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Zeve Marcus | Research Manager | ITNAmerica

January 10, 2026

Work supported by CareQuest Institute for Oral Health®

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Ride Momentum and Oral Healthcare Among Older Adults: Behavioral patterns in transportation use

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ITNAmerica’s Mission

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ITNAmerica promotes lifelong mobility for older adults and people with mobility challenges. We support sustainable, community-based transportation by leading a national transportation network grounded in technology, research, policy analysis and education.

ITNAmerica is the first national, non-profit transportation network for older adults and people with mobility challenges.

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��By leveraging 30 years of rides data, we are able to…�� • Quantify mobility patterns at scale, how ride frequency, purpose, distance, and cancellations evolve over time and across communities.�� • Link mobility behavior to health engagement, showing how sustained transportation use predicts follow-through on care (e.g., dental participation).�� • Identify equity gaps in transportation-supported populations and pinpoint where access still doesn’t translate into participation.�� • Detect shifting system dynamics (e.g.,cancellation determinants).�� • Build evidence to guide programs and policy, helping partners design interventions that strengthen “ride momentum,” reduce missed care, and support aging in place.��Turning Ride Data Into Mobility Insights��

www.ITNAmerica.org

By leveraging almost 30 years of rides data, we are able to…

• Quantify mobility patterns at scale, how ride frequency, purpose, distance, and cancellations evolve over time and across communities.

• Link mobility behavior to health engagement, showing how sustained transportation use predicts follow-through on care (e.g., dental participation).

• Identify equity gaps in transportation-supported populations and pinpoint where access still doesn’t translate into participation.

• Detect shifting system dynamics (e.g., distance x cancellation).

• Build evidence to guide programs and policy, helping partners design interventions that strengthen healthcare access and support aging in place.

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Setting the table: Oral health is not “optional care”

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Setting the table: Oral health is not “optional care”

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20.2% have untreated dental issues (Centers for Disease Control and Prevention, 2025)

12.9% have complete tooth loss (edentulism), with prevalence increasing with age (Fleming et al., 2020).

Tooth loss can limit food choices and impede social interaction (Fleming et al., 2020).

Oral care can be a safety issue: improved oral hygiene can improve pneumonia/respiratory infection outcomes (Sjögren et al., 2008; Cao et al., 2022).

For adults 65+

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When transportation fails, care fails

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Transportation barriers are associated with missed/delayed appointments and poorer disease management (Syed et al., 2013; Wolfe et al., 2020)

Non-emergency medical transportation (NEMT) can reduce missed care in some settings (Shekelle et al., 2022; Wallace et al., 2005)

Barriers disproportionately affect people with lower income and chronic conditions

What’s often missing is behavioral engagement over time (patterns, routines, momentum), not just “access”

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“Ride momentum” as a marker of health engagement�Zeve Marcus, Katherine Freund, Alan Fried

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Hypothesis: consistent transportation use may build behavioral capacity to follow through on preventive care

Operationalization (this study):

Medical ride activity (non-dental) + convenience ride activity
Longitudinal rider-year structure

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Ride momentum Design�Zeve Marcus, Katherine Freund, Alan Fried

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1.6M+ door-through-door rides

National, older-adult transportatiocommunity-basedn

Panel built at the rider-year level

Allows within-person change over time

Dental engagement

medical rides, consumer rides, distance, demographics, year

Outcome:

Predictors:

Data (N_rider-years= 43,786):

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Rides by Purpose: 1997-Present

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Results

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Medical rides (+1 SD): OR 2.26 (≈ +126%)
Consumer rides (+1 SD): OR 1.61 (≈ +61%)
Men: OR 0.60 (≈ 40% lower odds)
Black vs White: OR 0.69 (≈ 31% lower odds)
Other/Mixed vs White: OR 0.62; Missing/Unknown: OR 0.61

Sustained mobility engagement is the strongest behavioral driver and equity gaps persist after adjustment.

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Results

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Engagement grows sharply with more medical rides (stronger slope for women).

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Results

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Consistent gaps by race/ethnicity and gender.

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Additional insight: cancellations and distance relationships changed after 2020

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A protective association of longer trip distance in the 2000s reversed after 2020, with longer trips predicting slightly higher cancellation risk.

Barriers to healthcare access can shift over time

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Key Takeaways

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Mobility engagement is a powerful predictor of dental participation

“Access” is not just distance, it's sustained behavior and support

Equity gaps persist even with comparable ride activity

Barriers to healthcare access can shift over time

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Questions

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Contact Information

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Questions about this research?

Contact: zeve.marcus@itnamerica.org

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Contact Information

www.ITNAmerica.org

Katherine Freund

President & CEO, ITNAmerica

207.415.1630

Katherine.Freund@ITNAmerica.org

One of "12 People Who Are Changing Your Retirement" �- Wall Street Journal�
Presidential Appointee, Advisory Committee for the White House Conference on Aging�
AARP Inspire Award Honoree