Original ArticleDriving strategies used by older adults with macular degeneration: assessing the risks
Introduction
Living with macular degeneration is a challenge often faced by older adults. Estimates suggest that 6% of persons aged 52 to 64 years and 41% of individuals aged 70 years and older are affected with some degree of this disease (Cheraskin, 1992, Weksler, 1998). Macular degeneration, the leading cause of blindness in older adults, is a chronic, progressive eye disease that robs individuals of their central vision and color vision and generally affects both eyes. Despite visual deficits, older adults diagnosed with macular degeneration generally seek to achieve a sense of normalcy in their lives. This is often accomplished by devising creative and innovative strategies for accomplishing the tasks of daily living (Moore, 1999).
One very important task of everyday life for many older adults is driving. Currently, approximately 26% of women older than 85 years have a driver's license or drive and 75% of men older than 85 years have a license, with 54% of those men driving (Eberhard, 1998). As the number of seniors increases, one estimate suggests that older drivers will increase from 10% to 20% of all drivers by the year 2030 (National Highway Traffic Safety Administration, 1999).
Considering the fact that driving is an important task that continues into older adulthood, it is not surprising that seniors living with macular degeneration would devise strategies to accomplish this important activity despite visual loss. Although some driving strategies may be safe, especially during the early stages of macular degeneration, as the disease progresses and the declines in function that accompany aging occur, some of these strategies may become increasingly risky. Because 90% of the sensory input required for driving is visual (Stutts, 1998), safety concerns arise for these older adults, fellow passengers, other drivers, and pedestrians. Such concerns highlight the need for an increased awareness of all health-care professionals regarding the driving strategies used by older adults diagnosed with macular degeneration. The purpose of this article is to present findings from a secondary analysis that explored the driving strategies used by older adults diagnosed with macular degeneration. Macular degeneration differs from other visual impairments in relation to driving because of the resultant color blindness and the loss of central vision. Therefore, the driving strategies devised by individuals with macular degeneration may be different from those of individuals with other visual disorders. The implications of such strategies are also addressed. By understanding these driving strategies, nurses and other health-care professionals who provide care for seniors can better assess risks, counsel, and educate older adults and their families regarding driving issues.
Section snippets
Background
The driving strategies used by older adults, specifically those with macular degeneration and other visual conditions, have received minimal attention in the literature. Of the few studies conducted, some studies noted driving strategies used by older adults to accommodate various functional impairments including visual deficits. Such strategies as reducing the mileage driven, avoiding nighttime driving, and avoiding driving in peak hours, in adverse weather conditions, and in heavy traffic
Research design
A secondary analysis may be conducted to answer new questions or expand the analysis of previous findings not fully explored in the original research (Hinds, Vogel, & Clarke-Steffen, 1997). Findings presented in this article are based on a secondary analysis of data from two previous studies conducted by the two authors—one that explored the meaning of severe visual impairment in older women (Moore, 2000) and one that explored this meaning in older men (Moore & Miller, 2003). These studies were
Findings
Secondary analysis of the data revealed that 15 of the 16 older adults spoke of driving while they shared their stories of visual loss. Only one participant made no mention of driving. However, because driving was not the focus of the original studies, it was not clarified whether this participant had ever been a driver. Of the 16 participants, 10 specifically described driving strategies. Fifty data bits that related to driving strategies were identified from the transcripts. Seven of the
Discussion and implications
Findings from this study contribute to the body of literature focused on older adult drivers, specifically those individuals with macular degeneration. Although some findings mirror findings in the literature, others have not been previously documented. Many of the findings have significant implications for health-care providers. However, findings should be viewed in light of the context in which the original studies were conducted: all participants had sought assistance from an agency for the
Summary
Older adults with macular degeneration use multiple driving strategies. Many driving strategies are problematic and may place these older adults and others at risk. Only by understanding such strategies can health-care providers fully assess the conditions under which these older adults are willing to drive and the risks taken while driving. Such an understanding will guide health-care providers in accurately assessing, counseling, and educating older adults regarding driving issues. Because
Acknowledgments
We thank the Cincinnati Association for the Blind (Cincinnati, Ohio) for its support to this research.
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