Older adults' driving reduction and cessation: perspectives of adult children.

448962 onnell et al.Journal of Applied Gerontology

JAG32810.1177/0733464812448962C

Article

Older Adults’ Driving Reduction and Cessation: Perspectives of Adult Children

Journal of Applied Gerontology 32(8) 975–996 © The Author(s) 2012 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0733464812448962 jag.sagepub.com

Cathleen M. Connell1, Annie Harmon1, Mary R. Janevic1, and Lidia P. Kostyniuk1

Abstract Purpose of the Study. Adult children are often directly affected by aging parents’ decision to limit or stop driving. This qualitative study examined the process of driving reduction and cessation (DRC) from the perspective of adult children, with a focus on family communication. Design and Methods. Four focus group interviews were conducted with 37 adult children (29/37 female; mean age = 45.5) of older parents using a structured protocol.Transcripts were analyzed by two independent coders to identify major themes. Results. Themes represented three aspects of the DRC process: family communication and dynamics (i.e., discussion, negotiation, and planning; avoidance and side stepping; resignation and refusal), taking action to end a parent’s driving career (i.e., engaging a third party; taking away the car), and post-cessation reflection (i.e., relief; social benefits; resentment and guilt). Implications. Despite the potential benefits of planning for DRC, families are unsure about how best to approach this topic. Adult children worry about assuming responsibility for their parents’ transportation needs and their parents’ reactions to restricted mobility. Despite a reluctance to communicate openly Manuscript received: November 4, 2011; final revision received: April 17, 2012; accepted: April 23, 2012. 1

University of Michigan School of Public Health, Ann Arbor, MI, USA

Corresponding Author: Cathleen M. Connell, PhD, University of Michigan School of Public Health (2834 SPH I), 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. Email: [email protected]

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about DRC, adult children and their parents share similar and significant concerns that merit increased attention. Keywords family communication, mobility, transportation, focus group interviews, qualitative Older adults have become the most rapidly growing segment of the driving population as baby boomers reach retirement age (U.S. Department of Transportation, 2007). Besides the obvious convenience of being able to drive when and where one chooses, many older adults derive compelling psychological benefits from driving, particularly a sense of independence and freedom (Oxley & Whelan, 2008). Indeed, driving in older adulthood may be especially important to maintaining a sense of self as productive and engaged (Bauer, Rottunda, & Adler, 2003), as health problems, retirement, and changing social networks may limit opportunities for successful aging (Rudman, Friedland, Chipman, & Sciortino, 2006). It is widely recognized, however, that the physical changes associated with aging, including declines in vision, hearing, information processing, and reaction time, as well as disease symptoms and complications, can negatively affect driving ability (Anstey, Wood, Lord, & Walker, 2005). If confronted by declining driving ability, older drivers may make adaptations such as restricting when, where, and how far they drive; slowing down; and driving with a “co-pilot” (Baldock, Mathias, McLean, & Berndt, 2006; West et al., 2003). Older drivers may stop driving only when no further compensation is possible or as a result of overall health declines, disability, cognitive impairment, or a catastrophic event (e.g., crash; Anstey, Windsor, Luszcz, & Andrews, 2006; Dellinger, Sehgal, Sleet, & Barrett-Connor, 2001; Mattson, 2011). In addition to the substantial body of research on the driving reduction and cessation (DRC) process (Anstey et al., 2006, 2005; Charlton et al., 2006; Dellinger et al., 2001; King et al., 2011; Ragland, Satariano, & MacLeod, 2004; Siren, Hakamies-Blomqvist, & Lindeman, 2004; West et al., 2003) the negative consequences of ending a driving career have also been documented. For example, driving cessation is associated with depression (Fonda, Wallace, & Herzog, 2001), decreased social integration and activity (Edwards, Lunsman, Perkins, Rebok & Roth, 2009; Marottoli et al., 2000; Mezuk & Rebok, 2008), and impaired physical functioning and health status (Edwards et al., 2009). Given these negative outcomes, efforts to help older drivers stay on the road safely to preserve mobility and independence are key (Wang & Carr, 2004). One area that has received limited attention is the impact of an older adults’ DRC on the entire family (Dickerson et al., 2007). The few published studies in


