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assessing elderly drivers

Assessing Elderly Drivers: Ability Means More Than Age

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How To Know When It’s Time To Hang Up the Keys. 

Elderly Driver Buckles Up

The ranks of elderly drivers are large and growing. About 33 million licensed drivers in the U.S. are over age 65, up more than 20 percent in 10 years, according to the Centers for Disease Control and Prevention (CDC).

Thanks to their sheer numbers, some stereotypes about the failings of older drivers are fading. Yet safety concerns persist, especially after news reports of elderly drivers’ crashes, such as one at a farmers market in Santa Monica, California, in 2003, when an 86-year-old man drove into a crowd, killing 10 and injuring 63..

About 5,500 adult drivers age 65 and older die each year in vehicle crashes, according to the CDC. That is double the number of teens killed annually in vehicle crashes. It is understandable, then, that the question is still with us: When is it time to hang up the keys?

Experts say there is never an easy answer, nor one that will work for everyone. These days, however, there is much more help than in the past to guide you with the decision, whether you are the aging driver or the loved one of an elderly driver who may no longer be driving safely.

Experts know, for instance, which age-related changes most compromise driving, and what can be done to compensate for them. A variety of driving evaluations — in car and out — are available online and from specialists. Some states even step in to monitor older drivers, reducing the time between license renewals.

There’s also a new approach to “the talk” that adult children have with an aging parent, and it promises to make everyone less uncomfortable and inspire a more productive conversation.

Think Abilities, Not Birthdays

Deciding how long a person should continue driving shouldn’t be based only on birthdays, according to Jake Nelson, director of traffic safety advocacy and research for the AAA Foundation for Traffic Safety, a nonprofit organization.

“We believe driving safety is a function of driving ability, not your age,” he says. What counts most, he says, is what he terms your “medical fitness to drive.”

Jodi Olshevski, a gerontologist at The Hartford insurance company, agrees. “Usually if a person has a difficult time driving, it’s due to some underlying health condition, not age,” she says. “It’s more about health, not necessarily the number of birthdays you have had.”

Nelson says there is no baseline age at which drivers or those who care about aging drivers should start monitoring their skills. However, he suggests paying attention to warning signs of declining driving ability. These include frequent fender-benders, being honked at often by other drivers and frequently getting tickets for moving violations. A good time to assess driving, he adds, is when retirement planning starts in earnest.

 

The States and Older Drivers

Maryland’s Motor Vehicle Administration has a medical advisory board that assesses medical fitness to drive in those who may be impaired.

Nelson says it’s a model system. Drivers with certain conditions (including stroke, epilepsy and autism) must be medically reviewed. Doctors, family and concerned citizens can also request a review of drivers they fear are unfit to drive.

Other states, he says, have ”a patchwork of laws” on the question. As of April 2015, 20 states have shorter renewal period intervals for drivers older than a specified age,  according to a tally by the Insurance Institute for Highway Safety. In 19 states, older drivers must undergo more frequent screening or testing of their vision than younger drivers. Of the states that allow drivers to renew licenses by mail or online, 15 states and the District of Columbia do not allow older drivers to do so.

Maryland and D.C. require drivers 70 and older to get a physician’s approval to renew their driver’s license. And in Illinois, drivers older than age 75 must complete a road test each time they renew.

Texas, however, doesn’t step up renewal intervals until drivers turn 85, when they have to renew every two years instead of every six. Many states require in-person renewals after a certain age.

Compensating for Challenges

Age does bring some declines that affect driving. Chief among them are night vision that is less sharp, declining mobility that can make turning around or craning your neck difficult, and slower reaction times.

Drivers can compensate for some of the age-related changes, Nelson and Olshevski agree. Being aware of the decline is crucial, of course. Research suggests that aging drivers, rather than being in denial, are aware of their physical shortcomings. They recognize, for example, that strength, reach and dexterity could be declining with age, making it difficult to turn around to check for traffic or pedestrians.

In surveys, Olshevski says, older drivers told her that driving at night was a big concern, due to the declining night vision that comes with age. The majority of older drivers, she has found in her research, will voluntarily modify their driving to stay safe. They’ll cut out night-driving, for instance, or make other changes such as avoiding heavy traffic times if that makes them anxious.

Besides modifying driving habits, paying attention to overall health can help aging drivers stay safe behind the wheel, Olshevski says. “Be a healthy driver,” she says. “Get regular physicals. Assess the side effects of your medication.”

Exercise also is important, Olshevski says. Older adults can ask their doctors about resistance or weight training to maintain the muscle tone and strength that safe driving require.

