Aging, Autos and Walkable Neighborhoods

About a year ago, my 83-year-old mother blacked out at the wheel, drove into a phone pole and totaled her car. Amazingly, she wasn’t killed. She walked away with little more than scratches. But ever since, I have worried that her dependence on driving is shortening her life in slower and more insidious ways.

Fact is, car dependence is unhealthy for all seniors, not just my mother.
A mini park in my very walkable neighborhood
A mini park in my neighborhood

This post will look at how walkable neighborhoods figure into the aging-in-place equation – that is, how long and how comfortably we can live in our own homes without having to move into some kind of assisted living.

As always, I invite you to engage me in discussion about these issues. To spark collective thinking, I have also included a poll at the end of this post. It asks just one question: How well could you get along without your car for a full month? (So far, the responses are weirdly reversing the bell curve!) I have also discovered a fabulous website that maps where you live, shows how far away the necessary amenities are located, and gives you an immediate “walk score.” You might want to keep those items in mind as you read on.

Isn’t This an Interior Design Blog?

Writing about what’s outside my door is a bit a departure for this blog. I usually write about sustaining a life of comfort and joy inside the house. But as regular readers know, sustainable living is not only a leitmotif in my writing, it has also been a frequent topic lately. In researching the post I wrote two weeks ago on Greening the Little Red Schoolhouse, I stumbled across the news that the United States Green Building Council, which created the  LEED system, is currently developing ratings for sustainable neighborhoods.

Another part of my Neighborhood
Another part of my neighborhood

That intrigued me. Because I have worked for nonprofits and research organizations that were: 1) providing alternatives to solo driving to reduce traffic congestion and air pollution, 2) trying to prevent domestic violence and 3) developing and evaluating interventions to improve public schools, I’m familiar with several fascinating, and seemingly unrelated, bodies of research. As I read about LEED for Neighborhoods, however, I began to see connection both to those bodies of research and also to lessons I have learned in overcoming personal challenges with asthma and depression. Voila, a blog topic!

But what does all this have to do with my mother and her car? Reading about sustainable neighborhoods has convinced me that anyone who wants to age in place – my mother, you, me, your elderly auntie – needs not only to think about how to sustain health and happiness inside the house, but also about whether the location of that house is going to damage their health and well-being by forcing them to be car-dependent.

To put it bluntly, I believe that our dependence on cars is killing us. That damage may be done in the blink of an eye – as happened when my mother lost consciousness at the wheel – or it may be a more-gradual abrasion of physical, emotional and social health. Here’s why I say that.

Cars Harm Our Physical Health

Air pollution in China
Air pollution in China

If you’ve ever lived close to a busy street or a freeway, you’ve seen the grit and grime that accumulates on your furniture. The same gunk is accumulating in your lungs. You’ve seen photos of the orange-brown smog that hangs over the Los Angeles basin. You may have even stumbled across the interesting fact that traffic cops in China now live only about 40 years before they are killed off by air pollution. Improvements in mileage and smog control devices have been outpaced by the sheer number of miles we drive. As a result, the EPA has stated that:

…motor vehicles (onroad) still contribute significantly to air pollution, accounting nationwide for a quarter of the CFCs in the air, 51 percent of the carbon monoxide, 30 percent of the carbon dioxide, 34 percent of the nitrogen oxides, nearly one-third of VOCs emitted in the United States… transportation is a significantly greater source of pollution than are industrial sources, power plants or small businesses.

There, of course, are conclusive links between air pollution and a host of lung and heart diseases. The American Heart Association published its first official statement on air pollution and cardiovascular disease in 2004. After  reviewing the scientific evidence, an expert panel stated that [even] short-term exposure to elevated particulate matter, which includes auto  emissions, “significantly contributes to increased acute cardiovascular mortality, particularly in certain at-risk subsets of the population.” More recently, Dr. Barbara Hoffmann, head of the unit of environmental epidemiology at the University of Duisburg-Essen, measured calcium build-up in the arteries to explore the impact of living close to auto exhaust. She found that  people living within 160 feet of heavy traffic suffered a 63% higher risk of coronary artery calcification than people living 642 feet away!

But the health effects are not limited to damage from air pollution. LEED for Neighborhoods references scientific evidence that tells us that:

…physical inactivity can lead to obesity and other more serious illnesses. Lack of mobility and resulting isolation may be linked to depression and overall lower recovery from illnesses, which can lead to early death. Thus, urban environments that are not conducive to walking and bicycling and provide few transportation alternatives for older people can have significant health impacts on this growing portion of the American population.