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this area suggest that family members and friends influence decisions about when to stop driving and also help to meet transportation needs after cessation (Johnson, 2008; Taylor & Tripodes, 2001). Much of this work, however, focuses on the unique issues that families face when the older driver has dementia (Byszewski, Molnar, & Aminzadeh, 2010; Dobbs, Harper, & Wood, 2009; Perkinson et al., 2005; Stern et al., 2008; Taylor & Tripodes, 2001); few studies have addressed how families adapt to more common age-related declines that affect driving. The purpose of this exploratory study was to examine the process of DRC from the perspective of adult children, with a particular focus on the family dynamics surrounding this common age-related transition. Adult children play a key role in their parents’ DRC process and often assume an informal caregiving role by providing transportation and mobilizing family support. To date, few published qualitative studies of driving and aging have included adult children (Classen, Winter, & Lopez, 2009). An increased understanding of family roles and communication prior to and after DRC may help to inform comprehensive models of driving retirement and practice and policy initiatives designed to ease this transition.

Method Procedure This study is based on secondary analyses of qualitative data collected from focus group interviews conducted as a preliminary phase of larger survey-based study of DRC (Kostyniuk & Shope, 2000, 2003; Kostyniuk, Shope, & Molnar, 2001). A total of four focus group interviews were conducted with adult children of older parents, two in rural areas and two in a major metropolitan area. Focus group interviews were selected to allow participants to frame their issues and concerns with their older family member’s driving from their unique vantage point and to do so in a group setting. Participants were identified by two professional recruitment firms located in southeastern Michigan using several strategies (i.e., random selection from the firm’s database of potential participants supplemented by membership lists of community organizations and referrals). A telephone screening instrument was administered to determine eligibility criteria (i.e., adults with parents/step-parents/parents-in-law aged more than 65 whose current driving was of concern to them, or whose driving had been a concern if they had stopped driving within the previous 3 years). Participants were given a small monetary incentive for their time. The University of Michigan Institutional Review Board approved this study. Focus group interview sessions ranged from 60 to 90 minutes each and were facilitated by a professional moderator using a protocol that focused on the adult


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children’s experiences and concerns regarding an older relative’s driving. Specifically, participants were asked to discuss any concerns about their older family members’ driving, whether they discussed these concerns with the driver, whether their parents had planned for the time after they stopped driving, and whether their parents’ transition to not driving had an impact on them or other family members. The research team observed the interviews using a one-way mirror as an extra check on data quality and to assure that the appropriate protocol and process was used consistently. Archived audio tapes were transcribed verbatim for this secondary analysis by a professional transcription service.

Participants Before each focus group interview, participants completed a brief questionnaire; responses were used to create a descriptive profile of the sample. Of the 37 adult children interviewed (mean age = 45.5, age range = 24 to 63), more than three fourth (29) were female. The groups ranged in size from 4 to 10 participants each; 34 participants were White/Caucasian, and 3 identified as Black/African American. Whereas all 37 participants had at least one older relative whose driving was of concern to them, 15 reported experiences with two older family members. Across the four focus group interviews, concern was reported for a total of 52 older relatives: 21 mothers, 15 fathers, 6 father-in-laws, 3 mother-in-laws, 3 grandfathers, and 4 grandmothers. Of these, 38 were currently driving at least once a week; the other 14 were described as former drivers.

Analysis Strategy The analysis strategy reflected the primary goal of the study—to explore family dynamics surrounding the DRC process. Portions of the transcripts related to this goal were selected for analyses (e.g., participants’ concerns about their parents’ driving, how their parents’ transition to not driving affected them or other family members, whether they discussed their concerns with the driver). Portions that addressed topics not relevant to this study were excluded (e.g., attachment to/meaning of driving, alternative forms of transportation). Next, two coders worked independently to identify initial themes from a randomly selected transcript. Using a constant-comparison approach, they then compared their individual coding schemes; differences were resolved by review and discussion. Next, the coding scheme was revised and validated by review of each transcript to capture all possible themes and to reach consensus among coders, including which portions of the transcript were to be retained for analyses as


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recommended by Huberman and Miles (2002) and Miles and Huberman (1994). All transcripts were then reviewed using the final coding scheme.

