On the Road—Older Adult Drivers

The number of older Americans is expected to double over the next 25 years. All but the most fortunate seniors will confront an array of medical and other constraints on their mobility even as they continue to seek an active community life.
—Sandra Rosenbloom, The Mobility Needs of Older Americans: Implications for Transportation Reauthorization, July 2003

Readily available transportation is a vital factor in the quality of life of older adults. Transportation is essential for accessing health care, establishing and maintaining social and family relationships, obtaining food and other necessities, and preserving independence and self-esteem.

The ability to drive often determines whether an older adult is able to live independently. Driving is the primary mode of transportation in the United States, and personal vehicles remain the transportation mode of choice for almost all Americans, including older people. Surveys conducted by the AARP repeatedly confirm that people over the age of sixty-five make nearly all their trips in private vehicles, either as drivers or passengers. Even in urban areas where public transit is readily available, private vehicles are still used by most older people, with nondrivers relying heavily on family members or friends for transport. Figure 6.1 shows that 67% of adult nondrivers aged seventy-five and older rely on rides from family or friends, and the remaining 33% use public transportation, walk, or ride in senior vans or taxicabs.

According to the National Highway Traffic Safety Administration, in Traffic Safety Facts: Older Population (January 30, 2007, http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/TSF2005/810622.pdf), the number of drivers aged sixty-five and older increased by 17% from 1994 to 2004 to more than twenty-eight million. During this same period the total number of licensed drivers grew by just 13%. Federal Highway Administration data reveal that in 2005 the percentage of older drivers was comparable for men and women aged sixty-five to seventy-four, but from age seventy to eighty-four somewhat more women than men were licensed drivers, then the figures were roughly equal again for drivers aged eighty-five and older. (See Table 6.1.) Joanna Lyn Grama notes in "Driving and the Older Adult" (GP Solo Law Trends & News, May 2005) that as the huge cohort (a group of individuals that shares a common characteristic such as birth years and is studied over time) of baby boomers (people born between 1946 and 1964) joins the ranks of older adults, the number of drivers aged sixty-five and older will continue to grow, exceeding forty million by 2020.

Even though many older adults drive and many more are expected to in the future, driving is not a viable alternative for a significant number of older people. According to Linda Bailey of the Surface Transportation Policy Project, in Aging Americans: Stranded without Options (April 2004, http://www.transact.org/library/reports_html/seniors/aging.pdf), 21% of adults aged sixty-five and older do not drive. Many older adults choose to stop or limit their driving for health or safety reasons.

Limited income also restricts many older adults' use of automobiles. According to the U.S. Bureau of Labor Statistics, car ownership costs are the second-largest household expense in the United States, and the average household spends nearly as much to own and operate a car as it does on food and health care combined. Table 6.2 shows that the average costs associated with car ownership rose from $7,801 in 2004 to $8,344 in 2005, a 7% increase, largely in response to increased spending on gas and motor oil. The cost of owning and operating an automobile, especially during periods of rising fuel prices, may be prohibitive for older adults living on fixed incomes. As a result, an ever-increasing proportion of the older population depends on alternative forms of transport in those areas where such transport is available; however, some older adults remain isolated and immobilized by the absence of accessible, affordable transportation in their communities. According to the U.S. Government Accountability Office (GAO) in Transportation-Disadvantaged Seniors: Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance and Information (August 2004, http://www.gao.gov/new.items/d04971.pdf), in 2004 adults aged seventy-five and older who lived in small towns (45%) and rural areas (23%) were much less likely than residents of cities (84%) and suburbs (69%) to have access to public transportation. (See Figure 6.2.)

OLDER AMERICANS' OPINIONS,
ABOUT TRANSPORTATION

According to Older American Attitudes toward Mobility and Transportation (December 12, 2005, http://www.apta.com/media/releases/documents/051206harris_interactive.pdf), a Harris Interactive survey, older Americans feel that transportation is vitally important and enables them to maintain their independence. More than three-quarters (82%) of survey respondents said they were concerned about being stranded when they are unable to drive and 42% felt that their communities had not planned sufficiently to ensure for older residents' transportation needs.

This survey confirms that 82% of respondents agreed that "public transportation is a better alternative to driving alone, particularly at night," and that 66% felt that "their community needs to provide more transportation options for older adults such as easy-access busses and senior citizen mini-van services." Even though most survey respondents (74%) said they have never used public transportation, the same proportion (73%) said that if it was available they would use it.

THE NATIONAL HOUSEHOLD TRAVEL SURVEY

The National Household Travel Survey (NHTS), which is conducted by the Bureau of Transportation Statistics, is the nation's inventory of daily and long-distance travel. The survey includes demographic characteristics of households, people, and vehicles, as well as detailed information on daily and longer-distance travel. The most recent NHTS data available, from the 2001–02 survey, were published in the Summary of Travel Trends: 2001 National Household Travel Survey (December 2004, http://nhts.ornl.gov/2001/pub/STT.pdf) by Pat S. Hsu and Timothy R. Reuscher. Hsu and Reuscher confirm that the number of miles driven per licensed driver continues to increase. Among adults aged sixty-five and older, the average number of miles driven annually increased by 48.6% from 1969 to 2001. (See Table 6.3.) During this same period the average annual mileage increased by 71.7% for older men and by 31.1% for older women.

Hsu and Reuscher note that even though adults aged sixty-five and older make the fewest daily trips of all drivers, their average number of trips per person nearly doubled—from 1.8 in 1983 to 3.4 in 2001. Among people aged sixty-five and older in 2001, men made 3.8 daily trips, whereas women made 3.1 trips. (See Table 6.4.) Even though older adults traveled the fewest miles per day of any driving age group, their average daily miles traveled more than doubled between 1983 and 2001, from 12 to 27.5 miles. (See Table 6.5.) Trips taken by women of all ages were considerably shorter than those taken by men; in 2001 women aged sixty-five and older logged an average of 23.5 miles per day, compared to older men's 32.9 miles. Older adults spent just under an hour a day in a vehicle in 2001, less than other adult age groups but more than children under age eighteen. (See Figure 6.3.)

MOTOR VEHICLE ACCIDENTS

The Insurance Institute for Highway Safety (IIHS), a nonprofit, scientific, and educational organization that is dedicated to reducing the losses from motor vehicle accidents, reports that, apart from the youngest drivers, older drivers have the highest rates of fatal crashes per mile

	Male drivers			Female drivers			Total drivers
Age	Number	Percent of total drivers	Drivers as percent of age group*	Number	Percent of total drivers	Drivers as percent of age group*	Number	Percent of total drivers	Drivers as percent of age group*
*These percentages are computed using population estimates of the Bureau of the Census. Under-16 age group is compared to 14 and 15-year-old population estimates; the other age brackets coincide with those from the Bureau of the Census.
Under 16	11,922	0.0	0.5	11,980	0.0	0.6	23,902	0.0	0.5
16	620,265	0.6	28.7	603,479	0.6	29.3	1,223,744	0.6	29.0
17	1,118,051	1.1	52.4	1,077,148	1.1	53.1	2,195,199	1.1	52.8
18	1,433,362	1.4	67.9	1,351,680	1.3	67.3	2,785,042	1.4	67.6
19	1,596,260	1.6	74.8	1,513,143	1.5	75.0	3,109,403	1.6	74.9
19 and under	4,779,860	4.8	44.3	4,557,430	4.5	44.5	9,337,290	4.7	44.4
20	1,656,734	1.7	76.9	1,594,045	1.6	78.7	3,250,779	1.6	77.8
21	1,651,658	1.6	77.6	1,613,014	1.6	81.1	3,264,672	1.6	79.3
22	1,716,841	1.7	78.8	1,680,522	1.7	83.1	3,397,363	1.7	80.9
23	1,773,406	1.8	80.9	1,745,065	1.7	85.1	3,518,471	1.8	82.9
24	1,798,788	1.8	81.7	1,777,408	1.8	84.9	3,576,196	1.8	83.3
(20–24)	8,597,427	8.6	79.2	8,410,054	8.4	82.6	17,007,481	8.5	80.8
25–29	8,851,540	8.8	86.2	8,675,911	8.7	88.6	17,527,451	8.7	87.4
30–34	9,215,964	9.2	90.8	8,987,753	9.0	90.6	18,203,717	9.1	90.7
35–39	9,819,601	9.8	93.0	9,579,226	9.6	91.8	19,398,827	9.7	92.4
40–44	10,586,308	10.6	93.1	10,484,293	10.5	91.3	21,070,601	10.5	92.2
45–49	10,478,460	10.5	94.3	10,492,639	10.5	92.2	20,971,099	10.5	93.3
50–54	9,419,933	9.4	96.2	9,490,927	9.5	93.0	18,910,860	9.4	94.6
55–59	8,230,597	8.2	97.7	8,285,708	8.3	92.8	16,516,305	8.2	95.2
60–64	6,109,471	6.1	98.5	6,154,597	6.1	90.5	12,264,068	6.1	94.3
65–69	4,575,782	4.6	96.9	4,645,819	4.6	85.9	9,221,601	4.6	91.0
70–74	3,618,004	3.6	95.0	3,754,467	3.7	79.9	7,372,471	3.7	86.6
75–79	2,893,211	2.9	92.8	3,162,551	3.2	73.6	6,055,762	3.0	81.7
80–84	1,909,682	1.9	88.3	2,211,996	2.2	63.5	4,121,678	2.1	73.0
85 and over	1,166,305	1.2	72.7	1,403,456	1.4	40.2	2,569,761	1.3	50.4
Total	100,252,145	100.0	87.2	100,296,827	100.0	83.0	200,548,972	100.0	85.1

driven. Even though older drivers tend to limit their number of miles driven as they age and they drive at the safest times—in daylight and avoiding rush-hour traffic—their rate of accidents per mile is extremely high. In Fatality Facts 2005: Older Drivers (January 2, 2007, http://www.iihs.org/research/fatality_facts/olderpeople.html), the IIHS observes that from April 2001 through March 2002 drivers aged eighty-five and older were involved in nine times the number of fatal crashes as drivers aged twenty-five to sixty-nine. The oldest and youngest drivers have the highest fatality rates on a per-mile-driven basis, but a key difference between the two age groups is that older drivers involved in crashes are less likely than younger drivers to hurt others—older drivers pose more of a danger to themselves. Drivers under the age of thirty are responsible for far more of the injuries and deaths of others than are older adult drivers.

Table 6.6 shows that in 2004 the death rate (the number of deaths per one hundred thousand people) for motor vehicle–related injuries for adults aged sixty-five and older was 20.4%, compared to 14.7% for adults aged forty-five to sixty-four. The higher fatality rates of adults aged seventy-five to eighty-four and eighty-five and older who were involved in crashes—24.5% and 26.1%, respectively—are attributable to older adults' fragility as opposed to the likelihood of being involved in an accident. Older people are more susceptible to injury, especially chest injuries, and are more likely to die as a result of those injuries. However, the IIHS indicates that relatively few deaths—less than 1%—of adults aged seventy and older are attributable to motor vehicle accidents.

The IIHS reports that in 2005, 80% of motor vehicle crash fatalities among people seventy and older involved occupants in passenger vehicles, and 15% were pedestrians. The death rate per one hundred thousand people for pedestrians aged seventy and older in 2005 was higher than for pedestrians in all younger age groups.

In 2005 about 78% of fatal crashes involving drivers eighty-five and older were multiple-vehicle accidents. Of those, nearly half (48%) occurred at intersections. The IIHS observes that drivers over the age of sixty-five are more likely than younger drivers to have accidents when making left turns and attributes this to the fact that older drivers take longer to make turns, increasing the risk of a crash.

