Older Drivers: Show ‘Em Some Grace

In our senior population, miles driven decreases with age. Nevertheless, motor vehicle crashes are the leading cause of injury-related deaths in the population aged 65 -74 years old and the second leading cause (behind falls) for those 75 and older. Compared to other drivers, older drivers have a higher fatality rate per mile driven than any other age group except drivers under the age of 25. Based on miles driven, drivers age 85 and older are 9 times more likely to be involved in a fatal car accident than drivers aged 25-69 years old.

The American Medical Association has predicted that in coming years, an increasing number of older drivers will be licensed and that such drivers will drive increasingly higher mileage. With this expansion and increase in mileage, the AMA has predicted that traffic fatalities for seniors could potentially triple.

So, does this mean that seniors are lousy drivers? Absolutely not. We could all take lessons from older drivers. They are more likely to wear seat belts and less likely to drive at night, speed, tailgate, consume alcohol prior to driving or to engage in other risky behaviors. Elderly drivers tend to self-restrict their driving behaviors, generally driving less, and may also change when and how they drive by limiting their driving to local roads.

Eliminating highway miles unfortunately may mean more hazards: road signs, stop lights, heavy traffic, pedestrians, bikers and intersections, leading to an increase in crashes per mile driven. Increasing crashes necessarily increases fatalities for elderly drivers. Beginning at age 60 to 64, drivers grow more fragile and this fragility increases steadily with age. By age 80, a male driver is 4 times more likely to die from an injury as a result of a motor vehicle crash than his 20 year-old counterpart.

In the Physician’s Guide to Assessing and Counseling Older Drivers, the American Medical Association and the National Highway Transportation Safety Administration drew the following conclusions:

Compared with younger drivers, whose car crashes are often due to inexperience or risky behaviors, older driver crashes tend to be related to inattention or slowed perception and response. Older driver crashes are often multiple-vehicle events that occur at intersections and involve left-hand turns. The crash is usually caused by the older driver’s failure to heed signs and grant the right-of-way. At intersections with traffic signals, left-hand turns are a particular problem for the older driver; at stop sign-controlled intersections, older drivers may not know when to resume driving.

The Guide further asserts that "the risk of crash depends on whether each individual driver’s decreased mileage and behavior modifications are enough to counterbalance any decline in driving ability."

Although senior drivers with physical limitations tend to self-restrict their driving, sometimes the deterioration can be so gradual that the driver doesn’t acknowledge the loss. The Guide suggests that if any of the following statements is true for a particular driver, it’s time to evaluate driving performance:

I get lost while driving.
My friends and family members say they are worried about my driving.
Other cars seem to appear out of nowhere.
I have trouble seeing signs in time to respond to them.
Other drivers drive too fast.
Other drivers often honk at me.
Driving stresses me out.
After driving, I feel tired.
I have had more "near misses" lately.
Busy intersections bother me.
Left-hand turns make me nervous.
The glare from oncoming headlights bothers me.
My medication makes me dizzy or drowsy.
I have trouble turning the steering wheel.
I have trouble pushing down on the gas pedal or brakes.
I have trouble looking over my shoulder when I back up.
I have been stopped by the police for my driving recently.
People will no longer accept rides from me.
I don’t like to drive at night.
I have more trouble parking lately.

(By the way, try responding to those questions yourself while you drive and talk on your cell phone. Recent studies show that we all drive like our mothers when we drive and use our cell phones at the same time.)

Obviously, the rubber meets the road in this discussion with the senior driver who has obvious deficits and refuses to self-restrict his behaviors. Because driving in our society is a necessary evil to protect our independence, family members know that any discussion of limiting or eliminating driving privileges necessarily means confrontation. Too often, in order to avoid this confrontation, family members will rationalize that dad only drives to the grocery store or other well-known routes. The information above should make clear that familiar routes provide false security.

So, what is a concerned family member to do? The Hartford insurance company web site offers suggestions for starting a conversation with senior loved ones about their driving performance. You can visit their web site at www.thehartford.com/talkwitholderdrivers

The dementia patient presents unique concerns for driving. A diagnosis of dementia does not necessarily mean that the patient should give up driving privileges, particularly for the patient in the early stages of the disease process. The American Academy of Neurology recommends that driving evaluations be performed every six months. The Alzheimer’s Association also offers guidance to loved ones concerned about a senior driver at www.alz.org/Care/SafetyIssues/driving.asp

For both the dementia patient and the senior with physical limitations, family members should enlist the help of the senior’s physician. In North Carolina, physicians are encouraged to report unsafe drivers to DMV. Physicians are protected by statute for breaching confidentiality in order to report an unsafe driver. Family members and police may also make reports to DMV of unsafe driving. However, such reporting is not anonymous or confidential and the driver may request a copy of his record containing the report. Family members are often afraid to alienate the senior by reporting, so it may be easier to let your loved one be angry with his physician.

In terms of what the rest of us on the road can do for senior drivers, I am reminded of a sermon I heard some twenty years ago. I will confess that I did not spend many Sunday mornings in church while I was in college. But I do recall a sermon at Reynolda Presbyterian in which the minister admonished the congregation to respond with grace instead of anger in our everyday experiences – when the washing machine breaks, the ketchup won’t come out of the bottle, the dog doesn’t come when called. The example he used was the little old lady in the land yacht who’s directly in front of you and driving 10 miles below the speed limit. Put down your cell phone and show her some grace. If we’re lucky, someday we’ll all be senior drivers.

Much of the information in this article came from The Physician’s Guide to Assessing and Counseling Older Drivers. You can find The Guide at www.ama-assn.org/ama/pub/category/10791.html