Travel Patterns of Older Americans with Disabilities

Meg Sweeney

Abstract

There are currently about 35 million adults aged 65 and older in the U.S. and this number is projected to double by 2030 (U.S. Census Bureau). Medical and health impairments associated with this population raise concern about the impaired person’s ability to drive and remain mobile. This report uses data from the Bureau of Transportation Statistics Transportation Availability and Use Survey (2002) to examine travel patterns of older U.S. residents with disabilities and compares these patterns to those of older residents without disabilities as well as to younger people with disabilities. Findings indicate that elderly persons with disabilities remain mobile. There is a heavy reliance on the use of the private motor vehicle (PMV) for both local and long distance travel. Although many of the elderly persons without disabilities are driving, many of the elderly with disabilities are riding as passengers in PMVs.

KEYWORDS: aged drivers, handicapped drivers, travel patterns, statistical analysis, travel surveys, aged, older Americans

Currently, there are about 35 million adults aged 65 and older in the U.S. (about 13 percent of the population) and this number is projected to double by 2030 (U.S. Census Bureau). Accordingly, there will be an increased number of drivers aged 65 and older as well as an increased number of people needing and using the transportation system. In 2001, there were an estimated 27.5 million licensed drivers in the U.S. age 65 and older; 4.7 million more than in 1991 (see Figure 1) (Federal Highway Administration). On a daily basis, adults aged 65 and older make 3.4 trips (U.S. Department of Transportation, Bureau of Transportation Statistics [US DOT, BTS], 2003a). Foley, Guralnik, Brock, and Heimovitz (2002) report that drivers aged 70 to74 could expect to drive for another 11 years.

However, as people age, there is an increased likelihood of medical or health impairment. The U.S. Census 2000 shows that almost 42 percent of those aged 65 and older have a disability compared to 19 percent of those aged 16 to 64.¹ Specifically, 4.7 million people 65 years and older report a sensory disability, 9.5 million report a physical disability, 3.6 report a mental disability, 3.2 report a self-care disability and 6.8 report a disability that prevents them from going outside the home (a person may report more than one type of disability).

The potential of incurring a disability is a concern because these impairments can affect driving ability (See Wang, Kosinski, Schwartzberg, and Shanklin, 2003 for summary information). For example, age and disease-related changes of the eye and brain may affect visual acuity, visual field, and night vision. Some, such as night vision may be treated medically or behaviorally by avoiding nighttime or low visibility driving. Musculoskeletal disabilities can compromise motor strength and range of motion and in some cases may be countered with rehabilitative therapy, medical treatment, or adaptive automobile devices.

Nevertheless, medical and health impairments associated with aging and disabilities raise concern about the impaired person’s ability to drive and eventually his or her ability to remain mobile. In 2003 the Bureau of Transportation Statistics (US DOT, BTS 2003b) reported that almost 4 percent of persons with disabilities (an estimated 1.9 million) are homebound and their average age was 66 years. This report uses data from the BTS Transportation Availability and Use Survey (2002) to examine travel patterns of older U.S residents with disabilities and compares these patterns to those of older residents without disabilities as well as to younger people with disabilities.

Method

Data Source. The data used in this report are from the Bureau of Transportation Statistics’ Transportation Availability and Use Survey. This survey collected information about transportation use by persons with physical, mental, or emotional disabilities. In order to ensure full access to the interview by all respondents, the extended questionnaire was available by computer-assisted telephone interviewing (CATI), by mail, and by internet. Interviews began on July 12, 2002 and closed on September 29, 2002. Of the 5,019 interviews completed, 2,321 were with disabled people (self identified through the Census 2000, Americans with Disabilities Act (ADA) or special education questions) and 2,698 with nondisabled people. Survey weights were developed to reduce bias introduced by nonresponse cases, unknown residential status, nontelephone households, multiple telephone line households, and subsampling for disability status. Additional information on the weighting and variance estimation procedures is available as part of the survey documentation (US DOT, BTS 2003c).

Definition of Disability. Survey respondents were asked to self-identify disability according to several definitions including the Census 2000 definition (see Table 1), the ADA definition which considers disability as a physical or mental impairment that substantially limits one or more of the major life activities, and a definition that addresses whether a child in the household received “special education services”. In this report, the Census definition is used to define disability status because it allows for comparibility with US Census results.

Age categories. Persons of any age (including children) were eligible to respond to the survey. Proxy interviews with knowledgeable respondents were required for people under the age of 16 years as well as for those who were unable to complete the interviews for themselves due to the severity of their impairments.

In this report, three broad categories of age are defined: < 25 years, 25-64 years, and 65 years and older (referred to as older or elder in this report).

