MMS Physician Focus: June 2009
By Janet Jankowiak, M.D.
In 2004, I wrote about issues surrounding older drivers, as
accidents caused by elderly motorists resulting in multiple deaths
focused nationwide attention on the subject.
Now, five years later, the elderly driver is again in the
spotlight. No less than three accidents involving vehicles driven
by elderly persons occurred recently in Greater Boston, resulting
in more than a dozen people injured, and, tragically, the death of
a 4-year-old girl.
Legislators, policymakers, police, and public safety advocates
struggle with possible solutions, while many elderly and some of
their advocates balk at criticism, cite discrimination, and cry
'ageism.' With our population aging rapidly, and the motor vehicle
as a longtime symbol and tool of our independence, the issue
remains a significant and growing national public health concern.
(This topic of driver safety is magnified with drivers of all ages
who text and use cell phones, speed, and are generally inattentive
to the serious task of operating a motor vehicle. But that's
another issue.)
The facts are clear about elderly drivers. Federal Highway
Administration data indicate that drivers 75 years and older have
higher rates of fatal motor vehicle crashes than any other age
group except teenagers. And statistics from the Insurance Institute
for Highway Safety show that drivers 85 and older have nearly twice
the number of fatal accidents as those 16-19. Collisions and
traffic violations in the elderly population reflect errors of
inattention, failure to yield, difficulty maneuvering, and driving
too slowly. Left-hand turns are notoriously dangerous.
What's also clear is that a time will come for every elderly
person, whether through physical or mental impairment, when it will
be unsafe to keep driving. While the rate of decline varies
markedly from person to person, safe driving requires physical,
intellectual, and mental skills, and there's no denying it: aging
takes its toll on those abilities.
The most critical skills for drivers include (1) vision,
straight-ahead and peripheral, and the ability to gauge distance
between objects, especially for night and bad-weather driving; (2)
sensory motor abilities, or reflexes, which can be diminished by
various illnesses such as diabetes and can result in serious
mistakes, like hitting the gas pedal instead of the brakes; and (3)
cognitive abilities, including attentiveness, processing
information, and quick decision-making. The ability to
multi-task is a major problem for both teens and older adults,
contributing to higher accident rates.
Difficulties arise when the elderly begin to lose these skills
and the physical and mental abilities required for operating a
motor vehicle, but don't realize or don't want to admit they're
losing them.
So, apart from enacting new legislation, regulations, and
requiring testing for elderly drivers, what can be done to address
the situation of the elderly driver?
Physicians and children and relatives of senior citizens can
play an important role, an idea suggested by several groups,
including the AAA Foundation for Traffic Safety (www.seniordrivers.org)
Children or relatives should first pay close attention to the
abilities of their elders. Ride in a car with them or behind them
to see how they drive. If you see problems, talk with him or her.
Also take into account the individual's overall health. Are they
taking prescription or over-the-counter medications? Are there side
effects? Do they have underlying chronic medical conditions,
such as heart disease, diabetes or arthritis? Can these conditions
affect driving?
Then engage the senior's physician in the discussion. Often the
doctor, after a thorough medical examination, must tell the senior
that it's no longer safe to drive or may advise a road test as part
of an objective evaluation. Patients often accept such advice from
a physician when they wouldn't accept it from others, including
relatives. If the person must give up driving, understand that it
will be difficult for the senior to contemplate life without the
freedom that comes with driving. They may become upset or
defensive. That's when friends and relatives may matter most.
The Massachusetts Medical Society's Medical Perspectives on
Impaired Driving discusses the effects of aging on motorists, as
well as other factors like alcohol, drugs, and disease, among
others. While developed for physicians, this 43-page guide can be a
useful resource for others. You can download a free copy at www.massmed.org.
Janet L. Jankowiak, M.D., a geriatric neurologist at Radius
Specialty Hospital in Boston, is a longtime member and advisor to
the Committee on Geriatric Medicine of the Massachusetts Medical
Society. Physician Focus is a public service by the Massachusetts
Medical Society. Readers should use their own judgment when seeking
medical care and consult their personal physician for
treatment.
