Journal of Aging Studies 20 (2006) 227–235www.elsevier.com/locate/jaging

Older adults' perspectives on driving cessation

Geri Adler a,⁎, Susan Rottunda b,1

a Graduate College of Social Work, 237 Social Work Building, Houston, TX, 77204-4013, USAb Geriatric Research, Education and Clinical Center, Rt. 11G, Veterans Affairs Medical Center, Minneapolis, MN, 55417, USA

Received 3 June 2005; received in revised form 14 August 2005; accepted 16 September 2005

Abstract

Relinquishing the privilege to drive is a difficult issue for older adults. To better understand factors that influence drivingdecisions and to identify approaches that could help ease the transition to a non-driving status, we conducted focus groups withelders who had recently stopped driving. Results demonstrate that the decision to stop driving is reluctantly made by elders on theirown or after prompting from others. While all have other means of transportation, a sense of loss of independence remains.Participants urged policy makers to address older driver issues and were proponents of developing procedures to identify at-riskdrivers. They also stressed the importance of making plans for retirement from driving. Findings suggest that while there is “lifeafter driving,” efforts are needed to help older drivers, and their families develop a plan for driving cessation that includesidentifying the appropriate time to stop and acceptable transportation alternatives to driving.© 2006 Elsevier Inc. All rights reserved.

Keywords: Driving cessation; Transportation; Mobility

1. Introduction

The subject of older drivers is attracting more interest not only in the medical community but also with the generalpublic. As the population ages there will be more older drivers on the road and by the year 2020 it is predicted that 20%of licensed drivers will be over the age of 65 (Chu, 1994). In addition, the fact that over 60% of trips taken by olderadults are taken alone illustrates the extent to which older adults depend on their cars (Eberhard, 1996). Therefore, theconsequences of driving cessation have the potential to profoundly effect mobility and quality of life for the olderdriver.

The private automobile provides transportation and is also important in maintaining autonomy and self-esteem.However, it is not uncommon for elders to make gradual changes over several years to their travel habits and patterns inresponse to their changing needs and capabilities (Burkhardt, 1998; Marottoli et al., 1993). Eventually many stopdriving altogether. In an effort to better understand issues, behaviors, and attitudes about driving cessation among olderdrivers we conducted focus groups with individuals who had stopped driving within the past two years.

⁎ Corresponding author. Tel.: +1 713 743 8133; fax: +1 713 743 8016.E-mail addresses: gadler@sc.rr.com (G. Adler), susan.rottunda@med.va.gov (S. Rottunda).

1 Tel.: +1 612/467 3345; fax: +1 612/7252084.

0890-4065/$ - see front matter © 2006 Elsevier Inc. All rights reserved.doi:10.1016/j.jaging.2005.09.003

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2. Literature review

The decision regarding whether or not an older adult continues to drive or stops is influenced by a variety of factors.One of the most important factors that influence driving decisions is the status of an individual's health. Physiologicchanges of aging can affect reaction time, vision, hearing, muscle strength, range of motion, and trunk and neckmobility (Coughlin, 2001). In addition, the pathological effects of various diseases and the medications used to treatthem may affect one's ability to drive (Ray, Thapa, & Schorr, 1993). As a consequence of declining health, many olderdrivers compensate by self-regulating, that is, not driving in situations that make them uneasy and by simplifying thedriving task. It is not uncommon for older drivers to report driving less at night, on freeways or during bad weather(Bauer, Adler, Rottunda, & Kuskowski, 2003; Cobb & Coughlin, 1997; Forrest, Bunker, Songer, Coben, & Cauley,1997). Ultimately, medical problems are often the reason older adults stop driving (Dellinger, Sehgal, Sleet, & Barrett-Connor, 2001).

While health status is an important determinant of driving decisions, many elderly will continue to drive out ofnecessity due to the lack of acceptable transportation alternatives. Reliance on the automobile is particularly importantbecause almost three-quarters of all elders live in low-density suburban or rural areas (Kostyniuk & Shope, 2000)where alternative transportation options are limited (Forrest et al., 1997; Glasgow, 2000). However, even among olderadults who reside in central cities where more transportation options are available, almost 90% of all trips are taken byprivate vehicles (Glasgow, 2000). Overall, public transportation is considered inadequate and not responsive to an olderperson's needs (Kostyniuk & Shope, 2000). Not surprisingly, when older adults can no longer drive, most rely onfamily and friends for transportation (Kostyniuk & Shope, 2003).

