Transportation barriers, loneliness, and depressive/anxiety symptoms in older adults

Transportation is crucial to maintaining social engagement in later life. Lack of transportation is significantly associated with depressive/anxiety symptoms in older adults. In this study, we examined the extent to which loneliness mediates the relationship between transportation barriers and depressive/anxiety symptoms.

Using the 2023 National Health and Aging Trends Study (N = 7,547; age 65+), we defined transportation barriers as transportation problems that kept older adults from visiting family/friends, attending religious services, attending club meetings, or going out for enjoyment. We fitted a path model, and to test the mediation effect, we used bootstrapped analysis to obtain estimates of the indirect effects and their 95% confidence intervals (CIs).

Of the study population, 4.4%, or 2 million people, reported transportation barriers. We found significant direct effects of transportation barriers on loneliness and depressive/anxiety symptoms and indirect effects of loneliness (0.40, 95% CIs = [0.23, 0.57], z = 4.57, p < .001) on depressive/anxiety symptoms. The ratio of the indirect effect to the total effect of transportation barriers on depressive/anxiety symptoms (indirect effect [0.40] + direct effect [0.50] = 0.90) was 0.44. The ratio of the indirect effect of loneliness to the direct effect of transportation barriers on depressive/anxiety symptoms was 0.80.

Loneliness significantly mediates the association between transportation barriers and depression/anxiety in older adults. Transportation should be recognized as both a mobility and a mental health issue. Policies to enable older adults to continue social engagement, decrease loneliness, and alleviate depression/anxiety are needed.