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 | Driving
By Michael Spilane, MD
Americans believe that driving a car is a God-given right. Not surprisingly, many older persons dig in their heels when a family member or a doctor suggests it is time to turn in the keys.
Statistics indicate that the older population, as a group, drives reasonably safely until about the middle of the seventh decade. The accident rate then begins to climb sharply, reaching alarming levels for those over age 85.
Some who are in advanced age continue to drive safely. The challenge is to identify the high-risk older drivers, and then to persuade them to stop driving.
There are many reasons why older drivers have more accidents. Safe driving requires lightening-quick integration of sensory input, reflex action and judgment. Problems with the senses, reflexes and brain function lead to increased risk of driving error and accidents. And advancing age is strongly associated with declining ability in all of these body functions.
Let's start with the senses. It is apparent that bad sight makes for bad driving. Less apparent is the fact that problems with sight are universal by the seventh and eighth decades. There is a decline in general visual acuity, night vision, peripheral vision and ability to visually discriminate moving objects. The magnitude of deterioration varies greatly among individuals, but no older person is entirely spared.
Though less important to safe driving than sight, hearing loss becomes problematic when it is severe. It is not just the unheard sirens and horns. Inability to appreciate general traffic noise eliminates cues that are important for safety on the road.
Reflexes slow with advancing age. Bum knees or hips and degenerative changes in the neck and upper extremities interfere with reaction time. And the nervous system itself becomes sluggish, leading to slower and more imprecise body movements. Sluggish may be too harsh a word, but even a fraction of a second makes a lot of difference in the complex act of driving. If an individual can not walk steady on a railway tie, the reflexes are not what they used to be. Maybe good enough, maybe not.
Many studies have demonstrated that failing brain function is the most significant causative factor in car accidents involving elderly drivers. Even if the senses and reflexes are perfect, impaired judgment will take its toll. Judgment acts as the mediator between the sensory input and the reflex actions. Driving demands that the brain processes much information very quickly, and an older brain may not be up to the task. The very first sign of a dementia may be erratic driving behavior. In fact, a dementing ailment need not exist--the natural age-related slowing of brain processing ability may be sufficient to increase the risk of driving error.
Despite the fears of older drivers, the State is not out to get them off the road. It is just the opposite--toleration is high. The State of Minnesota requires that elderly drivers pass a simple vision test every fourth year when applying for license renewal. That's it--the same as for younger drivers. But a police officer, a family member or a physician may request that the State call for a formal road test if there is evidence to support unsafe driving.
Physicians in the State of Minnesota are not legally required to report patients who are judged unfit to drive. Professional considerations suggest that they should report, but this is seldom the manner in which the car keys are finally hung to rest. Most older persons who stop driving do so on a voluntary basis, often after a near miss or in recognition of the high expense versus the few miles driven. Prodding by family members and the physician are often influential. But some will resist all persuasion and will continue to drive until formal action is taken. A few will continue to drive after the formal action is completed and the license is revoked!
Those in their late seventies and beyond need to assess their fitness for driving and perhaps consider modifications of driving habits:
- Periodically discuss your driving performance with family members and your physician. Others may see things differently.
- Consider restricting your driving to daytime hours and to familiar routes, and avoiding rush hour traffic and freeways.
- If you have an accident or a near miss, try to objectively analyze blame.
- Many older individuals drive very few miles each year. Make an honest appraisal and determine if the expense and hassle of owning a car are worth it.
- Take the driving refresher courses offered by the American Association of Retired Persons and numerous other local organizations. You are likely to get a reduction in your car insurance cost.
Life without a car can seem bleak. But driving is a privilege rather than a right, and the privilege demands competence. If you are competent, drive-on. But do not ignore the warning signs that can come from many sources--family members, a physician, an accident, a near miss, whatever. Honest introspection will serve you and your community better than irrational heel dragging.
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