Regular exercise is absolutely essential for older people. Our balance, mobility and flexible follow the rule of nature that says that if you don’t use it, you lose it. My fellow blogger Stan Cohen, who teaches movement seminars for seniors, writes about the importance of regular exercise as we age. In his “Intuitive Movement” blog he says, “Practicing movement routines helps you live life better and do daily living activities than without it. Plain and simple truth. The more you practice, and do the exercises, the more you will be able to do. It makes no matter what age you are. You can make improvements, be more self-sufficient, do more life activities and live healthier. ”

We cling to our cars because we want to be independent, mobile and self-sufficient, while ironically, we live in landscapes that undermine our personal mobility. Urban carscapes impose physical barriers to walking and bicycling – the most frequent forms of exercise seniors use – and they also isolate us.

Alice Wallace, longtime friend of the author
Alice Wallace, longtime friend of the author and beloved member of the Unitarian Universalist Society of San Francisco

An example: After the accident, the State of Arizona suspended my mother’s driver’s license, grounding her in the most debilitating way. The nearest grocery store is about two miles away as the crow flies. A pedestrian trying to reach it would need to walk nearly double that distance, coping with meandering and dead-end streets and detouring around fences and brick walls. The only option available to my carless mother was a senior transportation charter that arrived after hour-and-a-half waits, making each social, medical, or work trip a half-day affair. I fully understood my mother’s jubilance when Arizona returned her license. At the same time, I question the state’s wisdom in safeguarding her health and that of others endangered by a senior who may be a danger behind the wheel.

That brings me to my final point about autos and bodily health. When car bodies and human bodies collide, the results are devastating. My dear friend Alice Wallace, pictured above at right, was hit and killed on busy 19th Avenue, a dangerous, in-town extension of California Route 1 here in San Francisco. Alice had moved out of her home into an assisted living facility only a few weeks earlier at the age of 86. Alice was an avid walker who swam laps every day, and given the circumstances of her death, I consider her death a fatality that can be attributed to living in an environment that favors the convenience of cars over the health of human beings.

Interestingly enough, moving out into suburban situations like my mom’s does not lessen the likelihood of car crashes. The toll from car crashes is actually higher in the suburbs than it is in high-density urban neighborhoods. Here’s LEED again:

In general, research shows that any reduction in the amount or speed of vehicle travel will result in a reduction of collision rates. Increasing density reduces both factors. More specifically, studies find that per capita automobile crashes are about four times higher for residents in low-density suburbs than in higher-density urban neighborhoods. All else being equal, a doubling of the neighborhood density corresponds to a five percent reduction in traffic accidents per capita…

Cars Undermine Human Connections

The top map shows social connectedness with light colors indicating the lowest levels of connection and dark colors showing highest levels of connection. Nevada stands out in this map for its lack of social capital. The map directly above shows suicide rates, with red indicating the areas highest rates. Look at Nevada again!  The Radical Cartography blog, which features these two maps, has an amazing collection of maps and is well worth a visit.

Human beings are social creatures and become depressed when isolated. (This is also true for many other mammals.) When we’re depressed, we suffer chemical changes that degrade our physical health and put us at increased risk for a variety of diseases and chronic conditions. The connection between social deprivation and poor health has been documented for both communities and individuals.

I mentioned earlier that one of the health issues I have struggled with has been depression. A year ago, I was fortunate to be treated at Kaiser Permanente, where I was taught to alter both mood and mental chemistry through Cognitive Behavior Therapy (CBT). My physician cited numerous long-term studies and stated flatly that three things have been absolutely proven to be effective in lifting depression: 1) exercise, 2) social activities, and 3) SSRI (selective serotonin uptake inhibitor) medications. “If you don’t want to take meds,” he said, “You’d better make darn sure you say ‘yes’ every time someone asks you to do something remotely social –  and you’d better get regular exercise.” He then went on to say that untreated depression was serious, leading not only to suicides, but also to a dramatically increased risk of developing Alzheimers.

The importance of social connections is further underscored by public health studies that show dramatic correlations between longevity and social activity, or conversely, disease and social isolation. That correlation can be seen graphically in the two maps at the left, which are drawn from the blog Radical Cartography. The top map charts the rate of suicide in the US while the lower map, from Robert Putnam’s book Bowling Alone, graphs the social interconnectedness of US states based a weighted combination of the following fourteen statistics:

  • Rate of serving on a committee of a local organization during previous year
  • Rate of serving as an officer of a local organization during previous year
  • Mean number of club meetings attended during previous year per person
  • Mean number of group memberships per person
  • Turnout in presidential elections, 1988 and 1992
  • Rate of attending town or school meetings
  • Number of nonprofits per person
  • Rate of working on a community project during previous year
  • Rate of volunteerism
  • Rate of agreement with “I spend a lot of time visiting friends”
  • Rate of entertaining at home during previous year
  • Rate of agreement with “Most people can be trusted.”
  • Rate of agreement with “Most people are honest.”
  • Civic/social organizations per person

While it’s true that having a car makes it easier to go see a friend, the fact that we must get into our cars and leave our neighborhoods every day has led to sprawling development, long commutes and bedroom communities in which neighbors really know very little about one another. In addition, most of us have to make an appointment to see a friend. Net result: someone like my mother really can’t count on her neighbors for social or emotional support, or even a ride to the grocery store.

