Putting the Breaks on Elder Driving.
Part 3: Having “The Talk”
By Heidi Nestor

She walks into the room wearing her favorite strawberry lip gloss, a touch of blush to put color on her delicate features, and that pretty blue sweater that brings out the sparkle in her eyes. She gathers her things in a bag and is going off to meet her friends at the center for a day of activities. She mentions something about that cute guy she likes and maybe going to an afternoon matinee with him. She grabs the car keys and then you’re reminded of all the dents that she’s put on the vehicle while embracing her independence. You wonder if “cute guy” is distracting her driving. Then reality hits you, it’s time to have “The Talk.” Not about the birds and bees, she already knows about that, after all, she’s your mother. This is the other talk, the one that…no matter how delicately you put it…says you’re too old to drive.

Part one of this three part series on elder driving addresses the debate over senior accident statistics and how the natural aging process can affect driving skills. Part two explores the degenerative mental process along with medications that can affect motor skills and reaction time. This final section of our three part series explains how to determine if the senior is becoming a hazard on the road, and gives suggestions on how to have “The Talk” with an elderly family member about turning in their car keys.

But before you enter into that slippery road of taking your loved one’s freedom away you may want to assess your own perspective first. Is your view being validated by facts or emotions? Do you want to take the keys away just because you’re worried over their safety or have you truly witnessed the elder being a hazard on the road?

It may be best to examine the situation through a different approach by asking your siblings or the neighbors if they believe there is a problem. Perform an eye-sweep over their car to see if there are new dents and scratches. Research the medications your loved one is taking; do they cause drowsiness and need to be taken during the day while the senior is out and about driving around? Perhaps, it is the senior, themselves, who is concerned about their driving ability.

After performing your own checklist to verify you don’t have an unfair bias, then you can proceed in crafting a compelling argument, backed up with evidence and safety statistics, as to why you are taking the keys away - right?

WRONG!

I’m sure you realize that extreme sensitivity needs to be evident when calmly sitting down to discuss the driving concerns you have with your loved elder. Keep in mind, most likely your family member will not see it your way. Worse yet, might see it as some kind of punishment.

Even with your empathic reasoning, safety concerns, and impressive corporate-style power point presentation discussing the legal ramification of accidents with seniors…why do they still drive? Is it their Ego? Their stubbornness? Perhaps to some degree, but it goes much deeper resulting in their fear of being dependant says John Siberski, author of Knowing When to Break: Older Adults and Driving. Siberski explains that:

...losing a driver’s license is akin to house arrest without the ankle bracelet. The nondriver becomes dependent on the kindness of family, friends, and neighbors, as well as strangers driving taxis. The impact on the individual’s family is significant. Shopping, doctor appointments, trips to the beauty salon, picking up some milk at the store, and so on may – and often does – entail inconvenience, often elaborate planning and timing, and sometimes annoyance, resentment, and argument. The impact of allowing cognitively impaired older drivers to remain on the road, however, is even more problematic.

A big part of an elder’s fear of turning in their car key is that they are suddenly at the mercy of family, friends, and strangers to get their basic needs met. And if you are part of the sandwich generation, the senior’s concerns are warranted especially with family member’s lives being so busy.

In, The Driving Dilemma: The Resource Guide for Families and Their Older Drivers, Elizabeth Dugan gives a list of solid advice on how to prepare for that talk. Her suggestions include:

Roll with Resistance
Dugan recommends you not only expect resistance but prepare for it. Arguing is counterproductive to the change process. Your task is to listen, express empathy and use the speaker’s “momentum” to further explore his or her view. Help the person weigh the pros and cons of the decision to stop driving.

If the driver becomes too argumentative to deal with let them know you won’t be pulled into an argument and that you’ll talk about your concerns at a later date.

If the senior becomes overly-emotional, calm him/her down and remind them that this is about your concern with them and you are working towards reaching mutual agreement. A win/win situation could be that they limit their driving to the store or the doctors and only during certain, non-rush hour, times of the day.

Develop Discrepancy
Discrepancy helps the driver to see a problem. If they believe they are a good driver, discrepancy would be to ask them what constitutes a good driver and have them see how they may fall short of that.