Results Themes emerging from analysis were grouped into broad categories, representing three aspects of the DRC experience. The first and broadest category is family communication and dynamics regarding DRC decision making. Themes within this category include (a) discussion, negotiation, and planning, (b) avoidance and side stepping, (c) resignation and refusal, (d) burden and reciprocity, and (e) role reversal. The second category, taking action to end a parent’s driving career, includes two themes: (a) engaging a third party (as an authoritative outsider to address concerns about driving safety), and (b) taking away the car (as a concrete step to limit or end an older adults’ access to driving). The third and final category is post-cessation reflection on the effects of driving retirement on the participant and his or her family member. Themes include (a) relief, (b) social benefits, and (c) resentment and guilt (see Table 1 for a summary of categories and themes). Illustrative quotes are presented for each theme.

Category 1: Family Communication and Dynamics Family communication, and related parent–child dynamics about DRC, are reflected in the first theme. Discussion, negotiation, and planning. Some adult children reported that they talked about driving issues with their parents and initiated plans for the end of their parents’ driving careers. We talked about what changes she would have to make (when she stops driving). She’d have to move in with us. Dad stopped driving after they moved a year ago. It’s part of the overall plan . . . so that they don’t have to rely on other people. In some cases, the parents’ DRC process was described as incremental rather than sudden, allowing time to plan and adjust to changes. In the face of specific and challenging driving conditions (e.g., bad weather, busy highways, at night, long distances), some older adults were already self-regulating their driving and/ or asking family members and friends for rides.


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Discussion, negotiation, and planning Avoidance and sidestepping

Resignation and refusal

Burden and reciprocity

Role reversal

Engaging a third party

Taking away the car

Relief

Social benefits

Resentment and guilt

Taking action

Post-cessation reflection

Theme

Family communication and dynamics

Category

Description Parent and adult child openly communicate about parent’s current and future needs and plan for the transition to nondriver Adult child does not directly approach parent with concerns but rather circumvents the issue in a passive manner (e.g., refuses to be a passenger when parent drives) Adult child believes that the parent will not voluntarily stop driving and that communication and planning will have limited or no impact on parents’ driving status Parent is concerned that he or she will become dependent on others if unable to drive; adult child may view his or her parent’s increased dependence as a familial obligation Adult child feels compelled to assert authority over parent’s driving behavior, reversing established parent–child roles and creating discomfort for both Adult child appeals to someone outside the family to approach the topic of driving retirement with his or her parent (e.g., physician, law enforcement) Adult child engages in action to prevent his or her parent from driving (e.g., hide keys) Adult child views his or her parents’ driving cessation as necessary and appropriate Adult child views increased social interaction resulting from accepting rides as a positive outcome Adult child worries about parents’ nondriver status as evidenced by negative outcomes (e.g., depression, anger), triggering feelings of guilt

Table 1. Qualitative Analyses Summary: Categories, Themes, and Descriptions.

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We’re already transitioning to help her get places—in the winter and when she doesn’t feel well. So, the change wouldn’t be that great. She’s got her car sitting there, but if she’s not feeling well, she has absolutely no qualms about calling me up and telling me, “I need to go to the doctor today and I don’t want to drive.” Participants often mentioned triggers to such discussions, typically a serious illness or a health decline. She had three things [medical problems] hit her at once in September . . . mom and I actually talked quite extensively about what we were going to do. Well, the planning occurred afterwards, after her stroke. Although many older drivers restrict their driving or gradually cede driving to others, some families described a process of negotiating options with their parent or taking a more direct approach by putting guidelines and rules in place. I briefly discussed it [driving restrictions] with my mom. She primarily drives herself to church, to the grocery store, to the bank, to get her hair done. . . . She doesn’t drive at night. . . . She doesn’t drive on expressways. And my husband sat him [his grandfather] down and gave him a list of ten rules . . . one of them was that he couldn’t drive outside town anymore. And the grandfather accepted that. As part of the second and third themes in this category, participants’ personal reactions to and perceptions of their older relative’s response to DRC were explored. Avoidance and side stepping. Some adult children ignore or side-step discussions about driving, in part, to avoid dealing with the possible consequences of a parents’ DRC. Instead of communicating openly and expressing concerns about their parents’ driving skills, adult children might refuse to be a passenger in a car driven by their parent or refuse to allow their own children to do so. I just did not drive in the car with my mother for 25 years because she scared the daylights out of me that long ago. She stopped at the bottom of the ramp in front of the highway and that was that. I couldn’t deal with that.


