January 1997, DOT-P10-97-01
BACKGROUND
The older adult population (defined here as those over 65) increased
in the United States eleven-fold during this century compared to a threefold
increase for those under 65. We are all aware that Americans are living longer
and many of us can look forward to an extended period of health and activity
beyond age 80. The older adult group, which numbered 33.5 million in 1995, or
12.8 percent of the population, will grow to 36.2 million by 2005. By the year
2020 it will be 53.2 million, or 16.5 percent of the population. This population
aging will impact all aspects of our society and represents a unique challenge
to the community of transportation officials. The actions we can take now to
prepare for this change will have a profound effect on the lives of future older
Americans.
The Department of Transportation (DOT) has for years been extensively
engaged in work to support the safety and mobility needs of older adults. The
National Highway Traffic Safety Administration (NHTSA) has had an older driver
program since 1988. The Federal Highway Administration (FHWA) embarked on a
major program in 1989 for improving highway travel for an aging population.
Federal Transit Administration (FTA) grant programs for older adults and persons
with disabilities for rural transportation, and for paratransit, all provide
benefits to older adults. Additional details on these programs are found below
and in Appendix A
of this report.
In December 1995, Secretary Peņa directed the Department to develop a
long range overview, and draw up a preliminary, proactive strategy to determine
the actions needed to accommodate the growing cohort of older adults who will be
transportation providers and consumers in the 21st century. This overview was to
encompass the perspective of older adults in all modes, operating commercially
and privately. A full report on the issues analyzed, and some of the
recommendations of the five expert panels that were convened follows. Specific
recommendations, relative priorities, and budget estimates that would be part of
a definitive long term strategic plan are the next step. The following
elaborates on issues of safety and mobility, and then describes a number of
components that would be integral to formulating such a plan.
SAFETY
The aging process affects individuals in many ways, resulting in a
broad range of capabilities and extensive differences among older adults. The
increased incidence of disease and decline in capabilities, that are part of the
normal aging process, gradually impair the cognitive, sensory, or psychomotor
capabilities needed for the operation of all transportation vehicles. Some
diseases, such as strokes, cause sudden impairments. Generally, however, there
is a slow decline of capabilities, at rates that vary widely among individuals.
Most people, as their capacities diminish, withdraw gradually and responsibly
from operating vehicles. Consequently, there is not at present a sufficient
number of crashes associated with older users and operators to define a serious
safety problem, although the changing demographics could lead to serious
problems in the decades ahead.
Automobile Drivers - The perception of an older driver safety
problem comes about when the crash and fatality rates per mile driven are
examined. The fatality rate per 100 million vehicle miles traveled stays
reasonably level for drivers up to age 75, and then begins to rise, climbing
steeply for persons over 80.(1)
The much higher fatality rate for those over 80 is partly attributable to their
greater fragility, compared with younger persons.
By 2020 there will be an additional 20 million more older adults in
the population. Of particular concern are those aged 75 and above, and applying
today's fatality rates to that group indicates that for them, traffic deaths
could increase 45 percent (and possibly higher based on other trends), unless
the efforts of the safety community can dramatically lower their crash rate or
increase their crash protection.
Pedestrians - The safety of older pedestrians presents a
significant challenge to the Department. Pedestrians aged 70 and over
represented almost 9 percent of the population, but accounted for 19 percent of
all pedestrian fatalities in 1994. The fatality rate for this group was higher
than for any other age group -- 4.36 per 100,000 (vs. 2.1 for the overall
population).
Commercial Operators - Older operators of trucks, buses,
general aviation airplanes or ships do not appear to present a significant
safety problem at this time. Typically, they maintain their performance levels
by using their experience, automation of some activities, streamlining of tasks,
and accommodation. The vast majority of older commercial operators retire
responsibly, before medical conditions or diminishing capacities become an
issue.
SAFE MOBILITY, FOR LIFE
One vibrant force in this country is its high degree of personal
mobility. Most of us are conditioned to go where we please, how we please, on
our own schedule. This is part and parcel of the quality of American life. We
now have more cars than licensed drivers, more than 11.4 million documented
watercraft, and 170,000 airplanes, all for personal mobility (necessity or
recreation) in one form or another.
Except for persons living in our largest cities, and those with low
incomes, the primary constraint on full mobility in the personal lives of most
Americans comes with the erosion of the capacities necessary for the safe
operation of a vehicle. There comes a time for most older adults when a
difficult adjustment must be made, to find alternative means to get to such
necessary destinations as grocery stores, medical appointments, places of
worship, family, and social engagements. If safe, affordable mobility
alternatives are not available, as can often be the case for those who retire to
or live in rural areas or the outlying suburbs, the quality of life is clearly
diminished.
It is in the national interest to keep people operating their
personal vehicles as late in years as possible for quality of life reasons; yet
we do not want that operation to unnecessarily endanger the individual or the
public. It is also in the public interest to maintain the productivity and value
added to our national economy of those older adults who operate vehicles
commercially, as long as it is safe, yet we must recognize that more stringent
screening and evaluating measures have been required to account for the higher
public risks presented by those operating commercial vehicles.