Older adults also suffer nonfatal injuries as drivers or passengers in motor vehicle crashes. In 2004 the National

				Percent change
Item	2003	2004	2005	2003–2004	2004–2005
*Income values are derived from "complete income reporters" only in 2003. Starting in 2004, income imputation was introduced and incomes are estimated for all consumer units.
Number of consumer units (in thousands)	115,356	116,282	117,356
Income before taxes	$51,128	$54,453	$58,712
Averages:
Age of reference person	48.4	48.5	48.6
Number of persons in consumer unit	2.5	2.5	2.5
Number of earners	1.3	1.3	1.3
Number of vehicles	1.9	1.9	2.0
Percent homeowner	67	68	67
Average annual expenditures	$40,817	$43,395	$46,409	6.3	6.9
Food	5,340	5,781	5,931	8.3	2.6
Food at home	3,129	3,347	3,297	7.0	−1.5
Cereals and bakery products	442	461	445	4.3	−3.5
Meats, poultry, fish, and eggs	825	880	764	6.7	−13.1
Dairy products	328	371	378	13.1	2.0
Fruits and vegetables	535	561	552	4.9	−1.7
Other food at home	999	1,075	1,158	7.6	7.7
Food away from home	2,211	2,434	2,634	10.1	8.2
Alcoholic beverages	391	459	426	17.4	−7.1
Housing	13,432	13,918	15,167	3.6	9.0
Shelter	7,887	7,998	8,805	1.4	10.1
Utilities, fuels, and public services	2,811	2,927	3,183	4.1	8.8
Household operations	707	753	801	6.5	6.3
Housekeeping supplies	529	594	611	12.3	2.9
Housefurnishings and equipment	1,497	1,646	1,767	10.0	7.4
Apparel and services	1,640	1,816	1,886	10.7	3.8
Transportation	7,781	7,801	8,344	.3	7.0
Vehicle purchases (net outlay)	3,732	3,397	3,544	−9.0	4.3
Gasoline and motor oil	1,333	1,598	2,013	19.9	26.0
Other vehicle expenses	2,331	2,365	2,339	1.5	−1.1
Public transportation	385	441	448	14.5	1.6
Healthcare	2,416	2,574	2,664	6.5	3.5
Entertainment	2,060	2,218	2,388	7.7	7.7
Personal care products and services	527	581	541	10.2	−6.9
Reading	127	130	126	2.4	−2.7
Education	783	905	940	15.6	3.9
Tobacco products and smoking supplies	290	288	319	−.7	10.8
Miscellaneous	606	690	808	13.9	17.1
Cash contributions	1,370	1,408	1,663	2.8	18.1
Personal insurance and pensions	4,055	4,823	5,204	18.9	7.9
Life and other personal insurance	397	390	381	−1.8	−2.3
Pensions and Social Security	3,658	4,433	4,823	21.2	8.8

Center for Injury Prevention and Control recorded 233,601 such nonfatal injuries in adults aged sixty-five and older. (Table 6.7 shows the 185,779 injuries to occupants of vehicles and 47,822 injuries attributable to other transport.) Motor vehicle accidents (called unintentional MV-occupant) were the third-leading cause of nonfatal injuries among adults aged sixty-five and older in the United States in 2004.

The data about older drivers are not all bad. According to the Centers for Disease Control and Prevention, in "Older Adult Drivers: Fact Sheet" (March 12, 2007, http://www.cdc.gov/ncipc/factsheets/older.htm), older adults wear seat-belts more often than any other age group except infants and preschool children, and they are less likely to drink and drive than other adult drivers. They also take fewer risks than younger drivers by limiting their driving during bad weather and at night.

AGE-RELATED CHANGES MAY IMPAIR OLDER
DRIVERS' SKILLS

Most older adults retain their driving skills, but some age-related changes in vision, hearing, cognitive functions (attention, memory, and reaction times), reflexes, and flexibility of the head and neck may impair the skills that are critical for safe driving. For example, reaction time becomes slower and more variable with advancing age, and arthritis (inflammation that causes pain and loss of movement of the joints) in the neck or shoulder may limit sufferers' ability to turn their necks well enough to merge into traffic, see when backing up, and navigate intersections where the angle of intersecting roads is less than perpendicular.

Changes such as reduced muscle mass and the resultant reduction in strength, as well as decreases in the efficiency of the circulatory, cardiac, and respiratory systems, are strictly related to aging. Others are attributable to the fact that certain diseases, such as arthritis and glaucoma (a disease in which fluid pressure inside the eyes slowly rises, leading to vision loss or blindness), tend to strike at later ages. The functional losses associated with these chronic (long-term) conditions are usually gradual, and many afflicted older drivers are able to adapt effectively to them. Most older adults do not experience declines until very old age, and most learn to adjust to the limitations imposed by age-related changes. Still, a substantial proportion of older adults do stop driving in response to age-related changes. In the press release "Questions Arise as More Older Americans Outlive Driving Privilege" (July 29, 2002, http://www.nia.nih.gov/NewsAndEvents/PressReleases/PR20020729Questions.htm), the National Institute on Aging reports that each year more than six hundred thousand older adults stop driving because of declines in their fitness level, vision, and ability to think clearly.

The Physician's Guide to Assessing and Counseling Older Drivers (May 2003, http://www.ama-assn.org/ama/pub/category/10791.html), which was copublished by the American Medical Association (AMA) and the National Highway Traffic Safety Administration (NHTSA), details medical conditions and their potential effect on driving and highlights treatment methods and counseling measures that can minimize those effects. In the preface, the AMA identifies motor vehicle injuries as the leading cause of injury-related deaths among sixty-five- to seventy-four-year-olds. Among adults aged seventy-five and older, motor vehicle-related injuries followed falls as the second-leading cause of such deaths. The AMA posits that significant growth in the older population and an increase in miles driven by older adults could act to triple the number of traffic fatalities in the coming years. Believing that the medical community can help stem this increase, the AMA calls on physicians to help their patients maintain or even improve their driving skills by periodically assessing them for disease- and medication-related conditions that might impair their capacity to function as safe drivers.

Acute and Chronic Medical Problems

According to the Physician's Guide to Assessing and Counseling Older Drivers, patients discharged from the hospital following treatment for serious illnesses may be temporarily, or even permanently, unable to drive safely. Examples of acute (short-term) medical problems that can impair driving performance include:

Acute myocardial infarction (heart attack)
Stroke (sudden death of a portion of the brain cells because of a lack of blood flow and oxygen) and other traumatic brain injury
Syncope and vertigo (fainting and dizziness)
Seizures (sudden attacks or convulsions characterized by generalized muscle spasms and loss of consciousness)
Surgery
Delirium (altered mental state characterized by wild, irregular, and incoherent thoughts and actions) from any cause

The guide also notes that a variety of chronic medical conditions can also compromise driving function, such as:

Diseases affecting vision—cataracts, diabetic retinopathy, macular degeneration, glaucoma, retinitis pigmentosa, and low visual acuity (the ability to distinguish fine details) even after correction with lenses. Driving is largely a visual task because about 95% of the information required is obtained visually. Many visual functions such as visual acuity, contrast sensitivity, and glare sensitivity decline with age. Impaired visual acuity can cause difficulty in reading signs. Reduced contrast sensitivity can affect the detection of pedestrians in low-light situations and the ability to see worn lane lines. Glare sensitivity makes driving at night and entering and exiting tunnels difficult, and this condition is aggravated by cataracts.

							Percent change
							Annual rate	Total change
Driver age	1969	1977	1983	1990	1995	2001	69–01	69–01
Notes:
Table reporting totals could include some unreported characteristics.
In 1995, some drivers indicating that they drove 'no miles' for their average annual miles were changed to 'miles not reported.'
All
16 to 19	4,633	5,662	4,986	8,485	7,624	7,331	1.44%	58.23%
20 to 34	9,348	11,063	11,531	14,776	15,098	15,650	1.62%	67.42%
35 to 54	9,771	11,539	12,627	14,836	15,291	15,627	1.48%	59.93%
55 to 64	8,611	9,196	9,611	11,436	11,972	13,177	1.34%	53.03%
65+	5,171	5,475	5,386	7,084	7,646	7,684	1.25%	48.60%
All	8,685	10,006	10,536	13,125	13,476	13,785	1.45%	58.72%
Men
16 to 19	5,461	7,045	5,908	9,543	8,206	8,228	1.29%	50.67%
20 to 34	13,133	15,222	15,844	18,310	17,976	18,634	1.10%	41.89%
35 to 54	12,841	16,097	17,808	18,871	18,858	19,287	1.28%	50.20%
55 to 64	10,696	12,455	13,431	15,224	15,859	16,883	1.44%	57.84%
65+	5,919	6,795	7,198	9,162	10,304	10,163	1.70%	71.70%
All	11,352	13,397	13,962	16,536	16,550	16,920	1.26%	49.05%
Women
16 to 19	3,586	4,036	3,874	7,387	6,873	6,106	1.68%	70.27%
20 to 34	5,512	6,571	7,121	11,174	12,004	12,266	2.53%	122.53%
35 to 54	6,003	6,534	7,347	10,539	11,464	11,590	2.08%	93.07%
55 to 64	5,375	5,097	5,432	7,211	7,780	8,795	1.55%	63.63%
65+	3,664	3,572	3,308	4,750	4,785	4,803	0.85%	31.09%
All	5,411	5,940	6,382	9,528	10,142	10,233	2.01%	89.11%

	Total					Men					Women

Age	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001
Notes:
Table reporting totals could include some unreported characteristics.
2001 data excludes persons aged 0 to 4 since such persons were not included in the 1990 and 1995 surveys.
Only the 1990 data have been adjusted to make them more comparable with the 1995 and 2001 data. Thus, there are limits on the conclusions that can be drawn in comparing travel with earlier survey years. The adjustments to 1990 data affect only person trips, vehicle trips, person miles of travel (PMT) and vehicle miles of travel (VMT).
Total	2.9	3.1	3.8	4.3	4.1	2.9	3.0	3.7	4.3	4.1	2.9	3.1	3.8	4.3	4.1
Under 16	2.3	2.6	3.1	3.7	3.4	2.3	2.6	3.0	3.7	3.5	2.3	2.6	3.1	3.8	3.4
16 to 20	3.3	3.5	4.2	4.6	4.1	3.2	3.5	4.2	4.6	4.0	3.4	3.5	4.2	4.7	4.2
21 to 35	3.5	3.6	4.4	4.6	4.3	3.4	3.5	4.2	4.5	4.2	3.5	3.7	4.6	4.8	4.5
36 to 65	2.9	3.2	3.9	4.6	4.5	2.9	3.1	3.7	4.6	4.4	3.0	3.3	4.1	4.6	4.5
Over 65	1.8	1.9	2.4	3.4	3.4	2.2	2.2	2.8	3.9	3.8	1.5	1.7	2.2	3.0	3.1

Cardiovascular (heart and blood vessels) disease, especially when associated with angina (chest pain from a blockage in a coronary artery that prevents oxygen-rich blood from reaching part of the heart), syncope, or cognitive losses
Neurologic disease, such as seizures, dementia, multiple sclerosis, Parkinson's disease, peripheral neuropathy (numbness or tingling in the hands and/or feet), and residual deficits (losses or disability) resulting from stroke

	Total					Men					Women

Age	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001
Notes:
Table reporting totals could include some unreported characteristics.
2001 data excludes persons aged 0 to 4 since such persons were not included in the 1990 and 1995 surveys.
Only the 1990 data have been adjusted to make them more comparable with the 1995 and 2001 data. Thus, there are limits on the conclusions that can be drawn in comparing travel with earlier survey years. The adjustments to 1990 data affect only person trips, vehicle trips, person miles of travel (PMT) and vehicle miles of travel (VMT).
Total	25.1	28.6	34.9	38.7	40.2	27.7	31.6	38.0	43.9	45.0	22.6	25.8	32.1	33.8	35.7
Under 16	16.2	16.2	20.1	25.0	24.5	16.8	16.3	20.3	23.7	24.6	15.4	16.1	19.9	26.2	24.4
16 to 20	22.2	28.1	34.4	36.4	38.1	23.0	30.1	36.9	37.6	34.1	21.5	26.2	32.2	35.0	42.5
21 to 35	31.1	36.5	44.3	46.0	45.6	32.8	40.4	48.2	51.3	49.8	29.5	32.9	40.7	40.8	41.5
36 to 65	29.2	33.0	40.1	45.1	48.8	33.6	36.5	43.4	53.2	57.7	25.2	29.7	37.0	37.5	40.4
Over 65	12.0	14.2	18.4	24.4	27.5	14.8	17.4	22.5	31.7	32.9	10.2	11.8	15.3	19.2	23.5

Psychiatric disease, such as mood disorders, anxiety disorders, psychoses (severe mental disorders in which patients suffer hallucinations, irrational thoughts, and fears and are unable to distinguish between the real world and the imaginary world), personality disorders, and alcohol or other substance abuse
Metabolic disease, such as diabetes mellitus (a condition in which there is increased sugar in the blood and urine because the body is unable to use sugar to produce energy) and hypothyroidism (decreased production of the thyroid hormone by the thyroid gland)
Musculoskeletal disabilities, such as arthritis and foot abnormalities
Chronic renal (kidney) failure
Respiratory disease, such as chronic obstructive pulmonary disease and obstructive sleep apnea (a breathing disorder characterized by interruptions of breathing during sleep).

