Safe Mobility for Older Americans (2005)

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1Introduction American society is continuing to experience a demographic transformation thatwill have far-reaching consequences in areas such as health care, retirement,housing, and transportation. For the entire 20th century, the growth rate in the number of Americans over 65 greatly exceeded the growth rate of the population as a whole. During the past 50 years, the U.S. population has grown older. From 1950 to 2000 the proportion under 18 years of age fell from 31 to 26 percent while the proportion over 65 rose from 8 to 12 percent. From 2000 to 2050 a small decline in the propor- tion of the population under 18 years of age is anticipated while a sizeable increase in the proportion of elderly is expected. As the “baby boom” generation turns 65, begin- ning in 2011, the size of the elderly population will grow substantially. By 2050 it is projected that one in five Americans will be elderly (Pastor et al. 2002). The U.S. Census Bureau has predicted that the number of senior Americans will more than double between 1996 and 2050, from 34 million to 78 million (Rosenbloom 2004). By the end of the period, one in four Americans will be over 65 years of age. During the same period, the number of Americans aged 85 and older, the fastest-growing cohort, is expected to quadruple (U.S. Department of Transportation 2003). From an international perspective, two-thirds of all the elderly who have ever lived are alive today (Center for Strategic and International Studies and Watson Wyatt Worldwide 2000). The “graying of America” (Blackman et al. 1999) is due to a number of factors: • More people are staying alive into old age for a variety of reasons, including health care improvements. • Research and prevention services have focused on the major causes of death and disability in older persons—arthritis, cancer, cardiovascular disease, dementia, and diabetes. This focus has resulted in breakthroughs in treatment and care and has pro- longed lives. • The baby boom generation (those born between 1945 and 1965) has matured. “Between 1946 and 1964, 75 million babies were born in the United States. In 2010, the first of the boomers who choose to retire at age 65 will be entering retirement, and by 2030, all ‘boomers’ will be over 65 years of age” (Hu et al. 2000). • Those of childbearing age are having fewer children. In spite of predictions to the contrary, fertility rates have continued to fall for the past 40 years (Rosenbloom 2004). 1

Fertility in every developed nation has fallen beneath the replacement rate of 2.1 (Center for Strategic and International Studies and Watson Wyatt Worldwide 2000). While the number of older people is increasing, the population composing the work- force (aged 15 to 64) is diminishing in all developed nations (Center for Strategic and International Studies and Watson Wyatt Worldwide 2000). By the early 2020s, there- fore, far fewer taxpayers and caregivers will be supporting each retired person. Demographers refer to this phenomenon of increased longevity as the “squaring of the pyramid” (see Figure 1). Historically, population age groups were largest at the bottom (the youngest cohorts) and gradually grew smaller at the top (the oldest cohorts). Currently, the population graphic can more nearly be characterized as a square rather than a pyramid because of the rapid growth in the proportion of the pop- ulation over 65, and such a characterization will be even more apt in the future. Thus, in addition to growth in the sheer number of older people, there is an evolving and significant shift in the age composition of the total population (Rosenbloom 2004). Concerns related to the transportation of older individuals in the coming years are not new. The authors of Special Report 218 recognized that mobility is essential to the quality of life and that most older adults equate mobility with the ability to drive. Not only is the number of older drivers increasing, but today they are driving more miles. Their exposure to vehicle crashes in general and to fatal crashes in particular is thus increased. While older drivers are involved in fewer crashes per capita or per licensed driver, they are overrepresented in crashes and fatalities per mile driven and are more likely to be killed or injured as a result of collision than are drivers in most other age groups (Evans 1988; McCoy et al. 1989; Williams and Carsten 1989; Hu et al. 2000). For injured victims who are hospitalized and recover, the length of hospital stay is extend- ed with increasing age (Sartorelli et al. 1999). The elderly who sustain traffic injuries represent a costly problem in terms of both acute health care costs and the need for continued care. As the elderly proportion of the United States population increases, the burden of motor vehicle collisions in the elderly is also likely to increase. Several trends indicate that the older drivers of today may be different from the older drivers of yesterday. The following are among the important characteristics of the cur- rent generation of older Americans that differentiate them from previous generations: • They are wealthier. Persons 65 or older currently represent approximately 20 per- cent of the population, but they control more than 40 percent of all disposable income. Older adults in the United States have about $1.6 trillion in buying power, and their resources are expected to increase by 29 percent over the next 5 years (Coughlin 2002). • They are leading healthier, longer lives. More than 80 percent of higher-income older adults report good to excellent health, and the nation has experienced a decrease SAFE MOBILITY FOR OLDER AMERICANS 2