Gender also influences an older adult's driving behaviors and plans. Compared to older women, older men makeless drastic changes to their driving habits as they age (Eberhard, 1996) and are more reluctant to cede their drivingprivileges (Kostyniuk, Trombley, & Shope, 1998). In addition, older women voluntarily stop driving at younger agesand in better health than their male counterparts. Furthermore, women were more likely than men to cite stress and adesire to avoid difficult driving situations as contributing factors to driving cessation (Gallo, Rebok & Lesikar, 1999;Hakamies-Blomqvist & Wahlstrom, 1998).

For those elderly living on fixed incomes, the costs of owning, maintaining, and operating a motor vehicle can beprohibitive and have an impact on their driving decisions. Furthermore, low-income elderly have less means availableto pay for alternative transportation (Carp, 1988).

Although driving cessation changes the lives of most elderly people, very little is known about the driving cessationprocess. Considering the growing elderly population, and the fact that they depend on their automobiles fortransportation, it is important to more fully understand factors that influence driving decisions and the effects thosedecisions have on older adults. Such information may help to develop strategies that promote awareness of drivingissues common to older adults and help them make plans for eventual retirement from driving. The objectives of theproject were to better understand issues and behaviors about driving cessation and to identify ideas for programs andpolicies that could help ease the transition to a non-driving status.

3. Methods

3.1. Study design

An exploratory study design was adopted for the conduct of this research. Focus groups were chosen as the datacollection method to enable examination of a topic that has not had extensive exploration, to foster discussion, and tofacilitate collaborative information sharing within a group (Neuman, 2004). It was expected that these groups wouldgenerate rich qualitative data that would yield “the views and opinions of the major actors themselves, namely theelderly” (Knodel, 1995, p.1). This approach overcomes limitations of questionnaire data frequently used in otherstudies of older drivers.

3.2. Participant group identification

Institutional Review Board (IRB) approval was obtained for the study. Potential participants were recruited fromthree different geographical locations— the metropolitan area of a largeMidwestern city, a suburb of the same city, and

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a rural community in the same state. These sites were chosen because travel distance between home and goods andservices and availability of transit options differ between urban, suburban, and rural areas. Since these factors influencedriving decisions, focus groups were held in each setting. Potential participants were recruited via newspaper ads, radioannouncements, and flyers in high-rise apartment buildings, libraries, pharmacies, and clinics. These advertisementsexplained the aim of the research and assured potential participants that their participation is voluntary and confidential.

A formal invitation was extended to all those who inquired. Respondents to the advertisements were pre-screenedby telephone to ensure that they met criteria for group membership. Individuals who were under the age of 60, elderswho had stopped driving more than two years prior to the study, and current drivers were excluded from the sample. Ifrespondents agreed to participate, a confirmation letter with date, time and location was sent, and a follow-up reminderphone call was made.

3.3. Participants

A series of three focus groups with twelve participants were held. Each group was comprised of three to fiveolder adults who had discontinued driving within the past two years. Eight women and four men participated. Theirages ranged from 70 to 85 years. Four individuals resided in an urban setting, five lived in a suburban location, andthree resided in a rural locale. Seven participants lived alone and four lived with a spouse (one participants did notrespond to this question). All were Caucasian. Their range of driving experience was broad, from 25 to 72 years.Female participants drove an average of 47 years before stopping driving and male participants drove an average of69 years.

3.4. Focus group format

The overall purpose of the focus groups was to 1) better understand issues, behaviors, and attitudes about drivingcessation among older adults who had recently (within the past two years) stopped driving and 2) to identify potentialideas for programs and strategies regarding driving cessation.

At the time of group participation, demographic information was collected from each participant. After discussingthe nature of the group and completing a demographic information sheet, all participants were asked to respond to aseries of specific guiding open-ended questions related to driving cessation.

A moderator guided the discussion of each group to ensure the participation of all attendees and to cue the verbalexchanges so that general issues of driving cessation were the focus of discussion. An assistant attended each session aswell. The assistant took memo notes and audiotaped the discussions. Memo notes, that included recordings of observedcharacteristics such as participant demeanor and facial expressions, augmented the tape-recorded transcripts. Eachgroup was approximately two hours in length.

3.5. Data analysis

The focus group sessions were transcribed verbatim, including pauses, false starts, laughs, and other remarks.Investigators reviewed the transcripts and memo notes separately. After multiple readings and discussion, primary andsecondary themes were identified from the transcribed sessions. Descriptive statistics were used to characterize thedemographic information collected from the participants.