The guide notes that driving requires a range of sophisticated cognitive skills, which is why some cognitive changes can compromise driving ability. It is not unusual for memory, attention, processing speed, and executive skills—the capacity for logical analysis—to decline with advancing age. Weakening memory may make it difficult for some older drivers to process information from traffic signs and to navigate correctly. As multiple demands are made on older drivers' attention, the drivers must possess selective attention—the ability to prioritize stimuli and focus on only the most important—to attend to vital stimuli such as traffic signs while not being distracted by irrelevant ones such as billboards. Selective attention problems challenge older drivers to distinguish the most critical information when they are faced with many signs and signals. Drivers must also be able to divide their attention to focus on the multiple stimuli involved in most driving tasks. Processing speed affects perception-reaction time and is critical in situations where drivers must immediately choose between actions such as accelerating, braking, or steering. Executive skills are required to analyze driving-related stimuli and make appropriate decisions; they enable drivers to decide to stop at a red light or stop at a crosswalk when a pedestrian is crossing the street.

Sex, race, Hispanic origin and age	1950 ^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
All persons	Deaths per 100,000 resident population
All ages, age-adjusted^d	24.6	23.1	27.6	22.3	18.5	15.4	15.3	15.2
All ages, crude	23.1	21.3	26.9	23.5	18.8	15.4	15.4	15.3
Under 1 year	8.4	8.1	9.8	7.0	4.9	4.4	3.6	3.5
1–14 years	9.8	8.6	10.5	8.2	6.0	4.3	4.0	4.0
1–4 years	11.5	10.0	11.5	9.2	6.3	4.2	3.9	4.0
5–14 years	8.8	7.9	10.2	7.9	5.9	4.3	4.0	4.1
15–24 years	34.4	38.0	47.2	44.8	34.1	26.9	26.6	26.3
15–19 years	29.6	33.9	43.6	43.0	33.1	26.0	25.7	25.2
20–24 years	38.8	42.9	51.3	46.6	35.0	28.0	27.5	27.5
25–34 years	24.6	24.3	30.9	29.1	23.6	17.3	17.1	17.6
35–44 years	20.3	19.3	24.9	20.9	16.9	15.3	15.7	15.1
45–64 years	25.2	23.0	26.5	18.0	15.7	14.3	14.6	14.7
45–54 years	22.2	21.4	25.5	18.6	15.6	14.2	14.9	15.1
55–64 years	29.0	25.1	27.9	17.4	15.9	14.4	14.2	14.1
65 years and over	.43.1	34.7	36.2	22.5	23.1	21.4	21.0	20.4
65–74 years	39.1	31.4	32.8	19.2	18.6	16.5	16.2	16.1
75–84 years	52.7	41.8	43.5	28.1	29.1	25.7	24.9	24.5
85 years and over	45.1	37.9	34.2	27.6	31.2	30.4	28.8	26.1
Male
All ages, age-adjusted^d	38.5	35.4	41.5	33.6	26.5	21.7	21.6	21.4
All ages, crude	35.4	31.8	39.7	35.3	26.7	21.3	21.4	21.3
Under 1 year	9.1	8.6	9.3	7.3	5.0	4.6	3.9	3.8
1–14 years	12.3	10.7	13.0	10.0	7.0	4.9	4.7	4.5
1–4 years	13.0	11.5	12.9	10.2	6.9	4.7	4.4	4.2
5–14 years	11.9	10.4	13.1	9.9	7.0	5.0	4.8	4.7
15–24 years	56.7	61.2	73.2	68.4	49.5	37.4	36.9	36.4
15–19 years	46.3	51.7	64.1	62.6	45.5	33.9	33.3	32.5
20–24 years	66.7	73.2	84.4	74.3	53.3	41.2	40.4	40.4
25–34 years	40.8	40.1	49.4	46.3	35.7	25.5	25.5	25.8
35–44 years	32.5	29.9	37.7	31.7	24.7	22.0	22.5	21.9
45–64 years	37.7	33.3	38.9	26.5	21.9	20.2	20.9	21.1
45–54 years	33.6	31.6	37.2	27.6	22.0	20.4	21.5	21.9
55–64 years	43.1	35.6	40.9	25.4	21.7	19.8	20.0	19.8
65 years and over	66.6	52.1	54.4	33.9	32.1	29.5	28.5	28.2
65–74 years	59.1	45.8	47.3	27.3	24.2	21.7	21.3	21.3
75–84 years	85.0	66.0	68.2	44.3	41.2	35.6	34.3	34.7
85 years and over	78.1	62.7	63.1	56.1	64.5	57.5	50.0	44.2
Female
All ages, age-adjusted^d	11.5	11.7	14.9	11.8	11.0	9.5	9.3	9.3
All ages, crude	10.9	11.0	14.7	12.3	11.3	9.7	9.5	9.5
Under 1 year	7.6	7.5	10.4	6.7	4.9	4.2	3.3	3.2
1–14 years	7.2	6.3	7.9	6.3	4.9	3.7	3.3	3.5
1–4 years	10.0	8.4	10.0	8.1	5.6	3.8	3.5	3.7
5–14 years	5.7	5.4	7.2	5.7	4.7	3.6	3.2	3.4
15–24 years	12.6	15.1	21.6	20.8	17.9	15.9	15.8	15.7
15–19 years	12.9	16.0	22.7	22.8	20.0	17.5	17.8	17.5
20–24 years	12.2	14.0	20.4	18.9	16.0	14.2	13.9	13.8
25–34 years	9.3	9.2	13.0	12.2	11.5	8.8	8.5	9.1
35–44 years	8.5	9.1	12.9	10.4	9.2	8.8	8.9	8.3
45–64 years	12.6	13.1	15.3	10.3	10.1	8.7	8.6	8.6
45–54 years	10.9	11.6	14.5	10.2	9.6	8.2	8.5	8.5
55–64 years	14.9	15.2	16.2	10.5	10.8	9.5	8.8	8.8
65 years and over	21.9	20.3	23.1	15.0	17.2	15.8	15.6	14.9
65–74 years	20.6	19.0	21.6	13.0	14.1	12.3	11.9	11.7
75–84 years	25.2	23.0	27.2	18.5	21.9	19.2	18.7	17.7
85 years and over	22.1	22.0	18.0	15.2	18.3	19.3	19.5	17.9

Medications

According to the Physician's Guide to Assessing and Counseling Older Drivers, many commonly used prescription and over-the-counter (nonprescription) medications can impair driving performance. In general, drugs with strong central nervous system effects, such as anti-depressants, antihistamines, muscle relaxants, narcotic analgesics (painkillers), anticonvulsants (used to prevent seizures), and stimulants, have the potential to adversely affect the ability to operate a motor vehicle. The extent to which driving skills are compromised varies from person to person and between different medications used for the

Sex, race, Hispanic origin and age	1950^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
	Deaths per 100,000 resident population
White male^e
All ages, age-adjusted^d	37.9	34.8	40.4	33.8	26.3	21.8	21.9	21.8
All ages, crude	35.1	31.5	39.1	35.9	26.7	21.6	22.0	21.9
Under 1 year	9.1	8.8	9.1	7.0	4.8	4.2	3.9	3.3
1–14 years	12.4	10.6	12.5	9.8	6.6	4.8	4.7	4.6
15–24 years	58.3	62.7	75.2	73.8	52.5	39.6	39.2	39.4
25–34 years	39.1	38.6	47.0	46.6	35.4	25.1	25.9	25.8
35–44 years	30.9	28.4	35.2	30.7	23.7	21.8	22.6	22.2
45–64 years	36.2	31.7	36.5	25.2	20.6	19.7	20.6	20.7
65 years and over	67.1	52.1	54.2	32.7	31.4	29.4	28.8	28.5
Black or African American male^e
All ages, age-adjusted^d	34.8	39.6	51.0	34.2	29.9	24.4	22.7	22.7
All ages, crude	37.2	33.1	44.3	31.1	28.1	22.5	21.1	21.2
Under 1 year	—	*	10.6	7.8	*	6.7	*	*
1–14 years^f	10.4	11.2	16.3	11.4	8.9	5.5	4.8	4.8
15–24 years	42.5	46.4	58.1	34.9	36.1	30.2	27.9	26.4
25–34 years	54.4	51.0	70.4	44.9	39.5	32.6	29.0	31.8
35–44 years	46.7	43.6	59.5	41.2	33.5	27.2	26.4	24.7
45–64 years	54.6	47.8	61.7	39.5	33.3	27.1	26.1	26.9
65 years and over	52.6	48.2	53.4	42.4	36.3	32.1	28.9	28.6
American Indian or Alaska native male^e
All ages, age-adjusted^d	—	—	—	78.9	48.3	35.8	35.2	34.5
All ages, crude	—	—	—	74.6	47.6	33.6	35.9	33.7
1–14 years	—	—	—	15.1	11.6	7.8	9.8	6.8
15–24 years	—	—	—	126.1	75.2	56.8	60.2	47.4
25–34 years	—	—	—	107.0	78.2	49.8	45.5	46.7
35–44 years	—	—	—	82.8	57.0	36.3	43.6	37.8
45–64 years	—	—	—	77.4	45.9	32.0	36.0	38.3
65 years and over	—	—	—	97.0	43.0	48.5	25.4	42.3
Asian or Pacific Islander male^e
All ages, age-adjusted^d	—	—	—	19.0	17.9	10.6	10.3	9.3
All ages, crude	—	—	—	17.1	15.8	9.8	9.4	8.8
1–14 years	—	—	—	8.2	6.3	2.5	2.4	2.6
15–24 years	—	—	—	27.2	25.7	17.0	18.3	15.3
25–34 years	—	—	—	18.8	17.0	10.4	8.2	8.4
35–44 years	—	—	—	13.1	12.2	6.9	6.8	7.4
45–64 years	—	—	—	13.7	15.1	10.1	9.7	9.0
65 years and over	—	—	—	37.3	33.6	21.1	20.1	17.0
Hispanic or Latino male^{e, g}
All ages, age-adjusted^d	—	—	—	—	29.5	21.3	22.0	20.9
All ages, crude	—	—	—	—	29.2	20.1	21.1	20.2
1–14 years	—	—	—	—	7.2	4.4	4.9	4.7
15–24 years	—	—	—	—	48.2	34.7	37.2	38.3
25–34 years	—	—	—	—	41.0	24.9	27.6	25.4
35–44 years	—	—	—	—	28.0	21.6	22.1	20.8
45–64 years	—	—	—	—	28.9	21.7	20.4	19.6
65 years and over	—	—	—	—	35.3	28.9	29.2	26.1
White, not Hispanic or Latino male^g
All ages, age-adjusted^d	—	—	—	—	25.7	21.7	21.6	21.7
All ages, crude	—	—	—	—	26.0	21.5	21.8	22.0
1–14 years	—	—	—	—	6.4	4.9	4.6	4.5
15–24 years	—	—	—	—	52.3	40.3	39.1	39.1
25–34 years	—	—	—	—	34.0	24.7	24.9	25.5
35–44 years	—	—	—	—	23.1	21.6	22.4	22.2
45–64 years	—	—	—	—	19.8	19.3	20.4	20.7
65 years and over	—	—	—	—	31.1	29.3	28.6	28.5

same purpose. The effects of prescription and over-the-counter medications may be intensified in combination with other drugs or alcohol.

