When You Are Concerned - A guide for families, friends and caregivers concerned about the safety of an older driver
(When You Are Concerned is also available as a PDF) Chapter 7
DRIVING SAFELY
"We usually think about older drivers from one perspective: Getting them off the road. But we are headed for a terrific problem with the lack of public transportation, ever-sprawling suburbia and a coming wave of aging baby boomers. What we really need to be looking at is how to keep them driving safely longer!"
Older persons especially, have much to gain if driving skills and judgment can be maintained or even enhanced. The good news is that studies show some older drivers can regain once lost skills and judgment. Some are even able to exceed levels considered previously adequate. What does it take? What's out there to help your loved one drive safely longer? Read on.
MOTIVATION
Those who have successfully returned to the wheel with improved skills and judgment often call motivation the "secret ingredient." It means your driver has to want to take the path. It's not easy and often a lot of work. But if your driver is able to return to the wheel with enhanced skills, confidence and judgment, it is a payoff you can't put a number on.
DRIVING ASSESSMENT
A first step is for your loved one to get assessed by a driving school professional or a driver rehabilitation specialist. Either one can quickly identify deficiencies and if the driver is an improvement candidate, chart the remediation needed.
IN-CAR SKILLS ENHANCEMENT
Where can you find help with improving in-car driving skills and judgment? Usually from the same folks who conducted the assessment: a driver rehabilitation specialist (check at a hospital or clinic), or a professional driving school with certified instructors who have experience with older or disabled persons. Both know how to help.
While "driver education" seems to have disappeared from the lexicon, never has driving skill and judgment been more important. The AAA (American Automobile Association) Foundation for Traffic Safety has called for a "re-invention" of driver education to address the growing concern over youth casualties. The program suggested by the Foundation would be comprehensive and utilize computer based interactive technologies like those used to train commercial airline and military pilots.
While the AAA Foundation's call is presently directed at helping "new" drivers, the other end of the driving age spectrum could also be a beneficiary when such a comprehensive program is developed. Don't be surprised to see movement in this direction.
"USE IT OR LOSE IT"
Team managers in the world of professional motorsports use the term "seat time." Seat time is time behind the wheel. They know even the fastest drivers in the world need adequate seat time before they can perform well in an event.
The same holds true in the world of daily driving. A driver needs seat time to maintain confidence and driving proficiency. That old adage about "using it or losing it" holds true for driving. While the tendency in older age is to drive less, there is a genuine need for an older driver to get enough seat time to keep judgment, skills and confidence from diminishing.
DRIVER FITNESS
Much has been written about fitness for driving. Both AARP and the AAA Foundation for Traffic Safety have excellent information about driver fitness and what a person can do to remain up to the physical challenges of driving. So do occupational therapists, physical therapists and driver rehabilitation specialists.
Fitness for driving, however, can be different for different people. Today, even persons with some of the most severe neuro-motor coordination difficulties are able to drive safely and successfully, often from wheelchairs in specially equipped vehicles. One ride with a driver who has a severe physical disability will permanently rearrange your notion of what constitutes physical fitness for driving!
The ability to drive and drive safely speaks both to the personal motivation of the folks who are disabled and to the tremendous strides made in vehicle systems and adaptive equipment which has given those with disabilities the same freedom of the road others enjoy.
VEHICLE EQUIPMENT
The right vehicle when properly equipped can significantly enhance a driver's safety. If vehicle replacement is an option for your driver, check that the new(er) vehicle has the following:
- Automatic transmission
- Power brakes and steering
- Column gear selector or console selector, which clearly shows gear selected (preferably on instrument panel)
- If console gear selector, check selector button release pressure (if too difficult to press sometimes it can be changed to a softer spring)
- Adjustable pedals. Some new Fords have them. Others will soon follow.
- Power seat. Power seats often have additional ranges of adjustment allowing for a better fit behind the wheel. Driver should sit high enough to see the road and be positioned to easily operate the controls. If vehicle is equipped with a steering wheel air bag, driver must sit at least 10 inches (25.4cm) from bag cover.
Fit in a new or existing vehicle can also be improved with seat cushions, pads or sometimes a seat change. Adjustable pedals, pedal extenders and pedal blocks also improve fit and provide the clearances needed for air bag equipped vehicles. Air bags save lives. But they can kill or injure a driver who is too close.
Drivers with a disability can also be accommodated by the addition of special equipment. Here are some examples of the kinds of adaptive vehicle equipment available:
- Seat belt adapters to make belts easy to reach, improve fit and make release buttons easier to operate by arthritic hands. Special torso restraints to hold driver upright.
- Full view inside mirrors and side "spot" mirrors to minimize blind spots.