Reflective Listening
Reflective Listening is good ways to have the elder realize that you are listening to them and that you understand their concerns. When the driver puts up an argument as to why they should keep their license, rephrase back to them the concerns they stated. Don’t merely repeat what they said, but reiterate it in your own words so the senior understands that you are listening to them.

If you have a family member showing any of these signs it is your responsibility to take action. If you are over 65, on medication, and have problems reacting to the rules of the road, you need to find alternative transportation.

The final assessment of this three part series concludes that until age restriction laws on elder drivers are passed, the responsibility lies with the family and doctors, to determine driving ability of their venerable loved one and if his/her motor skills and reflexes are good enough to maintain a level of safety on the road. Moreover, the family needs to discuss with doctors if the driver’s mental and/or physical health issues and any medications s/he is taking could impair driving ability. When the time comes to limit or stop driving all together keep in the mind the reasons why the elder may want to continue driving. Communicate your concerns about their safety without degrading them, and perhaps a difficult road ahead can be paved for an easier route.

Our goals at Life Alert are to promote wellness in all areas of life for all family members. With one push of a button, Life Alert sends emergency help fast possibly eliminating a potential catastrophe. If you or a loved one is in need of extra security and peace of mind we provide safety services for the healthy longevity and independence of seniors.

Works Cited
Aging Brain. Webindai123.com. 2000. 9 December 2009.

Clark, Ron. “Making the 'Key' Decision.” AgeNet., Inc. 2001. November 30, 2009.

Dugan, Elizabeth. The Driving Dilemma: A complete Resource Guide for Older Drivers and Their Families. New York: Harper Collins, 2006.

Karaim, Reed. “When is it Time to Quit Driving?” November 16, 2006. AARP.org December 2009.

"Senior Citizen Drivers: Are They a Menace? Should Licensing Laws Be Tougher?" Seniorjournal.com. 9 December 2009.

Siberski, John. “Knowing When to Break Older Adults and Driving.” Aging Well. Winter 2008: 37-39.

Putting the Breaks on Elder Driving.
Part 2: Mental Facilities and Motor Skills
By Heidi Nestor

You’re driving down the road when suddenly a car flashes past you. It slows down just long enough to hover at a stop sign and tease you into perusing it before making a sonic boom and disappearing into the future that would make “Doc” Brown’s DeLorean look like the Clampett’s 1921 Oldsmobile truck. “Damn Kids!” you yell.

Finally, a stop light appears as if divine intervention is settling the score and allowing you to catch up to those irresponsible youths so you can lecture them on the hazards of unsafe driving. You pull up next to the car and are about to start your sermon when you see it’s grandpa! He had no idea he was speeding, and what stop sign are you referring to?

In Part One of, Putting the Breaks on Elder Driving, we questioned if age is a sufficient cause to enforce limits on senior driving. Part Two explores the degenerative mental facilities with motor skills, medications for the aging body, and how to assess any signs of a driving problem.

Though The House Bill, H4466, was passed in February 2010 requiring driver’s over 75 to pass a vision test, and health care providers to report an individual’s inabilities to operate a motor vehicle safely, there still is not a cut-off age or stronger driving requirements for seniors. Several departments of motor vehicles have questionnaires for a senior driver but few of the questions are relevant to aging issues, such as, are you on any medications or do you have physical aliments that may prevent them from driving safely.

In, The Driving Dilemma: The Resource Guide for Families and Their Older Drivers, Elizabeth Dugan explains:

Contrary to what many people believe, age, by itself, does not determine driving fitness. What matters in driving are three fundamental functions: the ability to see, think and move. These abilities change at different rates for different people. Some people in their 90s and beyond are more healthy and fit for driving than some people in their 50s and 60s.

Growing older doesn’t necessary mean seniors need to be under house arrest. Many are still active, lucid, and young at heart but one aspect of aging we can’t ignore is the affect it has on our brains. The online article, Aging Brain, reveals that:

Two thirds of all people eventually experience some significant loss of mental lucidity and independence as a result of aging. 60 years and older experience significant cognitive decline, including declines in memory, concentration, clarity of thought, focus and judgment with an increase in the onset of several neurological problems like Alzheimer's disease, Parkinson's disease, stroke etc...