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We were not sure we wanted our children to go in the car with the grandparents. It’s getting to that point where we’re going to have to politely say, “That’s OK, we’ll drive her (grandchild).” Some adult children shared their concerns about their parents’ declining driving skills with their siblings, often excluding their parents from the initial discussions. A big part of the reason that this discussion has occurred behind her back is because the . . . older sister . . . the one responsible for actually approaching Mom is further away. So it’s going to happen when the siblings are actually together versus an over-the-phone kind of a way. Resignation and refusal. Some adult children reluctantly accept the fact that their parents will not stop driving voluntarily, despite their reservations and concerns, and worry that the burden of making a decision about the end to their parents’ driving career would fall on them. Honestly, my mother-in-law will die before she stops. I think that’s what will stop her. Death. You don’t want to hurt your relative’s feelings . . . to be the one to take that independence away . . . to be the one that puts the hammer on their lifestyle. One adult child admitted to encouraging her parents to drive because she viewed driving cessation as a marker of being sick and getting older. I encourage my parents to drive . . . . Quitting driving is an admission of being sick or getting older, in both my parents’ mind and in my mind. Other adult children point to their parents’ denial of declining driving skills as a roadblock to discussing needed changes. He just knows everything and no one can really tell him anything. I think she’s too confident. . . . She has had . . . other health issues—memory, reflexes, unhealthy eyes . . . that are slowing her down and she’s not ready to admit that yet. So, I think that makes her more dangerous because she’s not cautious.


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I don’t think my mom will stop until, you know, her health gets so bad that she can’t even walk or God forbid she hits something or someone. She’s stubborn. [Dad] offered to drive recently. He doesn’t have a grip on his limitations. And some of it would be that he [believes] the gentlemanly thing is to drive. For some adult children, ongoing attempts to discuss DRC are viewed as pointless in the face of their parents’ rejection of their feedback and suggestions. I don’t think the parents are going to listen. If they think they’re capable, they’re going to do it. She was in an accident four years ago and nearly lost her life, but . . . she’s recovering in the hospital yet she’s still worried about the car that’s totaled. She wants me to go out and hunt her out another car just like the one she had. It’s that important that she has a car. In some cases, aging parents provided the only source of transportation for other family members or friends, while needing increasing help themselves. I think that as long as my grandpa can’t drive and she’s the only transportation, I don’t think she will stop. Well, my mother said, “Who’s going to take the old lady to church?” And she’s 86. And she’s taking the 90-year-old, the 95-year-old, and 100-yearold ladies to church. She . . . needs to be independent so these other people can be dependent on her. Burden and reciprocity. Several participants mentioned the responsibility and potential burden to them that would result if their parent stopped driving. Some adult children dread the intrusion on their time and other commitments and fear their own loss of independence. Avoiding discussions about DRC allows the parent and adult child to remain independent, even as abilities decline. If I really felt she shouldn’t be driving . . . we would have to sit down and figure out some way. But as long as she’s doing fairly well . . . I would like to see her drive because . . . it is easier for us . . . she can get to my house without me having to go pick her up.