Automotive technology can help compensate, too, Olshevski says. Among those that are most useful for aging drivers are reverse monitoring and back-up cameras, blind-spot warning systems and other crash-avoidance technologies.

Technology “won’t ever replace turning around and using the rearview mirror,” she says. But it can help fill the gaps.

Older adults can enroll in a mature driver safety course to brush up on skills, Olshevski says. One example is the online AARP Driver Safety Course. As a bonus, auto insurance plans may give a discount on the premium for drivers who complete the course. Fees vary. In California, for instance, AARP members pay $17.95. For non-members, it’s $21.95.

 

Having the Talk

No one looks forward to that talk with an aging parent or other loved one about whether they need to hang up the keys. However, approaching that conversation a bit differently can make all the difference, Nelson says. Forget the typical conversation starters, such as “Mom, it’s time for you to stop driving.”

Nelson suggests first riding with the person you are concerned about. While in passenger mode, take note of the positives and the negatives about your loved one’s driving.

When you’re ready to talk, focus not on whether the driver should hang up the keys, but on mobility and the continued need for it. Talk about where the person needs to go, and when. Talk about alternatives to driving, such as mass transit or cabs or someone picking them up.

Ideally, Nelson says, you should have the talk years before the declines that affect driving set in. It’s a much more positive — and probably productive — approach, he says.

More help on broaching the subject is available in a downloadable booklet, “We Need to Talk” developed by The Hartford.

Getting Outside Opinions

It’s difficult to be objective about a loved one’s driving skills. Outside opinions can help everyone. Among the options is a do-it-yourself online test from the AAA Foundation for Traffic Safety.

Some occupational therapists and other driving rehabilitation specialists offer driving evaluations. These professionals have focused on driving assessments for decades, says Mary Johnson, an occupational therapist and certified driver rehabilitation specialist who runs a driver rehabilitation program at The New McLean, a senior living facility in Connecticut. She requires a doctor’s referral, to ensure that the driver’s physician is aware of the situation.

Older Drivers, Elderly Driving, Seniors at the Wheel

In the next 20 years the number of elderly drivers (persons 70 & over) is predicted to triple in the United States. As age increases, older drivers generally become more conservative on the road. Many mature drivers modify their driving habits (for instance to avoid busy highways or night-time driving) to match their declining capabilities. However, statistics show that older drivers are more likely than younger ones to be involved in multi-vehicle crashes, particularly at intersections.

Research on age-related driving concerns has shown that at around the age of 65 drivers face an increased risk of being involved in a vehicle crash. After the age of 75, the risk of driver fatality increases sharply, because older drivers are more vulnerable to both crash-related injury and death. Three behavioral factors in particular may contribute to these statistics: poor judgement in making left-hand turns; drifting within the traffic lane; and decreased ability to change behavior in response to an unexpected or rapidly changing situation.

Concern about the increased number of older drivers and their potentially decreased driving abilities is growing, especially among younger drivers. Statistics, based on all people injured or killed in traffic crashes, indicate that older drivers are at a disproportionate risk for becoming involved in fatal crashes. A NHTSA study of 1995 FARS (Fatal Accident Reporting System) data reports that senior citizens accounted for:

  • 5% of all people injured in traffic crashes
  • 13% of all traffic fatalities
  • 13% of all vehicle occupant fatalities
  • 18% of all pedestrian fatalities

In a 1997 NHTSA study, older people made up 9 percent of the population but accounted for 14 percent of all traffic fatalities and 17 percent of all pedestrian fatalities. NHTSA’s “Traffic Safety Facts 1997: Older Population” (DOT HS 808 769) reports that:

  • In 1997, more than 24 million people in the United States were over 70 years of age.
  • Representing 9 percent of the population in 1997, the 70-and-older age group grew 2.1 times faster from 1987 to 1997 than the total population.
  • In 1986 older drivers were 7 percent of licensed drivers; in 1996 they were 19 percent of licensed drivers.
  • Of traffic fatalities involving older drivers, 82 percent happened in the daytime, 71 percent occurred on weekdays, and 75 percent involved a second vehicle.
  • When a crash involved an older driver and a younger driver, the older driver was 3 times as likely as the younger driver to be the one struck. Moreover, 28 percent of crash-involved older drivers were turning left when they were struck– 7 times more often than younger drivers were struck while making left turns.
  • Older drivers involved in fatal crashes and fatally injured older pedestrians claimed the lowest proportion of intoxication–defined as a blood alcohol concentration of 0.10 grams per deciliter or higher.
  • While only 55 percent of adult vehicle occupants (ages 18 to 69) involved in fatal crashes were using restraints at the time of the crash, 70 percent of fatal- crash-involved older occupants were using restraints.
  • “On the basis of estimated annual travel, the fatality rate for drivers 85 and over is nine times as high as the rate for drivers 25 through 69 years old.”

