The impact of urban vs rural environments on driving in ageing

Abstract Background and objectives Older rural drivers are more dependent on driving than urban drivers to maintain community mobility due to reduced availability of transportation alternatives. Yet it is not understood how cognition impacts driving mobility and road safety across urban vs rural settings. The present study therefore aimed to establish whether cognitive changes impacted driving mobility and road safety differently across rural and urban older drivers. Research Design and Methods 969 older drivers (mean age: 71.01) were recruited for a prospective cohort study. Participants completed self-reported driving behaviour and road traffic incident (RTI) history questionnaires before completing an objective cognitive testing battery to establish global cognitive functioning; and were invited back to repeat the study procedure one-year later. Results We find that older rural drivers have a greater driving mobility than older urban drivers and are less likely to reduce their driving mobility over time, as only urban residents with cognitive decline reduced their driving space. We further corroborate previous findings that RTI incidence is greater within urban areas and establish a distinct association between worse cognitive functioning and RTI risk solely in urban residents. Discussion and implications Overall, we show for the first time how the interaction of age-related cognitive changes with geographical settings impact driving mobility and road safety in urban and rural areas. This paves the way for informed policymaking and future research directions to navigate driving cessation and improved road safety in ageing.