- Steering wheel spinners, turning devices, and reduced effort power steering, helpful to drivers who have use of one arm only.
- Directional signal crossovers to shift operation of directionals to other side or to foot.
- Extra loud turn signal "clickers" or relocated/brighter turn signal indicator.
- Left foot accelerator for those with limited or no use of the right foot.
- Touch pads or voice scan activation systems for car controls and electronic joystick controls for steering, gas and brake.
- Scooter and wheel chair loading devices, transfer assists to help person in an out of vehicle,
- keyless ignition, locking and automatic opening doors.
For information about the equipment listed above or a vehicle modifier, contact a rehabilitation hospital or clinic. The State University of New York at Buffalo (SUNYB) is one of the leaders researching special vehicle equipment for persons with disabilities. Reach them at: (716) 829-3712, or via the Internet at www:wings.buffalo.edu/ot/cat/rerca.htm (Internet address play on the regional food specialty is a clue creativity abounds at SUNYB!)
VEHICLE CONDITION
Your driver's vehicle also needs to be in sound mechanical shape. The prerequisites are safe and properly inflated tires, good brakes, steering, working directional signals, brake lights and wipers which actually clean. When was the last time you gave your driver's vehicle a safety check and test drive? One key to keeping a vehicle safe is a good relationship with a reputable mechanic/technician or dealership service manager. One way to find a reputable shop is by word of mouth. But you have to ask. The Internet is another. One popular public radio car care call-in program already has a Web site, which is becoming a repository of the best (and worst?) garages, automotive technicians, service managers and dealerships! Other sites are certain to follow. The Internet. Don't you just love it?
A CONSPIRACY STORY
"His family filed a report with us and we called him in to take a driving test. He passed the test without a problem. His family contacted us again. They were very concerned. How could we pass him when he was driving so unsafely?
They filed another report and we tested him again. He passed. His family was very upset with us. How could he pass when he had not been obeying traffic signals? They filed another report. And we tested him again. This time during the afternoon. Well, he failed the test! Why this time and not the others?
We found out at lunchtime he would have his big meal of the day. He would also take all of his medications for the day as most were to be taken with food! Well, this drug cocktail was affecting his judgment and causing the unsafe behavior."
MEDICATIONS AND MIMICS
Many things can conspire to erode safety and place an older driver at risk. When this happens quite often the driver will have to leave the wheel. Yet sometimes the cause of the problem, as in the above vignette, can be addressed and the person restored to safe driving.
Medications, anemia and depression can produce dementia-like conditions. Arthritis and post stroke conditions can make vehicle control difficult and place an aging driver at-risk. Barry S. Reiss, Ph.D., Chair-man, Department of Pharmaceutics, Albany College of Pharmacy, points out older persons use 30% of all drugs in the U.S. even though they represent only 12.5% of the population. Some 63 % of older persons regularly use over-the-counter (OTC) drug products. The non-prescription medications are more powerful now, as lots of prescription drugs have been moved to OTC.
More powerful OTC medications, age-related changes in drug absorption, prescription medications, and misuse (if one is good, two must be better) can conspire to undermine the judgment and safety of an older driver. Some drug cocktails can produce dementia-like symptoms. Others can cause loss of consciousness or even death.
Here are some things you can to do about medications to help your loved one continue driving safely:
- Gather the names, dosages and frequencies, expiration dates of the driver's prescription medications and take the information to a pharmacist. Ask for the technical printout for each medication. The printout gives information about driving. Ask the pharmacist what impact the medications, if taken as prescribed, are likely to have on driving. The pharmacist is a good source for information about substitutions, dosages and the timing of the medications. It is all information you can share with the driver's physician, if you have to.
- Gather the names of the driver's over-the-counter (OTC) medications. Check medicine cabinet, kitchen cabinets and drawers. Share the information with the pharmacist and learn which ones interact with the prescription drugs.
- Also check for multiple prescribers, duplication of medications, vague directions, perpetual refills and outdated medications.
- Check the caps. See how easy they are to get off. If your driver can't get the cap off, he or she can be at-risk driving for NOT taking needed medication!
- Pay attention to the driver's behavior when new medication is prescribed. The first six weeks are the time when new meds typically change behavior.