The guide indicates that medication side effects that can affect driving performance include drowsiness, dizziness, blurred vision, unsteadiness, fainting,

Sex, race, Hispanic origin and age	1950^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
	Deaths per 100,000 resident population
White female^e
All ages, age-adjusted^d	11.4	11.7	14.9	12.2	11.2	9.8	9.5	9.5
All ages, crude	10.9	11.2	14.8	12.8	11.6	10.0	9.8	9.8
Under 1 year	7.8	7.5	10.2	7.1	4.7	3.5	3.0	3.2
1–14 years	7.2	6.2	7.5	6.2	4.8	3.7	3.2	3.4
15–24 years	12.6	15.6	22.7	23.0	19.5	17.1	17.2	16.8
25–34 years	9.0	9.0	12.7	12.2	11.6	8.9	8.6	9.4
35–44 years	8.1	8.9	12.3	10.6	9.2	8.9	9.0	8.4
45–64 years	12.7	13.1	15.1	10.4	9.9	8.7	8.5	8.7
65 years and over	22.2	20.8	23.7	15.3	17.4	16.2	15.8	15.3
Black or African American female ^e
All ages, age-adjusted^d	9.3	10.4	14.1	8.5	9.6	8.4	8.3	8.1
All ages, crude	10.2	9.7	13.4	8.3	9.4	8.2	8.0	7.9
Under 1 year	—	8.1	11.9	*	7.0	*	*	*
1–14 years	7.2	6.9	10.2	6.3	5.3	3.9	3.5	4.0
15–24 years	11.6	9.9	13.4	8.0	9.9	11.7	9.6	10.9
25–34 years	10.8	9.8	13.3	10.6	11.1	9.4	8.7	8.7
35–44 years	11.1	11.0	16.1	8.3	9.4	8.2	8.9	8.3
45–64 years	11.8	12.7	16.7	9.2	10.7	9.0	8.9	8.8
65 years and over	14.3	13.2	15.7	9.5	13.5	10.4	12.4	9.6
American Indian or Alaska native female ^e
All ages, age-adjusted^d	—	—	—	32.0	17.5	19.5	20.8	17.8
All ages, crude	—	—	—	32.0	17.3	18.6	19.8	17.3
1–14 years	.—	—	—	15.0	8.1	6.5	6.3	7.3
15–24 years	—	—	—	42.3	31.4	30.3	27.7	27.0
25–34 years	—	—	—	52.5	18.8	22.3	24.5	21.6
35–44 years	—	—	—	38.1	18.2	22.0	18.7	21.4
45–64 years	—	—	—	32.6	17.6	17.8	22.6	10.4
65 years and over	—	—	—	*	*	24.0	32.3	30.0
Asian or Pacific Islander female ^e
All ages, age-adjusted^d	—	—	—	9.3	10.4	6.7	6.8	6.3
All ages, crude	—	—	—	8.2	9.0	5.9	6.4	6.0
1–14 years	.—	—	—	7.4	3.6	2.3	1.7	*
15–24 years	—	—	—	7.4	11.4	6.0	9.7	9.0
25–34 years	—	—	—	7.3	7.3	4.5	4.5	4.5
35–44 years	—	—	—	8.6	7.5	4.9	4.5	5.0
45–64 years	—	—	—	8.5	11.8	6.4	7.5	6.3
65 years and over	—	—	—	18.6	24.3	18.5	16.2	14.9
Hispanic or Latino female ^{e, g}
All ages, age-adjusted^d	—	—	—	—	9.6	7.9	8.0	7.7
All ages, crude	—	—	—	—	8.9	7.2	7.3	7.1
1–14 years	—	—	—	—	4.8	3.9	3.0	3.4
15–24 years	—	—	—	—	11.6	10.6	11.9	11.1
25–34 years	—	—	—	—	9.4	6.5	6.6	7.3
35–44 years	—	—	—	—	8.0	7.3	8.0	6.4
45–64 years	—	—	—	—	11.4	8.3	8.4	8.1
65 years and over	—	—	—	—	14.9	13.4	13.1	12.3

and slowed reaction time. Generally, these side effects are dose-dependent and lessen over time, but older adults are often more sensitive to the effects of medications and may take longer to metabolize them, prolonging their effects. Medications such as prescription sleep aids that cause drowsiness, euphoria, or amnesia pose an even greater risk, because they often diminish insight and objectivity, such that the driver may become impaired without any awareness of it.

Concern about Older Drivers' Safety Prompts Action

As the ranks of older adults swell, many states and organizations—the AMA and the NHTSA are chief among these groups—are taking action to ensure driver safety. Concern about older driver safety has intensified in recent years in response to a spate of serious crashes involving older drivers. For example, the article "Market Crash Raises Age Questions" (CBSNews.com, July 18, 2003) discusses a horrific accident that occurred in

Sex, race, Hispanic origin and age	1950^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
—Data not available.
*Rates based on fewer than 20 deaths are considered unreliable and are not shown.
^aIncludes deaths of persons who were not residents of the 50 states and the District of Columbia.
^bUnderlying cause of death was coded according to the Sixth Revision of the International Classification of Diseases (ICD) in 1950, Seventh Revision in 1960, Eighth Revision in 1970, and Ninth Revision in 1980–1998.
^cStarting with 1999 data, cause of death is coded according to ICD–10.
^dAge-adjusted rates are calculated using the year 2000 standard population. Prior to 2003, age-adjusted rates were calculated using standard million proportions based on rounded population numbers. Starting with 2003 data, unrounded population numbers are used to calculate age-adjusted rates.
^eThe race groups, white, black, Asian or Pacific Islander, and American Indian or Alaska native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska native and Asian or Pacific Islander populations are known to be underestimated.
^fIn 1950, rate is for the age group under 15 years.
^gPrior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate.
Notes: Starting with Health, United States, 2003, rates for 1991–1999 were revised using intercensal population estimates based on the 2000 census. Rates for 2000 were revised based on 2000 census counts. Rates for 2001 and later years were computed using 2000-based postcensal estimates. Age groups were selected to minimize the presentation of unstable age-specific death rates based on small numbers of deaths and for consistency among comparison groups. Starting with 2003 data, some states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget standards for comparability with other states. In 2003, California, Hawaii, Idaho, Maine, Montana, New York, and Wisconsin reported multiple-race data. In 2004, 15 states reported multiple-race data. In addition to the seven states listed above, Michigan, Minnesota, New Hampshire, New Jersey, Oklahoma, South Dakota, Washington, and Wyoming reported multiple-race data.
	Deaths per 100,000 resident population
White, not Hispanic or Latino female ^g
All ages, age-adjusted ^d	—	—	—	—	11.3	10.0	9.7	9.8
All ages, crude	—	—	—	—	11.7	10.3	10.2	10.2
1–14 years	—	—	—	—	4.7	3.5	3.2	3.4
15–24 years	—	—	—	—	20.4	18.4	18.3	18.0
25–34 years	—	—	—	—	11.7	9.3	9.0	9.8
35–44 years	—	—	—	—	9.3	9.0	9.1	8.7
45–64 years	—	—	—	—	9.7	8.7	8.5	8.6
65 years and over	—	—	—	—	17.5	16.3	15.9	15.5

Southern California when a disoriented eighty-six-year-old man drove at high speed down a street closed for a farmer's market, killing ten people and injuring dozens more. According to the authorities, the driver thought he might have hit the gas instead of the brake as he tried to stop.

Catherine A. Chan and Melissa Savage of the National Conference of State Legislatures report in the Transportation Review: Driver's Licenses and Identification Cards, 2004 (February 2005, http://www.ncsl.org/print/transportation/TRFeb2005.pdf) that each state has its own licensing and license renewal criteria for drivers, and some states—California, Delaware, New Jersey, Oregon, and Pennsylvania—require physicians to report unsafe drivers or drivers diagnosed with conditions that may cause lapses of consciousness to the licensing agency. Thirty-four states use medical review or medical advisory boards to decide when drivers should lose the privilege to drive because of safety or health issues. The boards are comprised of health professionals and physicians and generally do not issue judgments based solely on age. They also recommend licensing standards. For example, a few states use vision tests, accelerated renewal cycles, and in-person rather than mail or online renewals for older drivers. Illinois and New Hampshire drivers over the age of seventy-five are required to take road tests. In 2004 Kansas enacted legislation enabling physicians and optometrists to report drivers they feel are unable to safely operate a motor vehicle.

Ensuring the Safety of Older Drivers

In the Physician's Guide to Assessing and Counseling Older Drivers, the AMA advocates coordinated efforts among the medical and research communities, policy makers, community planners, automobile industry, and government agencies to achieve the common goal of safe transportation for the older population. The AMA calls for refined diagnostic tools to assist physicians in assessing patients' crash risk, improved access to driver assessment and rehabilitation, safer roads and vehicles, and better alternatives to driving for older adults.

Some auto insurance companies reduce payments for older adults who successfully complete driving classes such as the AARP Driver Safety Program. According to "AARP Driver Safety Program History and Facts" (June 2004, http://www.aarp.org/families/driver_safety/driver_program/), the AARP notes that since 2004 over nine million drivers have taken the eight-hour refresher

	Age groups
Rank	1	1–4	5–9	10–14	15–24	25–34	35–44	45–54	55–64	65+	Total
The "other assault" category includes all assaults that are not* classified as sexual assault. It represents the majority of assaults.
1	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional struck by/against	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall
	126,281	888,335	676,704	668,589	980,050	762,703	816,521	791,813	607,041	1,850,649	8,058,498
2	Unintentional struck by/against	Unintentional struck by/against	Unintentional struck by/against	Unintentional struck by/against	Unintentional MV-occupant	Unintentional overexertion	Unintentional overexertion	Unintentional overexertion	Unintentional struck by/occupant	Unintentional struck by/occupant	Unintentional struck by/occupant
	30,760	368,104	404,124	593,752	914,024	673,076	645,508	423,692	200,708	214,235	4,430,171
3	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional cut/pierce	Unintentional overexertion	Unintentional fall	Unintentional struck by/against	Unintentional struck by/against	Unintentional struck by/against	Unintentional overexertion	Unintentional MV-occupant	Unintentional overecertion
	12,753	145,001	115,886	272,797	869,363	669,346	575,089	393,861	200,451	185,779	3,279,383
4	Unintentional fire/burn	Unintentional foreign body	Unintentional pedal cyclist	Unintentional cut/pierce	Unintentional overexertion	Unintentional MV-occupant	Unintentional MV-occupant	Unintentional MV-occupant	Unintentional MV-occupant	Unintentional overexertion	Unintentional MV-occupant
	11,372	113,084	101,891	155,040	739,741	612,446	501,664	363,728	197,296	167,395	3,000,866
5	Unintentional foreign body	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional pedal cyclist	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce
	9,767	86,787	93,317	140,063	498,856	440,900	398,151	296,883	164,110	122,162	2,285,191
6	Unintentional other specified	Unintentional overexertion	Unintentional MV-occupant	Other assault* struck by/against	Other assault* struck by/against	Other assault* struck by/against	Other assault* struck by/against	Unintentional other specified	Unintentional other bite/sting	Unintentional other bite/sting	Other assault* struck by/against
	7,979	76,876	74,399	116,670	466,700	278,693	224,653	149,760	68,461	74,395	1,314,496
7	Unintentional inhalation/suffocation	Unintentional fire/burn	Unintentional overexertion	Unintentional MV-occupant	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional other specified	Other assault* struck by/against	Unintentional other specified	Unintentional poisoning	Unintentional other bite/sting
	7,801	57,728	73,980	99,353	194,493	173,843	176,427	118,537	59,121	61,888	1,103,257
8	Unintentional MV-occupant	Unintentional other specified	Unintentional foreign body	Unintentional unknown specified	Unintentional other specified	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional poisoning	Unintentional other transport	Unintentional other specified
	6,992	49,446	58,303	95,311	158,451	142,385	153,531	117,166	39,802	47,822	820,676
9	Unintentional cut/pierce	Unintentional poisoning	Unintentional dog bite	Unintentional other transport	Unintentional unknown specified	Unintentional other transport	Unintentional poisoning	Unintentional poisoning	Unintentional other transport	Unintentional unknown specified	Unintentional other transport
	6,152	47,402	52,568	70,429	142,089	102,175	118,140	92,787	33,856	40,910	623,846
10	Unintentional	Unintentional unknown unspecified	Unintentional other transport	Unintentional other bite/sting	Unintentional other transport	Unintentional foreign body	Unintentional foreign body	Unintentional other transport	Other assault* struck by/against	Unintentional other specified	Unintentional foreign body
	5,814	47,078	49,071	70,286	136,800	99,096	86,079	67,640	33,257	37,148	609,493

course, which offers guidance in assessing physical abilities and making adjustments accordingly. Each year approximately thirty-four thousand courses are conducted in communities nationwide. The American Automobile Association offers a similar program called Safe Driving for Mature Operators that strives to improve the skills of older drivers. These courses address the aging process and help drivers adjust to age-related changes that can affect driving. Both organizations also provide resources to assist older drivers and their families to determine whether they can safely continue driving.

