Posts Tagged ‘elderly drivers’

Government Report Highlights Problems With Older Drivers

APRIL 30, 2007  VOLUME 14, NUMBER 44

Several times over the past few years (most recently in Safety for the Older Driver: Is Skills Training the Answer?) we have reported on an issue of great concern to seniors—the effect of aging on the ability to drive. Now Congress has gotten interested in the topic, if a recent report from the Government Accountability Office (GAO) (“Older Driver Safety: Knowledge Sharing Should Help States Prepare for Increase in Older Driver Population“) is any indication.

Senators Herb Kohl (D-WI) and Gordon Smith (R-OR), the Chairman and ranking minority member, respectively, of the Senate Special Committee on Aging, requested a review of state laws governing older drivers. The report details some of the reasons for concern, including:

  • Older drivers are less likely than their younger counterparts to be involved in fatal automobile accidents. However, if the results are recalculated based on number of miles driven older drivers perform much more poorly. Those aged 75 or older have a fatal accident rate higher than the next-highest category, drivers aged 16-24. Those two groups both suffer considerably more than double the fatal accident rate of any other age group.
  • The number of older drivers on the road is, of course, increasing more quickly than other age groups. With the aging of our population, problems associated with age and driving are expected to increase steadily.
  • Older drivers experience a particularly higher accident rate in intersections. More than half of all fatal accidents involving drivers over age 85 occur in intersections. While 37% of all fatal accidents involving drivers over age 65 occur at intersections, for drivers aged 26 to 64 the comparable figure is only 18%.

“Navigating through intersections,” notes the report, “requires the ability to make rapid decisions, react quickly, and accurately judge speed and distance.” What can be done to reduce intersection risk for older drivers? The report details a number of design ideas which might be implemented, including signage well in advance of intersections, larger street name and stop signs, black signal backplates (to make traffic signals more visible to older drivers), and offset turn lanes (to make it easier to see oncoming traffic).

The report also details regulatory steps taken by a handful of states to help ease drivers off the roads when they are impaired as part of their aging. Sixteen states require older drivers to renew their licenses more frequently. Arizona driver’s licenses, for instance, do not require renewal at all until age 65, and then require renewal every five years. Ten states (including Arizona) require older drivers to pass vision tests. Five states require older drivers to renew their licenses in person, rather than by mail (Arizona is one of those states, as well, requiring in-person renewals after age 70).

Safety For the Older Driver: Is Skills Training the Answer?

MAY 3, 2004 VOLUME 11, NUMBER 44

Elder Law Issues addressed concerns relating to older drivers in two issues published in October, 2002 (“What Can Be Done About Driving Skills As We Age?” and “Dealing With Impaired Driving Skills in Aging Family Members“). Since then, much media attention has been focused on aging drivers, principally due to the tragedy caused by Californian George Weller, 87. In July, 2003, ten people died at a Santa Monica farmer’s market when Mr. Weller accelerated rather than braking at the crowd’s edge. In January, 2004, Mr. Weller was indicted on 10 counts of manslaughter.

In the last month discouraging news arrived with results of a study indicating that driver education programs may fail to make older drivers with functional impairments safer or prevent accidents. The study is reported in the April, 2004, American Journal of Preventive Medicine. Cynthia Owsley, Ph.D., MSPH, (Professor and Director of the Clinical Research Unit, Dept. of Opthalmology, University of Alabama, Birmingham) principal researcher for the study, examined drivers with certain visual impairments for a two-year period after they had high-quality skills training.

In a nutshell, Dr. Owsley was unable to find that the education programs in her study actually enhanced the older drivers’ skills. No significant crash reductions per mile driven were seen in those who participated in the educational programs as compared with other drivers of the same age. Owsley described the education programs used in her study as the “Cadillac” version of driver skills training because each study participant had one-on-one attention and the programs were tailored to meet participants’ individual needs. Dr. Owsley suggests that the benefits of driver education programs lie in the behavioral changes many older drivers make when made aware of driving challenges. These include reducing driving time, avoiding difficult situations (such as routes with many left turns and multiple turn-lanes, or trips in bad weather) and better self-monitoring of driving skills.