DEMENTIA-LIKE SYMPTOMS
Dementia-like symptoms can come from a range of conditions and disorders. Understanding and addressing the underlying problems in your driver can add years to being able to drive safely. Consider the following:
- D Drugs - interactions and side effects
- E Emotional illness and depression
- M Metabolic/endocrine disorders
- E Eye/ear and environmental problems
- N Nutritional/neurological conditions (such as mini-strokes)
- T Tumors/trauma - falls where head is injured
- I Infections - can cause confusion
- A Alcoholism/anemia/atherosclerosis
THE EYES HAVE IT
In the third (50-75) and fourth (75+) ages of life, cataracts and other vision problems can often develop quickly to undermine a driver's safety. Yet cataracts and certain eye conditions can be medically addressed to restore a driver's vision and, of course, the safety which comes with seeing clearly. For this reason, a thorough eye examination is the appropriate starting point in any process designed to keep an older loved one driving safely longer.
Your driver should also be wearing their corrective lenses when they are behind the wheel. Surprisingly, not all do report their family members and friends! Sometimes it is vanity. The driver does not like how they look in glasses. Other times it is fit or comfort. With vision so important to driving safety, make sure these simple and easily correctable things are not preventing your driver from driving safely.
FINAL THOUGHTS
Everyone knows you need to see to drive. But how well do you really need to see to drive safely? One noted vision investigator who conducted extensive research into visual acuity and safety, concluded that the current 20/40 acuity standard (actually an arbitrary one!) may be too restrictive and removing drivers who are able to drive safely!
Another respected vision investigator noted a minor or moderate acuity impairment is not going to make someone a bad driver, but a severe impairment is a concern.
Both observations have implications for the coming wave of automobile dependent baby boomers in bifocals. Will they face a vision standard, which will screen them out of their licenses, when they are still driving safely? Or will a demonstrated ability to operate safely be the final arbiter for keeping a license?
Older Driver Index (Top) Older Driver Population Expected to Rise
According to the U.S. Census Bureau, in 1994 one out of every eight Americans was age 65 or older. It is projected that by the year 2050, those aged 65 and over will be one out of every five Americans. It is to be expected that the number of individuals 65 and older who are still driving will follow that same trend.
Driver Retesting — A Possible Solution??
As a possible solution to this perceived problem, it is often proposed that mandatory retesting of older drivers be instituted. However, when driver fatality rates are calculated based on estimated annual travel, the highest rates are found to be among both the youngest and the oldest drivers. Mandatory retesting of just the older segment of the driving population would not solve a problem shared by the two age groups.
Mandatory retesting of aging drivers has not been implemented in New York State, or in other jurisdictions, primarily for three reasons:
- "...age alone is a poor predictor of individual driving ability." ("Transportation in an Aging Society," Transportation Research Board);
- Retesting only older drivers could be considered discriminatory since accident rates per miles of travel show both drivers over age 75 and drivers between the ages of 16 and 24 are at high risk; and
- The cost of retesting such a large portion of the driving population would be prohibitive.
DMV's Driver Retesting Policy For information about how DMV addresses drivers who may have physical or mental disabilities or who are involved in a series of accidents, see Driver Medical Conditions and Accident Re-Examination on the Driver License and Non-driver ID page.
Adjustments Older Drivers Can Make to Remain Mobile
For many, the loss of the driving privilege has significant social and psychological ramifications. The driver license is a symbol of independence on the part of both the new, younger driver and the older driver. It continues to be a nearly indispensable key to mobility in America today, regardless of driver age. The older driver can adjust his/her driving habits to compensate for a decrease in driving skills by restricting driving to:
- daylight hours
- off-peak traffic hours
- familiar roads
- shorter trips
- lower speed roads
This self assessment from AARP can help you determine if you should limit your driving: http://www.aarp.org/families/driver_safety/driver_safetyissues/a2004-06-21-whentostop.html
Technological and Engineering Advances Make Driving Safer
Technological and engineering advances have made driving easier and safer for all, as well as accommodating the older driver's decreasing driving skills. Some of these advances are:
- safer cars
- larger roadway markings/traffic signs
- special lanes for left turns
- improvements in traffic signaling, such as left turn arrows
- adjusting signal timings at traffic lights
For more information about older drivers, see the list of direct links to older driver issues from the New York State Office for the Aging on this page or visit the New York State Office for the Aging (SOFA) web site. They link to national, state and local senior citizen resources and provide information on how you can contact your local Office on Aging (many have their own web sites). They also provide a Senior Citizen's Hot Line at 1-800-342-9871.
NYSOFA TV Show: "Aging & You"
Aging & You is a 30-minute TV talk show that addresses issues of interest to older New Yorkers and their families. The program, hosted by the NYS Office for the Aging director and produced by NYSOFA staff, is distributed to over 65 cable and Public Access stations throughout New York State. The bi-monthly program is repeated and shown at various times, making it possible to reach many of New York's 3.2 million older citizens.
You may see a list of recently produced programs and watch them on-line at the NYS Office for the Aging website http://www.aging.ny.gov/NYSOFA/AgingAndYou.cfm