4. Findings

Content analysis identified several major themes related to the driving cessation process and recommendations forways to address older driver issues. Within each theme, secondary themes were also identified.

4.1. Becoming a non-driver: proactives and reluctant accepters

In each focus group, participants discussed the decision to stop driving. The former drivers in our study fell into oneof two groups, the “proactives” and the “reluctant accepters.” The proactive group can be described as those seniors whomade the decision to stop driving on their own and then, informed their family and friends of their intent. One proactive,

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a suburban female, Mrs. M reported that she began thinking about stopping driving when she was in her late seventies. Afew years later when she moved to a senior apartment complex that provided transportation Mrs. M decided, “there wasno point to have a car.” She informed her family, set a date to quit, and gave her car to her granddaughter. A fewproactives recalled a spouse or parent who had been resistant to stop driving in the years prior to their own decision. Thisexperience undoubtedly heightened their sensitivity to the emotional impact on family, and they consequently decided toavoid “putting their family through the same thing.” For example, Mrs. J, a rural participant, recalled that her husbanddid not want to stop driving even though he had had several “small strokes” and slowed reaction time. After she wentthrough “the business of stopping her husband” drive, she quit on her own.

The reluctant accepters can be described as those elders who had realistic perspectives of their driving skills andreluctantly made the decision to quit. They were not proactive in the sense that they made specific plans to stop. Ratherthese participants described a slow process of resignation, usually prompted by deteriorating health or suggestions fromtheir family or physician. For example, Mr. D, a rural participant stated that when he renewed his license at age 78, “Ijust barely passed the sight test,…and thought it was probably my last driver's license. Pretty much knew that Iwouldn't drive after that.” He stopped driving two years later. Another rural participant, Mr. P, had maculardegeneration for four years before he stopped driving. He, “knew the time was coming”, when he could no longer drive,but persisted until he failed the eye exam when he went to renew his driver's license.

According to our participants, a third group of older drivers were identified as “resisters.” Resisters were describedas older adults who are not realistic about their driving skills and continue to drive until they are forced to stop. Notsurprisingly, elders who had had such an experience self-selected to not participate in our study. Participants viewed“resisters” as a major problem for communities. All reported having friends who are still driving but should not bebecause they “are dangerous to themselves and others.” Interestingly, none of the participants were willing to discussthis issue with their resister friends— they simply will not ride with them. When asked if they had any advice for thisgroup, one rural participant stated, “[I] can't tell them to stop. Never been in a position to say anything.” It seems thatthe topic of driving cessation is difficult, even among former drivers with their own peers.

4.2. Influences on the decision

The decision regarding whether or not an older adults will continue to drive or will stop is influenced by a variety offactors. When asked what prompted the decision to stop driving, our participants identified health, costs related todriving, a frightening experience, family, physicians, lack of alternative transportation, and gender.

Nearly all participants mentioned health-related reasons for driving cessation. Four participants noted visionproblems. A female participant, Mrs. G, stated that she stopped driving “after having cataract surgery and had doublevision. [I] was too dangerous to keep driving.”Also mentioned were blackouts, slowing reflexes, and general fatigue. Asuburban participant said that he “had a couple of blackouts… and didn't want that to happen when I was driving.”Mrs.H, another suburban participant, reported stopping because “my reflexes weren't there.” Finally, Mr. S described fallingasleep at intersections when driving.

Reasons other than health contributed to driving cessation. When asked why she stopped driving, a rural femalestated, “Finances…I live on Social Security.” Other participants were concerned about the responsibilities associatedwith driving, and that they may cause injury to others. For example, a participant from a rural area responded “…don'twant the responsibility for hurting someone.” An urban male stated, “Feel if I drive will be a detriment to others.”

Several other participants reported having had a frightening experience that prompted the decision. One participantnoted, “I got lost in traffic and ended up downtown three times…”Another stated, “I…forgot to turn off the car. So, I leftthe car running for two hours. It scared me enough to think about stopping driving.”

Driving decisions were also influenced by family. Because several of the participants had themselves experiencedthe process of getting a family member to stop driving, they may have been more receptive to advice from family whentheir own driving became a concern. A suburban female described the problems with her 90 year old father who drovein spite of physical problems and a poor memory, “Father couldn't remember and I have that problem myself and ourreflexes don't react quickly enough….”Another suburban female stated, “listen to your family, they are with you all thetime. They can tell you when you are not driving right.”Mr. B reports having “had two daughters who asked me to stopdriving….they worried about me.”