As of 2007 there were no upper age limits for driving. The National Institute on Aging observes that because people age at different rates, it is not possible to choose a specific age at which to suspend driving. Setting an age limit would leave some drivers on the road too long, whereas others would be forced to stop driving prematurely. Heredity, general health, lifestyle, and surroundings all influence how people age.

Many states are acting to reduce risks for older drivers by improving roadways to make driving less hazardous. According to Al Karr, in "States Find Ways to Aid Older Drivers" (AARP Bulletin, September 2001), typical improvements include:

Wider highway lanes
Intersections that give drivers a longer view of oncoming traffic and allow more time for left turns
Road signs with larger, more visible letters and numbers
Bigger orange construction-zone cones
More rumble strips to reduce speeding.

SPEED-OF-PROCESSING TRAINING MAY REDUCE ACCIDENTS INVOLVING OLDER ADULTS.

As outlined in a press release by the American Geriatrics Society (May 14, 2005, http://www.americangeriatrics.org/news/elderly_training.shtml), research suggests that because age-related declines in visual information processing often contribute to older drivers' accidents, special training that enhances visual information processing ability could help prevent accidents involving older drivers. Investigators at the Veterans Administration Medical Center in Birmingham, Alabama, studied forty-five veterans, aged sixty to eighty, with impaired driving abilities. The veterans were divided into two groups: a control group received training in navigating the Internet, whereas the rest attended speed-of-processing (SOP) training sessions. Those who received SOP training—improving visual information processing by challenging subjects with increasingly difficult visual attention tasks—showed a marked increase in their ability to process visual information. During timed tests the subjects trained in SOP were much faster at identifying specific items on a computer screen filled with a variety of visual distractions.

PROVIDING ALTERNATIVE MEANS
OF TRANSPORTATION

In Transportation-Disadvantaged Seniors, the GAO considers issues and services for "transportation-disadvantaged" older adults—those who cannot drive or have limited their driving, or those who have an income restraint, disability, or medical condition that limits their ability to travel. The intent of this GAO study aimed to identify federal programs that address this population's mobility issues; the extent to which these programs meet their mobility needs; program practices that enhance their mobility and the cost-effectiveness of service delivery; and obstacles to addressing mobility needs and strategies for overcoming those obstacles. The GAO identifies fifteen federal programs designed to meet the transportation needs of older adults. Table 6.8 shows the various characteristics of each program, including the sponsoring agency, the target population served, the types of trips covered, and the type of service provided. For example, the U.S. Department of Health and Human Services funds both Community Services Block Grant Programs, which provide taxicab vouchers and bus tokens that enable low-income older adults to take general trips, and Social Services Block Grants, which provide assistance for transport to and from medical or social service appointments.

The GAO points out that besides the programs intended to provide assistance specifically to older people, there are other programs designed to aid transportation-disadvantaged segments of the population, including older adults. For example, the Americans with Disabilities Act (ADA) of 1990 required that changes to public transportation be made to provide better accessibility for people with disabilities; about half of ADA-eligible riders are aged sixty-five and older. Also, the Transportation Equity Act for the 21st Century (TEA-21), enacted in 1998, authorized funds for several programs, including a formula grant that supported states' efforts to meet the special transportation needs of older adults and people with disabilities.

Types of Transportation for Nondrivers

Transportation for older adults can include door-to-door services such as taxis or van services, public buses that travel along fixed routes, or ridesharing in carpools. According to the U.S. Administration on Aging (AoA), in Because We Care: A Guide for People Who Care (2006, http://www.aoa.gov/prof/aoaprog/caregiver/carefam/taking_care_of_others/wecare/we-care.pdf), there are three general classes of alternative transportation for older adults:

Demand response, also known as Dial-a-Ride, generally requires advance reservations and provides door-to-door service from one specific location to another. Such systems offer older adults comfortable and relatively flexible transport, with the potential for adapting to the needs of individual riders. Payment of fares or donations for demand-response transport is usually required on a per-ride basis.

Agency	Program	Target population	Type of trip allowed	Type of service provided
Note: It was not possible to determine the amount spent on transportation services through many of these federal programs.
Department of Education, Office of Special Education and Rehabilitative Services	Independent Living Services for Older Individuals Who Are Blind	Persons aged 55 and older who have significant visual impairment	To access program and related services, or for general trips	Referral, assistance, and training in the use of public transportation
Department of Health and Human Services, Administration for Children and Families	Community Services Block Grant Programs	Low-income persons (including seniors)	General trips	Taxicab vouchers, bus tokens
	Social Service Block Grants	Target population identified by states	To access medical or social services	Any transportation-related use
Department of Health and Human Services, Administration on Aging	Grants for Supportive Services and Senior Centers (Title III-B)	Seniors (aged 60 and older)	To access program services or medical services, or for general trips	Contract for service with existing transportation provider, or directly purchase vehicles (such as vans)
	Program for American Indian, Alaskan Native, and Native Hawaiian Elders (Title VI)	American Indian, Alaskan Native, and Native Hawaiian seniors	To access program services or medical services, or for general trips	Purchase and operation of vehicles (such as vans)
Department of Health and Human Services, Centers for Medicare and Medicaid Services	Medicaid	Generally low-income persons (including seniors), although states determine eligibility	Medicaid medical services (emergency and nonemergency)	Reimbursement for services with existing transportation providers (e.g., transit passes)
Department of Health and Human Services, Health Resources and Services Administration	Rural Health Care Services Outreach Program	Medically underserved populations (including seniors) in rural areas	To access healthcare services	Transit passes, purchase vehicles (such as vans)
Department of Labor, Employment and Training Administration	Senior Community Service Employment Program	Low-income seniors (aged 55 and older)	To access employment opportunities	Reimbursement for mileage
Department of Transportation, Federal Transit Administration	Capital and Training Assistance Program for Over-the-Road Bus Accessibility	Persons with disabilities (including seniors)	General trips	Assistance in purchasing lift equipment and providing driver training
	Capital Assistance Program for Elderly Persons and Persons with Disabilities (Section 5310)	Seniors and persons with disabilities	General trips	Assistance in purchasing vehicles, contract for services with existing transportation providers
	Capital Investment Grants (Section 5309)	General public, although some projects are for the special needs of elderly persons and persons with disabilities	General trips	Assistance for bus and bus-related capital projects
	Job Access and Reverse Commute	Low-income persons (including seniors)	To access employment and related services	Expansion of existing public transportation or initiation of new service
	Nonurbanized Area formula Program (Section 5311)	General public in rural areas (including seniors)	General trips	Capital and operating assistance for public transportation
	Urbanized Area Formula Program (Section 5307)	General public in urban areas (including seniors)	General trips	Capital assistance, and some operating assistance, for public transportation
Department of Veterans Affairs, Veterans Health Administration	Veterans Medical Care Benefits	Veterans (including seniors) with disabilities or low incomes	To access healthcare services	Mileage reimbursement or contract for service with existing transportation providers

Fixed route and scheduled services follow a predetermined route, stopping at established locations at specific times to allow passengers to board and disembark. This type of service typically requires payment of fares on a per-ride basis. Older adults are often eligible for discounted rates.
Ridesharing programs connect people who need rides with drivers who have room in their cars and are willing to take passengers. This system generally offers scheduled transportation to a particular destination, such as a place of employment, a senior center, or a medical center.

Meeting the Transportation Needs of Older Adults

In Transportation-Disadvantaged Seniors, the GAO cites research by the Beverly Foundation that identifies five attributes necessary for alternative transportation services for older adults:

Availability—older adults can travel to desired locations at the times they want to go.
Accessibility—vehicles can be accessed by those with disabilities; services can be door-to-door or door-through-door as necessary; stops are pedestrian-friendly. Door-through-door transport offers personal, hands-on assistance for older adults who may have difficulties exiting their homes, disembarking from vehicles, and/or opening doors. It is also called assisted transportation, supported (or supportive) transportation, and escorted transportation.
Acceptability—transport is safe, clean, and easy to use.
Affordability—financial assistance is available if necessary.
Adaptability—multiple trips and special equipment can be accommodated.

The GAO highlights specific unmet needs, such as transport to multiple destinations or for purposes that involve carrying packages; to life-enhancing activities, such as cultural events; and in rural and suburban areas. However, the GOA notes that there are limited data available to quantify or assess the extent of the needs that go unmet. The GAO also identifies obstacles to addressing transportation-disadvantaged older adults' mobility needs, potential strategies that federal and other government entities might take to better meet these needs, and trade-offs associated with implementing each strategy. For example, the GAO finds that older drivers are not encouraged to investigate or plan for a time when they will be unable to drive. One way to address this

Obstacles	Strategies	Trade offs
Seniors are not sufficently encouraged to plan for driving alternatives	Facilitate a gradual transition from driver to nondriver	Can increase demand for services and, therefore, increase costs
Government policies do not always address seniors' varied needs	Improve alternatives and include seniors in transportation-planning process	Can be expensive and time-consuming
Funding constraints limit local agencies' ability to address needs	Increase funding and funding flexibility and improve coordination	Takes funds away from other uses, flexibility can decrease accountability, and coordination requires sustained effort

obstacle might be to institute educational programs that would ease older adults' transition from driver to nondriver. This strategy does, however, have the potential to increase demand for alternative transportation services and the costs associated with their provision. (See Table 6.9.)

To increase and improve alternative transportation services, the GAO suggests enlisting the aid of volunteer drivers; sponsoring demonstration programs, identifying best practices, and increasing cooperation among federal programs; and establishing a central clearinghouse of information that could be accessed by stakeholders in the various programs. The GAO recommends that the AoA improve the value and consistency of information pertaining to older adults' transportation needs that is received from area agencies on aging, including providing guidance for those agencies on assessing mobility needs. The AoA is also called on to keep older adults and their caregivers better informed of alternative transportation programs and to ensure that the best methods and practices are shared among transportation and social service providers to enhance the older population's mobility.

On the Road—Older Adult Drivers

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On the Road—Older Adult Drivers

The number of older Americans is expected to double over the next 25 years. All but the most fortunate seniors will confront an array of medical and other constraints on their mobility even as they continue to seek an active community life.
—Sandra Rosenbloom, The Mobility Needs of Older Americans: Implications for Transportation Reauthorization, July 2003

OLDER AMERICANS' OPINIONS,
ABOUT TRANSPORTATION

THE NATIONAL HOUSEHOLD TRAVEL SURVEY

MOTOR VEHICLE ACCIDENTS

	Male drivers			Female drivers			Total drivers
Age	Number	Percent of total drivers	Drivers as percent of age group*	Number	Percent of total drivers	Drivers as percent of age group*	Number	Percent of total drivers	Drivers as percent of age group*
*These percentages are computed using population estimates of the Bureau of the Census. Under-16 age group is compared to 14 and 15-year-old population estimates; the other age brackets coincide with those from the Bureau of the Census.
Under 16	11,922	0.0	0.5	11,980	0.0	0.6	23,902	0.0	0.5
16	620,265	0.6	28.7	603,479	0.6	29.3	1,223,744	0.6	29.0
17	1,118,051	1.1	52.4	1,077,148	1.1	53.1	2,195,199	1.1	52.8
18	1,433,362	1.4	67.9	1,351,680	1.3	67.3	2,785,042	1.4	67.6
19	1,596,260	1.6	74.8	1,513,143	1.5	75.0	3,109,403	1.6	74.9
19 and under	4,779,860	4.8	44.3	4,557,430	4.5	44.5	9,337,290	4.7	44.4
20	1,656,734	1.7	76.9	1,594,045	1.6	78.7	3,250,779	1.6	77.8
21	1,651,658	1.6	77.6	1,613,014	1.6	81.1	3,264,672	1.6	79.3
22	1,716,841	1.7	78.8	1,680,522	1.7	83.1	3,397,363	1.7	80.9
23	1,773,406	1.8	80.9	1,745,065	1.7	85.1	3,518,471	1.8	82.9
24	1,798,788	1.8	81.7	1,777,408	1.8	84.9	3,576,196	1.8	83.3
(20–24)	8,597,427	8.6	79.2	8,410,054	8.4	82.6	17,007,481	8.5	80.8
25–29	8,851,540	8.8	86.2	8,675,911	8.7	88.6	17,527,451	8.7	87.4
30–34	9,215,964	9.2	90.8	8,987,753	9.0	90.6	18,203,717	9.1	90.7
35–39	9,819,601	9.8	93.0	9,579,226	9.6	91.8	19,398,827	9.7	92.4
40–44	10,586,308	10.6	93.1	10,484,293	10.5	91.3	21,070,601	10.5	92.2
45–49	10,478,460	10.5	94.3	10,492,639	10.5	92.2	20,971,099	10.5	93.3
50–54	9,419,933	9.4	96.2	9,490,927	9.5	93.0	18,910,860	9.4	94.6
55–59	8,230,597	8.2	97.7	8,285,708	8.3	92.8	16,516,305	8.2	95.2
60–64	6,109,471	6.1	98.5	6,154,597	6.1	90.5	12,264,068	6.1	94.3
65–69	4,575,782	4.6	96.9	4,645,819	4.6	85.9	9,221,601	4.6	91.0
70–74	3,618,004	3.6	95.0	3,754,467	3.7	79.9	7,372,471	3.7	86.6
75–79	2,893,211	2.9	92.8	3,162,551	3.2	73.6	6,055,762	3.0	81.7
80–84	1,909,682	1.9	88.3	2,211,996	2.2	63.5	4,121,678	2.1	73.0
85 and over	1,166,305	1.2	72.7	1,403,456	1.4	40.2	2,569,761	1.3	50.4
Total	100,252,145	100.0	87.2	100,296,827	100.0	83.0	200,548,972	100.0	85.1

