1. PPA 419 – Aging Services Administration Lecture 10a – Aging and Mobility

2. Source Sterns, H. L., Burkhardt, J. E., & Eberhard, J. W. (2003). Moving along the mobility continuum: Past, present, and future. Generations, 27 (Summer), 8-13.

3. Introduction “Mobility” refers to the quality of “being mobile, movable, or moving readily.” For older people, personal physical mobility is influenced to a considerable extent by age-related changes that in combination affect muscle strength, posture, balance, and joints.

4. Introduction The private automobile remains the main source of transportation in our society – the primary way people gain access to services and maintain social relationships. Continuing to drive is a major factor in avoiding social isolation and maintaining full participation in community life. With age, changes in abilities and skills related to driving may require the individual to modify driving behavior or cease driving.

5. Introduction At age 80-plus, the proportion of older adults whose usual means of transportation is their own car falls below 50 percent. Yet, changes in individual physical mobility often make it more difficult to use mass transportation systems unless the system makes special modifications.

6. Introduction Changes in mobility can lead to loss of quality of life for older people. In 1971, approximately 46 percent of heads of household age 65 and older had no car. Today, people are keeping their cars longer. Even frail older adults are driving more and more.

7. Introduction A major concern now is how to enable people to drive as late in life as possible, as long as they do so safely, and to get them to stop driving when it is no longer safe. The challenge is to facilitate the transition from driving to the next phase, driving and using transportation services, to the next phase, not driving but using transportation services.

8. Introduction Clearly, then, any consideration of transportation of older people clearly must go beyond issues about driving. However, the primacy of the personal automobile in the United States is one of the greatest barriers to development, or even discussion, of a workable system, and this situation shows few signs of changing.

9. Introduction What is required is that people of all ages be made aware of the importance of developing and supporting a range of transportation services in our communities, and they must be made aware of the range of service options that are available.

10. Introduction Licensing agencies, safety forces, physicians, service providers, and families all play a role in a complex process. The primary concern is to provide information on individual differences in ability and offer interventions and solutions that give older adults choices that maintain their mobility in the community.

11. Self-Management and Choices The individual needs to be in charge, in control, and able to select adaptive options. An important continuing area of research will focus on the ability of older people to plan and manage their own retirement.

12. Self-Management and Choices An important aspect of such planning for later life is consideration of mobility: How will I get around when I am older and my capabilities have changed? Successful planning for later life means making choices that will allow the person to live in the style that he or she chooses.

13. Self-Management and Choices For many people, maintaining driving skills is clearly important. Even more important is making sure that if they can no longer drive, they live in a location that provides transportation services.

14. Mobility and Safety Older adults need to continue to live and work as they always have. It should be remembered, however, that age-related changes and declines in health caused by disease may alter the performance level of critical skills, making older adults less able to meet task demands and thus subject to an increased risk of injury.

15. Mobility and Safety The term “safety” may be defined as the state of being free from danger or injury, or the use of various methods and devices to reduce, control, or prevent accidents. –Descriptions of danger more likely to be precise than descriptions of safety. In carrying out their daily activities, individuals are exposed to a number of risks.

16. Mobility and Safety Their level of skills, their exercise of those skills, and the resulting level of safety are variables in a complex cost-benefit equation. People make judgments regarding activities to determine whether the risk of injury is sufficient to be a deterrent.

17. Mobility and Safety Since some older adults may not be aware of their changing levels of skill, they may be unrealistic in their judgments. If necessary, the individual may need to be counseled to stop an activity, such as driving.

18. Maintaining Personal Mobility Trips out of the home are increasing dramatically. Most of these trips by older people are now made in private autos. Today’s older adults use public transit for about 3 percent of their trips. Many older adults now live in communities that are highly auto-oriented, and many more will do so in the future.

19. Maintaining Personal Mobility In the future, older adults will expect to be able to make more and different types of trips that are not currently available because of various limitations. People will expect high levels of consumer choice and flexibility. It is clear that we are not ready to meet the forecasted changes.

20. Maintaining Personal Mobility Focus-group research indicates that older adults are most concerned about: –The reliability of public transit. –Inability to wait outside for extended periods. –On-time arrivals. –Door-to-door service. –Flexible service that responds to the needs of the trip. –Comfortable vehicles and waiting areas. –Access on less than 24-hours notice. –Travel more hours per day and days per week than the typical system offers. –As consumers, they want control, autonomy, and choice. Our understanding comes at a time when there is a lack of funding, lack of interest, and reluctance to begin change.

21. Perspectives on Transportation Modes: Independence-Dependence At every level of capability, older adults desire to maintain independence, decision-making and choice. Traditionally, transportation choices have been studied in the framework of a transit- centered continuum, which emphasizes the modes of transportation.

22. Perspectives on Transportation Modes: Independence-Dependence

23. This bipolar continuum begins with drivers of a private vehicle, considered to be most desirable because it provides the greatest independence, and ends with a public fixed-route bus or train, considered to be the least independent. The model ignores the capabilities necessary to use public transportation and ignores multiple mode users.

24. Perspectives on Transportation Modes: Independence-Dependence Better model uses bipolar scales of independence and dependence for separate modes of transportation. This model recognizes individual capabilities and multiple modes.

25. Perspectives on Transportation Modes: Independence-Dependence

26. The market-centered continuum emphasizes the individual user’s independence of choice and action in using various modes of transportation and the complexity involved in making choices on which modes to use.

27. Perspectives on Transportation Modes: Independence-Dependence Research indicates that older adults do not rely on single mode of transportation for all trips. They tend to choose a variety of modes for specific trips, depending on their capability for making a particular trip and mode availability.

28. Perspectives on Transportation Modes: Independence-Dependence Older adults prefer the independence afforded by fixed routes and demand- responsive public transportation to the dependence on family or friends for a ride.

29. Conclusions The importance of mobility through transportation options is central to the concept of independence. The best option is to draw on the formal system, but also have the informal system available.

30. Adaptive Strategies for Maintaining Mobility Drive regularly to maintain skills. Be aware of cost of car ownership, depreciation, insurance, and repair. Consider alternative approaches: driver, taxi, private transportation service, and public transportation service. Develop skills to be able to use mainline, route deviation, and when necessary, door-to-door transportation service.

31. Adaptive Strategies for Maintaining Mobility Make use of public transportation when driving is too demanding (for example, for long distances, in heavy traffic congestion, at night). Help others with shopping, physician and dentist visits, attending religious services, for example, creating a mutual support network.

32. Adaptive Strategies for Maintaining Mobility Choose a house, apartment, or other abode that is close to shopping, services, hospital, well-lit streets with low congestion to allow driving for as long as possible. Choose a home on or proximate to mainline transportation or where route deviation and door-to-door services are available.

33. Adaptive Strategies for Maintaining Mobility Choose a home with layout that is conducive to independent living by frail elders. Modify home to support frail elders. Engage in physical and mental activity, health promotion, strength training. Maintain regular contact with neighbors and friends.

34. Adaptive Strategies for Maintaining Mobility Maintain contact with family who are in the immediate area and who live at a distance who can serve as an advocate or supporter. Engage in educational, recreational, and volunteer activities. Locate and introduce yourself to a social service agency that can provide homemaker and home health aid services, if needed.