Skip to main content Accessibility help

Attitudes: Mediators of the Relation between Health and Driving in Older Adults

  • Holly Tuokko (a1), Paweena Sukhawathanakul (a2), Laura Walzak (a2), Alexandra Jouk (a1), Anita Myers (a3), Shawn Marshall (a4), Gary Naglie (a5) (a6) (a7), Mark Rapoport (a8), Brenda Vrkljan (a9), Michelle Porter (a10), Malcolm Man-Son-Hing (a11), Barbara Mazer (a12) (a13), Nicol Korner-Bitensky (a12) (a13), Isabelle Gélinas (a12) (a13), Michel Bédard (a14) and on behalf of the Candrive II Research Team...


We examined the relations between perceived health (e.g., self-perceived health status) and driving self-regulatory practices (e.g., frequency of driving, avoiding challenging driving situations) as mediated by driving attitudes and perceptions (i.e., driving comfort, positive and negative attitudes towards driving) in data collected for 928 drivers aged 70 and older enrolled in the Candrive II study. We observed that specific attitudes towards driving (e.g., driving comfort, negative attitudes towards driving) mediate the relations between health symptoms and self-regulatory driving behaviours at baseline and over time. Only negative attitudes towards driving fully mediated the relationships between changes in perceived health symptoms and changes in driving behavior. Perceived health symptoms apparently influence the likelihood of avoiding challenging driving situations through both initial negative attitudes towards driving as well as changes in negative attitudes over time. Understanding influences on self-regulatory driving behaviours will be of benefit when designing interventions to enhance the safety of older drivers.

Nous avons examiné les relations entre la santé perçue (p. ex., l’état de santé auto-évaluation) et des pratiques d’autorégulation de la conduite (p. ex., la fréquence de la conduite, l’evitement des situations de conduite difficiles) comme médiée par les attitudes et les perceptions de conduite (à savoir, le confort de conduite, les attitudes positif et négatif envers la conduite) dans les données recueillies pour 928 conducteurs âgés de 70 ans et plus inscrits à l’étude Candrive II. Nous avons observé que les attitudes spécifiques à la conduite (p. ex., le confort de conduite, les attitudes négatives envers la conduite) assurent la médiation des relations entre les symptômes de santé et les comportements de conduite auto-reglementés au début et au fil du temps. Seuls les attitudes négatives à l’égard de conduite ont mediés entièrement les relations entre les changements dans les symptômes perçus de la santé et les changements dans le comportement de conduite. Les symptômes perçus pour la santé influencent apparemment la probabilité d’éviter des situations difficiles de conduite par le biais de deux attitudes négatives initiales pour la conduite, ainsi que des changements dans les attitudes négatives au fil du temps. Comprendre les influences sur le comportement de conduite d’auto-réglementation seront bénéfiques lors de la conception des interventions visant à améliorer la sécurité des conducteurs âgés.


Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Dr. Holly Tuokko Centre on Aging University of Victoria PO BOX 1700, STN CSC Victoria, BC V8W 2Y2 (


