Can driving status can be considered a proxy for successful aging?

By Pooja Toshniwal PahariaMay 8 2023Reviewed by Danielle Ellis, B.Sc.

In a recent study published in PLOS ONE, researchers evaluated the association between the functional, cognitive, and social aspects of car diving and successful aging (SA).

Study: Association between car driving and successful ageing. A cross sectional study on the "S.AGES" cohort. Image Credit: Dusan Petkovic/Shutterstock.com

Background

Assessing SA is critical to identifying modifiable factors to promote health. SA comprises three domains: low likelihood of illness and associated disabilities, high physical functional and cognitive capacity, and active lifestyles. The participation of older adults in road traffic is increasing, and so are road fatalities among individuals aged >65 years due to multiple comorbidities and sensory and cognitive impairments.

Driving may be associated with SA since it preserves social well-being and requires maintenance of cognitive and functional status with good coordination, eyesight, and muscle and strength control. However, the relationship between the ability to drive and SA among older adults has not been well characterized.

About the study

In the present cross-sectional study, researchers investigated whether the status of driving could be considered a proxy for successful aging by assessing driving-associated determinants among individuals aged 65 years and older.

The study included participants of the Sujets AGE´S-Aged Subjects (S.AGES) prospective cohort-type study, which included individuals aged ≥65 years who suffered from atrial fibrillation (AF, 1,087 individuals), chronic pain (1,400 individuals), or type-2 diabetes (1,004 individuals), and was conducted between 2009 and 2014.

SA success was determined based on three domains; the physiological domain comprising autonomy and comorbidity scores; the psychological domain comprising emotional states and cognitive status; and the social domain. The team randomly allocated 650 general practitioners (GPs) to the sub-cohorts, with the instructions to include one aged 65 to 75 and two individuals aged ≥75 years. The GPSs assessed the individuals semi-annually over a period of 3.0 years.

Multivariate logistic regression models were used to determine the odds ratios (OR) by adjusting for covariates such as physiological age, chronological age, level of education, sex, employment status, rural or urban residence, polypharmacy, alcohol consumption, and tobacco intake. The autonomy component was measured using the Activity of Daily Living (ADL) scale. The physiological domain of SA was considered successful if the autonomy and comorbidity components were successful.

Cognitive status was evaluated using the Mini-Mental State Evaluation (MMSE) scores, and the status of depression was assessed using the Geriatric Depressive Scale (GDS). The psychological domain was considered successful if the depressive and cognitive statuses were successful. The social domain was assessed using the social isolation data. Individuals were deemed to age successfully if all three domains (social, psychological, and physiological) were successful. Individuals with missing data on the status of driving, cognition, or depression were excluded from the analysis.

Results

Initially, 3,491 individuals were included, from whom the team excluded 82 individuals with unknown driver status, 747 individuals with missing MMSE values, and 805 individuals with missing GDS values. Further, the team excluded 57 individuals who could not meet the eligibility criteria, and therefore, 2,098 individuals were considered for the final analysis. Among the study participants, 58% (n=1,226) were drivers, and 42% (n=872) were non-drivers.

The mean age of the drivers versus non-drivers was 79 years versus 76 years, with physiological-type age either equivalent to or higher than the chronological-type age for 1,146 individuals (94%) versus 763 individuals (88%), respectively, and mean MMSE values of 28 versus 27, respectively. Of 2,092 individuals, 17% (n=351) attained SA, among whom 24% (292 of 1,266 individuals) were drivers and 7.0% (59 of 872 individuals) were non-drivers.

SA was found to be related to the status of driving (OR 1.9). The finding could be due to the requirements of driving free from functional and cognitive impairments. However, on the whole, the physiological domain attained the least success: 33% (n=701), and the rates for the social domain were 65% (n=1,382). The rates for community-residing elders ranged between 24% and 88% and were 64% (n=1,335) for the psychological component.

Driving individuals were significantly lower aged (OR 0.9) and also had a lower physiological age (OR 0.3) compared to non-driving individuals, concordant with higher rates of comorbidities and polypharmacy among non-drivers. Further, drivers were more likely to reside in rural or semi-rural areas than urban areas, with OR values of 3.0 and 2.2, respectively. The male sex showed a significant association with driving (OR 6.8), and tobacco and alcohol intake were significantly associated with the status of driving, with OR values of 1.5 and 1.7, respectively.

Among driving individuals, 44% (n=535) attained success in SA’s physiological domain, with 55% (n=673) and 73% (n=898) attaining success in the comorbidity and autonomy components, respectively. Among non-driving individuals, 19% (n=166) attained success in the physiological domain, with 36% (n=311) and 41% (n=356) attaining success in autonomy and comorbidity components, respectively. In the driver and non-driver groups, 72% (n=884) and 52% (n=451) attained success in the psychological component, respectively. Concerning the social domain, the corresponding percentages were 75% (n=912) and 53% (n=464), respectively.

Conclusion

Overall, the study findings showed that driving might be regarded as a proxy for SA since driving represents the cognitive abilities, independence, and social well-being of elders. Road safety could be improved by regularly screening older adults for driving status and developing particular rehabilitation health programs to enhance cognitive functioning. Nevertheless, mobility is required to be maintained by the elderly to achieve SA, which can be attained by developing special transport and communal services to reduce the fear of older drivers.