- Title
- Driving in later years of life and age-related vision changes among older Australian women: assessment of healthy ageing and healthcare utilisation using driving as an operational indicator of ageing well
- Creator
- Hambisa, Mitiku Teshome
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Abstract: This thesis is intended to investigate driving in later life, age-related cataracts, and cataract surgery uptake in relation to healthy ageing among older Australian women. Specifically, the work in this thesis examined predictors of driving and driving cessation over time, factors associated with age-related cataracts and cataract surgery uptake in older women. The thesis proposes that driving is a key aspect of healthy ageing for these women and that cataracts will impede driving. The thesis utilised data from the Australian Longitudinal Study on Women's Health (ALSWH) 1921-26 birth cohort. The following statistical methods were applied to address the study objectives: a qualitative content analysis to get insight into women’s comments about driving and driving cessation and eye disease, multivariable logistic regression to determine the prevalence and determinants of driving, and a generalised estimating equation (GEE) modelling to identify predictors of driving over time, factors associated with age-related cataracts, and cataract surgery. The women described driving as central to their health, well-being, and independence. They valued driving and worried in the event they couldn't drive. However, as the women have aged, many experienced deteriorations in vision that led to driving cessation and dependence on others for transport, typically children and friends. While vision impairment due to age-related cataracts was a barrier to continuing driving, successful cataract treatment helped resume driving. The odds of driving decreased over time, however women living in the states of Victoria and Western Australia (where there are no mandatory age-based older drivers screening) were more likely to drive on the longitudinal analysis. Driving was also associated with level of education, living in remote and outer regional Australia, living alone, providing care, participating in volunteer activities, and having higher levels of social interaction. However, older women with vision impairment, diabetes, stroke, and need help for daily tasks due to long-term chronic illness or disability were less likely to drive. The findings indicate that age and medical conditions alone do not determine driving in later life. The context of personal, social, and environmental factors should also be considered and aligned with the healthy ageing goals when developing driving policy for older people. This finding indicates that, since driving is central to their health and what older women value in life, it can be considered an indicator of healthy ageing. Predisposing factors of increasing age and smoking, and need factors of vision impairment, skin cancer, and more General Practitioner (GP) visits, increased the odds of cataract surgery. Women with private health insurance had a 27% higher likelihood of having surgery, with this being considered as an enabling factor according to the Andersen Newman behavioural model of health care use. The findings indicate some inequity regarding access to cataract surgery in the Australian setting. Therefore, policymakers could consider a specific and targeted policy for this age group that addresses timely access to health service use and prioritise those with no private insurance as a way to more equitably promote healthy ageing.
- Subject
- healthy ageing; driving in later years; health service utilisation; longitudinal analysis; age-related eye disease; cataract surgery
- Identifier
- http://hdl.handle.net/1959.13/1513650
- Identifier
- uon:56755
- Rights
- Copyright 2022 Mitiku Teshome Hambisa
- Language
- eng
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