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How Old Is Too Old to Drive? - 2003-08-10


Last month, an 86-year-old man drove his automobile into a crowded farmers' market in California, killing 10 people. Russell Weller later said he confused the brake and gas pedals on the car. At other times this year in Florida, the U.S. state with the largest per capita population of old people, drivers over 80 plowed into a Chinese restaurant, a post office, and a state representative's office. These incidents and many like them have fueled a spirited debate over what to do about unsafe older drivers.

Russell Weller had had some accidents but had apparently never been charged. So far as anyone knows, he'd never even a speeding ticket. Three years ago, he passed both written and visual drivers' tests at the licensing bureau. There was no immediate evidence that he fell asleep, had been drinking, or was taking strong medications. But older drivers like him, who apparently become disoriented and pull out into traffic, poke along on high-speed freeways, and mow down pedestrians are an increasing menace. By 2030, the number of drivers 65 and older in the United States is expected to double to 60 million. In that year, the Institute for Highway Safety estimates, older drivers are likely to cause one-fourth of all U.S. highway deaths.

But a new study by the Brookings Institution think tank confirms that baby boomers, those post-World War II children now getting close to retirement, are used to choices and freedom of movement and will vigorously resist any efforts to get them out of their cars.

Eric Cravey knows firsthand what they mean. His 77-year-old father, Cyrus, who lives in the little town of Milan, Georgia, simply refuses to stop driving, even though he's hit two other vehicles with his car and kept right on going. Eric Cravey says he and his brothers and sisters worry not only that their father might kill himself next time, but also that he might take innocent people with him.

"It would be heart-wrenching. It would be disastrous," he said. "It would be more than any of us could bear. And, at the same time, I'm down here in Florida, three-and-one-half hours away, and other siblings are in other cities as well. What are we going to do? We can't make him stop driving. The overall mindset he takes is, 'I'm gonna do what I'm gonna do, and they're not going to stop me.' My mom still drives as well, but she's a very careful driver. The last time she had an auto accident, my dad was in the passenger seat, telling her how to drive."

Barbara Morris, 74, still works full-time as a pharmacist in Escondido, California. She proudly drives to and from work each day and by no means considers herself elderly.

"The test for whether or not we're a good driver should be based upon our ability to perform, rather than on chronological age," she said. "Recently I was stopped at a light, and a young woman plowed into the back of me. And her excuse was that she was distracted. She was watching some guys on the sidewalk. This is crazy! I mean, what does age have to do with it [bad driving]?"

Joan Wilson, who is 76 and living in Palm Springs, California, still drives, but she and her daughters wrestled with the problem of how to pry the keys away from her husband, who developed Alzheimer's Disease.

"And the neurologist said, 'The minute I report this, they'll take away your driver's license. Well, that really hit him hard. I mean, that was taking away his whole manhood and his car. And the very last day that I had to put him away, he said he still wanted to drive that day. I said, 'I'm going to the optometrist. You want to go?' He said, 'If you let me drive.'"

Sue MacDonald's parents are both 79, are still farming in Ohio, and are still driving. Ms. MacDonald says taking away their car keys, moving her folks into town, and breaking their hearts would be tough.

"The whole parent-child relationship does a flip-flop. It's almost as if the adult children have to become the parents. And the parents are almost like the children again, because they're the ones that are acting irresponsibly, whether they know it or not," she said. "You know, we're still mom and dad's kids. And it's very hard to say to your parents, 'Sorry, you can't drive any more.' I mean, for anybody, the ability to drive is the ultimate symbol of freedom. And our fear is that they'll do things like drive somewhere and then forget where they're going, get lost, not know how to get back home. And we can see that happening."

And Rosemary Forrest, an ecologist in South Carolina, wrote VOA to say her uncle quit driving only after his car wiped out another car, a boat, and a telephone pole. Then he complained loudly that the wrecker driver stole his car. Why, Ms. Forrest writes, do we let our frail and judgment-impaired elders on the road with two-ton weapons?

What to do about such drivers has been a focus of the National Institute on Aging, where Dan Foley's research indicates that it's the ninth decade of life - in one's eighties - when drivers have to face up to the prospect of a new lifestyle without a car.

"As far as an older person feeling so wedded to their license and their privilege to drive that public safety be damned, I'm not sure that's a responsible driver holding that viewpoint, I don't care how old they are," he said.

According to Dan Foley, many seniors self-regulate their driving to the extent that they drive less often and avoid frightening high-speed highways.

"As we see more congestion and we see greater variability in speed, we see a lot more difficulty in the older drivers trying to interact in that environment," he said. "You have a need to react very quickly, but you make the wrong choice. So whenever I hear about confusing a gas pedal for a brake, that to me is a reaction where the brain cannot carry through on the set of instructions. And to me it suggests that there's something wrong with your cognitive processing skills, the onset of dementia."

Indeed, research is showing that it is those complex processing skills, not problems with simple vision or hearing that get tested at motor vehicle bureaus, that are the root cause of seniors' dangerous driving.

Karlene Ball at the University of Alabama at Birmingham has been measuring driving function in older drivers for twenty years to see what factors might predict that a given driver would be involved in a crash. She says many older drivers see just fine in the usual sense, but what she calls their useful field of view diminishes and blind spots greatly increase.

"Many times what happens is that the person appears to look but hasn't really processed the information," she explained. "It's not getting to the conscious level where they recognize a threat or the fact that another car is coming. They just don't see it. It is confusing to other drivers, because they appear to make eye contact."

At the association that represents state and provincial motor-vehicle administrators in the United States and Canada, Jason King says new laws and more driving tests will not fix the problem of unsafe driving by the elderly. His organization favors refresher courses for seniors and better education for their children and doctors.

"We all age at very different rates," he said. "And because of that, it's very difficult to pinpoint a certain age at which someone should be called in to be re-tested."

Time and time again, the powerful alliance of seniors, the American Association of Retired Persons, has mobilized the elderly to lobby successfully against legislation that would establish age-specific driving tests. Everyone's an individual, AARP's Mark Beach told an interviewer. And folks who are older tend to be in better health these days.

Require road-testing for renewal of driver's licenses if you must, the AARP has said. But test everyone, not just seniors.

The nation's largest group of physicians, the American Medical Association, has just launched an online program aimed at getting its members more involved in assessing their patients' fitness to drive. The association's president-elect, Dr. John Nelson of Salt Lake City, Utah, says a physician is in an excellent position to see changes in a patient's medication, behavior, and mental ability. Where a red flag is spotted, the AMA guidelines recommend that doctors administer simple tests of mental acuity.

"You say to someone, 'Can you draw the face of a clock and draw three o'clock or put the numbers in correct order?' That's easy for most people," said Dr. Nelson. "A person who might be undergoing early dementia, a person who has some psychiatric disease or is unusually depressed, may not be able to do that well. The physician is not acting as a policeman. The goal of this guideline is not to take older drivers off the road. Rather, it's to keep them on the road longer, but safely."

Dr. Nelson says taking away an older driver's keys is a momentous decision, especially in rural settings or cities where seniors have little public transportation to turn to. He says older patients can quickly grow depressed when they are robbed of the independence and free will that their automobiles represent.

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