When Dr. Richard Marottoli sees elderly patients, he can measure bone loss and high blood pressure. He can order tests for glaucoma and kidney function. But he often struggles to determine when the women and men under his care are no longer able to drive safely.
“It’s not as if there’s a blood test,” Marottoli said. “It’s not like how we know when your thyroid levels are off.”
Now as one of four new studies funded through Women’s Health Research at Yale’s Pilot Project Program, Marottoli aims to add to his body of work with elderly male drivers and identify the cognitive, health and environmental factors that can predict adverse events among women drivers, such as crashes and tickets. His goal is to develop interventions that can make his patients and the public safer.
“I think it will give us a chance to make a vast improvement over our current capability to assess safe driving capability,” Marottoli said.
By 2030, one-fifth of all drivers will be at least 65 years old. Currently, 73 percent of women over 65 still drive. Between 1990 and 2020, the distances traveled by older female drivers will increase by 500 percent.
“Older women are more likely to live alone, and they often feel compelled to keep driving in order to maintain their social connections and keep important appointments,” said Dr. Carolyn M. Mazure, Director of Women’s Health Research at Yale. “Yet, driving when skills are not adequate leaves women at risk. Dr. Marottoli’s study will help shed light on this growing issue and lead the way toward solutions.”
Because women, on average, live longer than men, the study addresses an urgent need to provide guidance in determining when women should stop driving.
“I think every adult child’s fear is either mom or dad is going to get into an accident,” Mazure said, expressing the need to inform or dispel those fears with solid data. “Children, partners, friends – I think people are really hungry for helpful information.”
The study will utilize data from the Women’s Health Initiative Memory Study (WHIMS), a longitudinal examination of the cognitive effects of aging originally collected between 1993 and 1997. Since then, researchers have completed annual cognitive assessments of the participants, who are currently between the ages of 68 and 93.
Beginning in 2013 and 2014, the researchers added questions on driving, including the participants’ current driving status, adverse driving events, alternative means of transportation, driving problems, specific driving practices, and self-reported confidence.
Currently, doctors guide their decisions with studies that rely on either detailed information on a small number of people or limited information on a large number of people. The WHIMS data boasts a uniquely large size; a focus on women; a wide racial, ethnic, and geographic scope; a deep well of information; and longitudinal follow-up.
Dr. Marottoli plans to analyze the 2,549 participants’ data to identify the key factors that can predict adverse driving events and driving cessation in comparison to 1,330 older male drivers taken from Marottoli’s previous New Haven-based studies.
In addition, Marottoli aims to use brain scans from a group of 1,400 WHIMS participants to seek any relationship between brain volume, cognitive functioning, and adverse driving events and driving cessation.
“The hope would be to dispel some myths,” Marottoli said. “In situations where both men and women drive, they are equally competent and do equally well.”
Dr. Marottoli has studied geriatrics since attending Yale School of Medicine as a student and completing his thesis on the topic.
“Older people in my family were always the center of attention,” Marottoli said of the fondness he felt for the Italian clan he grew up with. “All the holidays and social functions revolved around them.”
But as people age, Marottoli understands how their physical and cognitive limitations affect their mood. And when it comes to driving in our increasingly spread-out communities, determining when to put down the keys for good becomes a matter of safety.
“It’s a big deal for people,” Marottoli said. “In the vast majority of our country, if you don’t drive, you can’t leave home. It’s synonymous with freedom and independence.”
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