How old is too old to drive?
WASHINGTON, June 16th, 2003
First, the elderly woman tried to drive between a delivery van and two people walking on a narrow Florida street. Then, busy chatting, she didnÃƒÂ¯Ã‚Â¿Ã‚Â½t notice a car stopping in front of her. At a stop sign, she pulled out in front of a truck. This was a test to see if it was time for the 75-year-old to give up her keys ÃƒÂ¯Ã‚Â¿Ã‚Â½ and when driving specialist Susan Pierce emerged from the car, it was to break bad news.
ÃƒÂ¯Ã‚Â¿Ã‚Â½SHE STOOD up and literally pounded her fist on the table and said, ÃƒÂ¯Ã‚Â¿Ã‚Â½I am not giving up my driverÃƒÂ¯Ã‚Â¿Ã‚Â½s license and not giving up my home,ÃƒÂ¯Ã‚Â¿Ã‚Â½ÃƒÂ¯Ã‚Â¿Ã‚Â½ before storming out, recalls Pierce, an occupational therapist certified to assess driving skills. ÃƒÂ¯Ã‚Â¿Ã‚Â½ThatÃƒÂ¯Ã‚Â¿Ã‚Â½s probably the toughest part of my job, when I know I have to say ÃƒÂ¯Ã‚Â¿Ã‚Â½no.ÃƒÂ¯Ã‚Â¿Ã‚Â½ÃƒÂ¯Ã‚Â¿Ã‚Â½
Losing the ability to drive can be a traumatic experience of aging ÃƒÂ¯Ã‚Â¿Ã‚Â½ and knowing when itÃƒÂ¯Ã‚Â¿Ã‚Â½s time to quit can be immensely difficult. Tests in doctorsÃƒÂ¯Ã‚Â¿Ã‚Â½ offices arenÃƒÂ¯Ã‚Â¿Ã‚Â½t completely reliable. And nationwide there are only 300 specialists like Pierce certified to perform road tests and offer techniques to help some seniors stay behind the wheel a few more years.
Now medical and traffic groups are beginning some major programs to address the issue:
The American Medical Association will issue guidelines in July to help doctors tell when older patientsÃƒÂ¯Ã‚Â¿Ã‚Â½ driving is questionable and get them help to stay on the road as long as it is safe. This fall, the AMA also will run a program to train doctors about medical fitness to drive.
The government recently earmarked $1.6 million to start a National Older Drivers Research Center. Run by the University of Florida and the American Occupational Therapy Association, it will train more ÃƒÂ¯Ã‚Â¿Ã‚Â½certified driving rehabilitation specialistsÃƒÂ¯Ã‚Â¿Ã‚Â½ like Pierce, and create better off-road tests to screen drivers for problems.
ELDERLY BABY BOOMERS
As the baby boomers age, one in four drivers is expected to be over age 65 by 2030. Some 600,000 people age 70 or older give up their keys each year, estimates the National Institute on Aging.
Problems with vision, perception and motor skills increase with age. Some are obvious, such as severe dementia. But many arenÃƒÂ¯Ã‚Â¿Ã‚Â½t. Diabetes can numb the legs and feet, making it hard to know if youÃƒÂ¯Ã‚Â¿Ã‚Â½re properly pumping the brake. Arthritis can hinder turning and checking for traffic.
Then there are problems like PierceÃƒÂ¯Ã‚Â¿Ã‚Â½s student had: diminished reaction time, ability to judge spatial relations and juggle more than one task.
As for eyesight, the tests administered to get a driverÃƒÂ¯Ã‚Â¿Ã‚Â½s license only check visual sharpness. Yet seniors can lose peripheral vision; have blind spots from cataracts, strokes or eye diseases, or lack contrast sensitivity ÃƒÂ¯Ã‚Â¿Ã‚Â½ making it hard to see a dark car at dusk.
AN END TO INDEPENDENCE
Seniors often deny problems, because losing their license is a giant blow, says the NIAÃƒÂ¯Ã‚Â¿Ã‚Â½s Dr. Stanley Slater.
ItÃƒÂ¯Ã‚Â¿Ã‚Â½s not just demeaning: Having no easy, reliable way to get to the grocery store or doctorÃƒÂ¯Ã‚Â¿Ã‚Â½s office can mean an end to elderly independence. Recall PierceÃƒÂ¯Ã‚Â¿Ã‚Â½s student: She wound up having to move in with the daughter whoÃƒÂ¯Ã‚Â¿Ã‚Â½d insisted on the driving test.
The question is how to spot a problem before a crash, something that usually falls to worried relatives. Few states require more frequent license renewals or eye exams for the elderly.
The AMA guide will urge doctors to ask patients and their relatives about driving problems, watch for possible red flags and hunt medical treatments to help them drive as long as possible.
Occupational therapists increasingly are assessing driving skills with memory and other tests, and offering rehabilitation services to strengthen driving skills.
DRIVING TESTS ARE BEST TOOL
But ultimately, driving tests are the best tool, says Dennis McCarthy, co-director of the new National Older Drivers Research Center.
TheyÃƒÂ¯Ã‚Â¿Ã‚Â½re more complex than those parking-and-steering tests offered at driving schools, says Pierce, who performs them in Orlando, Fla. Nor is it always pass-or-fail: She often finds ways to keep people driving longer.
For example, unprotected left turns ÃƒÂ¯Ã‚Â¿Ã‚Â½ those without a turn-only light ÃƒÂ¯Ã‚Â¿Ã‚Â½ and unfamiliar roads can be big challenges. Some drivers merely need to restrict driving close to home and avoid risky intersections.
Avoiding night driving also helps. So can adaptive technology ÃƒÂ¯Ã‚Â¿Ã‚Â½ special mirrors or hand controls.
The cost for driving evaluations varies widely, from $250 to $800. Elder advocates are lobbying for Medicare coverage, today available in only a few states, Pierce says.