To avoid going into a lecture akin to a high school science class dissecting a frog to see how motor skills work, this writer will spare you the technical lingo and just sum up the highlights of the Aging Brain article which explains that as our bodies age, our brains age too thus decreasing in weight and volume resulting in a loss of neurons and cellular fluid, both key components for mental awareness.

These biological changes can have an affect on thinking and judgment as seen with “Pedal Confusion”, believing your foot is on the brake when it’s on the accelerator. This was the situation when George Weller ran his car through a Los Angeles farmer’s market killing and injuring many people. “George Weller’s not alone in pedal confusion,” remarks researcher Barbara Freund in, When is it Time to Quit Driving? “They [elder drivers] recognize they’re not stopping, so they press the [accelerator] pedal harder. They can’t sort out what’s happening.” Confusion becomes more prevalent as one grows older but these “senior moments” can have a catastrophic outcome behind the wheel.

What about Medications?

Another issue to consider may not have to do with brain function or cognitive ability at all, but just good old fashion achy bones. You or your aged loved one may still have all of your mental faculties but have you ever woken up with a stiff neck? Remember how hard it is to drive with cramped, sore shoulder - so much so - that you really don’t turn around to look out your side view mirrors as much as you should. That is what it feels like to have arthritis in your neck and shoulders. Seniors may not be turning around to look at side traffic as much as they should, not because they’re forgetful, but because it just hurts too much.

But for whatever ails us medically there is an equal and opposite medication that can help. However, with every medication there is also an equal and opposite side affect that, if not careful, could have grandpa calling from the local police department asking you to post bail for his D.U.I.

John R. Siberski notes in, Aging Well, that:

While few of the normal changes of aging are sufficient to prohibit driving, their cumulative effect, superimposed on medical illnesses and/or dementia, can take a significant toll on driving ability and safety. Medications can also contribute to poor diving performance.

Perhaps it’s not so much the physical ailments that can affect one’s driving, but the treatment that is the problem. By the time we’re in our 50s most of us are taking some kind of pill for this or a prescribed medication for that; when we reach our 60s we can have a pharmacy in our medicine cabinets. Dugan explains that the older we get the more medications we consume:

Adults age 65 and older consume more prescription and over-the-counter medication than people in any other age group. A recent national survey of the non-institutionalized [not living in a care facility] adult U.S. population found that more than 90% of people 65 or older use at least one medication per week. Approximately one half (46%) take five or more prescription medications, and 12% take 10 or more different medications per week.

With seniors popping as many pills as Ronald Reagan popped jelly beans it’s no wonder the medical review boards are taking action when notified of a driver’s physical or mental inabilities. In, When is it Time to Quit Driving?, Reed Karaim says that states are requiring doctors to report certain health problems of a driver to the local Department of Motor Vehicles.

Let’s say you or your elderly driver are in good health, medications are minimal, and your reflex reaction time has been liken to that of Bruce Lee, there’s still something else to consider; over the counter allergy medication, such as antihistamines, can cause drowsiness and/or muscle incoordination. Moreover, some anti-inflammatory drugs “may increase the risk of heart attack and stroke, which in turn could endanger you when driving” (Dugan). Even someone in their 30s can become a problem on the road if under the influence of some kind of over-the-counter allergy drug, but a combination of a 75 year old who takes an antihistamine can lead to more confusion and less reaction time while driving.

How to assess any signs of a problem:

If you are a senior or a family member of a senior who still drives, companies such as AARP, AAA, and AMA supply lists of warning signs to look for that indicate impaired driving. Dugan lists these in colored categories from the highest risks being RED, to the cautionary risks being YELLOW, and GREEN indicating safety issues that can be corrected. “Having one of the red risks”, Dugan says, “is a signal to immediately begin the conversations about driving and to seek a professional assessment.”

RED:
The highest level of risk.
• One or more auto accidents in the past five years.
  