Older adults also suffer nonfatal injuries as drivers or passengers in motor vehicle crashes. In 2004 the National

				Percent change
Item	2003	2004	2005	2003–2004	2004–2005
*Income values are derived from "complete income reporters" only in 2003. Starting in 2004, income imputation was introduced and incomes are estimated for all consumer units.
Number of consumer units (in thousands)	115,356	116,282	117,356
Income before taxes	$51,128	$54,453	$58,712
Averages:
Age of reference person	48.4	48.5	48.6
Number of persons in consumer unit	2.5	2.5	2.5
Number of earners	1.3	1.3	1.3
Number of vehicles	1.9	1.9	2.0
Percent homeowner	67	68	67
Average annual expenditures	$40,817	$43,395	$46,409	6.3	6.9
Food	5,340	5,781	5,931	8.3	2.6
Food at home	3,129	3,347	3,297	7.0	−1.5
Cereals and bakery products	442	461	445	4.3	−3.5
Meats, poultry, fish, and eggs	825	880	764	6.7	−13.1
Dairy products	328	371	378	13.1	2.0
Fruits and vegetables	535	561	552	4.9	−1.7
Other food at home	999	1,075	1,158	7.6	7.7
Food away from home	2,211	2,434	2,634	10.1	8.2
Alcoholic beverages	391	459	426	17.4	−7.1
Housing	13,432	13,918	15,167	3.6	9.0
Shelter	7,887	7,998	8,805	1.4	10.1
Utilities, fuels, and public services	2,811	2,927	3,183	4.1	8.8
Household operations	707	753	801	6.5	6.3
Housekeeping supplies	529	594	611	12.3	2.9
Housefurnishings and equipment	1,497	1,646	1,767	10.0	7.4
Apparel and services	1,640	1,816	1,886	10.7	3.8
Transportation	7,781	7,801	8,344	.3	7.0
Vehicle purchases (net outlay)	3,732	3,397	3,544	−9.0	4.3
Gasoline and motor oil	1,333	1,598	2,013	19.9	26.0
Other vehicle expenses	2,331	2,365	2,339	1.5	−1.1
Public transportation	385	441	448	14.5	1.6
Healthcare	2,416	2,574	2,664	6.5	3.5
Entertainment	2,060	2,218	2,388	7.7	7.7
Personal care products and services	527	581	541	10.2	−6.9
Reading	127	130	126	2.4	−2.7
Education	783	905	940	15.6	3.9
Tobacco products and smoking supplies	290	288	319	−.7	10.8
Miscellaneous	606	690	808	13.9	17.1
Cash contributions	1,370	1,408	1,663	2.8	18.1
Personal insurance and pensions	4,055	4,823	5,204	18.9	7.9
Life and other personal insurance	397	390	381	−1.8	−2.3
Pensions and Social Security	3,658	4,433	4,823	21.2	8.8

AGE-RELATED CHANGES MAY IMPAIR OLDER
DRIVERS' SKILLS

Acute and Chronic Medical Problems

Acute myocardial infarction (heart attack)
Stroke (sudden death of a portion of the brain cells because of a lack of blood flow and oxygen) and other traumatic brain injury
Syncope and vertigo (fainting and dizziness)
Seizures (sudden attacks or convulsions characterized by generalized muscle spasms and loss of consciousness)
Surgery
Delirium (altered mental state characterized by wild, irregular, and incoherent thoughts and actions) from any cause

The guide also notes that a variety of chronic medical conditions can also compromise driving function, such as:

Diseases affecting vision—cataracts, diabetic retinopathy, macular degeneration, glaucoma, retinitis pigmentosa, and low visual acuity (the ability to distinguish fine details) even after correction with lenses. Driving is largely a visual task because about 95% of the information required is obtained visually. Many visual functions such as visual acuity, contrast sensitivity, and glare sensitivity decline with age. Impaired visual acuity can cause difficulty in reading signs. Reduced contrast sensitivity can affect the detection of pedestrians in low-light situations and the ability to see worn lane lines. Glare sensitivity makes driving at night and entering and exiting tunnels difficult, and this condition is aggravated by cataracts.

							Percent change
							Annual rate	Total change
Driver age	1969	1977	1983	1990	1995	2001	69–01	69–01
Notes:
Table reporting totals could include some unreported characteristics.
In 1995, some drivers indicating that they drove 'no miles' for their average annual miles were changed to 'miles not reported.'
All
16 to 19	4,633	5,662	4,986	8,485	7,624	7,331	1.44%	58.23%
20 to 34	9,348	11,063	11,531	14,776	15,098	15,650	1.62%	67.42%
35 to 54	9,771	11,539	12,627	14,836	15,291	15,627	1.48%	59.93%
55 to 64	8,611	9,196	9,611	11,436	11,972	13,177	1.34%	53.03%
65+	5,171	5,475	5,386	7,084	7,646	7,684	1.25%	48.60%
All	8,685	10,006	10,536	13,125	13,476	13,785	1.45%	58.72%
Men
16 to 19	5,461	7,045	5,908	9,543	8,206	8,228	1.29%	50.67%
20 to 34	13,133	15,222	15,844	18,310	17,976	18,634	1.10%	41.89%
35 to 54	12,841	16,097	17,808	18,871	18,858	19,287	1.28%	50.20%
55 to 64	10,696	12,455	13,431	15,224	15,859	16,883	1.44%	57.84%
65+	5,919	6,795	7,198	9,162	10,304	10,163	1.70%	71.70%
All	11,352	13,397	13,962	16,536	16,550	16,920	1.26%	49.05%
Women
16 to 19	3,586	4,036	3,874	7,387	6,873	6,106	1.68%	70.27%
20 to 34	5,512	6,571	7,121	11,174	12,004	12,266	2.53%	122.53%
35 to 54	6,003	6,534	7,347	10,539	11,464	11,590	2.08%	93.07%
55 to 64	5,375	5,097	5,432	7,211	7,780	8,795	1.55%	63.63%
65+	3,664	3,572	3,308	4,750	4,785	4,803	0.85%	31.09%
All	5,411	5,940	6,382	9,528	10,142	10,233	2.01%	89.11%

	Total					Men					Women

Age	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001
Notes:
Table reporting totals could include some unreported characteristics.
2001 data excludes persons aged 0 to 4 since such persons were not included in the 1990 and 1995 surveys.
Only the 1990 data have been adjusted to make them more comparable with the 1995 and 2001 data. Thus, there are limits on the conclusions that can be drawn in comparing travel with earlier survey years. The adjustments to 1990 data affect only person trips, vehicle trips, person miles of travel (PMT) and vehicle miles of travel (VMT).
Total	2.9	3.1	3.8	4.3	4.1	2.9	3.0	3.7	4.3	4.1	2.9	3.1	3.8	4.3	4.1
Under 16	2.3	2.6	3.1	3.7	3.4	2.3	2.6	3.0	3.7	3.5	2.3	2.6	3.1	3.8	3.4
16 to 20	3.3	3.5	4.2	4.6	4.1	3.2	3.5	4.2	4.6	4.0	3.4	3.5	4.2	4.7	4.2
21 to 35	3.5	3.6	4.4	4.6	4.3	3.4	3.5	4.2	4.5	4.2	3.5	3.7	4.6	4.8	4.5
36 to 65	2.9	3.2	3.9	4.6	4.5	2.9	3.1	3.7	4.6	4.4	3.0	3.3	4.1	4.6	4.5
Over 65	1.8	1.9	2.4	3.4	3.4	2.2	2.2	2.8	3.9	3.8	1.5	1.7	2.2	3.0	3.1

Cardiovascular (heart and blood vessels) disease, especially when associated with angina (chest pain from a blockage in a coronary artery that prevents oxygen-rich blood from reaching part of the heart), syncope, or cognitive losses
Neurologic disease, such as seizures, dementia, multiple sclerosis, Parkinson's disease, peripheral neuropathy (numbness or tingling in the hands and/or feet), and residual deficits (losses or disability) resulting from stroke

	Total					Men					Women

Age	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001	1983	1990	1990 Adj	1995	2001
Notes:
Table reporting totals could include some unreported characteristics.
2001 data excludes persons aged 0 to 4 since such persons were not included in the 1990 and 1995 surveys.
Only the 1990 data have been adjusted to make them more comparable with the 1995 and 2001 data. Thus, there are limits on the conclusions that can be drawn in comparing travel with earlier survey years. The adjustments to 1990 data affect only person trips, vehicle trips, person miles of travel (PMT) and vehicle miles of travel (VMT).
Total	25.1	28.6	34.9	38.7	40.2	27.7	31.6	38.0	43.9	45.0	22.6	25.8	32.1	33.8	35.7
Under 16	16.2	16.2	20.1	25.0	24.5	16.8	16.3	20.3	23.7	24.6	15.4	16.1	19.9	26.2	24.4
16 to 20	22.2	28.1	34.4	36.4	38.1	23.0	30.1	36.9	37.6	34.1	21.5	26.2	32.2	35.0	42.5
21 to 35	31.1	36.5	44.3	46.0	45.6	32.8	40.4	48.2	51.3	49.8	29.5	32.9	40.7	40.8	41.5
36 to 65	29.2	33.0	40.1	45.1	48.8	33.6	36.5	43.4	53.2	57.7	25.2	29.7	37.0	37.5	40.4
Over 65	12.0	14.2	18.4	24.4	27.5	14.8	17.4	22.5	31.7	32.9	10.2	11.8	15.3	19.2	23.5

Psychiatric disease, such as mood disorders, anxiety disorders, psychoses (severe mental disorders in which patients suffer hallucinations, irrational thoughts, and fears and are unable to distinguish between the real world and the imaginary world), personality disorders, and alcohol or other substance abuse
Metabolic disease, such as diabetes mellitus (a condition in which there is increased sugar in the blood and urine because the body is unable to use sugar to produce energy) and hypothyroidism (decreased production of the thyroid hormone by the thyroid gland)
Musculoskeletal disabilities, such as arthritis and foot abnormalities
Chronic renal (kidney) failure
Respiratory disease, such as chronic obstructive pulmonary disease and obstructive sleep apnea (a breathing disorder characterized by interruptions of breathing during sleep).