House of the Valley Cats - one of those cats is the author of this blog.
House of the Valley Cats - one of those cats is the author of this blog.

A hundred and fifty years ago, almost everyone walked to work, and the “commute” took five to minutes to half an hour. The progress of the past century has made hour-long commutes common, and longer commutes are associated with high blood pressure, loss of family time, and increased absences from work.

I have had my own struggles with commuting. Years ago, I lived in Hinsdale, Illinois, and commuted into Chicago for my graduate studies in design. One memorably snowy winter, an oncoming snowstorm trapped thousands of people in downtown Chicago and turned my thirty minute commute into a three-hour, white-knuckle nightmare. I developed a dogged determination to never again live in a place where I was utterly dependent on an automobile to carry on the tasks of daily life.

Fast forward a decade. My career took me to Los Angeles for about a year. While there, I attempted to avoid LA’s freeways by quirkily opting to live where I could walk to work. This is simply not done in LA. Those who try to walk are architecturally punished. My walk, from Bunker Hill to Figueroa Street in downtown LA, was only about six blocks. But it involved having to climb up stairs to cross the roofs of buildings, descending an escalator into an underground shopping mall and dodging shoppers to cross an otherwise pedestrian-proof street! Since I was able bodied and in my twenties, this was merely annoying. For a mobility-impaired person, it would have been impossible.

Moreover, I quickly discovered that other than my job, there was almost nothing to walk to. The nearly abandoned streets did not feel safe at night, and I seldom left my luxury apartment house except to visit its whirlpool spa. I soon began to feel like a prisoner under house arrest. I imagine a great many older people in the US feel that way. In its study “Aging Americans: Stranded Without Options“,  the Surface Transportation Policy Partnership (STPP) found inhat “compared with older divers, older non-drivers in the United States make:

  • 15% fewer trips to the doctor
  • 59% fewer shopping tips and visits to restaurants
  • 65% fewer trips for social, family and religious activities

STPP also found that more than half of all non-drivers aged 65 and over stay at home in a given day, often because they do not have transportation options… Older people use public transportation when it is available… However, only half of older Americans have access to public transportation to meet their daily needs.

So there you have it. This rant pretty much explains why I chose to live in the city, and why, when making plans for aging in place, I chose my Noe Valley neighborhood. (There are some considerable drawbacks too. I live in an area of unwanted seismic activity, in a house badly in need of earthquake retrofitting that I won’t be able to afford for some time.) But for walkability, I would say that my neighborhood rates five stars on the poll.

How would you rate yours?


“Engineering the daily physical activity out of our lives has fueled the obesity epidemic, which in addition to creating health problems, impacts our aging population, who rely heavily on walking and transit to access the services they need.  As landscape architects, we can design active living components back into our communities, working with developers and public officials to make sure people have transportation options besides getting behind the wheel of a car.”

-Susan L.B. Jacobson, FASLA
President of The American Society of Landscape Architects (ASLA)

“Non-elderly people with disabilities face many of the same limitations of transportation as do older people – personal vehicles and taxis may not be accessible to many people who use mobility aids or have sensory impairments.  Barriers on vehicles and on rights of way make it difficult to use public transportation where it is available.  As with older Americans, people with disabilities may be isolated – not by choice.  Paralyzed Veterans of America also supports federal transportation policy that adequately funds public transportation, increases safe and accessible rights of way, and requires inclusive planning so all Americans can move around their communities.”

-Maureen McCloskey
Director of National Advocacy for the Paralyzed Veterans of America

Today more than three and a half million Americans age 65+ risk isolation simply because they don’t drive, and their numbers will explode after 2025 when Boomers enter their 60s, 70s and 80s. Federal, state and local policymakers must start now to plan for the time when Americans who grew up in cars put down their keys for good…”

-Byron Thames
AARP Board Member


17 thoughts on “Aging, Autos and Walkable Neighborhoods

  1. My city has NO walkable neighborhoods and NO public transit of any kind. The old town area is close because it has that kind of “feel” and does have some services nearby. I purchased an infill lot a couple miles north of this old town in an established neighborhood with a high percentage of seniors. The problem is many of the streets are steep! The streets are wide and traffic is slow, but I can’t imagine most of these seniors navigating those streets on foot or bike even if there were a market and other essentials close. The city plans nearby greenways, but that won’t fix the fact we’re halfway up a mountain.