• Recent traffic tickets or police warnings.
  
• Severely impaired vision, cognition, or mobility.
  
  YELLOW:
  Somewhat lower than Red but still a significant safety risk.
  
• Recent near misses or close calls while driving.
  
• Having friends/family say they don’t want to ride with you (or the elder driver).
  
• Accumulation of vehicle dents and dings.
  
• Having other drivers honk, gesture, or be annoyed at you (or elder driver) when driving.
  
• Difficulty judging gaps in traffic, at intersections, and on highway entrances/exit ramps.
  
• Failing to notice objects on the sides of the road when looking straight ahead.
  
• Not seeing lights, signs, signals, or pedestrians soon enough to respond.
  
• Taking medications.
  
• Slow response to unexpected situations.
  
• Become easily distracted or having difficulty concentrating while driving.
  
• Difficulty negotiating turns and intersections.
  
• Hesitating over right-of-way decisions.
  
• Difficulty keeping the car in the proper lane.
  
  GREEN:
  
• Trouble seeing over the steering wheel.
  
• Difficulty looking back over one’s shoulder.
  
• Trouble physically moving the steering wheel or looking out mirrors.
  
• Difficulty getting in or out of the vehicle.

There are plenty of websites that have online quizzes you can take to assess you or your elder’s driving ability. It’s better to be safe than sorry so if you don’t know if you or the senior driver is a risk go to your local Department of Motor Vehicles and take a driving test. This little bit of effort can avoid a pricey catastrophe that could cost you and your family severely. In summary, the natural aging process can inhibit motor skills, but medications are also a big problem with slowing down reflexes. Possible solutions to keep active seniors on the road can be time of day curfews, increased testing of driving skills, and self assessments. Life Alert promotes senior wellness in all areas of life whether the elderly is at home or on the go. If you or a loved one wants added protection while away from home, Life Alert’s 911 cell phone can send help fast in case of an emergency. In Part Three, we will have The Talk - how to approach the issue of turning in the car key.

Works Cited Aging Brain. Webindai123.com. 2000. 9 December 2009.

Clark, Ron. “Making the 'Key' Decision.” AgeNet., Inc. 2001. November 30, 2009.

Dugan, Elizabeth. The Driving Dilemma: A complete Resource Guide for Older Drivers and Their Families. New York: Harper Collins, 2006.

Karaim, Reed. “When is it Time to Quit Driving?” November 16, 2006. AARP.org December 2009.

"Senior Citizen Drivers: Are They a Menace? Should Licensing Laws Be Tougher?" Seniorjournal.com. 9 December 2009.

Siberski, John. “Knowing When to Break Older Adults and Driving.” Aging Well. Winter 2008: 37-39.

Putting the Breaks on Elder Driving.
Part 1: What’s a Good Age to Quit Driving?
By Heidi Nestor

Ralph Parker, 93, mowed down a pedestrian and continued driving unaware that his victim was imbedded into his windshield. When asked by the police to explain what happened he said that the body seemed to have fallen from the sky.

86 year old, George Russell Weller, lost control of his car and crashed into the Farmer’s Market in Los Angeles killing 10 people, injuring 63 others.

An 85 year old woman hit a police officer as he was pulled over to the side of the road writing a ticket for another driver. The officer was catapulted on to the roof of the woman’s car and hit the windshield before being thrown to the pavement.

These stories seem to be popping up more and more fueling the heated debate over elder driving and safety. Yet, aged related accidents may be occurring more often, not because seniors are bad drivers per se, but because there’s more of them on the road. As a generation, they are living longer while becoming increasingly more active.

Owing to healthy lifestyles, extended retirements, and magic pills that can ease any little ailment, we have become more energetic in our golden years. Gone are the days of sipping lemonade on the porch and knitting a scarf while rocking away in a chair. Today, seniors are far more adventurous as seen with former president George H.W. Bush skydiving to celebrate his 85th birthday, and 80 year old Clint Eastwood directing and acting in a new movie. As for rocking away in a chair the new “older generation” is rocking away at concerts. Bob Dylan, The Rolling Stones, and Paul McCartney, all pushing 70, and all rocking out to sold out arenas with fans of all ages including grandparents and great-grandparents. And forget getting a knitted scarf from grandma, she’s too busy with her Yoga/Pilates core conditioning program at the senior center before getting on the net to plan her African safari trip. With seniors being so active and young at heart, it should appear that driving is as simple as walking. Perhaps, accidents with the elderly are over-rated.

