The Influence of Transportation and Access on the Well-Being of Older Adults William A. Satariano, Ph.D., MPH School of Public Health University of California, Berkeley

Purpose To review research on the association of transportation on patterns of health and functioning in older populations. To review research on the association of transportation on patterns of health and functioning in older populations. To consider the implications of that research for policy. To consider the implications of that research for policy. To suggest new directions for research and practice in this area. To suggest new directions for research and practice in this area.

Background The population is aging. The population is aging. This has important implications for the incidence and prevalence of health and disability and associated social and economic costs. This has important implications for the incidence and prevalence of health and disability and associated social and economic costs.

Aging of the U.S. Population, Percent of the U.S. Population aged 65 and older by year Percent of the U.S. Population aged 65 and older by year     

Aging, Health, and Disability Chronological age is associated with an increase in health conditions and disabilities. Chronological age is associated with an increase in health conditions and disabilities. There is considerable variation, however, in health and disability among older people of the same. There is considerable variation, however, in health and disability among older people of the same. Some older people do well; others do not. Some older people do well; others do not.

Aging, Health, and Disability Why are some older people able to do well and maintain their health and quality of life, while others are not? Why are some older people able to do well and maintain their health and quality of life, while others are not? That question is the basis for most research in the fields of epidemiology and public health. That question is the basis for most research in the fields of epidemiology and public health.

Health Outcomes Longevity Longevity Diagnosed conditions Diagnosed conditions Functioning Functioning

Functioning The relative ease in the performance of tasks associated with everyday life. The relative ease in the performance of tasks associated with everyday life. Everyday functioning can range from simple generic tasks, such as lifting and reaching, to more complicated tasks, such as running errands and driving a car. Everyday functioning can range from simple generic tasks, such as lifting and reaching, to more complicated tasks, such as running errands and driving a car.

Ecological Model Ecological model is being used increasingly in public health and epidemiology to better understand the age-related patterns of health and functioning. Ecological model is being used increasingly in public health and epidemiology to better understand the age-related patterns of health and functioning.

Ecological Model Patterns of health and well-being are affected by a dynamic interplay of biological, behavioral, social, and environmental factors, an interaction that unfolds over the life course of individuals, families, neighborhoods, and communities. Patterns of health and well-being are affected by a dynamic interplay of biological, behavioral, social, and environmental factors, an interaction that unfolds over the life course of individuals, families, neighborhoods, and communities.

Mobility and Transportation in Older Populations Mobility and transportation are associated with positive and negative health outcomes. Mobility and transportation are associated with positive and negative health outcomes. Necessary to develop a comprehensive research agenda to a full range of health and functional outcomes. Necessary to develop a comprehensive research agenda to a full range of health and functional outcomes.

The Significance of Mobility and Transportation Mobility and transportation are included in assessments of functioning. Mobility and transportation are included in assessments of functioning. Physical activity (defined here as a type of mobility) is associated with a variety of health and functional outcomes. Physical activity (defined here as a type of mobility) is associated with a variety of health and functional outcomes. Mobility and transportation associated with access to goods, services, and recreation. Mobility and transportation associated with access to goods, services, and recreation. Mobility and transportation associated with contact with friends and relatives. Mobility and transportation associated with contact with friends and relatives.

Mobility and Transportation Activities of Daily Living (ADL) Activities of Daily Living (ADL)  Walking across a room  Moving from a bed to a chair Instrumental Activities of Daily Living (IADL) Instrumental Activities of Daily Living (IADL)  Getting to places beyond walking distance  Grocery shopping Physical Functioning Physical Functioning  Walking upstairs  Walking a quarter of a mile

Mobility and Transportation Physical Performance Physical Performance  Walking speed

Physical Activity, Health, and Functioning Physical activity is associated with a reduced risk of cardiovascular disease and selected forms of cancer. Physical activity is associated with a reduced risk of cardiovascular disease and selected forms of cancer. Physical activity is associated with longevity and increased survival following diagnosis and treatment for leading conditions. Physical activity is associated with longevity and increased survival following diagnosis and treatment for leading conditions. Physical activity is associated with maintenance of physical and cognitive functioning. Physical activity is associated with maintenance of physical and cognitive functioning.

Mobility, Transportation, Goods and Services Mobility and transportation associated with… Mobility and transportation associated with…  Food stores (nutritional status)  Recreation and leisure-time activities  Health and social services  Evacuation and public safety

Transportation Needs of Older Populations Rosenbloom S. Transportation needs of the elderly population. Clinics in Geriatric Medicine. 1993;9: Rosenbloom S. Transportation needs of the elderly population. Clinics in Geriatric Medicine. 1993;9:  “All evidence suggests that the elderly population of today and tomorrow will continue to depend on the private car to give them freedom.”  “When they can no longer drive and receive rides, their mobility will drop and they may have to make drastic changes in their whole life network..”

Perceived Barriers to Health Care Perceived reasons for not receiving care Perceived reasons for not receiving care ( National interview of adults 65+yrs, n = 46,659)  Cost27%  Too long a wait20%  Transportation 9%  Office hrs 8% _____ _____ Okoro CA et al. Access to health care among older adults and receipt of preventive services. Results from the Behavioral Risk Factor Surveillance System, Preventive Medicine 2005;40:

Mobility, Transportation, and Social Networks Mobility and transportation associated with… Mobility and transportation associated with…  Contact with friends and relatives  Receipt and provision of social support

Mobility, Transportation, Crashes, Injuries, and Pollution Mobility and transportation are associated with… Mobility and transportation are associated with…  Crashes  Driver, passenger, and pedestrian injuries, disabilities, and death.  Environmental pollutants (noise, water, and air pollution).  Environmental sprawl

Benefits and Costs It is necessary to establish a balanced research agenda that addresses the full range of health outcomes associated with mobility and transportation in older populations. It is necessary to establish a balanced research agenda that addresses the full range of health outcomes associated with mobility and transportation in older populations.

A Research Agenda Examine the range of transportation options used by older people. Examine the range of transportation options used by older people.  Conduct a “health impact assessment” of mobility and transportation options.  Assess how the range of options varies by demographic, socioeconomic, environmental, psychosocial, health, and functional factors.  Assess how transportation options vary over time. What is the “natural history” of transportation in older populations?

A Research Agenda Special attention should be given to the private automobile. Special attention should be given to the private automobile.  Leading form of transportation.  Driving involves a full range of integrated functions.  Driving is associated with positive and negative health outcomes.  Driving cessation is associated with positive and negative health outcomes.

A Research Agenda Translation of research into practice and policy Translation of research into practice and policy  Enhancement of individual capacity  Enhancement of technological capacity, e.g., automobile design.  Modification of environmental demands.