“The conversation” is the conversation that an ever-increasing number of relatives, close friends, caretakers, or healthcare providers are having with mature drivers. The topic is whether it is time for the elderly driver to modify or restrict his or her driving habits. Worse yet, the conversation may involve a request that the senior stop driving totally. While some seniors will welcome the discussion because they have already begun to question their own driving abilities, others will respond with indignation and anger. Suggesting to the person who fed, clothed, educated, and provided for you that he or she is no longer capable of driving is problematic. Asking that person to turn over the car keys may incite Armageddon. However, as people live longer lives and the baby boomer population continues to age, the number of these conversations will undoubtedly rise as drivers outlive their ability to drive.
Driving: Good for Capable Seniors
The National Highway Traffic Safety Administration (NHTSA) estimates that 28 million senior drivers will be on the roads by the year 2020. Nearly 20 percent of the population will be age 65 and older by 2025. If a person received a driver’s license at age 16, he or she will have driven for 49 years by age 65. Seniors drive for the same reasons that all drivers choose to drive: convenience, safety, and need. Rather than either wait for an adult child to take her to the pharmacist or impose on a neighbor, the senior simply drives her car. Some mature drivers have moved away from urban areas with ample public transportation systems. Others live in empty nests without extended families to attend to their day-to-day needs. Others still are chauffeuring grandchildren as they assist adult children with childcare or raise grandchildren on their own. These seniors drive to go to doctors’ appointments, attend to daily needs, and participate in senior-friendly activities, and, for the most part, do so safely every day.
Participating in meaningful activities is a major contributor to a good quality of life. Studies continue to connect independence with positive attitudes and healthier outcomes. Those seniors who lose their mobility through physical impairments or driving cessation are more prone to depression, isolation, and loneliness. Declining quality of life and emotional satisfaction adversely affects physical health. Non-drivers are more likely to be institutionalized than drivers. Thus, it is good public policy, recognized by most states, to allow seniors to maintain their driving privileges as long as they are physically and mentally capable. How to determine capability and who makes that determination become the questions.
Finding the Balance
As the aging process continues, the body begins a process of deterioration. Degeneration occurs both physically and mentally throughout one’s lifetime. Inevitably, the senior begins to experience a functional decline. A loss of strength, a reduction in visual acuity, and a slower reaction time are common. The elderly driver may have reduced peripheral vision, be subject to some hearing loss, and have cardiovascular issues, all of which can adversely affect driving. Additional medical issues may affect elderly drivers, ranging from loss of flexibility due to arthritis to reduced vision due to cataracts to diminished capacity resulting from cognitive disorders such as dementia. Those conditions can decrease the senior’s ability to drive safely.
Health, physical fitness, genetics, and medical conditions all affect a senior’s ability to operate a motor vehicle. The changes in a person’s condition vary from person to person. The fact that the aging process is so individualized prevents a one-size-fits-all program from addressing the unique needs of mature drivers. Some seniors may be perfectly capable of daily driving at age 90, while others are no longer safe drivers at 67. Citing equal protection, discrimination, and due process concerns, AARP correctly reminds us that age is no predictor of driving ability. In fact, every senior advocacy group emphasizing the individualized nature of aging vehemently opposes age-triggered restrictions on driver privileges. Seniors are our fastest growing demographic, and lobbying groups such as AARP are afforded considerable deference.
Legislators who ask seniors for their votes are reluctant to anger them as a group. The legislators recognize that, by 2030, when all baby boomers will be at least age 65, they will be responsible for 25 percent of all fatal crashes. Legislators understand that society expects them to protect both the seniors and the public from the 100-year-old driver who backs down the sidewalk injuring schoolchildren or the 86-year-old driver who plows into the farmer’s market. With each sensational headline spotlighting some elderly driver’s traffic accident, these legislators continue the search for the right balance.
Seniors Are the Safest Drivers
To set the record straight, according to the NHTSA and the Insurance Institute for Highway Safety statistics, the safest drivers of any age group are those between 64 and 69 years old: seniors. The most dangerous group of drivers by age is presumed free from physical and mental deficits: male teenage drivers. Those age 75 and over are responsible for approximately three percent of traffic accidents, while those between 25 and 34 are responsible for 20 percent. Mature drivers are much more conscientious and responsible; they engage in less risky behavior, limit driving during bad weather, wear seatbelts more often than the rest of the populace, rarely get speeding tickets, and are less likely to drive while impaired. Only five percent of older drivers involved in fatal crashes had blood alcohol concentrations of 0.08 percent or higher, compared with 25 percent of younger drivers.
Mature drivers instinctively or through peer modeling begin to modify their driving habits as they age. As an example, we all know about seniors who say they “don’t drive at night.” Is it just the fear of being out late that causes this change in behavior, or is it their recognition that they have decreased visual acuity? If you work with seniors, you will recognize the driver who “prefers” to travel the side streets to the expressways. Have the seniors ceded the roadways to those “crazy young kids,” or is this an accommodation to the degenerative physical or mental changes they are experiencing? Indeed as they continue to pursue active lives in their churches, senior groups, and communities, elderly drivers merely modify driving patterns and continue to drive. From shortening the length of trips to opting for more carpooling, self-regulation as a group actually seems to be working on the whole. The statistics actually verify that there is driving self-regulation occurring in senior populations. Seventy percent of all senior accidents occur during daylight hours on weekdays near the driver’s home.