Sex, race, Hispanic origin and age	1950 ^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
All persons	Deaths per 100,000 resident population
All ages, age-adjusted^d	24.6	23.1	27.6	22.3	18.5	15.4	15.3	15.2
All ages, crude	23.1	21.3	26.9	23.5	18.8	15.4	15.4	15.3
Under 1 year	8.4	8.1	9.8	7.0	4.9	4.4	3.6	3.5
1–14 years	9.8	8.6	10.5	8.2	6.0	4.3	4.0	4.0
1–4 years	11.5	10.0	11.5	9.2	6.3	4.2	3.9	4.0
5–14 years	8.8	7.9	10.2	7.9	5.9	4.3	4.0	4.1
15–24 years	34.4	38.0	47.2	44.8	34.1	26.9	26.6	26.3
15–19 years	29.6	33.9	43.6	43.0	33.1	26.0	25.7	25.2
20–24 years	38.8	42.9	51.3	46.6	35.0	28.0	27.5	27.5
25–34 years	24.6	24.3	30.9	29.1	23.6	17.3	17.1	17.6
35–44 years	20.3	19.3	24.9	20.9	16.9	15.3	15.7	15.1
45–64 years	25.2	23.0	26.5	18.0	15.7	14.3	14.6	14.7
45–54 years	22.2	21.4	25.5	18.6	15.6	14.2	14.9	15.1
55–64 years	29.0	25.1	27.9	17.4	15.9	14.4	14.2	14.1
65 years and over	.43.1	34.7	36.2	22.5	23.1	21.4	21.0	20.4
65–74 years	39.1	31.4	32.8	19.2	18.6	16.5	16.2	16.1
75–84 years	52.7	41.8	43.5	28.1	29.1	25.7	24.9	24.5
85 years and over	45.1	37.9	34.2	27.6	31.2	30.4	28.8	26.1
Male
All ages, age-adjusted^d	38.5	35.4	41.5	33.6	26.5	21.7	21.6	21.4
All ages, crude	35.4	31.8	39.7	35.3	26.7	21.3	21.4	21.3
Under 1 year	9.1	8.6	9.3	7.3	5.0	4.6	3.9	3.8
1–14 years	12.3	10.7	13.0	10.0	7.0	4.9	4.7	4.5
1–4 years	13.0	11.5	12.9	10.2	6.9	4.7	4.4	4.2
5–14 years	11.9	10.4	13.1	9.9	7.0	5.0	4.8	4.7
15–24 years	56.7	61.2	73.2	68.4	49.5	37.4	36.9	36.4
15–19 years	46.3	51.7	64.1	62.6	45.5	33.9	33.3	32.5
20–24 years	66.7	73.2	84.4	74.3	53.3	41.2	40.4	40.4
25–34 years	40.8	40.1	49.4	46.3	35.7	25.5	25.5	25.8
35–44 years	32.5	29.9	37.7	31.7	24.7	22.0	22.5	21.9
45–64 years	37.7	33.3	38.9	26.5	21.9	20.2	20.9	21.1
45–54 years	33.6	31.6	37.2	27.6	22.0	20.4	21.5	21.9
55–64 years	43.1	35.6	40.9	25.4	21.7	19.8	20.0	19.8
65 years and over	66.6	52.1	54.4	33.9	32.1	29.5	28.5	28.2
65–74 years	59.1	45.8	47.3	27.3	24.2	21.7	21.3	21.3
75–84 years	85.0	66.0	68.2	44.3	41.2	35.6	34.3	34.7
85 years and over	78.1	62.7	63.1	56.1	64.5	57.5	50.0	44.2
Female
All ages, age-adjusted^d	11.5	11.7	14.9	11.8	11.0	9.5	9.3	9.3
All ages, crude	10.9	11.0	14.7	12.3	11.3	9.7	9.5	9.5
Under 1 year	7.6	7.5	10.4	6.7	4.9	4.2	3.3	3.2
1–14 years	7.2	6.3	7.9	6.3	4.9	3.7	3.3	3.5
1–4 years	10.0	8.4	10.0	8.1	5.6	3.8	3.5	3.7
5–14 years	5.7	5.4	7.2	5.7	4.7	3.6	3.2	3.4
15–24 years	12.6	15.1	21.6	20.8	17.9	15.9	15.8	15.7
15–19 years	12.9	16.0	22.7	22.8	20.0	17.5	17.8	17.5
20–24 years	12.2	14.0	20.4	18.9	16.0	14.2	13.9	13.8
25–34 years	9.3	9.2	13.0	12.2	11.5	8.8	8.5	9.1
35–44 years	8.5	9.1	12.9	10.4	9.2	8.8	8.9	8.3
45–64 years	12.6	13.1	15.3	10.3	10.1	8.7	8.6	8.6
45–54 years	10.9	11.6	14.5	10.2	9.6	8.2	8.5	8.5
55–64 years	14.9	15.2	16.2	10.5	10.8	9.5	8.8	8.8
65 years and over	21.9	20.3	23.1	15.0	17.2	15.8	15.6	14.9
65–74 years	20.6	19.0	21.6	13.0	14.1	12.3	11.9	11.7
75–84 years	25.2	23.0	27.2	18.5	21.9	19.2	18.7	17.7
85 years and over	22.1	22.0	18.0	15.2	18.3	19.3	19.5	17.9

Medications

Sex, race, Hispanic origin and age	1950^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
	Deaths per 100,000 resident population
White male^e
All ages, age-adjusted^d	37.9	34.8	40.4	33.8	26.3	21.8	21.9	21.8
All ages, crude	35.1	31.5	39.1	35.9	26.7	21.6	22.0	21.9
Under 1 year	9.1	8.8	9.1	7.0	4.8	4.2	3.9	3.3
1–14 years	12.4	10.6	12.5	9.8	6.6	4.8	4.7	4.6
15–24 years	58.3	62.7	75.2	73.8	52.5	39.6	39.2	39.4
25–34 years	39.1	38.6	47.0	46.6	35.4	25.1	25.9	25.8
35–44 years	30.9	28.4	35.2	30.7	23.7	21.8	22.6	22.2
45–64 years	36.2	31.7	36.5	25.2	20.6	19.7	20.6	20.7
65 years and over	67.1	52.1	54.2	32.7	31.4	29.4	28.8	28.5
Black or African American male^e
All ages, age-adjusted^d	34.8	39.6	51.0	34.2	29.9	24.4	22.7	22.7
All ages, crude	37.2	33.1	44.3	31.1	28.1	22.5	21.1	21.2
Under 1 year	—	*	10.6	7.8	*	6.7	*	*
1–14 years^f	10.4	11.2	16.3	11.4	8.9	5.5	4.8	4.8
15–24 years	42.5	46.4	58.1	34.9	36.1	30.2	27.9	26.4
25–34 years	54.4	51.0	70.4	44.9	39.5	32.6	29.0	31.8
35–44 years	46.7	43.6	59.5	41.2	33.5	27.2	26.4	24.7
45–64 years	54.6	47.8	61.7	39.5	33.3	27.1	26.1	26.9
65 years and over	52.6	48.2	53.4	42.4	36.3	32.1	28.9	28.6
American Indian or Alaska native male^e
All ages, age-adjusted^d	—	—	—	78.9	48.3	35.8	35.2	34.5
All ages, crude	—	—	—	74.6	47.6	33.6	35.9	33.7
1–14 years	—	—	—	15.1	11.6	7.8	9.8	6.8
15–24 years	—	—	—	126.1	75.2	56.8	60.2	47.4
25–34 years	—	—	—	107.0	78.2	49.8	45.5	46.7
35–44 years	—	—	—	82.8	57.0	36.3	43.6	37.8
45–64 years	—	—	—	77.4	45.9	32.0	36.0	38.3
65 years and over	—	—	—	97.0	43.0	48.5	25.4	42.3
Asian or Pacific Islander male^e
All ages, age-adjusted^d	—	—	—	19.0	17.9	10.6	10.3	9.3
All ages, crude	—	—	—	17.1	15.8	9.8	9.4	8.8
1–14 years	—	—	—	8.2	6.3	2.5	2.4	2.6
15–24 years	—	—	—	27.2	25.7	17.0	18.3	15.3
25–34 years	—	—	—	18.8	17.0	10.4	8.2	8.4
35–44 years	—	—	—	13.1	12.2	6.9	6.8	7.4
45–64 years	—	—	—	13.7	15.1	10.1	9.7	9.0
65 years and over	—	—	—	37.3	33.6	21.1	20.1	17.0
Hispanic or Latino male^{e, g}
All ages, age-adjusted^d	—	—	—	—	29.5	21.3	22.0	20.9
All ages, crude	—	—	—	—	29.2	20.1	21.1	20.2
1–14 years	—	—	—	—	7.2	4.4	4.9	4.7
15–24 years	—	—	—	—	48.2	34.7	37.2	38.3
25–34 years	—	—	—	—	41.0	24.9	27.6	25.4
35–44 years	—	—	—	—	28.0	21.6	22.1	20.8
45–64 years	—	—	—	—	28.9	21.7	20.4	19.6
65 years and over	—	—	—	—	35.3	28.9	29.2	26.1
White, not Hispanic or Latino male^g
All ages, age-adjusted^d	—	—	—	—	25.7	21.7	21.6	21.7
All ages, crude	—	—	—	—	26.0	21.5	21.8	22.0
1–14 years	—	—	—	—	6.4	4.9	4.6	4.5
15–24 years	—	—	—	—	52.3	40.3	39.1	39.1
25–34 years	—	—	—	—	34.0	24.7	24.9	25.5
35–44 years	—	—	—	—	23.1	21.6	22.4	22.2
45–64 years	—	—	—	—	19.8	19.3	20.4	20.7
65 years and over	—	—	—	—	31.1	29.3	28.6	28.5

same purpose. The effects of prescription and over-the-counter medications may be intensified in combination with other drugs or alcohol.

The guide indicates that medication side effects that can affect driving performance include drowsiness, dizziness, blurred vision, unsteadiness, fainting,

Sex, race, Hispanic origin and age	1950^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
	Deaths per 100,000 resident population
White female^e
All ages, age-adjusted^d	11.4	11.7	14.9	12.2	11.2	9.8	9.5	9.5
All ages, crude	10.9	11.2	14.8	12.8	11.6	10.0	9.8	9.8
Under 1 year	7.8	7.5	10.2	7.1	4.7	3.5	3.0	3.2
1–14 years	7.2	6.2	7.5	6.2	4.8	3.7	3.2	3.4
15–24 years	12.6	15.6	22.7	23.0	19.5	17.1	17.2	16.8
25–34 years	9.0	9.0	12.7	12.2	11.6	8.9	8.6	9.4
35–44 years	8.1	8.9	12.3	10.6	9.2	8.9	9.0	8.4
45–64 years	12.7	13.1	15.1	10.4	9.9	8.7	8.5	8.7
65 years and over	22.2	20.8	23.7	15.3	17.4	16.2	15.8	15.3
Black or African American female ^e
All ages, age-adjusted^d	9.3	10.4	14.1	8.5	9.6	8.4	8.3	8.1
All ages, crude	10.2	9.7	13.4	8.3	9.4	8.2	8.0	7.9
Under 1 year	—	8.1	11.9	*	7.0	*	*	*
1–14 years	7.2	6.9	10.2	6.3	5.3	3.9	3.5	4.0
15–24 years	11.6	9.9	13.4	8.0	9.9	11.7	9.6	10.9
25–34 years	10.8	9.8	13.3	10.6	11.1	9.4	8.7	8.7
35–44 years	11.1	11.0	16.1	8.3	9.4	8.2	8.9	8.3
45–64 years	11.8	12.7	16.7	9.2	10.7	9.0	8.9	8.8
65 years and over	14.3	13.2	15.7	9.5	13.5	10.4	12.4	9.6
American Indian or Alaska native female ^e
All ages, age-adjusted^d	—	—	—	32.0	17.5	19.5	20.8	17.8
All ages, crude	—	—	—	32.0	17.3	18.6	19.8	17.3
1–14 years	.—	—	—	15.0	8.1	6.5	6.3	7.3
15–24 years	—	—	—	42.3	31.4	30.3	27.7	27.0
25–34 years	—	—	—	52.5	18.8	22.3	24.5	21.6
35–44 years	—	—	—	38.1	18.2	22.0	18.7	21.4
45–64 years	—	—	—	32.6	17.6	17.8	22.6	10.4
65 years and over	—	—	—	*	*	24.0	32.3	30.0
Asian or Pacific Islander female ^e
All ages, age-adjusted^d	—	—	—	9.3	10.4	6.7	6.8	6.3
All ages, crude	—	—	—	8.2	9.0	5.9	6.4	6.0
1–14 years	.—	—	—	7.4	3.6	2.3	1.7	*
15–24 years	—	—	—	7.4	11.4	6.0	9.7	9.0
25–34 years	—	—	—	7.3	7.3	4.5	4.5	4.5
35–44 years	—	—	—	8.6	7.5	4.9	4.5	5.0
45–64 years	—	—	—	8.5	11.8	6.4	7.5	6.3
65 years and over	—	—	—	18.6	24.3	18.5	16.2	14.9
Hispanic or Latino female ^{e, g}
All ages, age-adjusted^d	—	—	—	—	9.6	7.9	8.0	7.7
All ages, crude	—	—	—	—	8.9	7.2	7.3	7.1
1–14 years	—	—	—	—	4.8	3.9	3.0	3.4
15–24 years	—	—	—	—	11.6	10.6	11.9	11.1
25–34 years	—	—	—	—	9.4	6.5	6.6	7.3
35–44 years	—	—	—	—	8.0	7.3	8.0	6.4
45–64 years	—	—	—	—	11.4	8.3	8.4	8.1
65 years and over	—	—	—	—	14.9	13.4	13.1	12.3