Hide All
American Association of Motor Vehicle Administrators. (2009). Driver fitness medical guidelines. National Traffic Safety Administration. Washington, DC: U.S. Department of Transportation.
Anstey, K. J., Windsor, T., Luczcz, M., & Andrews, G. (2006). Predicting driving cessation over 5 years in older adults: Psychological well-being and cognitive competence are stronger predictors than physical health. Journal of the American Geriatrics Society, 54(1), 121126.
Anstey, K. J., Wood, J., Lord, S., & Walker, J. (2005). Cognitive, sensory and physical factors enabling driving safety in older adults. Clinical Psychology Review, 25(1), 4565.
Baldock, M. R., Mathias, J. L., McLean, A., & Berndt, A. (2006). Self-regulation of driving and its relationship to driving ability among older adults. Accident Analysis & Prevention, 38(5), 10381045.
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 11731182.
Blanchard, R. A., & Myers, A. M. (2010). Examination of driving comfort and self-regulatory practices in older adults using in-vehicle devices to assess natural driving patterns. Accident Analysis & Prevention, 42(4), 12131219.
Blanchard, R. A., Myers, A. M., & Porter, M. M. (2010). Correspondence between self-reported and objective measures of driving exposure and patterns in older drivers. Accident Analysis & Prevention, 42(2), 523529.
Brabyn, J. A., Schneck, M., Lott, L., & Haegerstrom-Portnoy, G. (2005). Night driving self-restriction: Vision function and gender differences. Optometry & Vision Science, 82(8), 755764.
Canadian Medical Association. (2012). CMA Driver’s Guide: Determining medical fitness to operate motor vehicles (8th ed.). Toronto, ON: Author.
Carmel, S., Rechavi, T. B., & Ben-Moshe, Y. (2014). Antecedents of self-regulation in driving among older drivers. Ageing and Society, 34, 10971117.
Crizzle, A. M., Myers, A. M., & Almeida, Q. J. (2013). Self-regulatory practices of drivers with Parkinson’s disease: Accuracy of patient reports. Parkinsonism and Related Disorders, 19(2), 176180.
Crizzle, A. M., Myers, A. M., Roy, E. A., & Almeida, Q. J. (2013). Drivers with Parkinson’s disease: Are the symptoms of PD associated with restricted driving practices? Journal of Neurology, 260, 25622568.
D’Ambrosio, L. A., Donorfio, L. K. M., Coughlin, J. F., Mohyde, M., & Meyer, J. (2008). Gender differences in self-regulation patterns and attitudes towards driving among older adults. Journal of Women & Aging, 20, 265282.
Donorfio, L., D’Ambrosio, L., Coughlin, J., & Mohyde, M. (2008). Health, safety, self-regulation and the older driver: It’s not just a matter of age. Journal of Safety Research, 39(6), 555561.
Donorfio, L., Mohyde, M., Coughlin, J., & D’Ambrosio, L. (2008). A qualitative exploration of self-regulation behaviors among older drivers. Journal of Aging & Social Policy, 20(3), 323339.
Edwards, J. D., Lunsman, M., Perkins, M., Rebok, G. W., & Roth, D. L. (2009). Driving cessation and health trajectories in older adults. Journal of Gerontology: Series A: Biological and Medical Sciences, 64, 12901295.
Gwyther, H. & Holland, C. (2012). The effect of age, gender and attitudes on self-regulation in driving. Accident Analysis & Prevention, 45, 1928.
Hudon, C., Fortin, M., & Vanasse, A. (2005). Cumulative illness rating scale was a reliable and valid index in the family practice context. Journal of Clinical Epidemiology, 58, 603608.
Jouk, A., Tuokko, H., Myers, A., Marshall, S., Man-Son-Hing, M., Porter, M. M., et al. (2014). Psychosocial constructs and self-reported driving restriction in the Candrive II older adult baseline cohort. Transportation research Part F, 27, 110.
Librero, J., Peiro, S., & Ordinana, R. (1999). Chronic comorbidity and outcomes of hospital care: Length of stay, mortality, and readmission at 30 and 365 days. Journal of Clinical Epidemiology, 52, 171179.
Lindstrom-Forneri, W., Tuokko, H., & Rhodes, R. (2007). “Getting around town”: A preliminary investigation of the theory of planned behavior and intent to change driving behaviors among older adults. Applied Gerontology, 26(4), 385398.
Lindstrom-Forneri, W., Tuokko, H. A., Garrett, D., & Molnar, F. (2010). Driving as an everyday competence: A model of driving competence and behavior. Clinical Gerontologist: The Journal of Aging and Mental Health, 33(4), 283297.
Linn, B. S., Linn, M. W., & Gurel, L. (1968). Cumulative illness rating scale. Journal of American Geriatrics Society, 16, 622626.