    My lot is still trees and rocks, but that hasn’t stopped some of these seniors from stopping to talk as they drive by. One cheerfully nagged my mother and I not to walked in those woods, calling us “girls!” Well, she WAS about my grandmother’s age. 🙂

    The point of this ramble is that sometimes choosing a place to live means choosing good neighbors, too. And being a good neighbor in return.

  2. I’m lucky to be able to use public transit easily but I’m an absolute EVANGELIST for San Francisco’s City CarShare ( Two cars — one is a Prius — are parked only three blocks away. They’re part of the fleet I can access 24/7 by online or telephone reservation. I don’t know how many neighbors I share the cars with but they’re always clean, maintained and at least half full of gas. The pricing creates an incentive for fuel conservation and it’s a community-owned non profit. Triple bottom line! (

  3. It appears as though businesses and individuals are working harder as of late to create a more green environment for everyone. There’s actually a bank moving to my town called e3bank ( that is offering a triple bottom line…incentivizing people to install eco-friendly features to their homes and/or businesses. Hopefully with the introduction of these new green banks comes new initiatives that help save our environment!

  4. I am a native of New York City and have stayed because, for all its faults, it has more mass transit than any other American city and is fairly walkable.

    My Dad is 81 and hasn’t driven a car in more than 50 years. He still walks to the local supermarket a couple of times a week (except in very bad weather) and does local errands on foot. For longer trips he uses transit or a car service. Of course I have no proof, but I’m inclined to think that the walking is healthy for him.

    For those who are interested, NYC has a great organization called Transportation Alternatives that advocates for cyclists and pedestrians. They occasionally post information about transportation issues and older people. Some info might resonate with those outside NYC.

  5. Accessible communities are key to a improving the quality of life. In today’s NY Times, Vauban, Germany is featured.

    “Vauban, Germany, is an affluent new suburban community that differs from traditional suburbs in many respects. The most important difference is that cars are forbidden on most of Vauban’s streets, and houses cannot have driveways or garages. Though not quite car-free, Vauban, a district of Freiburg, near the Swiss border, is a highly “car-reduced” suburb.”

    Cars, along with ambulances, firetruck and police cars are needed. Rather than try to ban the vehicles we need to encourage walkable and bikeable ocmmunities.

    Vauban is described as “…a children’s paradise, where youngsters wander from a young age in safety.” Everyone should feel comfortable wandering in their neighborhood.

  6. That’s very exciting, Jason. It sounds like a topic for another blog post. Thanks for letting me know about it, and thanks for reading. I keep seeing your knowledgeable notes and I’m glad that you’re visiting.

  7. Nicolette,

    This is one of the most stimulating articles I’ve read in a while. It was refreshing not to see the same regurgitated concepts that seems to permeate so much of what is written online about aging in place.

    I believe you have touched on a topic that many in the (commonly perceived) aging in place industries fail to acknowledge: It’s not just about modifying your home and getting someone to come in for your healthcare every once in a while. Rather, it is about making life changes & plans that support your ability to maintain your quality of life as you age.

    Aging in place is a choice, but one that is not (can cannot) be easily made without the proper foundation *in the community* and the proper planning by the individual.

    I fear for the individuals in communities that cannot see the writing on the wall or are unable to begin crafting solutions to meet the growing needs of it’s population.

    Thanks so much for your insight and taking the time to craft this great article.

  8. Thank you very much, Mark. I think community is very much a key concept here. I appreciate both your comment and your leadership in the aging in place arena.

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  10. There are some cultures especially in Asia wherein the family grows together vertically and horizontally. In this way, the elderly doesnt have the problem of living alone. Most oftentimes they live and grow old in one of their children’s family. This is also a good way of taking care of them.

  11. good to see someone else who cares so much about these issues. sadly in so many cases it’s only the upper middle to upper class who can actually DO anything about it. for example. for many years i was forced to stay in baltimore city because i was either homeless or carless or both, so i had to stay close to the “joke” of a public transit system. while there i had to deal with a myriad of crime and severe air pollution. finally i bought a car and left for the “good life” in the country. i’m extremely socially isolated, still live on a busy noisy highway and am dealing with serious crime here too. there are zero sidewalks here, and most of the drivers are in gigantic titanium f350’s and they are doing 50 miles over the limit , angry and on a cell phone. talk about killing us a little more each day. since i’m living solely on a disability income, i don’t know how i’d move to san fran or manhat. and afford the rents even tho’ i could theoretically get rid of the car

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