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Assessing the older driver

By Janet L. Jankowiak, M.D.
Special to Reminder Publications

In 2004, I wrote about issues surrounding older drivers, as accidents caused by elderly motorists resulting in multiple deaths focused nationwide attention on the subject.
Now, five years later, the elderly driver is again in the spotlight. No less than three accidents involving vehicles driven by elderly persons occurred recently in Greater Boston, resulting in more than a dozen people injured, and, tragically, the death of a four-year-old girl.
Legislators, policymakers, police and public safety advocates struggle with possible solutions, while many elderly and some of their advocates balk at criticism, cite discrimination and cry "ageism." With our population aging rapidly, and the motor vehicle as a longtime symbol and tool of our independence, the issue remains a significant and growing national public health concern. (This topic of driver safety is magnified with drivers of all ages who text and use cell phones, speed and are generally inattentive to the serious task of operating a motor vehicle. But that's another issue.)
The facts are clear about elderly drivers. Federal Highway Administration data indicate that drivers 75 years and older have higher rates of fatal motor vehicle crashes than any other age group except teenagers. And statistics from the Insurance Institute for Highway Safety show that drivers 85 and older have nearly twice the number of fatal accidents as those 16 to 19. Collisions and traffic violations in the elderly population reflect errors of inattention, failure to yield, difficulty maneuvering and driving too slowly. Left-hand turns are notoriously dangerous.
What's also clear is that a time will come for every elderly person, whether through physical or mental impairment, when it will be unsafe to keep driving. While the rate of decline varies markedly from person to person, safe driving requires physical, intellectual and mental skills, and there's no denying it: aging takes its toll on those abilities.
The most critical skills for drivers include (1) vision, straight-ahead and peripheral, and the ability to gauge distance between objects, especially for night and bad-weather driving; (2) sensory motor abilities, or reflexes, which can be diminished by various illnesses such as diabetes and can result in serious mistakes, like hitting the gas pedal instead of the brakes; and (3) cognitive abilities, including attentiveness, processing information and quick decision-making. The ability to multi-task is a major problem for both teens and older adults, contributing to higher accident rates.
Difficulties arise when the elderly begin to lose these skills and the physical and mental abilities required for operating a motor vehicle, but don't realize or don't want to admit they're losing them.
So, apart from enacting new legislation, regulations and requiring testing for elderly drivers, what can be done to address the situation of the elderly driver?
Physicians and children and relatives of senior citizens can play an important role, an idea suggested by several groups, including the AAA Foundation for Traffic Safety (www.seniordrivers.org).
Children or relatives should first pay close attention to the abilities of their elders. Ride in a car with them or behind them to see how they drive. If you see problems, talk with him or her. Also take into account the individual's overall health. Are they taking prescription or over-the-counter medications? Are there side effects? Do they have underlying chronic medical conditions, such as heart disease, diabetes or arthritis? Can these conditions affect driving?
Then engage the senior's physician in the discussion. Often the doctor, after a thorough medical examination, must tell the senior that it's no longer safe to drive or may advise a road test as part of an objective evaluation. Patients often accept such advice from a physician when they wouldn't accept it from others, including relatives. If the person must give up driving, understand that it will be difficult for the senior to contemplate life without the freedom that comes with driving. They may become upset or defensive. That's when friends and relatives may matter most.
The Massachusetts Medical Society's Medical Perspectives on Impaired Driving discusses the effects of aging on motorists, as well as other factors like alcohol, drugs and disease, among others. While developed for physicians, this 43-page guide can be a useful resource for others. You can download a free copy at www.massmed.org.
Janet L. Jankowiak, M.D., a geriatric neurologist at Radius Specialty Hospital in Boston, is a longtime member and advisor to the Committee on Geriatric Medicine of the Massachusetts Medical Society. Physician Focus is a public service by the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult their personal physician for treatment.