Doctors, either general practice or geriatricians, are increasingly being faced with the difficult task of determining an older driver’s ability to drive safely. Adult children may express concern to the physician, a spouse, or perhaps a police officer prompts the conversation.

Doctors have a reference for assessing and elder’s ability to drive safely. The American Medical Association published the Physician’s Guide to Assessing and Counseling Older Drivers, developed in cooperation with the National Highway Traffic Safety Administration. The introduction reads:

The information in this guide is provided to assist physicians in evaluating the ability of their older patients to operate motor vehicles safely as part of their everyday, personal activities. Evaluating the ability of patients to operate commercial vehicles or to function as professional drivers involves more stringent criteria and is beyond the scope of this publication.

This guide is not intended as a standard of medical care, nor should it be used as a substitute for physicians’ clinical judgment. Rather, this guide reflects the scientific literature and views of experts as of December 2009, and is provided for informational and educational purposes only.

Download the 246 page pdf file here.

Studies predict that within 15 years, 25% of all drivers on U.S. highways will be age 65 or older. When drivers reach the 75 and older age bracket, the likelihood of their becoming involved in a fatal accident increases greatly. These statistics and facts will present challenges for state governments trying to assure safe highways and for the elders hoping to retain their driving independence for as long as safely possible.

What can states do to assure senior drivers are safe drivers?

States can test senior drivers more frequently. Some states do not allow different testing standards based solely on age, and people do age differently, but more frequent testing around certain birthdays is something states will consider more frequently. This will do little to allay fears seniors have toward Departments of Motor Vehicles (DMV), as one California DMV research study indicated while testing to determine if educational materials mailed to seniors increased driving safety (it didn’t); but it could improve safety by screening out unsafe elder drivers. Is this idea discriminatory?

Improve road design. Today’s roads are far more complicated and busy than what they were years ago.  A Canadian brochure on the subject outlines a variety of ideas to improve road safety for older drivers. These ideas include:

• improve sight distance at intersections by clearing unnecessary obstructions
• better use of designated turning lanes
• greater use of protected green arrow turn signals
• larger traffic lights and signs
• clear and bright road lines
• longer acceleration lanes for highways

Reporting bad drivers. States can encourage family members, friends, doctors and police to essentially “tattle” on elder drivers they believe are unsafe. This idea makes some feel uncomfortable, but if states successfully push the idea as safety first, both for the individual and other drivers, the concept may take hold and attitudes could change with an active public awareness campaign.

Educate elder drivers. While the California study linked to above did not indicate much success through its limited educational campaign, it was just that – limited. A wide reaching educational campaign targeted at elders and their family members touting safe driving techniques could prove effective, particularly if the ideas focused on ways to continue driving, but staying safe, ideas like those outlined in this post.

Encourage use of public transportation and alternative driving programs. Programs like the Independent Transportation Network are growing and taking hold with our aging population. Expect their growth to continue. Public transportation, disliked by many, may also play a bigger role as drivers get older, but seek to continue being active in their communities. Public transit’s popularity increases each time gasoline prices reach $4 a gallon. It is a reasonable assumption that other factors, like more elder drivers, could increase its use as well.

Brian Joyce, a State Senator from Massachusetts, has submitted a bill that would require anyone renewing their license after their 85th birthday to pass a vision and a road test every five years. Oh the controversy!

The Canton Citizen newspaper reports:

In a press release issued last week, Joyce, a Milton Democrat whose district includes the town of Canton, announced he is re-filing “An Act to Promote Safe Driving,” a bill that would require all persons renewing their license after their 85th birthday to pass a vision and a road test every five years. Described by Joyce as “simple age-based reforms,” the bill would nonetheless mark a distinct departure from current Massachusetts law, which “prohibits discrimination by reason of age with regard to licensing.”

“Current law requires only a vision test once every 10 years,” Joyce explained, “which means that an 85-year-old driver can renew his or her license without further testing until age 95, at which time the driver would only have to pass a simple vision test.”

There are presently about nineteen million seniors on the road in the U.S. By 2020 it’s expected that number will grow to 30 million. Statistics indicate drivers aged 75 and older have a 37% higher crash rate than younger drivers.

Is this an appropriate safety measure, to test aging drivers’ skills and abilities? Or is it age discrimination, ageism? The AARP has declared this bill discriminatory. When is it time to give up or take an elder’s car keys? What do YOU think?

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Photo by Greg Marshall – some rights reserved

The topic of when someone is too old to drive is often a highly emotional discussion with profound implications for the elder in question. National statistics indicate that by 2030 one out of every four drivers in the United States will be 65 or older. The problems associated with aging, such as slower reaction times, impaired judgment, and physical limitations all play a role determining when to hang the keys up for good. The subject is usually first raised after an accident or a series of near-miss accidents. There are no clear answers and it’s entirely dependent on individual skills, abilities, and limitations.

Emotions run high, because the ability to drive often means the ability to maintain one’s independence, and for people living in rural areas, it can often mean the difference between living at home and the need to move. When one is unable to rely on public transportation, volunteer drivers, or family and friends to get food, visit the doctor, etc. losing the ability to drive is like losing everything, including one’s identity. Without the ability to come and go, many seniors feel isolated and become depressed. They have lost control of their lives, and it can signal the end of life as they know it. Caregivers, family, and friends should proceed with caution when addressing driving concerns with a senior.

There are three types of senior drivers:

1. the older driver that is alert and safe
2. the older driver that has impairments – and is aware of them
3. the older driver that has impairments – and is either not aware of them or in denial

There is no issue for the first type of driver, but the second type of driver must take steps to ensure safe driving habits. This typically includes:

1. restricting driving to daylight hours
2. staying in familiar areas
3. driving with friends or partners

The third type of driver, the driver that doesn’t recognize his/her impairments or refuses to admit them, presents the most difficult challenge. Some elders will fight tooth and nail before giving up their license and it often involves a doctor, police officer, or state office administering license renewals telling them to stop. Doctors often find themselves in a difficult situation as they listen to the spouse or adult child on one hand informing them of their concerns, and the elder on the other hand maintaining they have no such problems, or that the concerns are being blow out of proportion.

The first step is to begin talking with the person. The sooner the conversation takes place the better, because it forces the individual to consider his/her driving abilities. The conversation should focus on your concern for the individual’s safety, and for the safety of others. The process can be gradual, starting with offering rides, encouraging daylight driving only, etc. with additional measures when/if impairments increase.

Here are ten warning signs to determine if you or your loved one should consider driving changes:

1. getting disoriented and lost
2. bumping curbs, scraping the car against shopping carts, etc.
3. wavering in one’s lane
4. slowed response to sudden changes
5. confusion at intersections and nervousness with left-hand turns
6. frequent close calls
7. inability to accurately judge distance and speed
8. other drivers honking at you or your loved one
9. difficulty looking over one’s shoulder to see obstacles and cars
10. easily distracted in the car, leaving the radio off when you or your loved one always preferred having it on

Additional thoughts:

• State offices responsible for issuing a driver’s license may retest a driver upon request. This could be an intermediate solution to resolve questions about the ability of the driver.
• Deteriorating driving abilities could be a sign that other skills may be declining. Family and friends should watch for additional changes.
• The person losing his/her license should be supported. Connections should be made with friends and resources to keep the person connected and to prevent them from feeling trapped in their home.
• AARP offers a Driver Safety Program that may benefit you or your loved one. Find your local AARP office by visiting ElderGuru’s Resources by State page.

Have you had experience with this issue that would be of benefit to others? Do you have specific questions? Leave a comment below.