The first part of this three part series discusses what the true statistics are between seniors and accidents, and should there be a cut-off age for elderly driving.

So, what is the true statistics between seniors and accidents?

Answer: It depends on who you ask. Various articles, online news sources, and even books on the topic can range from seniors causing the majority of accidents – to – drivers over 65 are the most careful and cautious people on the road.

John R. Siberski writes in, Knowing When to Break, that: “Thirteen percent of elders in the U.S. population are involved in 18% of road fatalities.” Whereas, Reed Karaim notes in, When is it Time to Quit Driving, that “…even statistics deliver a mixed message: Older drivers generally have few accidents per driver than the national average – but they have more accidents per mile of driving.” In addition, David Rosenfield, Editor for Elder Law Journal, states in, Senior Citizen Drivers, that senior citizens “have sped past teenagers as the age group with the highest number of traffic accidents per mile”, and according to the article, Making the "Key" Decision, Ron Clark adds:

The AAA reports that almost a fifth of the fatalities on US roads in 1997 were elderly people. This is a substantial number, especially when you consider that older adults generally avoid driving at night, during rush hour, and under other high-risk conditions.

In, The Driving Dilemma: The Resource Guide for Families and Their Older Drivers, geriatric researcher Elizabeth Dugan writes that older drivers actually have relatively low rates of accidents. Could some of the confusion lie with understanding just how many older drivers are on the road? There’s an expectant rise of senior driving now that the first wave of baby boomers have reached 65. Moreover, SeniorJournal.com estimates that by 2020 there will be about 30 million elderly drivers on the road since they are the “fastest growing segment of the driving population.” And within 20 years, Karaim affirms, all of the baby boomer generation, years 1946 – 1964, will be 65 or older and still driving:

By 2030 the 65-plus population is expected to double to 71 million and make up a quarter of U.S. drivers. By then there will be 9.5 million Americans 85-plus and almost all will have spent most of their lives driving. Many will be fully capable of remaining behind the wheel—even teaching younger drivers. Yet there is no question that drivers 85-plus have notably higher accident rates.

With more elderly drivers on the road it’s only statistically feasible that more accidents will occur thus triggering general public debates on what to do with senior drivers. This concern, says Elinor Ginzler who oversees AARP’s driving initiatives, “is going to go through the roof when that age tsunami hits us” (When is it Time to Quit Driving?).

Though we may not have a true statistical number of seniors causing accidents as of yet, one thing we do know, according to Siberski, is that “motor vehicle incidents are the leading cause of injury-related fatalities in the age group of 65 to 74 and the second-leading cause for those over 75.” Rosenfield concurs by saying:

And because they [seniors] are more physically fragile than their younger counterparts, senior drivers are more likely to be injured in a car crash. With the exception of teenage drivers, seniors have the highest probability of death resulting from an auto-related accident of any age group.

Dugan also agrees that seniors are more likely to be injured or to die as a result of those accidents, and they recover more slowly from any injuries sustained.

So, whether senior drivers are causing the accidents or not the fatality rate is the highest among the elderly group when involved in a collision. And though there are mixed statistics on how much the elderly contributes to car accidents, one thing is certain, as the baby boomer generation ages there are going to be a lot more of them on the road.

Should there be a cut off age?

At what age do we put the breaks on elder driving? Should age have anything to do with it at all? Due to age discrimination laws, having a cut-off age for drivers seems, somewhat, not politically correct. Yet, when we start approaching the years of 60, 65, 70 and so forth, our abilities slow down; add pharmaceuticals for medical conditions and we could have a cornucopia of medications in our system causing us to inadvertently be Driving Under the Influence.