Seniors Are at Most Risk of Injury
Unfortunately, while they are the safest category of drivers, they are also at the most risk of injury. An alarming 17 percent of all traffic fatalities are mature drivers. Health issues, frailty, and medical complications are more likely to push a senior driver out of the injured category and into the fatality category. A majority of seniors are on at least one maintenance drug; many take multiple drugs daily. They are generally much more fragile and, in 60 percent of the fatalities involving senior drivers, the mature driver is most often the fatality. How do we protect the senior driver and the public while allowing seniors to maintain their dignity, independence, and social networks?
A mandatory vision test for elderly drivers is currently required in 10 states, starting at age 40 in Maryland. States allowing driver’s license renewal by mail now require in-person renewal of seniors. Eighteen states have shortened the renewal period from as much as 10 years (as it currently is in Colorado) to four-, two-, or even one-year intervals. For example, in Illinois, drivers age 69–80 can renew their licenses for four years. Those 75 and older must take a road test each time they renew. Drivers age 81–86 must renew every two years, and those over 87 must renew and retest yearly. Most states require all driver’s license applicants to attest to their fitness to drive. Some require doctor’s statements for mature adults, and others require doctors to report any disabilities that would affect their patients’ driving abilities.
The Goal and Means of Achieving It
The goal is to identify at the earliest point the inability of a driver to continue operating a motor vehicle safely. By creating more opportunities for testing personnel to examine the driver, future tragedies will hopefully be avoided. States are also looking at structural conditions that may affect the number of senior traffic accidents. Intersections, for example, are particularly troublesome for many mature drivers. Forty percent of all fatal collisions involving persons age 70 and older occur at intersections. Failure to yield in left-turn situations is a major factor, and traffic safety experts now recommend that more dedicated left-turn lanes be installed to reduce those types of crashes.
Whether age-based driver regulation efforts have proven effective is uncertain. Because a marked decline in cognitive abilities and physical conditions can occur suddenly, the people best able to question a driver’s capability are friends, family, and caretakers. The licensing agency may weed out some drivers who fail the test and others who, knowing that they face a road test, simply cease driving. The deterioration in condition caused by an illness, however, can occur shortly after re-licensing. Therefore, it is up to family, friends, and caretakers to observe, acknowledge the problem, and then take the necessary steps to protect elderly drivers from injuring themselves or others.
How old is too old? What are the signs one should look for? These questions are particularly important because, at some point, each of us may be on the initiating or receiving end of “the conversation.” The evidence suggests that these questions are present in the minds of thousands daily. More than half of adult children of senior drivers—55 percent—say they are concerned about their parents’ driving habits. Only 23 percent have had a discussion with their parents. Is now the time?
When the police pull over a car, seniors may become nervous and be unable to find the insurance card in the glove compartment promptly, even if they are fully insured. For the most part, they appear in court to answer citations for driving without headlights or with bright lights, driving too slowly or too fast, stop-sign and red-light violations, or failure to yield. Those drivers, if accompanied by a family member, may appear in a courtroom before or soon after “the conversation.” The court, however, does not have the frequency of contact to be able to assess whether or not a conversation is needed.
AARP introduced the nation’s first driver safety course for seniors in 1979, noting that most drivers had not taken a driver’s education course since they were first licensed at age 16—perhaps more than 49 years ago. Now most cities, driver licensing agencies, senior support groups, and insurers throughout the country provide senior-refresher courses. Those courses not only review the rules of the road, but they also discuss the effects of aging on driving¸ technological enhancements available to aid the elderly driver, and self-regulation of driving.
Refresher courses are additional tools for courts when drivers present with traffic violations. Just as teens are routinely sentenced to traffic schools, more mature drivers involved in violations and accidents could be referred to refresher courses. A refresher course involving actual road testing would also provide the individualized assessment that might alert licensing agencies to whether a particular driver needs further assessment. When that 100-year-old driver appears in court after seriously injuring another, the court will usually revoke driving privileges. In these cases, the age of the defendant, health, prior background, and all other permissible considerations usually entitle the defendant to extended periods of probation or house arrest, in addition to the revocation. The purpose of having “the conversation” is to avoid that outcome.
The Conversation, Continued
That was the case of the daughter who appeared in my court with her dad. “Can you tell him to stop driving?” she asked. I responded that that was a discussion best had with family, medical providers, and friends. I referred her to the American Society on Aging, the NHTSA, and the Secretary of State’s office. I told her that both http://www.AARP.org and http://seniordriving.aaa.com have articles on this very topic. I then spoke to her father, saying, “Your daughter is here today because she loves you and, because she loves you, she wants to sit down and talk to you about making your life easier and safer. I had a similar talk with my father a few years ago, and I think we both felt better when it was over.”