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  • Opinion The Older Driver: Questions & Issues

    We’ve read the stories and seen the wreckage: elderly persons driving their cars into populated areas with multiple deaths resulting. They’re terrible tragedies, and solutions to prevent such events from recurring aren’t quick or easy. 

    For our elderly, a time will come, whether through physical or mental impairment, when it will be unsafe for them to continue driving. Yet, the older we get, the more we want to remain independent, and driving a car is one of the biggest symbols of individual independence. Even driving to the local supermarket to do one’s own shopping becomes a huge expression of freedom.

    As our society ages, and particularly as the large Baby Boom generation gets older, the ability of older people to drive safely becomes an important public health concern.

    Safe driving requires certain physical, intellectual, and mental skills. Unfortunately, the aging process can take its toll on skills that involve vision, hearing, cognition, motor and reflex ability. The most critical skills for driving include:

    Vision. This includes straight-ahead and peripheral vision as well the ability to gauge distance between objects. All of these attributes are vital for night and bad-weather driving. Many older drivers must stop driving at night when their vision begins to decline.

    Sensory motor abilities. This includes limitations from muscle weakness to problems such as loss of limb function due to stroke or a loss of a limb. For older drivers, sensory motor problems can result in serious problems, such as hitting the gas pedal when they meant to hit the brakes. Sensory motor troubles can be caused by various illnesses. Diabetes, for example, can result in decreased feeling in the feet, as well as impaired vision. And as we age, our reflexes aren’t as quick as they once were.

    Cognitive abilities. Many elderly know when their abilities have faded and choose to avoid driving at night or in storms. A serious problem arises when elderly lose necessary physical or mental abilities but do not realize — or don’t want to admit — this is happening.

    Two recent studies offer more information. The AAA Foundation for Traffic Safety, in a recent study of older drivers and crashes in Texas, found that drivers over age 65 are twice as likely to die in car crashes as those 55-64. The Institute for Healthcare Advancement, a nonprofit health literacy and educational foundation, surveyed senior citizens on errors they make in caring for themselves. The number one mistake? Driving when it’s no longer safe. So even seniors recognize the risk.
    AAA Foundation suggests that “physicians and children of senior drivers can play a major role in assessing older drivers’ capabilities.” So what can you do if you’re concerned about your elderly parent or relative who wants to remain behind the wheel?

    Most of all, be concerned and get active. Ride in a car with the older driver to see how they drive. Look for things such as driving too fast or too slow, getting lost, spending too long at a traffic light, indecisiveness, cutting in front of other motorists, near-collisions with other cars, walls, or utility poles.

    After that, if you have noted problems with the individual’s driving, talk with him or her. Then get that person’s physician involved.

    A family member or two should attend this doctor’s appointment. Understand that it likely will be difficult for the older driver to contemplate life without the freedom that comes with driving. They may become upset or defensive.

    Often it’s the doctor, after a thorough medical examination, who must tell the elderly patient that it’s no longer safe to drive. Patients often accept such advice from a physician when they wouldn’t accept it from a spouse, son or daughter.

    When an older person gives up driving, that’s when friends and relatives may matter most. Arrange for alternative transportation. Create a personal transportation plan so the former driver will know that shopping, keeping appointments, and seeing friends and relatives will continue. Above all, be patient, kind and caring. Giving up the car keys means giving up some freedom. Family, friends, and loved ones are the best ones to help ease the loss.

    Janet L. Jankowiak, M.D. is a geriatric neurologist at Jewish Memorial Hospital and Rehabilitation Center, Boston. She is also vice chair of the Committee on Geriatrics of the Massachusetts Medical Society. MMS Physician Focus is provided as a public service by the Massachusetts Medical Society and your community newspaper. Readers should use their own personal judgment when deciding to seek medical care, and should consult with their own personal physician for treatment. Comments are welcome. Write PhysicianFocus@mms.org.

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