Unfortunately, many older drivers also have chronic diseases that may affect driving. Dr. Owsley says that older drivers “need to make sure that they get the best medical care to reduce the impact that their functional problems have on their driving. They want to go to a driving fitness clinic where a certified driving rehabilitation specialist can evaluate their potential risk and safety on the road.”

The Association for Driver Rehabilitation Specialists boasts 550 members nationwide. A half dozen Certified Driver Rehabilitation Specialists practice in Arizona, and their contact information appears on the organization’s website.

Dealing With the Older Driver: Driving Skills Assessments

MARCH 24, 2003 VOLUME 10, NUMBER 38

Elder Law Issues has devoted several recent weeks’ articles to some of the problems involving aging drivers. If you are concerned about your own driving skills or those of an older family member, you may wish to obtain a formal skills assessment.

The Association of Driver Rehabilitation Specialists (ADED) provides information about driving assessments and referrals to certified specialists. ADED recommends that a driving assessment include testing on visual perception, functional ability, reaction time and a road test.

Visual processing speed, an important component of safe driving, decreases as we age. The Useful Field of View (UFOV) test is a measure of visual processing speed that is increasingly touted as a reliable predictor of accident probability. Researchers at University of Alabama-Birmingham UAB have worked on UFOV for more than a decade.

UFOV is given in three parts. First, a silhouette of a car or truck flashes for less than a second on a computer screen and test takers must touch the word on the screen that corresponds to the vehicle type. Second, test takers must remember where a circular shape flashed on the screen near the vehicle. Last, they must be able to ignore a third object which appears only as a distraction.

Encouraging news: UFOV can be a training tool as well as a diagnostic instrument. According to UFOV researcher Dr. Karlene Ball, in those elderly drivers with poor visual processing skills, training with a modified version of the computer test for four to seven hours may raise visual processing speed to within normal levels.

Recovering stroke victims may wish to explore with a driving rehabilitation specialist or occupational therapist the possibility of incorporating adaptive aids. Cars can be adapted for post-stroke patients so that they accommodate the driver’s “good” side, or allow steering by a modified hand or foot control. Simple adaptations such as adding larger rear and side-view mirrors to cars may assist many drivers with decreased neck mobility.

In addition to ADED, local occupational therapists, local area agencies on aging, your state department of motor vehicles, or your physician may provide driving assessment referrals. Remember that mature driver courses are offered by a variety of organizations, the best-known of which is AARP’s Driver Safety Program. (formerly 55 Alive). Course schedules nationwide may be found on AARP’s website or by calling its toll-free line at (888)AARP-NOW. Participating in safety courses entitles older drivers to insurance discounts mandated by law in most states.

Older Drivers and State Laws: A Few Things to Consider

MARCH 17, 2003 VOLUME 10, NUMBER 37

Twice in October 2002, Elder-Law Issues highlighted concerns of and about older drivers. (See What Can Be Done About Driving Skills As We Age? and Dealing With Impaired Driving Skills In Aging Family Members) This week and next we continue our examination of driving and aging. If you are concerned about the driving habits of an older family member or client, or want to know what is in your own future, here are some things you should know:

a. Older persons do not automatically lose their driver’s licenses. No state has an age-based revocation of driving privileges.

b. Road tests and vision exams are rarely required to maintain a driver’s license. Only drivers 75 or older living in Illinois or New Hampshire must take a road test to renew a driver’s license. However, your state department of motor vehicles may initiate a re-examination interview and road testing upon receiving a referral from family, friends, health care or other professionals who have concerns about an unsafe driver.

