Safe Senior Drivers: A Guide for a Critical Time

Handey

CONTENTS     

INTRODUCTION

PART I: THE ROAD TO DRIVING RETIREMENT

1. A Growing Problem – or Not?

2. America’s Car-Centered Lifestyle

3. Autonomy

4. Warning Signs

5. The Daisy Decelerator

6. Our Driving Brethren Aren’t Helping

7. Flavors of Aggression

PART II: NEVER TOO LATE TO DRIVE SMARTER

8. Return to the Basics

9. For Us, Maybe Even More Important

10. Don’t Forget Those Three Little Words…

11. And a Bunch More to Live By

12. Stay Cool, Be Happy

13. Meanwhile, Technology Is Riding to the Rescue

PART III: REACHING THE END OF THE ROAD

14. A Farewell to Driving

15. There’s Light at the End of the Tunnel

16. When Dad Stopped Driving

ABOUT THE AUTHORS

NOTES

INTRODUCTION

By Phil Berardelli

I published my first book on safe-driving techniques in 1996. It was the natural outcome of an article I had written two years earlier for The Washington Post about teaching my daughters how to drive. When I began the project, I admit, I was interested more in making a buck than in the particular subject of the book. Such is the nature of freelance writing. Ideals are fine, but you’ve got to pay the bills. On the other hand, in order to make that buck, I had to produce something worth buying. So I set out to expand my original article into a detailed blueprint to help parents teach their teenagers to become, as the book’s eventual title stated, Safe Young Drivers.

Two things emerged from that process – along with a book that has remained in print and sold reliably for over 15 years. First, I began a detailed observation of our society’s driving habits that I have continued to this day. Second, I became and remain truly appalled by what I observed. As a society we are damned incompetent, dangerously so, behind the wheel, which is why tens of thousands of us die on the roads each year, and millions are injured.

That assessment led me to my second book, The Driving Challenge: Dare to Be Safer and Happier on the Road, which I first published in 2001, I updated as an ebook in 2011, and the lessons from which I have adapted here.

Safe Senior Drivers: A Guide for a Critical Time is the third in the series, and it’s quite different. For one thing, I decided early on that the subject was far too complex to cover on my own. Helping a senior driver – which I will soon become myself – is not nearly as clear-cut a task as devising an instructional program for teens. It isn’t even as direct as analyzing the problem of aggressive driving and devising methods to combat our collective bad habits.

No. Driving among seniors is the most difficult and complex problem of all.

That’s why I’ve called on five other authors, each of whom has amassed a particular field of expertise, to help me:

Dr. Allan F. Williams, former chief scientist for the Insurance Institute for Highway Safety, puts the senior-driving issue into perspective.

Lidia Wasowicz Pringle, my former colleague at United Press International and a specialist in health issues, focuses her formidable research and interviewing skills on the experiences of individual seniors and on organizations that have established programs to help.

Dr. Robert A. Comunale, a physician in family practice for many years, discusses how advancing age can translate into specific physical liabilities.

John Matras, a lifelong auto writer, examines how technology is helping to extend the tenure of and protect our seniors on the road.

And Jessie Thorpe, my co-editor and publishing partner, connects the many themes of the book in a personal account of how this issue can affect families.

Together, we hope to give you the best tools available to manage driving in your senior years, or to manage the transition of your parent or loved one into a less active – and eventually inactive – driving reality.

PART I: THE ROAD TO DRIVING RETIREMENT

1. A Growing Problem – or Not?

By Dr. Allan F. Williams

I want to prolong driving as long as I can, so I belong to a group that walks 3 miles a day and to an aqua exercise class. I’m well aware of what happens when you can’t drive anymore, having a friend who had her keys taken away by her doctor when she was 84. She takes the bus whenever she can, but it gets very lonely when you can’t hop into your car whenever you’ve got places to go and people to see.

– Gini M., 73

Next time you’re at a social gathering, try bringing up the subject of senior drivers. Chances are you’ll elicit a story or two about someone’s aged parent who insists on staying behind the wheel despite obvious difficulties doing so.

It’s become a common theme. Families across the country are involved in disagreements – sometimes wrenching and deeply divisive – over the driving competency of their senior members, with seniors typically claiming fewer problems than their children, relatives and friends have been noticing.

Get used to it. The Baby Boomers have reached retirement age. That bumper crop of postwar babies born between 1946 and 1964 has already begun to swell the portion of Americans age 65 and over – estimated by the 2010 Census to be 40 million, about 13 percent of the population. By 2030 the number of U.S. seniors is expected to reach 70 million, or 20 percent of the total. Of those, nearly 10 million will be age 85 and over – and many will still be driving. Our culture on wheels is dug in, as those of us in our golden years hang onto our car keys longer and rack up more miles than ever.

