sample quotes:

. . . ability to see clearly, to move easily and to respond to the changes of the environment. If you are driving down the road . . . and your responses are not fast enough, then you could hurt someone.

. . . if my car stays running. I have an older car and can’t afford a new one. I hope it stays running.

. . . in the winter, there is a great deal of snow. I might have trouble getting around.

That would be if I can still drive. Since we live in a semi-rural area, if you do not [know] how to drive, then you cannot get anywhere.

Ability (25%) was the second most commonly mentioned theme as exemplified by “decreasing mobility and energy levels, less motivation to go out and do things.” Alternative transportation was the third most mentioned theme (18%) and some discussed it in connection with driving:

That would be the type of transportation. Am I going to drive? Do I have to call a cab or take a bus? Do I have a family member to take me and can my spouse pick me up?

Others mentioned alternative transportation without connecting it to driving:

Availability of buses and the money to pay for the rides. Or someone to take me there.

Figure 1.

Percentage of adults aged 60–74 years in good to excellent health without mobility problems who reported a challenge when asked “What is the first thing that comes to mind when you think about challenges you might face in getting to the places you need to go, as you get older?,” (n = 846), 2014.

Discussion

This study found that three fourths of older adults were motivated to protect their ability to get around their home and community as they aged, at baseline and did not change after participants saw the mobility assessment materials. This high motivation was expected as older adults think of mobility as integral to health and independence (Goins et al., 2015; King et al., 2011; Oxley & Charlton, 2009). Although older adults were motivated to protect their mobility, only one quarter were initially thinking about how their mobility might change as they age or how they could protect it.

Similarly, other research found few older adults report planning for their future mobility (King et al., 2011). Harmon et al. (2018) found that older drivers wait until they are about to stop driving before they start preparing for these changes. This, in part, might be a result of older adults reporting the inevitability of declining mobility or that mobility issues were not a current concern but might become a problem later in life (King et al., 2011). Older adults might be reluctant to think about driving cessation because of the possibility of negative outcomes and a lack of good alternatives for getting around (King et al., 2011; Peel et al., 2002). Older adults’ children or other caretakers might also not want to discuss this issue due to the increased burden of providing transportation once the older adult stops driving (Peel et al., 2002). Planning, even short-term, can result in better outcomes with former drivers who made a decision to stop driving reporting more satisfaction with their mobility compared with those who stopped driving due to others’ decisions (Oxley & Charlton, 2009). As many older adults will outlive their ability to drive safely (Foley et al., 2002), this failure to think about their mobility and how to protect it could result in a lack of preparation for mobility changes that decreases their quality of life as they age (Chihuri et al., 2016; Oxley & Charlton, 2009).

This study’s findings varied by demographics with women and those with a lower health status being more likely to report both thinking about their mobility and protecting it and Black respondents and those with a lower income being more likely to report protecting their mobility. Women and Blacks may have fewer resources for mobility-enhancing interventions (e.g., alternative transportation, home modification) as they age so they may be more concerned about future mobility (Oxley & Whelan, 2008; Thorpe et al., 2011). Women and Blacks are at a higher risk for mobility limitations (Thorpe et al., 2011; Vasquez et al., 2020). Non-Hispanic Blacks were the most likely to report mobility limitations compared with non-Hispanic Whites in an analysis of Medical Expenditure Panel for adults aged 60 years and above (Vasquez et al., 2020). Another study among adults ages 70–79 years found Black women (53%) compared with White (40%), and Black men (33%) compared with White (26%) were more likely to develop mobility limitations over 5 years (Thorpe et al., 2011). After controlling for health conditions and socioeconomic factors, the differences by race were no longer significant for women or men, and decreasing levels of education were associated with increasing odds of onset of mobility limitations. Demographic groups at higher risk of developing mobility limitations as they age may be more likely to be thinking about mobility as the current study found.

Also consistent with this study’s finding, Harmon et al. found that Black individuals and those in poorer health were more likely to plan for future transportation needs (Harmon et al., 2018). Former drivers are more likely to be female, and non-White (Choi et al., 2013; Dellinger et al., 2001). Men are less likely than women to think that there will be a time when they need to stop driving (Choi et al., 2013; D’Ambrosio et al., 2008; Dellinger et al., 2001). Demographic groups who are more likely to be future nondrivers are possibly more likely to be concerned about their future mobility. While these groups in this study were more likely to think about their mobility changes with age and think about protecting it compared with other groups, the percentages engaging in these planning activities were low (ranged from 29% to 44% at baseline).