Though each state has its own regulations for issuing driver’s licenses, the truth is, once a person reaches a certain age, reflexes, audio senses, and mental faculties become weaker and slower with each passing year posing the possibility of seniors having to take an annual driver’s test.

The closest we’ve gotten to changing age limit laws for seniors is the February 2010 passing of House Bill, H4466, which combines texting and senior drivers into one legislation. Yet, this bill only requires passing a vision test or providing a vision certificate signed by an optometrist or ophthalmologist for individuals over 75 to renew a driver's license, and health care providers to report an individual’s inabilities to operate a motor vehicle safely.

Clark notes that age alone shouldn’t determine whether older drivers should be on the road and that some seniors are excellent drivers. However, he adds, “Many of the physical assets necessary for safe driving such as good vision, hearing, flexibility and reflexes—all begin to decay fairly seriously around the age of 55.” He concludes that by the time we reach 75 to 80 years old that decay accelerates.

Does age in of itself become a hazard to driving? Joe Coughlin of MIT Age Lab believes, “Birthdays don’t cause accidents – health issues do.” (When is it Time to Quit Driving?). So, healthy 80-year-olds should continue to drive? Not according to Barbara Freund, a researcher who supports age-based mandatory testing. She says, “Studies have found that almost a third of people 65 and older have some kind of cognitive impairment, and 25 to 90 percent of those people are undiagnosed” (When is it Time to Quit Driving?). Rosenfield agrees that while age alone does not determine a person's ability to operate an automobile, evidence suggests that certain characteristics associated with aging impair driving performance.”

Since mental faculties along with visual and audio abilities begin to weaken with each passing year, would licensing renewal provisions do any good? If a driver over the age of 65 must be tested every other year at the local department of motor vehicles, could this kind of provisions begin to spot a problem before the driver gets on the road? “Skills may inevitable decline,” says Karaim, “but not necessarily enough to force a driver off the road completely.”

The trend that seems to be occurring isn’t so much having seniors be tested - it’s more about having them restricted. Some states are limiting certain age groups from driving at “rush hour” times of the day and giving them a curfew so they don’t drive at night. But then most older drivers, says Professor Sandi Rosenbloom, “restrict themselves as they age, avoiding situations that make them uncomfortable…this is particularly true of women, who often stop driving while they’re still capable behind the wheel” (When is it Time to Quit Driving?). As seen with a retired canine rescue police officer who turned in her driver’s license after suffering a mild stroke at 80. Though more lucid than a 40 year old, she cites the reason being out of fear of having another stroke and being a hazard behind the wheel.

While at home seniors can depend on personal medical alerts, such as Life Alert. So if a problem occurs, like a stroke, they can get help fast with minimal damage to others. But what happens if a stroke occurs while behind the wheel?

To sum up, accurate statistics of accidents caused by senior citizens is still up to debate and remains to be determined as more seniors stay mobile. But what is certain is age in of itself isn’t the problem; it’s all that bodily wear-n-tear that comes with it that seems to be affecting the reaction time needed to be a safe driver. Federal cut-off age for drivers hasn’t been passed yet, but each individual state may be assessing their own driving requirements differently and creating state laws that meet their needs.

Part Two of Putting the Breaks on Elder Driving, will explore degenerative mental facilities, motor skills, and medications for the aging body, and how to assess any signs of a driving problem. Later, in Part Three, we will look at how to assess an elder’s driving ability, and how to have “The Talk” when it’s time to take the keys away.


Works Cited
Aging Brain. Webindai123.com. 2000. 9 December 2009.

Clark, Ron. “Making the 'Key' Decision.” AgeNet., Inc. 2001. November 30, 2009.

Dugan, Elizabeth. The Driving Dilemma: A complete Resource Guide for Older Drivers and Their Families. New York: Harper Collins, 2006.

Karaim, Reed. “When is it Time to Quit Driving?” November 16, 2006. AARP.org December 2009.

"Senior Citizen Drivers: Are They a Menace? Should Licensing Laws Be Tougher?" Seniorjournal.com. 9 December 2009.

Siberski, John. “Knowing When to Break Older Adults and Driving.” Aging Well. Winter 2008: 37-39.