Procedures. Weighted data were used for analyses. Weighted percents and standard errors were calculated using SUDAAN. SUDAAN was designed to analyze data from complex sample surveys and other observational and experimental studies involving repeated measures and cluster-correlated data. Jacknife replication was used for variance estimation of parameters. Independent significance tests (p< .05) comparing the elderly disabled with the elderly nondisabled, the disabled aged 25-64 and the disabled < 25 years. All comparisons cited in the results section are significant and reflect differences based on weighted percentages or weighted means, not estimated numbers. Tables containing weighted percentages and standard errors are contained in Appendix A.

Results

General Information On average, elderly disabled leave home less often (4.0 days per week) than the younger disabled (5.1 days for those aged 25-64 and 5.6 days per week for those < 25) and the elderly nondisabled (5.6 days per week) (Table A1). While the proportion of elderly disabled making frequent trips from the home per week is not as great as for their nondisabled counterparts (44 percent left the house 5-7 days per week compared to 74 percent), this level of activity still equates to about 6.0 million elderly disabled making trips outside their home almost daily. However, about 9 percent (about 1.2 million) of the elderly disabled never leave home (Table A2). As a group, one-quarter of the elderly disabled describe their disability as severe, however, of those that never leave home almost 60 percent report their disability as severe (Tables A3 and A4).

About 31.9 percent of the elderly disabled need specialized assistance or equipment to travel outside the home compared to 22.4 percent of the disabled aged 25-64 and 9.5 percent of the disabled less than 25 years old (Table A5). The most frequent types of assistance and equipment needed by the elderly disabled are (Table A6):

• Cane, crutches, or walker (57.1 %),
• Assistance from person while outside the home (38.7%),
• Manual wheelchair (26.5%), and
• Assistance from person while inside the home (19.3%).

About 12 percent of the disabled have difficulty getting the transportation (Table A5). Small sample sizes preclude statements about the elderly disabled, however, for the disabled, the most frequently cited problems with getting the needed transportation (Table A7) include no/limited transportation (33.5%), Not having a car (26.1%), disability makes transportation hard to use (16.9 %) and no one to depend on (11.7%).

Transportation used for local travel

Private Motor Vehicle Use. Approximately 60 percent (about 7.7 million) of the elderly disabled are currently driving (Table A8). Proportionately, fewer of the elderly disabled are driving than of the disabled aged 25-64 (71 percent) or the elderly nondisabled (90 percent).

When asked about the type of transportation used in the past month, regardless of age group or disability status, the private motor vehicle (PMV) was reported more than any other mode of transportation (Table A9). Shown in Figure 2, fewer of the elderly disabled drove a PMV (55.6 percent) than the disabled aged 25-64 (68.6 percent) and the elderly nondisabled (88.8 percent). However, 70.5 percent of the elderly disabled rode as a passenger in a PMV compared to 62.2 percent of the elderly nondisabled. Perhaps reflecting the finding that the disabled < 25 age group contains children not yet old enough to drive, fewer of the elderly disabled rode as a passenger in a PMV than the persons with disablities aged < 25 (89.6 percent).

PMVs are used most frequently by the elderly disabled to commute to work, the doctor, or for other local travel (see Figure 3). As is true for the elderly nondisabled and the younger disabled, more drove a PMV to work than rode as a passenger. Of the elderly disabled that work, 78 percent drove a PMV. (Tables A10 and A11). Although 54.2 percent of the elderly disabled drove going to the doctor, more rode as a passenger in a PMV (37.4 percent) than the disabled aged 25-64 (28.9 percent) and elderly nondisabled (11.6 percent) (Table A12). For other local travel such as for shopping and recreation, 53.6 percent of the elderly disabled drove a motor vehicle and 39.6 percent rode as passengers in a personal motor vehicle (Table A13). More of the disabled < 25 rode as a passenger in a PMV commuting to the doctor (65.7 percent), or other local travel (55.9 percent) than the elderly disabled, however, because this age group includes children less than driving age the high percentage is not unexpected.

Walking. Shown in Figure 4, about 37.7 percent of the elderly disabled walked in the month previous to the survey; fewer than the other disabled or nondisabled age groups (Table A9). Additionally, fewer of the elderly walkers reported problems experienced while walking (30.7 percent) than the disabled aged 25-64 (56.6 percent) (Table A14 and Table A15). The most frequently cited problems by the elderly disabled were potholes and cracks (6.1 percent) and insensitive/unaware drivers (5.1 percent) which were also cited by younger disabled and elderly nondisabled walkers frequently, however, results must be viewed with caution due to small sample size.

Other modes of transportation used for local travel. Few of the elderly disabled used modes of transportation other than the PMV (Table A9):

• Taxicab (8.2 percent)
• Paratransit (7.2 percent)
• Electric wheelchair (6.2 percent)
• Public bus (5.8 percent)
• Private or chartered bus (4.7 percent)

Fewer elderly persons with and without disabilities rode on public buses than their younger counterparts (see figure 5) and fewer elderly disabled used taxicabs (8.2 percent) than disabled persons aged 25-64 (12.4 percent).

Although problems encountered when using other modes of travel were covered in the survey, the number of respondents using those modes and experiencing problems was too small to provide reliable population estimates (Table A14).