The prospect worries highway safety officials. Will this surge in senior drivers be accompanied by a spike in motor vehicle crashes and fatalities after decades of decline?

It’s possible. One reason is crash demographics. The high rate among teenagers begins to decline among twentysomethings and continues to ease on a long, slow curve until about age 70, when the incidents start rebounding. Then they jump markedly after age 80.

Fears about a coming crash epidemic caused by older drivers also get stoked occasionally by sensational incidents, such as the one in July 2003, when an 86-year-old man accelerated into a crowd of pedestrians at a Santa Monica, California, farmers’ market, killing 10 and injuring 63. Lawyers claimed that their client had confused his car’s gas and brake pedals.

Then there was the episode in October 2006 in Orlando, Florida, when an 84-year-old woman crashed her car through the front window of a Sears department store and plowed through to a cash-register counter, hitting a concrete support pillar. Rescuers found that the woman’s foot had become stuck between the gas pedal and the floor.

And in two separate but back-to-back incidents near Boston in June 2009, a 93-year-old man crashed into a Walmart entrance, injuring several shoppers, and a 73-year-old woman plowed into a group at a war memorial, injuring several more.

Misconceptions

All true, but do these incidents really justify widespread fear? Well, yes and no. Yes, because on an individual level the problems of a senior driver can be serious and even dangerous, given his or her physical or mental impairments. No, because seniors as a group have the lowest crash, fatality and injury rates of any age range.

Why the dichotomy? For one thing, even though seniors are driving more and longer, their licensing rates and average miles driven are lower than for younger drivers, and these trends should hold up even with the influx of the Baby Boomers.

For another, though the oldest seniors post higher crash rates per miles driven than all age groups other than teens, they’re also more likely than younger drivers to reside in dense urban areas, where crash rates are higher than on freeways and multilane roads.

Bottom line: If you examine the statistics carefully, you’ll find that all but the oldest seniors remain among the safest drivers on the road.

The Fragility Factor

There is one area where senior drivers tend to fare worse than their younger counterparts: injuries and fatalities. The reason is physiology. Our resident geriatric specialist, Dr. Robert Comunale, will cover this topic in more detail, but basically the problem has to do with the growing fragility of the human body that can begin as early as the 60s and accounts for more than half of senior deaths on the road.

In other words, many if not most of senior fatalities and injuries on the highway occur because the drivers’ aging bodies are beginning to let them down. They die in situations that younger drivers tend to survive. That goes for their passengers as well, because they also tend to be seniors. And in terms of fatalities, senior drivers mostly harm themselves. The frightening instances I described above notwithstanding, seniors tend not to kill others on the road.

A Favorable Trend

Taken altogether, the crash-involvement picture for seniors is decidedly mixed. They aren’t the menace they’re sometimes portrayed to be. In fact, there’s even some good news: Over the past decade the crash risk for senior drivers has been declining more than for middle-age drivers. Between 1997 and 2008, for example, fatal passenger vehicle crashes per senior driver fell by 37 percent, compared with a 23-percent drop among drivers ages 35-54. Moreover, drivers ages 80 and up experienced an even steeper decline: 49 percent.

These trends were quite unexpected. If fatal crash rates for senior drivers had mirrored the trends for middle-age drivers during these years, about 10,000 additional seniors would have been killed. Injuries and property damage also decreased more for seniors than for the younger group, and even the likelihood of an older person surviving a crash is getting better.

Frankly, we in the highway safety community don’t fully understand the reasons for these findings, but it may have something to do with improvements in the health and physical conditioning of seniors, as well as advances in emergency medical services and trauma care.

Self-Regulation

There’s another possibility related to this unanticipated good news: Seniors may be doing a proper job of policing themselves, modifying their driving as they sense diminished abilities to negotiate the roads.

I suspect many do this on their own or in response, perhaps reluctantly, to the advice – or maybe pleadings – of family or friends. We know about some of this from surveys, in which seniors say they are limiting their driving, a practice that increases with age. We also know that seniors with impairments in vision, memory, physical functioning and various medical conditions are most likely to do so.

The self-limiting sometimes involves giving up driving entirely, but for those still on the roads it typically involves driving less often, avoiding nighttime hours and confining trips to shorter distances within well-known areas.

Some of it also could be because seniors are heeding the materials distributed by the American Automobile Association, AARP, and the American Medical Association, among other organizations. All are working to help seniors and their family members understand how aging affects driving. They have provided useful information on the effects of medications and health conditions, and in general how to cope with difficulties experienced on the roads.