Physicians also played a role in driving cessation. Mr. S, who fell asleep behind the wheel, discussed these episodeswith his physician, who encouraged him to stop driving. Mr. S decided to “quit [driving] cold turkey,” as he had with

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cigarettes although “giving up driving isn't as easy.”An urban participant reported that he quit after, “doctors at the VAdecided I would be better off not driving.”

Lack of acceptable alternative transportation also influenced our participants' decision to stop driving. For manyolder adults, physical impairments preclude their ability to use public transportation such as the city bus. Furthermore,the fixed schedules of public transportation do not offer the convenience of a private automobile. As noted by Mrs. R, asuburban participant, “I don't take public transportation because I can't get to it and don't do it alone because I am notstable enough.”

Finally, gender may influence an older adult's driving decisions. Respondents believed that the decision wasespecially difficult for men. Mr. J, stated that after he quit driving he, “….lost a lot of confidence in myself. Don't feellike I did when I could do it all alone. Means more for a guy, I think, the masculinity issue. Don't feel like the wholeman I was.”Mrs. A, an urban resident noted that stopping driving is difficult, but especially so for “men in particular,…it's their car, they won't give it up. Men [are] reluctant to give up the key to the car.”

4.3. Effects of driving cessation

For many participants, not driving has limited their lives. Many felt an overwhelming loss of independence. Asuburban resident, Mrs. K lamented, “I want to stay in my home, but if I ran out of something, I love to cook and coulddash out and get what I needed. Now you don't ask neighbors for anything and it's depressing for older people not to beable to do that.” An urban woman, Mrs. J echoed a similar sense of loss, “[I] wouldn't be able to handle my specialneeds, like going to doctor, have to depend on someone else. Think I lost my independence.”

Without driving, our participants needed to pre-plan all of their trips. The inability to decide on the spur of themoment to drive somewhere was particularly difficult for an urban female who stated longingly, “…often wish to beable to jump in the car and drive to [the] park. I miss driving.” A suburban participant who had access to acceptabletransportation to shopping centers, grocery stores and the library also felt the loss of spontaneity, “…you have to know aday ahead and I'm a spontaneous person. That is what I'm learning to live with.”

4.4. Policy recommendations

Focus group participants agreed that drivers with serious mental and physical impairments should be evaluated. Inaddition, theymade a strong case formore vigilant driving policies for older drivers in general. A rural participant noted, “Ithink a regular driving test should be given after a certain age.” Another participant suggested the development of a self-evaluation that included input from both the older driver and a family member. In addition to vision exams, the groupssuggested incorporating other special tests at the time of renewal such as a knowledge exam of the rules of the road, a test ofreflexes, cognition and flexibility, a road test and driving simulator testing. Some participants were aware of the additionalcosts that increased testing would entail and suggested that the AARP ask for volunteers to conduct the driving tests.Although the test would not have the legal standing of the official state test, results would provide the older driver withanother perspective on their driving performance and may help them to decide if their driving needs further evaluation.

Regarding driving cessation, participants recommended small workshops that could be incorporated into currentlyexisting programs such as the AARP “55 Alive” program, company sponsored pre-retirements seminars, and variousservice and church organizations. Mr. K, a rural resident noted, “I think that would be good to have a get together once ayear to discuss driving or not driving and the issues involved. Involve people who have quit driving and those that havedriven still to speak. Service clubs could once a year give a talk about this.”

4.5. Alternatives to driving on your own

All participants reported that friends, family and/or neighbors fulfill some of their transportation needs. However,many participants were fearful of becoming a burden. A suburban female confided, “I wait for somebody to say theyare going shopping and ask me along. And you give back, by taking them to lunch.” A suburban female expressedconcern about obtaining rides from her son, “They say to make a list, but they can't always do things right now. So takeas much responsibility off your family as you can.”

When asked about their use of public transportation, responses reflected the well-documented reluctance to usepublic transportation (McKnight, 2003; Straight, 2003). Like many elderly, public transportation is viewed as

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inconvenient, inadequate, unsafe and generally not responsive to elders' travel needs (McKnight, 2003; Straight,2003). An urban male participant stated, “I take the bus a little, but it's not convenient and it's dangerous.”