Transportation used for long distance travel

Figure 6 shows that about 7.4 million of the elderly disabled (53.4 percent) reported traveling long distance (more than 100 miles one way) in the past year (Table A16). Both disabled and nondisabled elderly traveled less than those aged 25-64. The elderly disabled also traveled long distance less than elderly persons without disabilities.

The two primary modes of transportation used by the elderly disabled for long distance travel are PMVs and commercial airplanes (see Figure 7 and Table A17). More of the elderly nondisabled drove (67.1 percent) compared to 46.3 percent of the elderly disabled, however, more of the elderly disabled were PMV passengers (53.0 percent) compared to 39.4 percent of the elderly nondisabled). About three-quarters of those < 25 years with and without disabilities rode as passengers, again possibly reflecting the inclusion of children who are not old enough to be licensed to drive.

Approximately 30.1 percent of the elderly disabled that traveled long distance flew in a commercial airplane indicating roughly 2.2 million elderly persons with disabilities have made long distance trips by airplane in the past year. About half of the elderly disabled airplane passengers (49.8 percent) experienced problems at airports and 28.6 percent experienced problems on airplanes (Table A18). Although cautious of small cell size, the problems cited the most by elderly disabled airplane passengers include schedules not kept (10.8 percent), security procedures too restrictive (21.6 percent), and inadequate seating (17.9 percent). These problems were also cited by the elderly nondisabled and the younger disabled (Table A19 and Table A20).

Discussion

The results of this data analysis show that elderly persons with disabilities are mobile and get out of the house. Although some of the elderly with severe disabilities are not getting out of their home, more than 90 percent of the elderly disabled and 98 percent of the elderly nondisabled indicate they leave their home at least once a week. Additionally, more than half of the elderly disabled are traveling long distance.

The data indicate that the elderly, both disabled and nondisabled, continue to rely on the personal motor vehicle as a primary mode of transportation for both local and long distance travel. The results suggest that while many of the elderly persons without disabilities are driving, many of the elderly with disabilities are riding as passengers in PMVs. This was particularly apparent when the destination was the doctors. Only a small proportion of the elderly disabled use alternate modes of transportation such as paratransit or public buses, but about one-third walked.

Even though elderly persons with disabilities remain mobile, there appears to be some reliance on others given that fewer of the elderly disabled are currently driving and the higher proportion of elderly disabled are passengers as compared to the elderly without disabilities. Although this 2002 survey shows a small proportion of elderly disabled used paratransit services, (slightly more than 900,000) the continual increase in the number of people over the age 65 could lead to an increased need for paratransit services. These types of services might fill an important gap for the users who cannot drive or do not have a driver available yet want to and need to leave their home. The future need for such services should be explored.

Finally, this report considers the elderly disabled to be aged 65 and older which encompasses a large range of ages. Physical abilities, health and medical conditions vary considerably even within this age group (as well as from person to person). Sample size limitations prevented detailed analysis of the elderly age group. Additional research should focus specifically on the travel patterns of those older than 65 in finer detail.

References

Federal Highway Administration (1991-2001). Highway Statistics. http://www.fhwa.dot.gov/policy/ohpi/hss/hsspubs.htm. Accessed May, 2004.

Foley, D.J., Guralnik, J.M., Brock, B.B. and Heimovitz, H.K. (2002). Driving life expectancy of persons aged 70 years and older in the United States. American Journal of Public Health. 92(8). Pp. 1284-1290.

U.S. Census Bureau (2004). “U.S. interimprojections by age, sex, race and Hispanic origin. http://www.census.gov/ipc/www/usinterimproj. Accessed May, 2004.

U.S. Department of Transportation, Bureau of Transportation Statistics (2003a). NHTS 2001 highlights report, BTS03-05. Washington, DC.

U.S. Department of Transportation, Bureau of Transportation Statistics (2003b). Freedom to travel. BTS03-08. Washington, DC.

U.S. Department of Transportation, Bureau of Transportation Statistics (2003c). Transportation availability and use study for persons with disabilities, 2002. Washington, DC.

Wang, C.C., Kosinski, C.J., Schwartzberg, J.G., and Shanklin, A.V. (2003). Physician’s guide to assessing and counseling older drivers. Washington DC: National Highway Traffic Safety Administration.

Endnotes

¹ The Census 2000 has two items comprised of six elements that address disability: 16. Does this person have any of the following long-lasting conditions: a. Blindness, deafness, or a severe vision or hearing impairment? b. A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying? 17. Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities: a. Learning, remembering, or concentrating? b. Dressing, bathing, or getting around inside the home? c. (Answer if this person is 16 years old or over.) Going outside the home alone to shop or visit a doctor’s office? d. (Answer if this person is 16 years old or over.) Working at a job or business? Unless otherwise specified, questions 16 and 17 were asked of a sample of the population 5 years old and over.