INTRODUCTION 3 FIGURE 1 Squaring of the U.S. population pyramids, 1960–2020. (Source: U.S. Census Bureau, International Data Base.) 85+ 80–84 75–79 70–74 65–69 60–64 55–59 50–54 45–49 40–44 35–39 30–34 25–29 20-24 15–19 10–14 5–9 0–4 85+ 80–84 75–79 70–74 65–69 60–64 55–59 50–54 45–49 40–44 35–39 30–34 25–29 20-24 15–19 10–14 5–9 0–4 85+ 80–84 75–79 70–74 65–69 60–64 55–59 50–54 45–49 40–44 35–39 30–34 25–29 20-24 15–19 10–14 5–9 0–4 16 14 12 10 8 6 4 2 0 0 2 4 6 8 10 12 14 16 16 14 12 10 8 6 4 2 0 0 2 4 6 8 10 12 14 16 16 14 12 10 8 6 4 2 0 0 2 4 6 8 10 12 14 16 Population (in millions) Population (in millions) Population (in millions) MALE FEMALE MALE FEMALE MALE FEMALE 1960 1990 2020

in disability for all income groups (Coughlin 2002). Since people are expected to live much longer, it also might be expected that at some point many of them will suffer disabilities that affect their ability to drive safely. However, whether there will be an actual increase in disability prevalence is debatable. • They are more highly educated and technologically savvy. The number of older adults with 4 or more years of college has doubled in the past 20 years. The fastest- growing segment of computer/web users is 50 years of age or older (Coughlin 2002). • They prefer “aging in place” and are likely to remain in whatever housing arrangement they occupy prior to retirement for as long as possible (Rosenbloom 2004). Compared with previous generations, today’s older adults enjoy better health care. They consider themselves to be relatively healthy, are actively engaged in the lives of their families and communities, and are currently meeting their own mobility needs. These trends are likely to continue among individuals over the age of 65. However, the impact of increased longevity on the eventual incidence of disability is not clear. As the elderly reach their 80s and beyond, the rates of disability that are being effec- tively lowered among the young-old may once again begin to rise, with the shift occurring at increasingly advanced ages because of health care improvements. If so, disabilities with a direct impact on mobility in general and driving in particular will present continuing challenges to all who have a stake in transportation safety. Because mobility is such a critical component of independence and quality of life in later years, and because the cost of providing alternative transportation is so high in the United States, it will continue to be important for older persons to retain access to the private automobile for as long as possible. Trilling and Eberhard (2004) indicate in their vision for the future a desirable system for safe mobility for older persons. They describe it as follows: The transportation system offers safe mobility to all people and allows older adults to remain independent and to age in place. Investments in highway and pedestrian infra- structure and public transportation services support independence. Medical and social service communities, transportation managers, motor vehicle administrators, and care- givers work together to enable safe driving as late in life as possible and to offer other convenient transportation options when driving and walking must be curtailed. Public and private organizations form new partnerships to enable all citizens to enjoy safe mobility for life. REFERENCES Blackman, D. K., L. A. Kamimoto, and S. M. Smith. 1999. Overview: Surveillance for Selected Public Health Indicators Affecting Older Adults—United States. Morbidity and Mortality Weekly Report, Centers for Disease Control and SAFE MOBILITY FOR OLDER AMERICANS 4

Prevention, U.S. Department of Health and Human Services, Atlanta, Ga., 48(SS- 8), pp. 1–6. Center for Strategic and International Studies and Watson Wyatt Worldwide. 2000. Global Aging: The Challenge of a New Millennium. Catalog W315. www.csis.org. Coughlin, J. F. 2002. How Will We Get There from Here? Strategies to Keep an Older America Moving. Presented at the National Conference on Aging and Mobility, Scottsdale, Ariz., March 25. Evans, L. 1988. Older Driver Involvement in Fatal and Severe Traffic Crashes. Journal of Gerontology, Vol. 43, pp. S186–S193. Hu, P. S., D. W. Jones, T. Reuscher, R. S. Schmoyer, Jr., and L. F. Fruett. 2000. Projecting Fatalities in Crashes Involving Older Drivers, 2000–2025. ORNL-6963. Oak Ridge National Laboratories, Oak Ridge, Tenn. www- cta.ornl.gov/cta/Publications/pdf/ORNL-6963.pdf. McCoy, G. F., R. A. Johnston, and R. B. Duthie. 1989. Injury to the Elderly in Road Traffic Accidents. Journal of Trauma, Vol. 29, No. 4, pp. 494–497. Pastor, P. N., D. M. Makuc, C. Reuben, and H. Xia. 2002. Chartbook on Trends in the Health of Americans. Health, United States, 2002. National Center for Health Statistics, Hyattsville, Md. Rosenbloom, S. 2004. Mobility of the Elderly: Good News and Bad News. In Conference Proceedings 27: Transportation in an Aging Society: A Decade of Experience, Transportation Research Board of the National Academies, Washington, D.C., pp. 3–21. Sartorelli, K. H., F. B. Rogers, T. M. Osler, S. R. Shackford, M. Cohen, and D. W. Vane. 1999. Financial Aspects of Providing Trauma Care at the Extremes of Life. Journal of Trauma, Vol. 46, No. 3, pp. 483–487. Trilling, D., and J. Eberhard. 2004. Safe Mobility for a Maturing Society: A National Agenda. In Conference Proceedings 27: Transportation in an Aging Society: A Decade of Experience, Transportation Research Board of the National Academies, Washington, D.C., pp. 313–318. U.S. Department of Transportation. 2003. Safe Mobility for a Maturing Society: Challenges and Opportunities. Nov. Williams, A. F., and O. Carsten. 1989. Driver Age Versus Crash Involvement. American Journal of Public Health, Vol. 79, No. 3, pp. 326–327. INTRODUCTION 5