Driving was the most common potential mobility challenge mentioned by the older adults in this study. Older adults associate being able to drive with freedom, independence, a higher quality of life, and see driving cessation as a loss of an important part of their lives (D’Ambrosio et al., 2008; King et al., 2011; Oxley & Charlton, 2009). Driving cessation has been associated with reductions in both productive (paid and volunteer) work and social interactions, and increases in depression, mortality and entry into long-term care (Chihuri et al., 2016; Curl et al., 2014; Edwards et al., 2009; Freeman et al., 2006; Marottoli et al., 2000; Mezuk & Rebok, 2008; O’Connor et al., 2013). Although driving was the most commonly reported mobility challenge in the current study less than half (42%) of respondents named it as a concern. Naumann et al. (2014) found that the majority of older adults believe they will continue driving for many years to come—with more than half of older drivers reporting that they will stop driving in their 90s and 11% reporting they will never stop. The Federal Highway Administration (FHWA) reports 88% of adults aged 60 years and above (more than 62 million people) had driver’s licenses in 2017 (FHWA, 2018). Kostyniuk and Shope (2003) found that two thirds of older adults had not thought about or had only thought a little about how they would get around if they could no longer drive. In the current study, 11% of respondents had not given any thought to future mobility concerns. These respondents might have not considered there will ever come a time when they will still need to get around but are no longer able to drive.

Mobility assessment materials can increase older adults’ mobility planning attitudes. Significant increases from baseline to follow-up in overall thinking (25% increase), protecting (39% increase), and confidence (29% increase) in protecting mobility were reported across all groups. The mobility materials used in this study gave older adults actionable steps they could use to address age-related factors that reduce mobility including reduced muscle strength and balance, increased chronic conditions, medication use, and home hazards potentially explaining the increase in confidence. Motivation to protect mobility did not increase possibly because 77% of respondents reported being highly (4–5 out of 5-point scale) motivated at baseline, leaving less room for improvement. Future research is needed to better understand the decrease in motivation among some groups from baseline to follow-up (household income of >US$75,000 and 4-year degree or higher education), as well as ways to better target interventions to different groups of older adults.

Changing older adults’ mobility planning attitudes is an important first step toward improving mobility outcomes as Harmon found that older adults believed they would have a better future if they planned for mobility changes (Harmon et al., 2018). While there has been little research on effective programs or interventions to help older adults plan for mobility changes, Molnar et al. (2007) identified some key components for promising approaches regarding driving cessation. These components include developing a program for older adults that is based on research about life transitions; that involves early intervention and planning; that recognizes the transition process as an individualized process; that identifies alternative transportation options; and that includes involvement from a broad network of family members and professionals (Molnar et al., 2007). Oxley and Whelan recommended education for older adults to help maintain their driving ability including: screening to identify driving problems, methods of compensating for these problems, and managing medical conditions that may affect driving (Oxley & Whelan, 2008). Helping older adults plan for changes in mobility as they age will prolong their future safe mobility and protect their independence.

This study has limitations. First, the baseline response rate was 35% (including those who were ineligible and those who refused or did not want to participate) possibly due to the increased use of caller id and call blocking (Tourangeau, 2004). Second, the study sample was less racially and ethnically diverse than the general U.S. population. Therefore, results might not be representative of the U.S. population of adults aged 60–74 years. Third, the analysis presented here is descriptive; differences in mobility planning behaviors from baseline to follow-up may be confounded by demographic or other underlying conditions that were not controlled for statistically. Finally, long term sustainability of changes are not clear as follow-up occurred 1–2 weeks after baseline.

The older adult population is rapidly increasing and expected to make up one fifth of the U.S. population by 2030. With this increase will come an increase in mobility issues associated with aging including increased injuries and reduced independence. This study showed that even brief mobility assessment materials can encourage older adults to start thinking about how their mobility might change as they age. Given the increasing number of older adults, and the importance of mobility to quality of life, innovative interventions that can be tailored to an individual’s needs and values are needed to facilitate mobility planning to prolong independence for older adults (King et al., 2011). Many older adults plan for their financial, legal, health and housing needs in old age; including mobility in this planning can help them optimize and prepare for potential transitions due to change in mobility with aging (Silverstein, 2008).

