摘要：Objectives. Given the importance of driving in American society, older non-drivers may be unable to meet basic needs while living independently. We assessed whether not driving is an independent risk factor for entering long-term care (LTC) institutions. Methods. Data were used from 1593 older adults who participated in the Salisbury Eye Evaluation cohort study and completed an additional telephone survey. Questions on driving status and LTC entry were obtained by self/proxy report. Cox time-dependent regression procedures were used to adjust for demographic and health factors. Results. Former and never drivers had higher hazards of LTC entry after adjustment for demographic and health variables (hazard ratio [HR]=4.85; 95% confidence interval [CI]=3.26, 7.21; and HR=3.53; 95% CI=1.89, 6.58, respectively). Also, having no other drivers in the house was an independent risk factor for LTC entry (HR=1.72; 95% CI=1.15, 2.57). Discussion. Older adults are expected to make good decisions about when to stop driving, but the hardships imposed on older adults by not driving are not widely recognized. Innovative strategies to improve transportation options for older adults should be considered. Many older adults are faced with the difficult decision of when they should no longer drive a car after experiencing functional decline. A large percentage of adults continue to drive well past the age of 70 years. In 1 study, 82% of men and 55% of women aged 70 years and older who lived in the community still drove. 1 Given this great dependence on the car for mobility, it is important to understand what happens to older people who find it necessary to give up driving or who have relied all of their lives on someone else who is no longer able to drive. Ideally, the public transportation system, including buses, railways, and shuttles, could provide an alternative to driving for older adults. However, an estimated 40% of older adults in rural areas have no access to public transportation services and another 25% have negligible access. 2 Two national studies estimate that older people use public transportation for only 2% to 3% of their trips. 3 , 4 Many elderly people instead rely on informal transportation support from friends and family 5 but at the same time may feel concerned about being a burden to others and thus, limit their activities. Certain subgroups of older adults may be more susceptible to transportation problems after giving up driving. For example, one study of older people with dementia who had recently given up driving found that those who were unmarried or with no other licensed drivers in the household were more likely to report transportation problems. 5 Other populations who may be more susceptible to problems are those in rural areas, where there may be little or no public transportation. Some older adults may have no other choice but to enter long-term care (LTC) institutions because of transportation problems, despite being otherwise able to function independently inside the home. Entry into LTC is extremely expensive, as the average annual cost for nursing home admission is now $69 000 and the average annual cost of assisted living entry is $30 000. 6 Some studies have examined the consequences of driving cessation and have found them to include increased levels of depression 7 , 8 and decreased out-of-home activity levels. 9 Whether driving status increases a person’s risk of LTC entry is unknown, although such factors as “needing aid to get around” 10 and “getting out” less than daily, 11 which may include not driving, have been associated with nursing home entry in previous studies. The purpose of this study was to assess whether not driving was an independent risk factor for entering LTC in a small city on the eastern shore of Maryland. To accomplish this aim, we utilized data from the Salisbury Eye Evaluation (SEE) project, a prospective population-based cohort study collecting data over 8 years. 12