A vision test is required in Maine for first license renewals, at every second license renewal until 62, and thereafter at every renewal. In Oregon, vision screening is required every eight years for drivers 50 and above. Utah requires that drivers aged 65 or older take a vision test. Arizona requires a vision test verification form to have been completed within three months of a renewal by mail for those 65 or older.

c. Physicians are not required to report functional impairments in a driver—with two exceptions: 1. Physicians with demented patients in California. 2. Physicians who diagnose or treat patients with epilepsy in California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania. Although they may not be required to report impairments physicians are not ethically prohibited from reporting safety concerns.

d. Five states restrict driver’s license renewal by mail for older drivers. In Alaska, license renewal by mail is unavailable to drivers 69 or older. Arizona, California and Louisiana prohibit renewal by mail for drivers 70 and older. At 66, drivers in Colorado can no longer renew their licenses by mail.

e. 13 states have accelerated renewal periods for older drivers. Arizona, Colorado, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maine, Missouri, Montana, New Mexico and Rhode Island have shorter renewal cycles for older drivers, though the cycles vary among those states. In Idaho drivers must renew their licenses every four years beginning at age 63 and no longer have the option of electing an eight-year cycle. In Illinois once a driver turns 81 she/he must renew every two years until 87. At 87 the Illinois license renewal is annual. Rhode Island drivers must renew every two years starting at age 70. At 69 Missouri drivers must renew every three years.

Dealing With Impaired Driving Skills In Aging Family Members

OCTOBER 21, 2002 VOLUME 10, NUMBER 16

Two weeks ago, Elder Law Issues reintroduced to its readers a discussion on driving skills for the aging driver. We suggested continuing our discussion by introducing strategies to deal with the impaired driver.

We often hear stories like these: A client whose father gets lost driving in his neighborhood has a neighbor let the air out of her dad’s tires. Another client removes the distributor cap from his aunt’s car. A friend finally resorted to putting a large chain and padlock around his father’s steering wheel after a serious but non-injury accident.

Such measures can stop the impaired driver from driving that disabled car. A judge’s order in a guardianship forbidding the ward to drive may also work. Before disabling a car or seeking guardianship when disabilities worsen, however, a more appropriate first strategy is simply better understanding and greater sensitivity to the issue of driving.

For most people today “transportation” means the personal automobile. When one loses the ability to drive, one’s life often changes dramatically. At the March 2002 Maricopa Association of Governments’ conference, “Senior Mobility in the 21st Century: What Can We Do to Prepare?” keynote speaker Dr. Joseph Coughlin, Director of the Age Lab at the Massachusetts Institute of Technology, pointed out that seniors will find a way to make ‘priority trips’ — to get groceries and go to doctor’s appointments. But, Dr. Coughlin emphasized, “the trips that really make them happy and healthy — getting a haircut when they need it, visiting friends, going out to eat, window shopping — it’s that personal independence of going where you want, when you want, how you want that makes transportation so important to keeping seniors healthy.”

For a closer look at Dr. Coughlin’s insights into older drivers’ concerns see his AARP publication, “Transportation and Older Persons: Perceptions and Preferences.”

Another key strategy is to identify physical disabilities impairing driving as distinct from cognitive impairments. Where possible, utilize rehabilitation programs for physical impairments. The Traffic Safety Center at UC Berkeley cites results of a General Motors study on older drivers which found that 30% of stroke victims with physical disabilities could regain the skills necessary to drive safely.

The difficulties posed by impaired seniors who continue to drive are complex and challenging. We will discuss more transportation strategies in a future Elder Law Issues.

What Can Be Done About Driving Skills As We Age?

OCTOBER 7, 2002 VOLUME 10, NUMBER 14
Driving is an enormously important issue to our elderly (and disabled) clients, their family and friends. In the western U.S. and particularly in Tucson, transportation without a car is difficult and inconvenient. Safety of both the driver and the public is paramount, but the loss of independence and self-esteem as well as easy access to groceries and medical care must be addressed when a loved one can no longer safely drive.

