Driving status, avoidance, and visual impairment among older adults in the United States.

Background: Late-life visual impairment (VI) increases driving difficulty and affects driving outcomes, such as driving cessation and avoidance. Existing studies are limited by small sample sizes and a lack of objective VI measures in older drivers on a national scale. Methods: Using nationally representative data from the 2022 National Health and Aging Trends Study, we examined associations between objectively measured VI, driving cessation, and avoidance among U.S. adults aged ≥65 (n=4,980). VI was defined using measures of binocular distance visual acuity and contrast sensitivity (CS). Driving cessation was defined as no longer driving in the prior month, and driving avoidance included avoiding driving at night, alone, and on highways. Results: Weighted sample characteristics showed that 9.4% of older adults had distance VI (DVI) and 9.2% had CS impairment (CSI). Nearly half of older adults with VI avoided driving at night, about 1 in 7 avoided driving alone, and more than 1 in 4 avoided driving on highways. Compared to those without any VI, older adults with any type of VI were more likely to report driving cessation (OR=2.31, 95%CI=1.62-3.29) and to avoid driving at night(OR=1.63, 95%CI=1.15-2.32), on highways(OR=1.41, 95%CI=1.02-2.05), and alone(OR=1.76, 95%CI=1.07-2.89). DVI and CSI were each significantly associated with all outcomes, with stronger associations for more severe DVI. For each outcome, the joint association of combined DVI and CSI was stronger than for a single VI. Discussion: Preventing VI and deploying interventions to restore vision are necessary to promote independence in late life by keeping older adults driving safely.