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My mother doesn’t want my grandmother to stop driving since neither of us wants her to be dependent on us. I’m in school, I’m working full time, and I have things I have to do . . . but I have to . . . fit her in . . . on my lunch hour . . . pick her up some Kentucky Fried Chicken and bring it right away or . . . take her to the grocery store. It’s not an option for me to say, I cannot come today . . . and then she makes you feel bad. In one case, a discussion of burden was prompted by unease about a shift in the parent–child relationship and roles. And they’re the parent, and we respect that . . . and we don’t want to take things away from them. So, I always think that it’s treating them like a kid. But I’m thinking, “Well, I have to give up my freedom because I’m going to have to take mom or dad wherever. That means I can’t go there because I have to take them there . . . it’s a drain . . . but it is a responsibility on us and we . . . need to take care of our parents.” At the same time, participants felt that continuing to drive was important to their aging parents so that they didn’t feel like a burden. I don’t think driving is a real big issue to him, but I think he wants to not be a burden on anyone . . . it’s got to be hard . . . and . . . his wife expects him to take her places. So, I don’t think he will ever stop. I think someone will have to take it away from him and it will kill him. Some adult children specifically mentioned that they were ready and willing to help their nondriving parents, despite the potential role overload. Participants cited reciprocation for sacrifices their parents made for them, although this sense of filial obligation is also subject to ambivalence. Participants described not only their reluctance to begin this new phase of their parent–child relationship but also a sense of obligation to step up and assist given safety concerns. I would be happy to drive my parents. My father drives too much for his abilities. He has had accidents. I had to accept my responsibility that I was raised by this person. Now it’s my turn to turn around and do something back.


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I’m the only child . . . but I would do it. . . . I would rather have him not drive than take a risk. Role reversal. Some adult children acknowledged that when they expressed concern and asserted authority about their aging parents’ driving safety it was interpreted by their parent as disrespectful. The change in roles and responsibilities is perceived as uncomfortable and unwanted by both adult children and parents. I think there’s another factor involved . . . and that is being an adult and not wanting to regress back into childhood. And I know that many parents have said, “I’m not your child, you’re mine!” and that regression is frightening. I was unclear, as a daughter—what is my role? How bossy do I get to my dad? How much support can I offer my mother who is really now my friend? That was the hardest part for me. Adult children often feel as if their parents discount their advice and suggestions because they are just “kids.” She may forget what street she’s looking for. She’ll just stop. And I say, “Mother, you can’t just stop in the middle of the street. There’s someone behind you.” “Don’t tell me. I know what I’m doing.” And, you know, I’m still the baby. I’m still the child. I can’t tell her. So, it’s hard. One adult child summed up the parallel discomforts implicit in this role reversal. It’s a combination of someone pulling in the reins . . . taking away their independence but it’s also . . . that the . . . children are telling the parents what to do, and that is not a role that they ever had or want to have. Other participants anticipated a parent’s driving cessation would be a catalyst for a major life change, particularly a change in residence. For example, some adult children were prepared to have a parent move in with them. My mother’s been moving up here with me, once we get our house situated. And she was partly happy to give it (driving) up. It was not a big deal.


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Category 2:Taking Action to End a Parents’ Driving Career Engaging a third party. Some adult children reported a distinct lack of help and support from health professionals and state licensing agencies in decision making about ending their parent’s driving career. I know she’s got problems with her eyes, and I talked to her eye doctor, and he said, “There’s really nothing I can do.” Secretary of State’s not helping me . . . and we tried to take the car away last week and it’s like her children were killing her. We need someone to step in. We’re afraid for her safety and the safety of others [In Michigan, the Office of the Secretary of State is responsible for driver licensing]. I talked mother into stopping, but the doctor said it was okay, so she’s continued driving. One participant envisioned a neutral third party as serving a helpful role when discussing concerns and alternatives. It’d be nice if there was some kind of mediator . . . a go-between of sorts between the driver and . . . the family . . . someone who could . . . be there in the middle and make the final decision Taking away the car. In extreme situations, some adult children feel forced to take the keys (or the entire car) away from a parent who can no longer drive safely. Participants reported doing so reluctantly but that they felt compelled to do so for personal and public safety. Deception was employed in some cases, with adult children reporting “moving” or “loaning” the car or offering keys that do not actually start the engine. We had to take my mom’s car away from her, and that really hurt her immensely. But it was . . . one of those things we had to do. I tried to find a way, told her my daughter-in-law needed the car. . . . I said, “Can she borrow the car?” She had it two days and my mother’s on the phone, “Where’s my car?” And Mom was pretty firm about it. She did give him the keys but it only worked the door. It didn’t work the ignition.


