Date of Award

Spring 5-17-2019

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Ike Okosun

Second Advisor

Dr. Ruiyan Luo

Abstract

Introduction: Driving is an important instrumental activity of daily living, which allows older adults to access healthcare resources and manage their daily necessities. However, older adults belonging to low-income racial minorities, particularly women, make up a large proportion of never-driver seniors and are higher utilizers of alternative modes of transportation1,2. Our study is a comparative analysis of co-morbid health conditions among older drivers and non-drivers, matched by age and gender, receiving care at a safety-net hospital in Atlanta to assess utilization of health care resources and chronic disease burden between the two groups. Methods: We conducted a chart review of patients age 65 or older receiving care at the Emma Darnell Geriatric Center at Grady Hospital during 2/1/2016-2/1/2017. Data obtained by chart review of Epic electronic medical record (EMR) included demographics, insurance information, functional data sheet (which included data on activities of daily living, self-reported use of assistive device, self-reported hearing and vision impairment, self-reported driving status), number of Geriatrics Clinic visits in a year and associated visit diagnoses. The Katz and Lawton Activities of Daily Living (ADL) scales were modified based on available data, to calculate ADL scores. Results: A total of 690 patient charts were included in the analysis, 23% of whom reported being drivers. Mean age was 76 and 80 respectively in driver and non-driver group, with over 94% identifying themselves as African Americans and over 67% being women in both the groups. Functional dependency measured by mean modified Katz and Lawton ADL scores and self-reported use of assistive devices was higher in non-drivers compared to drivers. There was a higher prevalence of self-reported sensory impairment and diagnoses of cognitive impairment in 22 the non-drivers group, but the prevalence of other chronic diseases as measured by visit diagnoses didn’t differ between the two groups. Utilization of care, measured by the mean number of visits to Geriatrics Primary Care Clinic in a year, did not differ among drivers (1.2 mean visits per year) and non-drivers (1.3 mean visits per year) and didn’t improve for individuals enrolled in a Medicare Advantage plan. Conclusion: Approximately 23% of older adults getting care at a safety-net hospital in Atlanta drive a motor vehicle. Utilization of heath care resources, as measured by the number of geriatrics clinic visits per year, was generally low, and did not differ based on driving status.

Available for download on Friday, May 01, 2020

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