While public transit transportation was rarely used by our participants, transportation options offered by seniorresidences do receive a more favorable assessment. Such facilities often provide transportation within a limitedgeographical area. Destinations include the local supermarket or mall, doctor's offices and occasional social or culturaloutings. Explained Mrs. T, a suburban resident of such a facility, “They actually furnish the bus and put the groceries onthe bus for you and the driver brings them up. All you have to do is carry them into your apartment.” Anotherparticipant suggested that the cost of using a bus affiliated with a particular apartment complex be included in the rent.While many of the participants in the groups did have family available to provide some transportation, they often “askonly for necessity.”

The discussion of driving cessation is difficult. As stated earlier, some participants had friends who they believed tobe unsafe drivers, yet they were reluctant to bring it up in conversation. In order to normalize the discussion aboutdriving cessation, participants suggested the creation of a public service campaign to reassure older drivers that “there'slife after driving.” The recommendation was made to recruit as a spokesperson someone who is locally known and hascredibility with older adults.

Although there may be “life after driving,” for many older non-drivers, it is not the life they would like. As noted byMr. X, a rural participant, “When [you] stop driving, you become prisoner. Have to adhere to other people's schedule toget what I want. Don't have the freedom.” Participants recommended both public and private solutions to thetransportation gaps for older non-drivers. In addition to public transportation options such as Metro Mobility-Departments of Public Safety could involve organizations such as the Salvation Army for providing alternativetransportation to older non-drivers. Another recommendation was to solicit help from wealthy community leaders whomay want to leave a legacy that could be used to develop a program that provides assistance to older non-drivers inneed.

5. Discussion

Driving is a necessity in American society. Consequently, losing or giving up the privilege to drive is a difficult,emotional issue for many elders. In our study of former drivers, the decision to stop was reluctantly made by the eldersthemselves or after prompting from other sources. A loss of independence was the overarching feeling once thedecision was made. Although difficult, participants urged policy makers to address older driver issues. Whileacknowledging that lack of transportation options complicated driving decisions, participants were strong proponentsof more stringent license renewal procedures to identify at-risk drivers. They also stressed the importance of seniorsmaking plans for eventual retirement from driving.

Focus group participants fell into two groups. “Proactives” made the decision to stop driving on their own andinformed their families after the decision was made. For “reluctant accepters” the decision to stop driving was madejointly with family or other influential parties. Like the proactives, reluctant accepters were aware of declining drivingskills before they stopped. Our participants described a third category of older drivers as “resisters.” Resisters werecharacterized as peers who should not be driving but are unwilling to alter their behaviors. While our focus groupparticipants had definite concerns about the safety of these drivers they did not feel it was their place to discuss it withthem.

The decision to stop driving is influenced by a variety of factors. A decline in health contributed to the decision ofseveral of participants to stop driving. Changes in vision and slowed reaction time made continued drivingprogressively more difficult for several subjects. Input from family and physicians were also crucial to drivingdecisions. For others, the cost of maintaining a private automobile was prohibitive. A few participants experienced a“scare” while driving that led them to question their ability to remain safely behind the wheel. A lack of viabletransportation alternatives also influenced our participants' driving decisions. Finally, gender differences were noted.Traditionally, men are the principal drivers in most families, and therefore may have stronger ties to driving thanwomen and find it more difficult to quit (Kostyniuk et al., 1998; O'Neill, 1997).

Research indicates that older adults who give up driving are reluctant to ask family and friends for transportation andthis is especially true for older male drivers (Stutts & Wilkens, 1999). In a 1999 focus group study, Hunt (cited inStaplin & Hunt, 1999) participants expressed similar reservations for asking family for transportation assistance. “I'drather stay home than bother a family member unless it was critical, only something that I had to do.” Another

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participant stated, “I feel hurried when I ask a family member for help; they have their own commitments to keep.”There was less reluctance to ask for a ride if the older adult felt that it was a necessity, “Some family member willalways take me to the doctor…it is a necessity.” Therefore, if the non-driver is depending exclusively on family orfriends for transportation, their social or recreational trips may be less frequent, leading to more social isolation whichresearch has shown can lead to depression (Marottoli et al., 1997). This emphasizes the importance of identifyingacceptable alternative transportation prior to driving cessation.

6. Recommendations

Major policy and program changes require a significant time frame to develop, therefore we divide ourrecommendations into short and long term.