Assistance from Passengers

Another factor could be enhancing the driving safety of seniors: passengers. It’s well known that passengers can be deadly for teenage drivers, with the mutual horseplay and distractions creating a greatly elevated risk for major crashes.

For seniors, however, the presence of passengers is protective. New research suggests that crash rates are lower when seniors drive with a passenger than when they drive alone, and the protection is strongest for older male drivers.

What’s going on? It turns out that passengers can be helpful copilots, keeping drivers alert, assisting with navigation, warning of impending hazards, and operating the radio, heat and air-conditioning controls, or using the cell phone.

It makes sense. Many older driver/older passenger combinations are married couples who have long-established ways of interacting – outside as well as inside the vehicle. Also, among senior couples, the person who is more able tends to do the driving.

Sticky Questions

Now here’s the bad news – or, more precisely, the imponderables that currently surround senior drivers. For instance, exactly how well do they compensate for impairments, either alone or using help from their passengers?

It’s difficult to know. Though many seniors show no signs of impairment that would affect their driving, others do and need to make adjustments. But we lack good data on how they’re sorting it out.

For one thing, seniors might not even recognize they are developing certain visual defects, such as a narrowing field of view. For another, they may sense a condition that is negatively affecting their driving but haven’t tried to compensate for it. Or, they might be amenable to persuasion from their spouse or regular passenger, but that person hasn’t noticed the condition yet. In both cases these are not easy adjustments for seniors to make.

Also, a senior thinking about hemming in or giving up driving might be constrained by the logistical dilemma of finding alternative transportation, something that often requires the help of family members.

What if a debilitation begins to appear and the senior has no ready alternative to driving? In some states, physicians are legally obligated to report certain medical conditions to licensing authorities. Does that mean the senior will delay or stop going to the doctor to hide that condition?

What about the physician? Many doctors are reluctant to counsel their patients about driving decisions – especially long-standing patients. Instead, they may refer the senior to an occupational therapist or a driver-rehabilitation program. Good steps, but such options can be expensive.

Then there’s the male angle. Many older men insist on driving indefinitely, and studies indicate that men – no surprise – are the least likely to self-regulate. The result is a large but unknown number of seniors who are continuing to drive but should not.

New Trends

All of this represents a new way of framing senior-driving issues. It’s a departure from earlier times, when we would focus more on impairments and on identifying those who should be removed from the roads.

Two shifts have been under way for some time – in the United States and in other countries where seniors make up a significant portion of the driving population. One involves discarding the notion that links an elevated crash risk with all senior drivers. Instead, researchers and safety officials have begun focusing on the specific portions of the demographic at greatest risk.

The second and related development recognizes that the core of the senior crash problem primarily involves people with conditions that no longer allow them to drive safely, conditions that are irreversible, such as severe dementia or uncontrolled seizures. The question, then, becomes which older drivers are at higher risk?

Variations

Given what we’ve learned, it’s clear that restricting driving based solely on age or common stereotypes is not appropriate policy. Senior drivers encompass a wide age range, spanning more than 20 years. Some 85-year-olds are more capable drivers than 65-year-olds, and within any age there is a broad range of competencies.

The generalizations work both ways. You can read much in the popular literature about the healthy, happy golden age that combines wisdom and competence. It’s different from the past, when seniors were often portrayed negatively.

But glamorizing old age has its limits as well. For example, in Susan Jacoby’s book Never Say Die: The Myth and Marketing of the New Old Age, she writes that among the old old, meaning those in their late 80s and beyond, degenerative, chronic and irreversible conditions become increasingly common.

Bottom line: Mobility and independence for seniors are important, but maintaining these attributes eventually becomes a problem for everyone as they age. We just don’t know when and for whom.

When the Government Steps In

When a senior’s driving becomes unsafe, and he or she hasn’t been deterred by family or friends, state licensing agencies become the backstop – with license renewal the instrument – for driver reevaluation. A license in most states is valid for 4 to 6 years. A few states allow licenses to be renewed electronically or by mail, but in most cases drivers must appear in person, pay the license fee, and have a new photograph taken, along with taking a vision test.

Furthermore, over half of the states employ different procedures for drivers older than a certain age, generally 65 or 70. These procedures can include shorter intervals between renewals, along with the in-person requirement, the required vision testing and in some cases road testing.

At renewal time, licensing officials can take the measure of an applicant’s appearance to gauge whether he or she needs further assessment. Vision tests also may reveal issues, though they typically measure only visual acuity and field of vision, which do not necessarily relate well to crash risk.

Seniors can also be