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Category 3: Post-cessation Reflection Of the few participants who shared experiences with older relatives who stopped driving, a range of mixed reactions were expressed, from relief to unexpected benefits to resentment. Relief. For some adult children, knowing that their parents were no longer in danger (or a danger to others) while driving was a source of reassurance. [My grandfather] was the real . . . bad driver. He’d pull out in front of people and expect them to stop. And, so we’re all happy that he’s [no longer driving]. Social benefits. Adult children also mentioned a possible silver lining to their parents’ driving cessation—getting rides from family members and friends offered significant social benefits that were thought to reduce their parents’ loneliness and isolation. In a few cases, adult children reported that their parents’ enjoyed their new status as a nondriver. My mother is relying (for rides) on friends more now. Mother never liked driving. . . . She is happy to have one of us drive.” I think she’ll enjoy it—having other people come and get her . . . and take her here and there . . . She’s starved for company.” Resentment and guilt. Some participants reported that their parents’ resentment about no longer being able to drive and subsequently needing to rely on others lingered for years And still, [my grandfather] has trouble even talking about it, you know. It was very, very hard for him to give up. This resentment, in turn, triggers a sense of guilt on the part of the adult children who may have initiated their driving cessation. It’s hard for a child, no matter how old you are, to tell your parents what to do. And you can tell them, “You’re not going to drive.” They resent it . . . when you take the car away. The depression that they’re going to be in and they’re going to have to live with that.


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Discussion The goal of this study was to examine the process of driving reduction and cessation (DRC) from the perspective of family members, specifically adult children. Reflections offered as part of focus group interviews span the continuum from the early phase when parents and children discuss and plan for DRC (or avoid doing so), to taking action to end a parents’ driving career, to postcessation reflection on emotional and practical responses to DRC. Several adult children reported making plans and having discussions about anticipated changes in their parents’ driving, which seemed to offer a sense of relief and readiness for the transition. A similar finding was reported in previous work (Bauer et al., 2003). For example, one participant described how she created an incremental transition for her father by offering him rides on an as needed basis. In other cases, a sudden event (e.g., serious illness, car accident) forces discussion on and short-term planning for DRC. Although this scenario may not be ideal, it may push some families into a needed conversation that would have otherwise been postponed. Several participants adopted a direct approach and placed specific limits on their parents’ driving, reflecting the intent to balance safety concerns with the continued mobility needs of the driver. Despite evidence that planning for DRC reaps benefits, most families avoid or side-step discussions about this important life transition (Kostyniuk & Shope, 2003; Rudman et al., 2006; Silverstein, 2008). Results of this study provide many illustrations of how and why such avoidance takes place. Rather than deal with a parents’ declining driving abilities openly, some adult children in this study reported a passive approach (i.e., refusing to be a passenger, discussing driving concerns with sibling but not with parents). In part, this reluctance to approach the topic may reflect the value that they place on their parents’ autonomy and independence and their realization of how central driving is to their parent’s quality of life, mental health, and preferred lifestyle. This interpretation is consistent with previous research that suggests that adult children view protecting a parents’ autonomy and sense of self as part of their broader filial responsibility (Caron & Bowers, 2003; Funk, 2010). Of course, another part of the reluctance may stem from the desire to avoid a dreaded conversation that would “upset the balance in the family” (Rudman et al., 2006), particularly if complicated by a long-standing pattern of poor communication and/or a difficult relationship. In this study and as previously documented, the comments by adult children reflect the general societal belief that the driver’s family bears the majority of responsibility to “identify and deal with unsafe drivers” (Perkinson et al., 2005, p. 682). Several adult children in this study, however, reluctantly accepted the fact that their parents would not stop driving, no matter how much they tried to


