Trading the Car Keys for a Bus Pass
Reviewed By Gary Vogin
The light turns red and traffic stops. A mother eases her baby's stroller off the curb and starts across. Without warning, a stopped car roars to life and leaps into the intersection, missing her infant by a hair.
The shaken mother confronts the driver, a woman in her 80s, who is crying and in shock. The elderly woman had glanced at the green light signaling the cross traffic and processed it as a green light in her direction. Fortunately, this incident did not shatter the lives of mother and baby -- but it might have acted as a wakeup call for that driver. Time to consider hanging up the car keys.
Obviously, there are poor drivers in all age groups. Drivers 55 and over actually are less likely to be involved in crashes, according to the National Center for Statistics and Analysis, and are also less likely to be driving drunk. But, as the years roll by, the 70-and-up group is second only to the 16-20 set in traffic deaths.
Contrary to popular opinion, cognitive impairments such as Alzheimer's, and declining eyesight are less to blame than diseases such diabetes, Parkinson's, and heart disease. Physical stiffness from arthritis or osteoporosis can impair the ability to work the pedals. Older people also take a lot of medications, some of which can impair driving. All of this is significant because states that have passed or are considering retesting or relicensing based on age usually target vision, which can be the least of the problem.
David B. Carr, MD, a geriatrician and associate professor of medicine at Washington University in St. Louis, says "drive or not to drive" decisions might more cost-effectively be made on a case-by-case basis. Even people with early stages of Alzheimer's, whose orientation and other faculties beside memory are not affected, can drive safely. "We have to decide if screening is worth it. Even if you take away a person's license, they may continue to drive without it." (In one case, a man who kept hitting a tree next to his driveway refused to surrender his license and instead chopped down the tree.)
Role of the Family Physician
According to Richard A. Marottoli, MD, MPH, an associate professor of medicine and geriatrics at the Yale University School of Medicine, and chairman of the National Research Council's Safe Mobility for Older Persons Committee, the vast majority of drivers who quit do so on their own hook. "They experience uneasiness in certain situations and become progressively more uncomfortable," he says.
In some cases, however, alarmed adult children or spouses consult their family physician about the driver's condition. According to Carr, the doctor should first take a detailed driving history both from the patient and someone who has ridden with the person. Medications need to be reviewed. Of course, if the patient has a history of an impairing illness such as stroke, sleep apnea, alcohol abuse, illicit drug use, epilepsy, psychiatric disorders, Alzheimer's, and others, this must be taken into consideration. The physician will then check functioning, including complex reaction time, visual acuity, divided attention (think cell phones), hearing, and the width of the useful visual field.
Some physicians, warns Carr, do not want to get this involved. They may just refer the driver to a physical therapist specializing in retraining drivers. In other cases, courses and tips are available from both AARP ( http://www.aarp.org/55alive/home.html) and the American Association of Automobiles ( www.seniordrivers.org) . The 55Alive program from AARP has been taken by 6 million people thus far, but Carr says this is mostly for the self-aware driver who wants a refresher course, rather than the true road menace.
In the latter case, Carr clearly communicates his doubts about the patient's physical fitness to drive. "I say, 'You need to stop driving.' I also put it in writing (for a contract you can have the person sign to that effect, go to www.thehartford.com/alzheimers/agreement.html)." It's important, too, he says, that a family member be present for this discussion.
If the individual does not quit driving, Carr writes to the authorities and asks that the person's license be revoked. Even this can become a problem, however, in that sometimes people whose judgment is impaired will drive without a license or even buy another car if theirs is confiscated. In some cases, a family member may even need to file down the ignition key or remove the battery.
On a More Positive Note
Marottoli says family intervention works better if the individual is involved from the start and has some control in the matter. Otherwise, anger and depression can be the result.
Marottoli urges that family members and friends come up with some plan for alternative transportation that includes not just the necessities, such as medical visits, but the stops that make the person's life rich and full, such as plays or museums. Some suggestions:
"Once people quit," Marottoli comments, "they often say they appreciate how much more relaxed they feel. It dawns on them that driving has been contributing to a lot of anxiety."
Originally published May 6, 2002.
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