There is no mandatory cut-off age for giving up driving. However, even the healthiest senior citizens experience age-related “slowing down” at some point — less flexibility in movement, a decrease in night vision, blurred vision from cataracts, hearing loss, etc. When decreased physical or psychological function cause unsafe behavior —either on the road or in other activities — driving should be suspended until that behavior is evaluated.

If one has difficulty seeing to prepare meals or cannot hear when there is loud knocking at the door, driving is likely also a hazard. All drivers, but especially seniors (who tend to take increasing amounts of medication as they age) must be attuned to the fact that many medications create hazardous driving situations. For example, allergy medications as well as drugs used to treat high blood pressure often have a strong sedative effect.

Seniors and their friends/families have many information resources. Information available online includes the AAA-sponsored website www.SeniorDrivers.org and www.la4seniors.com, both of which help in identifying and addressing driving problems. For drivers concerned about maintaining their skill levels, AARP’s “55 Alive Driver Safety Program” is taught locally at the Pima Council on Aging (enrollment is limited; contact them at 298-3120 first.)

In 1999, the American Medical Association changed its ethical guidelines so that physicians, despite their duty to keep confidences, may report a patient’s driving impairments in order to protect public safety. Physicians or family members concerned that a senior should not be driving may contact the AZ Dept of Motor Vehicles, Medical Review Program at 1452 N Eliseo C. Felix, Jr. Way, Avondale, AZ 85323 [(623) 925-5795]. Advanced age alone is insufficient; the letter of concern should detail the driver’s deficits and must contain the driver’s name, address, date of birth, and if possible the driver’s license number.

Revoking a driver’s license may not stop the impaired driver. In a future newsletter we will discuss some strategies to deal with that problem.

Health Care Reform

DECEMBER 13, 1993 VOLUME 1, NUMBER 4

Much discussion has been heard about health care reform proposals. The administration’s plan, the “single payor” proposal, and the alternative plans of the Republican leadership, a bipartisan group of Senators and Congressmen, and Republican Nancy Kassebaum of Kansas have all been widely discussed.

Long Term Care

Most of the proposals deal with acute care, doctor and hospital visits and, in some cases, medications. Little attention has been paid to the long-term care component of our national health care costs.

Now two national coalitions of long-term care advocates have spoken up about the treatment of nursing care costs and services under each of the various proposals. The Long Term Care Campaign, consisting of 138 groups, and the Leadership Council of Aging Organizations, consisting of 35 groups, have given “passing” grades to only two of the proposals. According to the two advocacy groups, only Clinton’s health care plan and the “single payor” proposal of Rep. Jim McDermott (Dem.-Wash.) and Sen. Paul Wellstone (Dem.-Minn.) deal with the long-term care issue at all.

Alternative Proposals

According to the two coalitions, of the remaining proposals, only Sen. Kassebaum’s even addresses long-term care. That proposal would establish a commission to decide which long-term care costs would be covered in its basic benefits package. The bipartisan plan of Sen. John Breaux (Dem.-La.) and Rep. Jim Cooper (Dem.-Tenn.) was rated as a step backward because it would eliminate Medicaid, phase out long-term care funding altogether, and force states to pay for long-term care.

Of Interest

Curtailing Miss Daisy

(From Cooking Light, Nov/Dec 1993):

“Asking aging parents to give up their car keys is not easy, but it is a problem more sons and daughters will face as the population grows.

Statistics show that motor vehicle accidents cause the most injury-related deaths among 65 to 74 year olds and are second only to falls after age 75. Although people over age 75 drive less, their accident rates equal or surpass those of teenagers.

But allowing aging drivers to keep their independence is important, says Dave Carr, M.D., a geriatrician at St. John’s Mercy Medical Center in St. Louis. He advises adult children not to take lightly any attempt to restrict or eliminate a parent’s driving privilege. For one thing, elderly drivers often know their limits and restrict themselves by not driving at night, on highways, during rush hour, or in bad weather.

‘When older drivers fail to give up the road despite decreasing skills, it’s usually because their judgment is impaired,’ says Carr.”

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