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convince them to do so. Not surprisingly, some participants shared their frustration about their inability to get through to their parent and described the end of their parents’ driving career in extreme terms. In one scenario, participants’ predicted that death itself would be the only way their parents’ would stop driving. Others described the end of their parents’ driving career as something that would “kill” them. A few participants’ mentioned a particularly compelling incentive for a parent to keep driving, even if they were aware of declining abilities. Specifically, some older drivers’ were the sole source of transportation for a spouse or friends. Wanting to remain useful to others by offering rides seemed to the participants’ to add to the pressure for their parent to continue driving. Several participants reported feeling burdened and overwhelmed at the prospect that they would assume responsibility for their parents’ transportation needs while already juggling work and family demands. As reported in previous work (Perkinson et al., 2005), adult children may even downplay the dangers of their parents’ declining driving skills to avoid taking on a long-term caregiving role and to preserve their parents’ sense of dignity. This finding was supported in this study, with several participants encouraging their parents to drive to retain the status quo even in the face of accelerating risk and concerns. Research has also shown that older adults dread becoming a burden on their adult children (Calasanti & Slevin, 2001); the end of a driving career is sometimes the first step in a process of increased dependence (Bauer et al., 2003). In fact, older adults often prefer to get rides from friends, neighbors, or a transportation service than rely on family members specifically to avoid feeling like a burden or needing to reciprocate (Adler & Rottunda, 2006; Bauer et al., 2003). Results of this study also show that even when adult children are willing and able to assist with their parents’ changing mobility needs, finding the best way to offer help without such unintended consequences is often easier said than done. We also found that dealing with complex issues related to DRC forces some families to confront a self-described role reversal of sorts, with children telling older drivers what to do and older drivers resenting their loss of control. Venturing into these new roles and negotiations was described as uncomfortable and awkward for both parties; a similar finding was reported by Funk (2010) and Rudman et al. (2006). In one case, the end of a parents’ driving career precipitated an even larger role reversal of sorts—moving in with her children. Although this may be a welcome alternative to providing transportation from afar, coresidence certainly brings its own set of challenges. Instead of directly confronting their parents about driving concerns, several adult children stated a preference for getting help and support from a third party (e.g., physician, eye doctor, law enforcement, driving rehabilitation specialist,


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state licensing board). Instead, participants’ reported that they received limited or no help from these sources, despite their high hopes. The desperation reflected by the adult children who felt a third party was a last resort to end a driving career underscore how much more help is needed to help families deal with this sensitive and highly emotionally charged topic. Implications for practice. Results from this study suggest several areas for practice and intervention; for a review, see Windsor and Anstey (2006). For example, mobility counseling is a promising strategy to improve family communication in anticipation of DRC (Meuser, Berg-Weger, Chibnall, Harmon, & Stowe, in press). This person-centered approach focuses on the needs, resources, and context of the older adult and the family support network when planning for DRC. If mobility counseling is started early in the DRC process, it can facilitate positive outcomes for all concerned (Bauer et al., 2003). Another approach is to offer self-screening to older drivers to increase awareness about functional abilities associated with safe driving (Molnar, Eby, Kartje, & St. Louis, 2010). Of course, self-screening is voluntary and may not be appealing to the subset of older drivers who are not ready to reduce or stop driving. And, unless a screening or assessment is followed by a frank discussion about next steps, it may not result in needed change (Jones et al., 2011).At a broader level, our results support Silverstein’s recommendation that all professionals who serve older adults be aware of warning signs associated with declining driving skills to increase timely referrals for further assessment (Silverstein, 2008; Wang & Carr, 2004). Increased awareness of and attention to driving issues at multiple levels might help adult children to not feel so alone in trying to restrict or stop their parents’ unsafe driving behavior. This study also uncovered several positive aspects of DRC for the family members of older drivers. Such benefits have received little research attention to date but may be an important focus in programs designed to ease families through this process. Although many older adults prefer to continue driving without interruption, their adult children are often relieved when their parents’ reduce or stop driving, especially if safety concerns were apparent. And some adult children in this study reported that their parents seemed to enjoy having others offer rides, especially if it resulted in an increase in social activities or a reduction in isolation; a similar finding was reported in Glasgow and Blakely (2000). Finally, the fact that many older adults continue to drive does not necessarily mean that their transportation needs are being met. In some cases, older drivers may have limited their destinations to places where it is safe to drive with restrictions related to distance, time of day, traffic patterns, and/or parking options. With this in mind, driving cessation may have the unintended benefit of opening up new possibilities as long as transportation alternatives are available.