Concern about Older Drivers' Safety Prompts Action

Sex, race, Hispanic origin and age	1950^{a, b}	1960^{a, b}	1970^b	1980^b	1990	2000^c	2003	2004
—Data not available.
*Rates based on fewer than 20 deaths are considered unreliable and are not shown.
^aIncludes deaths of persons who were not residents of the 50 states and the District of Columbia.
^bUnderlying cause of death was coded according to the Sixth Revision of the International Classification of Diseases (ICD) in 1950, Seventh Revision in 1960, Eighth Revision in 1970, and Ninth Revision in 1980–1998.
^cStarting with 1999 data, cause of death is coded according to ICD–10.
^dAge-adjusted rates are calculated using the year 2000 standard population. Prior to 2003, age-adjusted rates were calculated using standard million proportions based on rounded population numbers. Starting with 2003 data, unrounded population numbers are used to calculate age-adjusted rates.
^eThe race groups, white, black, Asian or Pacific Islander, and American Indian or Alaska native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska native and Asian or Pacific Islander populations are known to be underestimated.
^fIn 1950, rate is for the age group under 15 years.
^gPrior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate.
Notes: Starting with Health, United States, 2003, rates for 1991–1999 were revised using intercensal population estimates based on the 2000 census. Rates for 2000 were revised based on 2000 census counts. Rates for 2001 and later years were computed using 2000-based postcensal estimates. Age groups were selected to minimize the presentation of unstable age-specific death rates based on small numbers of deaths and for consistency among comparison groups. Starting with 2003 data, some states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget standards for comparability with other states. In 2003, California, Hawaii, Idaho, Maine, Montana, New York, and Wisconsin reported multiple-race data. In 2004, 15 states reported multiple-race data. In addition to the seven states listed above, Michigan, Minnesota, New Hampshire, New Jersey, Oklahoma, South Dakota, Washington, and Wyoming reported multiple-race data.
	Deaths per 100,000 resident population
White, not Hispanic or Latino female ^g
All ages, age-adjusted ^d	—	—	—	—	11.3	10.0	9.7	9.8
All ages, crude	—	—	—	—	11.7	10.3	10.2	10.2
1–14 years	—	—	—	—	4.7	3.5	3.2	3.4
15–24 years	—	—	—	—	20.4	18.4	18.3	18.0
25–34 years	—	—	—	—	11.7	9.3	9.0	9.8
35–44 years	—	—	—	—	9.3	9.0	9.1	8.7
45–64 years	—	—	—	—	9.7	8.7	8.5	8.6
65 years and over	—	—	—	—	17.5	16.3	15.9	15.5

Ensuring the Safety of Older Drivers

	Age groups
Rank	1	1–4	5–9	10–14	15–24	25–34	35–44	45–54	55–64	65+	Total
The "other assault" category includes all assaults that are not* classified as sexual assault. It represents the majority of assaults.
1	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional struck by/against	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall	Unintentional fall
	126,281	888,335	676,704	668,589	980,050	762,703	816,521	791,813	607,041	1,850,649	8,058,498
2	Unintentional struck by/against	Unintentional struck by/against	Unintentional struck by/against	Unintentional struck by/against	Unintentional MV-occupant	Unintentional overexertion	Unintentional overexertion	Unintentional overexertion	Unintentional struck by/occupant	Unintentional struck by/occupant	Unintentional struck by/occupant
	30,760	368,104	404,124	593,752	914,024	673,076	645,508	423,692	200,708	214,235	4,430,171
3	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional cut/pierce	Unintentional overexertion	Unintentional fall	Unintentional struck by/against	Unintentional struck by/against	Unintentional struck by/against	Unintentional overexertion	Unintentional MV-occupant	Unintentional overecertion
	12,753	145,001	115,886	272,797	869,363	669,346	575,089	393,861	200,451	185,779	3,279,383
4	Unintentional fire/burn	Unintentional foreign body	Unintentional pedal cyclist	Unintentional cut/pierce	Unintentional overexertion	Unintentional MV-occupant	Unintentional MV-occupant	Unintentional MV-occupant	Unintentional MV-occupant	Unintentional overexertion	Unintentional MV-occupant
	11,372	113,084	101,891	155,040	739,741	612,446	501,664	363,728	197,296	167,395	3,000,866
5	Unintentional foreign body	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional pedal cyclist	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce	Unintentional cut/pierce
	9,767	86,787	93,317	140,063	498,856	440,900	398,151	296,883	164,110	122,162	2,285,191
6	Unintentional other specified	Unintentional overexertion	Unintentional MV-occupant	Other assault* struck by/against	Other assault* struck by/against	Other assault* struck by/against	Other assault* struck by/against	Unintentional other specified	Unintentional other bite/sting	Unintentional other bite/sting	Other assault* struck by/against
	7,979	76,876	74,399	116,670	466,700	278,693	224,653	149,760	68,461	74,395	1,314,496
7	Unintentional inhalation/suffocation	Unintentional fire/burn	Unintentional overexertion	Unintentional MV-occupant	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional other specified	Other assault* struck by/against	Unintentional other specified	Unintentional poisoning	Unintentional other bite/sting
	7,801	57,728	73,980	99,353	194,493	173,843	176,427	118,537	59,121	61,888	1,103,257
8	Unintentional MV-occupant	Unintentional other specified	Unintentional foreign body	Unintentional unknown specified	Unintentional other specified	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional other bite/sting	Unintentional poisoning	Unintentional other transport	Unintentional other specified
	6,992	49,446	58,303	95,311	158,451	142,385	153,531	117,166	39,802	47,822	820,676
9	Unintentional cut/pierce	Unintentional poisoning	Unintentional dog bite	Unintentional other transport	Unintentional unknown specified	Unintentional other transport	Unintentional poisoning	Unintentional poisoning	Unintentional other transport	Unintentional unknown specified	Unintentional other transport
	6,152	47,402	52,568	70,429	142,089	102,175	118,140	92,787	33,856	40,910	623,846
10	Unintentional	Unintentional unknown unspecified	Unintentional other transport	Unintentional other bite/sting	Unintentional other transport	Unintentional foreign body	Unintentional foreign body	Unintentional other transport	Other assault* struck by/against	Unintentional other specified	Unintentional foreign body
	5,814	47,078	49,071	70,286	136,800	99,096	86,079	67,640	33,257	37,148	609,493

Wider highway lanes
Intersections that give drivers a longer view of oncoming traffic and allow more time for left turns
Road signs with larger, more visible letters and numbers
Bigger orange construction-zone cones
More rumble strips to reduce speeding.

SPEED-OF-PROCESSING TRAINING MAY REDUCE ACCIDENTS INVOLVING OLDER ADULTS.

PROVIDING ALTERNATIVE MEANS
OF TRANSPORTATION

Types of Transportation for Nondrivers

Demand response, also known as Dial-a-Ride, generally requires advance reservations and provides door-to-door service from one specific location to another. Such systems offer older adults comfortable and relatively flexible transport, with the potential for adapting to the needs of individual riders. Payment of fares or donations for demand-response transport is usually required on a per-ride basis.

Agency	Program	Target population	Type of trip allowed	Type of service provided
Note: It was not possible to determine the amount spent on transportation services through many of these federal programs.
Department of Education, Office of Special Education and Rehabilitative Services	Independent Living Services for Older Individuals Who Are Blind	Persons aged 55 and older who have significant visual impairment	To access program and related services, or for general trips	Referral, assistance, and training in the use of public transportation
Department of Health and Human Services, Administration for Children and Families	Community Services Block Grant Programs	Low-income persons (including seniors)	General trips	Taxicab vouchers, bus tokens
	Social Service Block Grants	Target population identified by states	To access medical or social services	Any transportation-related use
Department of Health and Human Services, Administration on Aging	Grants for Supportive Services and Senior Centers (Title III-B)	Seniors (aged 60 and older)	To access program services or medical services, or for general trips	Contract for service with existing transportation provider, or directly purchase vehicles (such as vans)
	Program for American Indian, Alaskan Native, and Native Hawaiian Elders (Title VI)	American Indian, Alaskan Native, and Native Hawaiian seniors	To access program services or medical services, or for general trips	Purchase and operation of vehicles (such as vans)
Department of Health and Human Services, Centers for Medicare and Medicaid Services	Medicaid	Generally low-income persons (including seniors), although states determine eligibility	Medicaid medical services (emergency and nonemergency)	Reimbursement for services with existing transportation providers (e.g., transit passes)
Department of Health and Human Services, Health Resources and Services Administration	Rural Health Care Services Outreach Program	Medically underserved populations (including seniors) in rural areas	To access healthcare services	Transit passes, purchase vehicles (such as vans)
Department of Labor, Employment and Training Administration	Senior Community Service Employment Program	Low-income seniors (aged 55 and older)	To access employment opportunities	Reimbursement for mileage
Department of Transportation, Federal Transit Administration	Capital and Training Assistance Program for Over-the-Road Bus Accessibility	Persons with disabilities (including seniors)	General trips	Assistance in purchasing lift equipment and providing driver training
	Capital Assistance Program for Elderly Persons and Persons with Disabilities (Section 5310)	Seniors and persons with disabilities	General trips	Assistance in purchasing vehicles, contract for services with existing transportation providers
	Capital Investment Grants (Section 5309)	General public, although some projects are for the special needs of elderly persons and persons with disabilities	General trips	Assistance for bus and bus-related capital projects
	Job Access and Reverse Commute	Low-income persons (including seniors)	To access employment and related services	Expansion of existing public transportation or initiation of new service
	Nonurbanized Area formula Program (Section 5311)	General public in rural areas (including seniors)	General trips	Capital and operating assistance for public transportation
	Urbanized Area Formula Program (Section 5307)	General public in urban areas (including seniors)	General trips	Capital assistance, and some operating assistance, for public transportation
Department of Veterans Affairs, Veterans Health Administration	Veterans Medical Care Benefits	Veterans (including seniors) with disabilities or low incomes	To access healthcare services	Mileage reimbursement or contract for service with existing transportation providers

Fixed route and scheduled services follow a predetermined route, stopping at established locations at specific times to allow passengers to board and disembark. This type of service typically requires payment of fares on a per-ride basis. Older adults are often eligible for discounted rates.
Ridesharing programs connect people who need rides with drivers who have room in their cars and are willing to take passengers. This system generally offers scheduled transportation to a particular destination, such as a place of employment, a senior center, or a medical center.

Meeting the Transportation Needs of Older Adults

In Transportation-Disadvantaged Seniors, the GAO cites research by the Beverly Foundation that identifies five attributes necessary for alternative transportation services for older adults:

Availability—older adults can travel to desired locations at the times they want to go.
Accessibility—vehicles can be accessed by those with disabilities; services can be door-to-door or door-through-door as necessary; stops are pedestrian-friendly. Door-through-door transport offers personal, hands-on assistance for older adults who may have difficulties exiting their homes, disembarking from vehicles, and/or opening doors. It is also called assisted transportation, supported (or supportive) transportation, and escorted transportation.
Acceptability—transport is safe, clean, and easy to use.
Affordability—financial assistance is available if necessary.
Adaptability—multiple trips and special equipment can be accommodated.

Obstacles	Strategies	Trade offs
Seniors are not sufficently encouraged to plan for driving alternatives	Facilitate a gradual transition from driver to nondriver	Can increase demand for services and, therefore, increase costs
Government policies do not always address seniors' varied needs	Improve alternatives and include seniors in transportation-planning process	Can be expensive and time-consuming
Funding constraints limit local agencies' ability to address needs	Increase funding and funding flexibility and improve coordination	Takes funds away from other uses, flexibility can decrease accountability, and coordination requires sustained effort