For Elderly, Giving Up Driving Can Be Tough
FRIDAY March 19, 2010 -- For many Americans, driving equals independence -- the ability to run errands, go to church or visit family and friends as you please. So the decision to hand over the car keys for good can be a difficult one.
To help doctors, seniors and their family members spot the signs of someone who is too old and too frail to drive, the American Medical Association this week released the Physician's Guide to Assessing and Counseling Older Drivers. It includes screening tests, information about medical conditions and medications that may impact driving, and ways of talking to seniors about what can be an emotional issue.
Though largely directed at doctors, the guide is full of information that can help seniors and their families in determining if it's time to park the car in the garage for good, experts say.
"Most of the time, people naturally change their behavior as they get older -- they drive less, they only drive to familiar locations, they don't drive at night," noted Dr. James Goodwin, a professor of geriatrics and director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston. "It only becomes a problem in those who don't make that adjustment, but that is the exception."
Though few like to admit it, aging brings with it physical and mental changes that can compromise driving ability, including changes in vision, cognition (thinking) and motor function, added Dr. James Young, chairman of the department of physical medicine and rehabilitation at Rush University Medical Center in Chicago.
Aging eyes can take longer to adjust to changes in lightness and darkness, making glare and night driving more difficult. Cataracts, glaucoma, macular degeneration and stroke can all impact visual perception.
Cognitive declines that come with age can also make driving unsafe. Driving is a complex activity that requires memory, visual processing, attention and executive skills, or the ability to multi-task, according to the AMA report. All of these factors can be affected by medical conditions and medications.
Adding to the problem is the fact that 30 percent to 45 percent of people with early-stage Alzheimer's disease continue to drive after their diagnosis, according to a study in the March/April issue of the American Journal of Occupational Therapy.
That decision can have tragic consequences. Of 207 people with Alzheimer's who went missing between 1998 and 2008 while driving, 32 were found dead, 35 were found injured and 70 remained missing, according to an analysis of news reports collected in the study.
Arthritis of the neck or hands and stroke can also make it more difficult to turn the head, switch the foot from the accelerator to the brake and operate other controls, Young said.
"I have had patients who have driven after a stroke and they've killed people," Young said. "This is not something to be taken lightly."
In part because of age-related declines, drivers aged 75 and older are involved in significantly more motor vehicle crashes per mile driven than younger drivers, according to the AMA. They are also more likely to die in the accident. The fatality rate for drivers 85 years and older per mile driven is nine times higher than the rate for drivers 25 to 69 years old.
But Goodwin said it's also easy to overstate the risk.
While safe driving is certainly a concern for the elderly, statistics can be somewhat misleading, he said. Older drivers get in more accidents per mile driven, but they also log far fewer miles, so their overall likelihood of getting in an accident is lower than for younger people, Goodwin pointed out.
To improve safety, experts recommend that older drivers install wider rearview mirrors, sold at many auto-parts stores. Swivel seats can make getting in and out of the car easier, too, and there are all sorts of adaptive gadgets for people with disabilities.
Specially trained occupational therapists can also conduct a driver's evaluation, including knowledge of the rules of the road, reaction time and behind-the-wheel driving abilities. These specialists are not available in all areas, however, and Medicare doesn't cover the cost, which is several hundred dollars, Young said.
If a senior who appears to be an at-risk driver refuses to give up the keys, doctors can make an anonymous report to their state's Department of Motor Vehicles. Though laws vary by state, the DMV can often revoke driver's licenses in this way.
In discussing the issue with seniors, it's important to be sensitive to their feelings and to use objective reports, such as vision or physical therapy tests, to make your case. Being prepared to suggest alternatives -- such as taxis, mass transit, senior-center shuttles or other community transportation for seniors -- can help ease the blow.
And it's important to remember that age alone is not the key measure of whether someone is safe to drive, said Goodwin. He pointed out that he currently sees 90-year-old patients who remain good, safe motorists.
The AMA's older driver report can be found at their Web site.
Posted: March 2010
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