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Study limitations. Several study limitations should be noted. The protocol for the focus group interviews was designed to inform a telephone survey as part of a larger study; it was not intended to provide an in-depth examination of the family dynamics associated with DRC. Thus, it is likely that some important issues relevant to the topic were simply not discussed and are not reflected in the themes presented here. Because DRC can be a sensitive and highly charged topic, one-onone, in-depth interviews may be especially appropriate for future work in this area. Participants may have been reluctant to divulge their experiences in a group setting, especially about family matters and issues related to driving safety and abilities. In addition, this study is based on a small and select sample of individuals meeting eligibility criteria, limiting generalizability of the findings. Adult children of parents who were still driving and those who had ended their driving careers were combined for the focus group interviews. Because we did not conduct separate groups defined by parents’ driving status, our ability to explore differences along the driving reduction–cessation continuum may have been limited. And although we did not discover rural-urban differences, future work could more explicitly examine this issue because geographic area strongly affects driving safety and access to alternative forms of transportation (Johnson, 2008). Finally, although the study offers a description of the range of participants’ experiences with their family members’ DRC, the focus group interview data do not lend itself to assessing how common these experiences actually are in this sample or among families in general. For example, we are not able to determine whether participants were more likely to avoid or address the topic of DRC or to anticipate burden or relief after a parent stops driving. Directions for future research. To increase our understanding of how family roles and patterns of communication are affected by DRC and other age-related transitions (e.g., retirement, residential moves), the perspectives of within-family parent–child dyads would be very valuable. Ideally, such dyads would be followed over time to provide a dynamic view of how communication about and planning for transitions unfolds. Also, because race, ethnicity, and culture shape caregiving and norms for familial obligation (Janevic & Connell, 2001), diverse groups should be recruited to participate in future work. Finally, future research that addresses family roles and communication about DRC and other life transitions would benefit from an interdisciplinary approach, incorporating the broader literature on parental autonomy, responsibility, filial obligation, caregiving, and gender roles (Funk, 2010). Summary and conclusion. Being able to drive your own car is an accepted and established marker of competence, independence, and self-worth (Oxley & Whelan, 2008). For many adult children and their aging parents, driving reduction and cessation is a visible marker of age-related loss of independence and


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competence (Bauer et al., 2003). Driving issues force adult children to think ahead toward their parents’ old age and even death, even if they choose to avoid direct conversations or are uncomfortable with probable changes in family roles and responsibilities. In fact, the communication challenges described by adult children in this study (i.e., avoidance and side-stepping, resignation and refusal, and burden and reciprocity) are remarkably similar to those expressed by older drivers (King et al., 2011). Although both adult children and their aging parents are reluctant to communicate openly about the driving cessation process, they share similar and significant concerns that merit increased attention in the research, intervention, and policy arenas.

Acknowledgments Special thanks to Jean Shope, Principal Investigator of the parent project, and Danielle Vibbert, who assisted with an early phase of this work.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Michigan Center for Safe Transportation through the Lifespan funded to the University of Michigan Transportation Research Institute and by a Rackham Faculty Allies Award funded to the Department of Health Behavior and Health Education at the University of Michigan School of Public Health. Data collection for the parent project that supported this work was sponsored by the General Motors Corporation pursuant to an agreement between the General Motors Corporation and the U.S. Department of Transportation.

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Author Biographies Cathleen M. Connell is a faculty member in the Department of Health Behavior and Health Education at the University of Michigan School of Public Health and the Associate Director of the University of Michigan Center for Managing Chronic Disease. Her research focuses on family caregiving, public attitudes and beliefs about Alzheimer’s disease, chronic disease management, and the role of pets in the support networks of families facing dementia .


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Annie Harmon is a doctoral student in the Department of Health Behavior and Health Education at the University of Michigan School of Public Health. Her research interests focus primarily on intervention and policy related to meeting the mobility and transportation needs of our older adult population. Mary R. Janevic is an Assistant Research Scientist in the Department of Health Behavior and Health Education at the University of Michigan School of Public Health and a faculty associate of the University of Michigan Center for Managing Chronic Disease. Her research focuses on chronic disease management, the role of family members in disease management, and multimorbidity of chronic illness. Lidia P. Kostyniuk is a Research Scientist in the Behavioral Sciences Group at the University of Michigan Transportation Research Institute. Her expertise is in the field of travel behavior and safety and includes the driving reduction and cessation process among older drivers.


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