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Ellen E. Freeman, PhD, Stephen J. Gange, PhD, Beatriz Muñoz, MSc and Sheila K. West, PhD

Ellen E. Freeman, Beatriz Muñoz, and Sheila K. West are with the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Md. Stephen J. Gange is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.

Correspondence: Requests for reprints should be sent to Sheila West, Dana Center for Preventive Ophthalmology, Room 129, Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21205 (e-mail: shwest{at}jhmi.edu).

Objectives. Given the importance of driving in American society, older non-drivers may be unable to meet basic needs while living independently. We assessed whether not driving is an independent risk factor for entering long-term care (LTC) institutions.

Methods. Data were used from 1593 older adults who participated in the Salisbury Eye Evaluation cohort study and completed an additional telephone survey. Questions on driving status and LTC entry were obtained by self/proxy report. Cox time-dependent regression procedures were used to adjust for demographic and health factors.

Results. Former and never drivers had higher hazards of LTC entry after adjustment for demographic and health variables (hazard ratio [HR]=4.85; 95% confidence interval [CI]=3.26, 7.21; and HR=3.53; 95% CI=1.89, 6.58, respectively). Also, having no other drivers in the house was an independent risk factor for LTC entry (HR=1.72; 95% CI=1.15, 2.57).

Discussion. Older adults are expected to make good decisions about when to stop driving, but the hardships imposed on older adults by not driving are not widely recognized. Innovative strategies to improve transportation options for older adults should be considered.

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