These three policy objectives: safety, individual personal mobility, and facilitating the eventual transition to mobility alternatives define a strategic planning goal for the Nation's transportation system, Safe Mobility, For Life. This would be achieved through new extensions of the department's research, and improved coordination of funds and programs already available at the state and community level. The following precepts would characterize this goal:
1.) keep people operating cars as late in life as possible, as long as they can do so safely;
2.) promote technology and training that support those with functional or cognitive deficits so they can continue to operate vehicles safely;
3.) improve screening and evaluation techniques to detect when people should no longer be operating;
4.) bring new emphasis to the provision of non-driving alternatives for older adult transportation needs; and
5.) educate the public on how to maintain safety and what to prepare for in older age.
A proposed series of Departmental initiatives that could contribute
to this goal are outlined below. They must be added to a selected set of ongoing
programs, that should continue to receive enhanced priority.
RECOMMENDED NEW INITIATIVES
The following initiatives are needed to assure that the whole spectrum of concerns for older adults are comprehensively addressed.
Added Emphasis on Mobility Alternatives for Older Adults - Mobility for older adults should be integrated into planning at all levels: individual, community, state and Federal. At the community level, metropolitan planning organizations (MPO) and state planning agencies should consider the special needs of older adults. The following actions are proposed:
- Inventory best planning practices to assure mobility alternatives for older adults.
- Evaluate the most effective mobility services and systems, and provide the means to stimulate their replication.
- Better coordinate Departmental and other Federal efforts by upgrading the DOT/HHS Coordinating Council on Human Services Transportation.
- Increase the focus of the FTA Technical Assistance program to improve mobility alternatives for older adults.
- Use the ISTEA reauthorization process to assure planning for the mobility of older adults.
- Enlarge powers for DOT and HHS Secretaries to grant waivers and exceptions for funding community providers, where they would lead to more cost effective transportation service and higher system use rates.
Countermeasures for Fragility of Older Adults - Place new emphasis on research to develop countermeasures to compensate for the fragility of older adults, recognizing the growing level of older adult injuries and fatalities expected over the next 25 years.
Develop Medical Practice Parameters and Guidelines - Develop a set of guidelines and training modules for use by physicians and health care professionals as an authoritative source when conducting evaluations required for commercial licensure, as well as personal licenses in instances where medical examinations are required.
Policy Studies - Initiate selected studies to support public
policy decisions, covering such areas as Security in Transportation, Linkage of
Mobility to Health Care Costs, Influence of Mobility Alternatives on Driver
Cessation, and research to improve our understanding of the effects of certain
medical conditions, functional disabilities, and behavioral limitations on
operator performance and crash involvement.
CURRENT PROGRAMS RECOMMENDED FOR ENHANCED PRIORITY
The Department has had effective, even exemplary, programs underway for many years designed to accommodate and support the increasing number of older adults expected within the system. Some of those which merit continued high priority are:
Improving Highway Travel For an Aging Population - To be ready well in advance for the coming influx of older drivers, FHWA established a high priority research program in 1989 dedicated to improving travel for an aging population. While research continues, much useful information is now available and the results will be compiled soon into a Preliminary Older Driver and Highway Safety Handbook for distribution to highway engineers and community planners.
Improving Our Identification and Evaluation Systems - Today most problem drivers are identified somewhat haphazardly and belatedly by their crash experience, their traffic citations, reporting by physician, police or family, and their license renewal applications. NHTSA has under development improved identification techniques and new tests focusing on disabilities prevalent in older adults. It also has a research program underway designed to help the states determine who should and should not be driving. Built into the development is an extensive series of field tests to help ensure that older adults are not being discriminated against by the proposed measures.
Technology - Many performance-aiding technologies will become available over the next 10 to 20 years to enhance the safety and ease of operating vehicles, and thus directly support older operators. Development and introduction of these new technologies in all modes is being supported by DOT and other agencies, and also private organizations, many under the Intelligent Transportation Systems (ITS) program.
Some of the emerging technologies which hold the greatest promise for
improving the safety and mobility of older users are: Collision
Warning/Avoidance Systems (detection of objects and people in the path of the
vehicle); In-Vehicle Signing (providing advance notice in the vehicle of
caution, speed change, and contour signs that will shortly be encountered);
Incident Identification and Location Systems (Mayday rescue systems that
automatically alert authorities of the location of a vehicle experiencing
emergencies); Rural Public Transportation Information Systems (customer paging
systems, combined with vehicle location and tracking systems, to provide
real-time, demand-responsive services); and various simulator applications (to
assist in screening, evaluation, and training older adults to use new
technologies, as well as to assist in establishing test requirements or
developing new driving aids).
CONCLUSIONS
Secretary Peņa, concerned about the quality of life of the growing
older population, initiated a comprehensive, forward looking overview of what
improvements must be made to accommodate the changing demographic demands on the
Nation's transportation system. These demographics will find us with a large
population of older operators, who are more widely dispersed, and more
accustomed to full mobility. Safety problems for older adults are anticipated in
some areas and warrant continued attention. The effectiveness and productivity
of our testing, evaluation and rehabilitation programs need to be improved.
Countermeasures need to be developed to deal with the fragility and higher
fatality rate of older adults. New forms of mobility alternatives need to be
developed and tested. This will be an ongoing process, requiring continuous
monitoring and innovative policy making. How the Department meets this challenge
can have far ranging impacts on the quality of life for today's older adults and
ultimately all of us.
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