When was the last time you counseled a patient or their family about giving up their drivers license? Regardless of your medical specialty, it is a daunting task. To that point, I recently reviewed a survey conducted among baby boomers for the website caring.com in partnership with The National Safety Council. Investigators found that suggesting to parents that they stop driving was considered to be the most difficult subject for children to bring up with their parents. They found this to be a subject more difficult even than discussing funeral wishes or selling the family home! Thirty-nine percent (39%) of those surveyed said they would not be comfortable discussing driving status with their parents, while 25% felt that their parents should voluntarily impose some restrictions or safeguards on themselves. While it has not been studied, I would bet the same uneasiness holds true for medical professional bringing this subject up to their patients.

I have explored this subject and found some interesting information that those of us in the medical community would be well serve to be aware of.

In July 2003, an 86-year-old man drove his 1982 Buick into a crowd of pedestrians shopping at an open-air farmers market in Santa Monica, California, killing 10 and injuring more than 50 people.

In October 2005, a 93-year-old man struck a pedestrian in St. Petersburg, Florida, and did not notice the body hanging out his windshield until a tollbooth operator stopped him.

Shocking incidents such as these have reinvigorated a long-simmering debate over the risks of older drivers on the road and has led to calls for stricter state licensing policies for these drivers.

Scientific studies show that physical and cognitive degeneration at older ages compromises driving ability; it is not clear just how much more dangerous older drivers are than other drivers. Most published research shows that accidents per mile driven increase when drivers are in their fifties. And, by the time people reach their eighties, accidents per mile driven are almost as high as they are for the youngest drivers.(1)

In 2012, more than 5,560 older adults were killed and more than 214,000 injured in motor vehicle crashes. These statistics reveal that an average of 15 older adults killed and 556 injured in crashes every day”.(2)

Today there are more seniors on the roads than ever. In 2012 there were an estimated 36 million licensed older drivers on the road, which represents a 34 percent increase since 1999.(3)

By 2025, drivers 65 and older will represent 25 percent of the driving population (as compared to 15 percent in 2001).(4)

Per mile traveled; fatal crash rates increase starting at age 75, and increase notably after age 80. This fatality rate is largely due to increased susceptibility to injury and medical complications among older drivers, rather than an increased tendency to get into crashes.
The age-related decline in vision and cognitive functioning (the ability to reason and remember), as well as physical changes, may affect some older adults’ driving abilities. Across all age groups, males had substantially higher death rates than females.

There are some existing protective factors that already improve older drivers’ safety. They include: High incidence of seat belt use, the tendency to drive when conditions are the safest, and lower incidence of impaired driving.(3)

Another factor to consider is a lack of historical precedence. The group of elders who are currently facing the issue of when to quit driving lived through the Great Depression and WWII. Many people had cars during and after the depression but in not nearly the numbers that acquired them after WWII (during the mid-1940s through the 1950s). As a group, this cohort did not have to confront their parents about relinquishing driving privileges. For the most part, their parents did not have the life expectancy that we enjoy today, so the kinds of conversations we are discussing here simply did not take place.

Senior driving and the decisions that surround their continued safety is uncharted territory. As physicians, there is little guidance for us as how to best proceed if and when we observed patients who clearly are in no condition to continue to drive.

According to the Florida Department of Highway Safety and Motor Vehicles, research indicates that most people will outlive their driving ability by about ten years. The most at-risk driver is the one with cognitive impairment. The American Medical Association (AMA) regards the safety of older drivers as a public health issue. They estimate that the per-mile fatality rate for drivers over 85-years old is nine times as great as drivers 25 to 69 years old.

Why is relinquishing a driver’s license such a problem? Why are our elderly taking such risks, not only for themselves but also for their loved ones and others on the road? What do they see when they look in the mirror? I have been pondering these questions for many years and continue to be amazed at the resistance I receive when broaching the subject of the “senior driving dilemma.”

In my years as a geriatrician, the reactions, and subsequent behaviors I observe after a discussion on the topic of driving are not so surprising. Consider this: these seniors are fighting to maintain their independence. For some, the last bastion of that independence is their ability to drive. When they can no longer get back and forth to the doctor, grocery store or hairdresser, they may view life as being over. They might have to move to a retirement center to access transportation or, even worse, move to a different town or state to be near one of their children, an option that most find totally unacceptable. Many of them might willingly take advice from one of their children about some things, but giving up their driving is not one of them.

I have a personal view of the universe. It suggests that if I see something in my community, I know that the same drama is probably unfolding in every city and community in this country, and the world, for that matter. So, if I am aware of an unsafe driver in my town, there are likely also others in cities x, y and z.

Over my career as a physician, I have faced the issue of impaired drivers countless times. It is always a painful experience. The discussion triggers tears, anger and, sometimes, people demonstrating an outright disregard for the law, or for others who share the roadways. When my children were young, and I knew that these horribly unsafe drivers were on the local roads I felt very uneasy. I still do.

As medical professionals working in the trenches the question is what are we to do? I have five options that might apply to situations that arise:

  1. Talk to your patient, avoid being judgmental. Treat the subject like any other medical condition. They may take you very seriously and stop driving based on your recommendation. It might not be immediate but have some faith.
  2. Refer to an occupational therapy center that performs driver evaluations. Locally Morton Plant Hospital has a program called DRIVEable. It is a national program with a validated testing procedure that can detect cognitive issues and can predict a road test failure.
    AARP Smart Driver Program is another resource
  3. Local safety council where driver evaluations can be performed for a fee…
  4. Consider available resources to have meaningful discussions with your patients and their families utilizing Senior Driving Dilemma: Lifesaving Strategies as a reference guide making this available at your office.

I can only offer my hope that medical professionals and their staffs will take note of this serious problem and address it when seems it can prove to be a lifesaving Strategy.

You can continue the conversation with me via…

Email: David@davidbernsteinmd.com
Website: www.davidbernsteinmd.com
Twitter: https://twitter.com/DBernsteinMD
Facebook: www.facebook.com/DavidBernsteinMD
LinkedIn: http://www.linkedin.com/in/davidbernstein2200

References cited:

(1)  Reuben, D. B., Silliman, R. A. and Traines, M. (1988), The Aging Driver Medicine, Policy, and Ethics. Journal of the American Geriatrics Society, 36: 1135–1142. doi: 10.1111/j.1532-5415.1988.tb04403.x
(2)  Injury Prevention & Control: Motor Vehicle Safety http://www.cdc.gov/motorvehiclesafety/older_adult_drivers/
(3) (1) Injury Prevention & Control: Motor Vehicle Safety http://www.cdc.gov/motorvehiclesafety/older_adult_drivers/
(4) (1) What Risks Do Older Drivers Pose to Traffic Safety? http://www.rand.org/pubs/research_briefs/RB9272/index1.html

Bernstein, David MD, Senior Driving Dilemmas: Lifesaving Strategies, Nov 2015.

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