Statistics show that in two-vehicle fatal crashes involving an older and a younger driver, it is 3.1 times as likely that the vehicle driven by the older person will be struck. In 27% of these two-vehicle fatal crashes the older driver was turning left. Drivers over 65, along with new teen-age drivers, have the highest accident rates per miles driven. Another NHTSA study found that on the basis of estimated annual travel, the fatality rate for drivers 85 and over is nine times as high as the rate for drivers 25 through 69 years old.

Lawrence Nitz, a political scientist from the University of Hawaii, conducted a three-year study of Hawaiian traffic records and found that drivers over 75 were far more likely than other motorists to be cited for certain offenses, including failing to yield to pedestrians, backing up unsafely and failing to stop at a flashing red light.

What is being done to address the problem?

Mandatory driving tests – California, which requires retesting for anyone involved in a fatal crash or three or more crashes in one year, requires drivers over 70 to retest if they are involved in two or more crashes in one year. Proposals in several other states to toughen licensing requirements for older drivers have been thwarted by senior-citizen lobbying groups (AARP & others), who say age-based measures are discriminatory. They claim that a person’s chronological age is not an accurate predictor of driving ability. The lobbyists argue that if seniors are forced to take mandatory roadtests in the absence of an incident, other age groups should be required to take them as well.

Deficit reporting laws – Pennsylvania is one state that has a physician’s reporting law, requiring physicians to report disabilities that may affect driving ability. Some physicians, however, are reluctant to jeopardize their relationship with a patient by making such a referral. Most other states do not require physicians to report psycho-motor, visual, and cognitive deficiencies that may affect driving to licensing agencies.

What else can be done?

  • Deficit screening– Screening could be given to all drivers for whom age-related decline is suspected and whose performance is viewed as a safety concern for themselves and other motorists. In addition, health professionals and others who work with older populations could administer the tests. Screening could become a part of the regular process of license renewal. By reducing testing time, drivers could be quickly screened and identified either as capable, or as in need of further testing.
  • Crash statistics– DMV (Department of Motor Vehicles) and insurance company records can help identify high-risk older drivers. In addition to crash counts, the details of the crash (roadway condition, time of day, location, fault) are important. Some crash patterns (e.g., the driver stopped in the middle of the roadway) may be better predictors of future crashes than others. Given that many older drivers involved in crashes have never had a crash before and may not have another one during the following year, crash records will identify only a few high-risk older drivers. However, crash statistics may be an important part of a comprehensive program to identify high-risk older drivers.

What can you do? – You may wonder about older friends and family members’ performance on the road. You want to support their continued mobility but on the other hand you worry about their driving abilities. Unfortunately we don’t all retain the ability to drive a car throughout our lifetime. Physical disabilities, mental illness, medications, loss of vision, or frailty can end anyone’s driving career prematurely. Before you bring up the subject, keep in mind that the thought of losing a driver’s license is very disturbing to most older people. Americans rely upon their cars to get to work, go to the doctor, go shopping, and visit their friends and relatives. The elderly equate losing their driving privileges with being dependent, feeling trapped, perhaps losing choice, control, and spontaneity in life. Discussing driving skill with an older person requires great diplomacy.

AgeQuest, a specialty firm addressing the training needs of professionals in the field of aging, older adults, and family caregivers, suggests in its publication “Supporting the Mature Driver” that the decline of skills necessary for safe driving sometimes occurs suddenly or subtly. Signs may include a pattern of close calls, violations or collisions, increasing difficulty in noticing pedestrians, signs, objects, or other vehicles; an observable decline in physical abilities; or a rapid onset of fatigue from driving.

Older drivers need to be aware that medications can significantly impair their driving by making them drowsy or distracted. Physicians and pharmacists should be consulted before starting new medications, to see if the drug can affect the ability to drive. Since side effects are often worse for the first few days of a new medication, people should avoid driving until they know exactly how a new drug affects them. If any medication causes sleepiness or disorientation, someone else should do the driving.

Eyes change with age. They lose the ability to focus quickly. Peripheral vision narrows and the retina becomes less sensitive to light. Physical activity is needed to keep a person strong and flexible for those quick reactions needed while driving. To be a safe driver, paying attention to road conditions and your own body changes is essential. A person’s chronological age is not an absolute predictor of driving ability, but its impact should not be denied. Ultimately, however, what counts on the road is performance.

 

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