Supplemental Material

Suplemental_File_-_Assessment_Materials – Supplemental material for Older Adults’ Attitudes About Future Mobility Changes and the Usefulness of Mobility Assessment Materials

Supplemental material, Suplemental_File_-_Assessment_Materials for Older Adults’ Attitudes About Future Mobility Changes and the Usefulness of Mobility Assessment Materials by Bethany A. West, Gwen Bergen and Briana Moreland in Journal of Applied Gerontology

Footnotes

Acknowledgements

We thank Dr. Moshe Engelberg and Teresa Sanchez of Research Works, Inc. for their work on development and initial testing of the mobility assessment materials and Dr. Scott Kegler at the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control for his guidance on the statistical analyses presented in this paper.

Authors’ Note

This study was approved by the San Diego State University IRB (SDSU IRB) with IRB Number 1397090. SDSU IRB is part of San Diego State University’s Human Research Protection Program (HRPP) under the jurisdiction of the Division of Research Affairs. SDSU IRB approved verbal consent. Verbal consent was documented by telephone interviewer in data collection spreadsheet.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Authors’ Contribution

All authors made substantial contributions to the article to merit authorship.

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Bethany A. West

Gwen Bergen

Briana Moreland

Supplemental Material

Supplemental material for this article is available online.

References

Agresti

Min

(2005). Simple improved confidence intervals for comparing matched proportions. Statistics in Medicine, 24(5), 729–740.

Ambrose

A. F.

Paul

Hausdorff

J. M.

(2013). Risk factors for falls among older adults: A review of the literature. Maturitas, 75(1), 51–61.

Auais

Alvarado

Guerra

Curcio

Freeman

E. E.

Ylli

Guralnik

Deshpande

(2017). Fear of falling and its association with life-space mobility of older adults: A cross-sectional analysis using data from five international sites. Age and Ageing, 46(3), 459–465.

Centers for Disease Control and Prevention. (2019.). WISQARS (Web-based Injury Statistics Query and Reporting System). US Department of Health and Human Services, CDC. https://www.cdc.gov/injury/wisqars/index.html

Chihuri

Mielenz

T. J.

DiMaggio

C. J.

Betz

M. E.

DiGuiseppi

Jones

V. C.

(2016). Driving cessation and health outcomes in older adults. Journal of the American Geriatrics Society, 64(2), 332–341.

Choi

Mezuk

Lohman

M. C.

Edwards

J. D.

Rebok

G. W.

(2013). Gender and racial disparities in driving cessation among older adults. Journal of Aging and Health, 25(Suppl. 8), 147S–162S.

Collia

D. V.

Sharp

Giesbrecht

(2003). The 2001 National Household Travel Survey: A look into the travel patterns of older Americans. Journal of Safety Research, 34(4), 461–470.

Curl

A. L.

Stowe

J. D.

Cooney

T. M.

Proulx

C. M.

(2014). Giving up the keys: How driving cessation affects engagement in later life. The Gerontologist, 54(3), 423–433.

D’Ambrosio

L. A.

Donorfio

L. K.

Coughlin

J. F.

Mohyde

Meyer

(2008). Gender differences in self-regulation patterns and attitudes toward driving among older adults. Journal of Women & Aging, 20(3–4), 265–282.

10.

Dellinger

A. M.

Sehgal

Sleet

D. A.

Barrett-Connor

(2001). Driving cessation: What older former drivers tell us. Journal of the American Geriatrics Society, 49(4), 431–435.

11.

Dickerson

A. E.

Molnar

L. J.

Bedard

Eby

D. W.

Berg-Weger

Choi

Grigg

Horowitz

Meuser

Myers

O’Connor

Silverstein

N. M.

(2019). Transportation and aging: An updated research agenda to advance safe mobility among older adults transitioning from driving to non-driving. Gerontologist, 59(2), 215–221.

12.

Edwards

J. D.

Lunsman

Perkins

Rebok

G. W.

Roth

D. L.

(2009). Driving cessation and health trajectories in older adults. Journal of Gertontology: Biological Sciences and Medical Sciences, 64A(12), 1290–1125.

13.

Federal Highway Administration. (2018). Highway statistics 2017: Distribution of licensed drivers–2017. https://www.fhwa.dot.gov/policyinformation/statistics/2017/dl20.cfm

14.

Foley

D. J.

Heimovitz

H. K.

Guralnik

J. M.

Brock

D. B.

(2002). Driving life expectancy of persons aged 70 years and older in the United States. American Journal of Public Health, 92(8), 1284–1289.

15.

Freeman

E. E.

Gange

S. J.

Munoz

West

S. K.

(2006). Driving status and risk of entry into long-term care in older adults. American Journal of Public Health, 96(7), 1254–1259.

16.

Gillespie

L. D.

Robertson

M. C.

Gillespie

W. J.

Sherrington

Gates

Clemson

L. M.

Lamb

S. E.

(2012). Interventions for preventing falls in older people living in the community. Cochrane Database Systematic Reviews, (9), Article CD007146.

17.

Goins

R. T.

Jones

Schure

Rosenberg

D. E.

Phelan

E. A.

Dodson

Jones

D. L.

(2015). Older adults’ perceptions of mobility: A metasynthesis of qualitative studies. The Gerontologist, 55(6), 929–942.

18.

Harmon

A. C.

Babulal

G. M.

Vivoda

J. M.

Zikmund-Fisher

B. J.

Carr

D. B.

(2018). Planning for a nondriving future: Behaviors and beliefs among middle-aged and older drivers. Geriatrics, 3(19), 1–13.

19.

King

M. D.

Meuser

T. M.

Berg-Weger

Chibnall

J. T.

Harmon

A. C.

Yakimo

(2011). Decoding the Miss Daisy Syndrome: An examination of subjective responses to mobility change. Journal of Gerontological Social Work, 54(1), 29–52.

20.

Kostyniuk

L. P.

Shope

J. T.

(2003). Driving and alternatives: Older drivers in Michigan. Journal of Safety Research, 34(4), 407–414.

21.

Marottoli

R. A.

de Leon

C. F. M.

Glass

T. A.

Williams

C. S.

Cooney

L. M.

Jr. Berkman

L. F.

(2000). Consequences of driving cessation: Decreased out-of-home activity levels. Journal of Gerontology: Social Sciences, 55B(6), S334–S340.

22.

Mezuk

Rebok

G. W.

(2008). Social integration and social support among older adults following driving cessation. Journal of Gerontology: Social Sciences, 63B(5), S298–S303.

23.

Molnar

L. J.

Eby

D. W.

St Louis

R. M.

Neumeyer

A. L.

(2007). Promising approaches for promoting lifelong community mobility. AARP.

24.

Naumann

R. B.

West

B. A.

Sauber-Schatz

E. K.

(2014). At what age do you think you will stop driving? Views of older U.S. adults. Journal of the American Geriatrics Society, 62(10), 1999–2001.

25.

O’Connor

M. L.

Edwards

J. D.

Waters

M. P.

Hudak

E. M.

Valdes

E. G.

(2013). Mediators of the association between driving cessation and mortality among older adults. Journal of Aging and Health, 25(8S), 249S–269S.

26.

Oxley

J. A.

Charlton

J. L.

(2009). Attitudes to and mobility impacts of driving cessation: Differences between current and former drivers. Topics in Geriatric Rehabilitation, 25(1), 43–54.

27.

Oxley

J. A.

Whelan

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

28.

Peel

Westmoreland

Steinberg

(2002). Transport safety for older people: A study of their experiences, perceptions, and management needs. Injury Control and Safety Promotion, 9(1), 19–24.

29.

Satariano

W. A.

Guralnik

J. M.

Jackson

R. J.

Marottoli

R. A.

Phelan

E. A.

Prohaska

T. R.

(2012). Mobility and aging: New directions for public health action. American Journal of Public Health, 102(8), 1508–1515.

30.

Scheffer

A. C.

Schuurmans

M. J.

van Dijk

van der Hooft

de Rooij

S. E.

(2008). Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing, 37(1), 19–24.

31.

Silverstein

N. M.

(2008). When life exceeds safe driving expectancy: Implications for gerontology and geriatrics education. Gerontology & Geriatrics Education, 29(4), 305–309.

32.

Thorpe

R. J.

Koster

Kritchevsky

S. B.

Newman

A. B.

Harris

Ayonayon

H. N.

Perry

Rooks

R. N.

Simonsick

E. M.

(2011). Race, socioeconomic resources, and late-life mobility and decline: Findings from the health, aging, and body composition study. Journal of Gerontology: Medical Sciences, 66A(10), 1114–1123.

33.

Tourangeau

(2004). Survey research and societal change. Annual Review of Psychology, 55, 775–801.

34.

Vasquez

Germain

C. M.

Tang

Lohman

M. C.

Fortuna

K. L.

Batsis

J. A.

(2020). The role of ethnic and racial disparities in mobility and physical function in older adults. Journal of Applied Gerontology, 39(5), 502–508.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.76 MB