Walking, public transit, and transitions to non-driving among US Medicare enrollees

Background

Many older adults rely on private vehicles for their mobility and may continue to drive when they are advised to stop. Walking and public transit can fulfill mobility needs in some contexts, but in the U.S. these options may not adequately substitute for driving when older adults reduce or stop driving. We examined whether baseline walking or taking public transit was associated with reductions in older adults’ driving after a three-year period in the United States.

Methods

We analyzed National Health and Aging Trends Study data from community-dwelling older drivers in 2015 (n = 4574). We used weighted logistic regression to estimate associations between older drivers’ walking and use of public transit in 2015 and changes in their driving behavior three years later—avoiding more driving conditions, driving less often, or not driving at all. We also examined associations between neighborhood walkability and driving behavior change three years later.

Results

There were no statistically significant associations between walking or taking public transit in 2015 and the adjusted odds of driving behavior change three years later. However, older drivers living in the most walkable neighborhoods in 2015 had greater adjusted odds of avoiding more driving conditions compared to those in the least walkable neighborhoods (adjusted Odds Ratio (aOR) = 1.66; 95 % Confidence Interval (95 % CI): 1.23-2.25). Living in the most walkable neighborhoods compared to the least walkable neighborhoods was also associated with an increased odds of no longer driving in 2018 (aOR = 1.56; 95 % CI: 1.04–2.36).

Discussion

The walkability of one's neighborhood area—shorter distances between blocks, diverse land uses, and proximity to transit stops—is associated with driving behavior changes over time for older drivers. This work can inform programs and policies designed to connect older adults with alternative transportation options to driving.