6.1. Short term recommendations

As a way to aid older drivers with decisions about reducing or stopping driving, we propose the development of abrief self-evaluation. Questions about current medical conditions as well as questions about mental and emotionalhealth would help older drivers to begin thinking about their driving skills in the context of changes associated withnormal aging, as well as their personal medical and psychological status. The self-assessment along with input from atrusted family member or friend would give older drivers an opportunity to make their own assessment of potentialsafety concerns and if appropriate, make modifications to their driving habits, and identify alternative transportationresources. We also recommend periodic reassessment for older drivers who already have or develop medical conditionsthat impair vision, judgment, memory, motor abilities and other skills required for the safe operation of a motor vehicle.

As we learned from the participants in our study as well from others, older drivers do not plan to stop driving, eventhose who have a chronic disease that can impair driving performance (Adler, Rottunda, & Bauer, 1999; Adler,Rottunda, Bauer, & Kuskowski, 2000; Adler, Bauer, Rottunda, & Kuskowski, 2005). We suggest that a “Retirementfrom Driving” worksheet be used to help older drivers address the practical issues such as when to stop, who to tell,what to do for alternative transportation, travel budget, and disposal of the car. Currently, several guides and checklistsare available free of charge and could be used as a resource for older drivers to develop their own personalized tool. TheAmerican Medical Association (AMA) Physician's Guide to Assessing and Counseling Older Drivers (2003) includesa section with a checklist for driving safety and suggestions for making a transportation plan. The Hartford (2003)offers resources for both older drivers with dementia and their family members to assess current driving skills, a guidefor assisting family members in initiating a discussion about driving, sources for alternative transportation and aworksheet for calculating transportation expenses. The American Automobile Association (AAA) Foundation forTraffic Safety (n.d.) offers a list of transportation programs for each state. AARP (n.d.) has a brief questionnaire thatincludes warning signs suggesting the need to limit or stop driving. Boilerplate information worksheets could also beincluded in driver license renewal and insurance premium mailings as well as placed in public areas such as DMVlicense centers, senior centers, public libraries, hospital and clinic waiting areas and pharmacies.

6.2. Long term recommendations

Recommendations that require changes in state law or policy were endorsed by all focus groups. Several participantsrecommended briefer driver's license renewal cycles and more comprehensive testing for older drivers that includesbehind-the-wheel or driving simulator testing as well as tests measuring cognition, flexibility and reaction time. Theexpense of additional testing at each renewal cycle poses some barriers, namely expense and legality. A few statesalready have adapted accelerated renewal cycles and additional testing for older drivers and would be a resource forlearning how to develop and implement the new policies (AMA, 2003).

Other long-term recommendations included the inclusion of the topic driving cessation in corporate retirementseminars. This approach has the advantage of making the subject of driving cessation a part of the typical retirementplanning process, rather than a response to an adverse event. Meetings of service clubs, church groups and seniorhousing facilities were other venues suggested as appropriate for discussions of driving cessation. Organization leaderscould invite law enforcement personnel or fellow older adults to conduct workshops and seminars that incorporate aself-evaluation, planning worksheet and sources for alternative transportation within their communities.

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Finally, a public relations campaign to raise awareness of issues associated with the older driver would provide ameans for families and older drivers to approach the sensitive subject of driving. A conversation that is precipitated inthe context of a public safety matter may be less threatening to the older adult since the discussion could be about olderdrivers in general and not a particular individual.

7. Conclusion

Findings are limited because of the small sample size. Respondents self-selected to participate in a group discussionabout driving cessation. As would be expected, most had adjusted to the decision to stop driving and because of thatperhaps were more likely to recommend more stringent license renewal requirements for older drivers. The lack ofresisters makes sense given the recruiting method of relying upon people to self-select and taking the initiative bycalling to participate. It is likely that seniors who were forced to stop driving did not want to talk about the painfulprocess in a group setting. Information about resisters may be gathered more easily though discussion groups withfamily members or medical professionals who have had to enforce driving cessation. Due to the nature of the sampleand its size, findings should be interpreted with caution and policy recommendations considered directional in nature.However, the collective wisdom of our focus group participants provided some insight into the decision-makingprocess and concerns of older former drivers.

Acknowledgements

This material is the result of work funded by the Minnesota Department of Public Safety, St. Paul, Minnesota andwith the resources and use of facilities at the Veterans Affairs Medical Center, Minneapolis, Minnesota and theUniversity of South Carolina, Columbia, South Carolina.

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