MacDonald, L., Myers, A. M., & Blanchard, R. A. (2008). Correspondence among older drivers’ perceptions, abilities, and behaviors. Topics in Geriatric Rehabilitation, 24(3), 239252.
Marottoli, R., Cooney, L., Wagner, R., Doucette, M., & Tinetti, M. (1994). Predictors of automobile crashes and moving violations among elderly drivers. Annals of Internal Medicine, 121(11), 842846.
Marshall, S. C., & Man-Son-Hing, M. (2011). Multiple chronic medical conditions and associated driving risk: A systematic review. Traffic Injury Prevention, 12(2), 142148.
Marshall, S., Man-Son-Hing, M., Bédard, M., Charlton, J., Gagnon, S., Gélinas, I., et al. (2013). Protocol for Candrive II/Ozcandrive, a multicentre prospective older driver cohort study. Accident Analysis and Prevention, 61, 245252.
McGwin, G. Jr., Chapman, V., & Owsley, C. (2000). Visual risk factors for driving difficulty among older drivers. Accident Analysis & Prevention, 32(6), 735744.
Miller, M. D., Paradis, C. F., Houck, P. R., Mazumdar, S., Stack, J. A., Rifai, A. H., et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: Application of the cumulative illness rating scale. Psychiatry Research, 41(3), 237248.
Molnar, L. J., & Eby, D. (2008). The relationship between self-regulation and driving-related abilities in older drivers: An exploratory study. Traffic Injury Prevention, 9(4), 314319.
Muthén, L. K., & Muthén, B. O. (2012). Mplus User’s Guide (7th ed.). Los Angeles, CA: Muthén & Muthén.
Myers, A. M., Paradis, J., & Blanchard, R. A. (2008). Conceptualizing and measuring confidence in older drivers: Development of the day and night driving comfort scales. Archives of Physical Medicine and Rehabilitation, 89, 630640.
Myers, A. M., Trang, A., & Crizzle, A. M. (2011). Naturalistic study of winter driving practices by older men and women: Examination of weather, road conditions, trip purposes and comfort. Canadian Journal on Aging, 30, 577589.
O’Connor, M. L., Edwards, J. D., Small, B., & Andel, R. (2011). Patterns of level and change in self-reported driving behaviors among older adults: Who self-regulates? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 67(4), 437446.
O’Connor, M. L., Edwards, J. D., Waters, M. P., Hudak, E. M., & Valdés, E. G. (2013). Mediators of the association between driving cessation and mortality among older adults. Journal of Aging and Health, 25(8S), 249S269S.
Owsley, C., Stalvey, B., & Philips, J. (2003). The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers. Accident Analysis and Prevention, 35, 393400.
Parker, D., Macdonald, L., Sutcliffe, P., & Rabbitt, P. (2001). Confidence and the older driver. Ageing and Society, 21(02), 169182.
Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 3848.
Rochon, P. A., Katz, J. N., Morrow, L. A., McGlinchey-Berroth, R., Ahlquist, M., Sarkarati, M., et al. (1996). Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability: A prospective comparison of three comorbidity indices. Medical Care, 34, 1093–101.
Ruechel, S., & Mann, W. C. (2005). Self-regulation of driving by older persons. Physical and Occupational Therapy in Geriatrics, 23(2–3), 91101.
Stalvey, B. T., & Owsley, C. (2000). Self-perceptions and current practices of high-risk older drivers: Implications for driver safety interventions. Journal of Health Psychology, 5(4), 441456.
Steinfeld, E., Tomita, M., Mann, W. C., & DeGlopper, W. (1999). Use of passenger vehicles by older people with disabilities. Occupational Therapy Journal of Research, 19(3), 155186.
Tuokko, H., McGee, P., & Rhodes, R. E. (2006). Decisional balance and readiness to change driving behavior in older adults: A pilot study. Physical & Occupational Therapy in Geriatrics, 24(3), 112.
Tuokko, H., Myers, A., Jouk, A., Marshall, S., Man-Son-Hing, M., Porter, M. M., et al. (2013). Associations between age, gender, psychosocial and health characteristics in the Candrive II study cohort. Accident Analysis & Prevention, 61, 267271.
Tuokko, H. A., Rhodes, R. E., & Dean, R. (2007). Health conditions, health symptoms and driving difficulties in older adults. Age and Ageing, 36(4), 389394.
Turano, K., Munoz, B., Hassan, D., Duncan, D., Gower, E., Roche, K., et al. (2009). Poor sense of direction is associated with constricted driving space in older drivers. The Journals of Gerontology: Psychological Sciences, 64B(3), 348355.
Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473483.
Weinstein, N. D. (1988). The precaution adoption process. Health Psychology, 7(4), 355386.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed