The impact of urban vs rural environments on driving mobility and safety in older age

Older rural drivers rely more on driving due to limited transportation options, but the impact of cognition on driving in urban versus rural settings is unclear. This study examined whether cognitive changes affect driving mobility and road safety differently across these populations. In a prospective cohort study, 969 older drivers completed driving behaviour and road traffic incident (RTI) history questionnaires, followed by cognitive testing, with a follow-up one year later. 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. RTI incidence was higher in urban areas, with a stronger link between poor cognition and increased RTI risk in urban residents. This study suggests the interaction between cognitive changes and environmental setting on driving behaviour, providing insights for policy development on driving mobility and safety among older adults.