As the number of older drivers increases as the population ages, the question arises more often: When should the car keys be taken away to ensure the safety of older drivers -- and others on the road?
Reviewed By Michael Smith
When a police cruiser drove up to the Casa del Rio retirement community in Peoria, Ariz., assistant manager Debra Gauthier wasn't a bit surprised to see Mr. C, as she calls him, sitting in the back seat. The 93-year-old resident was being brought home by the authorities because he had parked his car in Phoenix and lost it. And it wasn't the first time he'd had a memory lapse on the road.
Fearful that Mr. C would crash while driving the next time, Gauthier and her co-workers made a plan. When the police returned his blue Ford Taurus, a Casa del Rio staff member parked it far from Mr. C's normal space, disconnected the battery, and held on to his keys.
"But he found it," Gauthier says. "He had it fixed and started driving again with an extra set of keys." He didn't even remember that he had lost the car. When she told Mr. C he shouldn't be driving, he became furious.
The to-drive or not-to-drive question will loom for more and more American families. In 2000, 1 in 10 drivers was over 70 -- a 36% increase from 1990, according to the National Highway Traffic Safety administration.
While some older drivers remain competent, others do not. In 2001, people 65 and older made up 16% of the driving age population and accounted for 16% of fatal vehicle crashes, according to the Insurance Institute for Highway Safety. By 2030, elderly people will make up 25% of all drivers and be involved in 25% of fatal accidents, the institute says.
The Legal Approach
Deciding which older drivers are safe on the road and which are dangerous is no small task. The best way to keep drivers like Mr. C off the road, some say, are stringent state laws that require more frequent testing of all older drivers, regardless of their driving records. But others see that approach as "ageist."
Nonetheless, 13 states require older drivers to renew their licenses more frequently than younger drivers, according to the Insurance Institute for Highway Safety. In Illinois, for instance, once drivers reach age 75 they must take a road test every time they renew their license. They must renew every two years starting at age 81 and every year after age 87.
Other states with special provisions for older drivers include Arizona, Colorado, Hawaii, Idaho, Indiana, Iowa, Kansas, Maine, Missouri, Montana, New Mexico, and Rhode Island.
The Fix-It Approach
Others suggest a more humanistic approach: helping older drivers stay on the road whenever possible by correcting physical problems. For instance, obstacles that once seemed incompatible with driving, such as cataracts and slow reaction times, now may be overcome.
Older drivers with a cataract, an opaque clouding of the eye's lens, are more than twice as likely to have been in a crash in recent years than those without them.
But the good news, according to Cynthia Owsley, PhD, a professor of ophthalmology at the University of Alabama at Birmingham, is that surgery can put these drivers safely back behind the wheel. In her study of 288 drivers with cataracts, ages 55 to 85, some 187 had cataract surgery. After the surgery, the study subjects had a crash rate 50% lower than those who didn't have the surgery.
Decreased reaction times, common among seniors, also can be improved, according to Karlene Ball, PhD, director of the Center for Research on Applied Gerontology at the University of Alabama at Birmingham.
To evaluate reaction time and predict crash risk, Ball tested more than 3,000 seniors with driving problems who were referred to the Maryland Motor Vehicle Authority medical advisory board. She used a test called "useful field of view" in which a person reports whether they see a car or a truck coming down the road in the middle of a computer screen. At the same time, the subject must notice the location of a car on the periphery. "It starts off fairly slowly and gets faster and faster," says Ball.
Drivers who showed a 40% or greater impairment in their useful field of view were more than twice as likely to be involved in a crash within three years of testing, according to Ball's study. But after undergoing 10 computer training sessions on how to make quick decisions, people can improve their performance by as much as 300%, Ball says.
Other rehabilitation programs are available. For instance, the AARP Driver Safety Program helps older drivers sharpen their skills and develop safe defensive driving techniques. It covers the following topics:
- Vision and hearing changes
- Effects of medication
- Reaction time changes
- Left turns and other right-of-way situations
- New laws and how they affect you
- Hazardous driving situations
Classes are held nationwide.
When It's Time to Quit
If an older driver's declining skills are beyond help, the best solution is helping family and friends convince the drivers to hang up their keys for safety's sake. While some older drivers relinquish their driving privileges on their own, most need to be persuaded to stop driving by a relative or doctor.
To get a driver off the road, police officers, doctors, social workers, and family members can file a hazardous driver report (in some states, anonymously) with the state Department of Motor Vehicles. The DMV is then, in effect, the "bad guy." When they revoke a license, most people will comply, if bitterly, according to Nancy Wexler, MA, MFCC, a founding member of the National Association of Professional Geriatric Care Managers, which helps families arrange for long-term care and other services.
Doctors, for their part, would prefer to limit their involvement to patient counseling. Despite a proposal of its Council on Ethical and Judicial Affairs stating that the reporting of impaired drivers is an "ethical obligation" of a physician, representatives to the American Medical Association twice rejected that position at the urging of many medical societies, including the American Academy of Ophthalmology.
"We were concerned that patients with potentially blinding diseases would not seek the medical care they might need to halt progression of vision loss once they learned their physician was obligated to turn them in to the DMV," says Craig H. Kliger, MD, a representative of the ophthalmology academy to the AMA. The AMA eventually adopted language that made it "ethically acceptable and desirable" to report an impaired driver, but not mandatory -- except where required by law.
But if the DMV is not involved, or the driver's doctor is unsuccessful in convincing the patient, more creative solutions are needed. Wexler recalls a man in his 80s suffering from dementia who refused to stop driving. Finally, the family asked a distant relative who was a police officer to come to the house and tell the man that his insurance had lapsed and his car was going to be removed. The man agreed to stop driving and instead of being angry with his family, called his son to complain about what the police had done. "If the person respects authority, this can work," says Wexler.
Mr C is finally off the road, too. His son came to visit and told his father he couldn't drive any longer. Oddly, Mr. C seemed relieved, says Gauthier, the retirement community's assistant manager. "He says, 'Well, my doctor kind of said I shouldn't be driving. ... ' " And he had been thinking about giving his car to his grandson, anyway.
Originally published Sept. 8, 2000
Updated July 17, 2003.
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