1. Finding the Mechanisms Underlying the Associations Between Falls, Fear of Falling, and Driving Among Older Adults
- Author
-
Cao, Jiawei
- Subjects
- Gerontology, older adults, driving behavior, falls, fear of falling, psychological pathways, mediation, conditional process model
- Abstract
In the United States, walking and driving are the two most common modes of mobility, which is fundamental for older adults to access social services and maintain independence, physical and psychological wellbeing, and social participation. Falls and motor vehicle crashes, which can result from walking and driving, respectively, are also the top two leading causes of injurious deaths among older adults. Previous studies have started to investigate the association between falls and crashes (and other driving measures such as driving exposure and behaviors). Despite identifying some significant relationships, a meaningful mechanism has yet to be determined. Specifically, whether falls affects driving-related measures through a particular pathway remains unknown. In addition, fear of falling, as an important psychological issue, has been largely overlooked in the literature regarding its relationship to driving.This dissertation utilized data from the AAA Longitudinal Research on Aging Drivers (LongROAD) study to examine whether and how falls and fear of falling are associated with consequent crashes, reduced driving exposure, and driving avoidance behaviors. Mediations of multiple physical and psychological measures were examined to identify meaningful pathways from falls and fear of falling to driving-related measures. Gender differences and the moderation of a history of falls were also examined in fear of falling and its effects on driving among older adults.Results indicated that falls and fear of falling have either direct or indirect effects on driving exposure and avoidance behaviors through distinct physical or psychological pathways, after controlling for covariates. For example, falls can indirectly affect miles driven through its impact on lower extremity function first and then onto miles (driving exposure, physical pathway); fear of falling can also indirectly affect the percentage of trips at night by influencing driving comfort first and then affecting the percentage of trips at night (driving avoidance measure, psychological pathway). Gender moderates the pathways from fear of falling to certain driving measures while having a history of falls does not.Given these results, public awareness of the connections between falls, fear of falling, and driving should be raised. Programs and interventions that currently work independently in each field may consider including elements of both to improve communication and collaboration, and to help older adults better balance safety and mobility. This dissertation also calls for further investigation into additional underlying mechanisms.
- Published
- 2021