Growing Community Health Concern: Are The Elderly Driving Safely?

By Dottie Evans

Family members and their older relatives alike both dread the moment.

But sooner or later the issue of driving safety arises, and it becomes advisable for the elderly driver to surrender his or her car keys.

Sometimes there are warning signs. The driver in question may be going slower than traffic, having difficulty making quick turns, or coming home with dents in the car. Then he or she wisely decides not to drive at night and not to drive on the highway.

But eventually there is the growing realization that the time has come to stop driving altogether, hopefully before an accident occurs and people are hurt, or worse.

More often than not, families wrestling with this life-changing decision involving a loved one are turning to physicians and community health providers to help them make the call.

Dr Stephen Peters, chief of Neuropsychological Services at Associated Neurologists in Danbury has sound advice about initiating that difficult conversation.

“It’s a touchy subject. No one wants to be the bad guy. You have to consider the balance between a person’s safety and the need to maintain independence,” Dr Stephens said, speaking December 13 at a Danbury Hospital Medical Town Meeting.

He suggested the use of direct language, while reassuring the person that you have his or her safety in mind.

“Be sure you tell them you want to help them drive safely for as long as possible. The elderly population is doubling compared to other drivers, yet seniors can be the safest drivers of all since they usually don’t tailgate, they don’t go out in bad weather, and they don’t drive at night.

“Yet, we’re diagnosing Alzheimer’s and dementia more and more often. And looking at the projected rate of growth of this segment of the population, we know that over time safe driving will definitely become a concern,” Dr Peters said.

He also predicted that before long, it will become a national health issue.

A Doctor’s Duty To Warn

 “In 2001, 16 percent of drivers on the roads were over the age of 65. This is a problem because drivers over age 75 have a nine times greater risk of accidents. The most staggering statistic, however, is that 98 percent of elderly drivers suffer health problems severe enough to impair driving. Yet they believe they are driving normally,” Dr Peters said.

“Giving up the license represents a turning point for the elderly,” he added.

It brings up a whole new set of issues such as how to get to doctors’ appointments or therapy sessions, how to run errands, pick up medications, do business, or visit friends.

“The decision to relinquish the keys must be fair and not arbitrary, and the subject must be broached in a sensitive, nonconfronting way,” he said.

In the best of circumstances, a mutually-arrived-at decision includes all parties and is followed by exploration of alternatives so the individual can begin adjusting to new ways of living without operating a car.

In the greater Danbury area, such ways include use of the Hart buses, calling for groceries to be delivered by Stop & Shop’s Pea Pod service, asking FISH volunteers for transport to doctors’ appointments, taking a cab, hiring a regular driver, or occasionally asking a friend or relative for a ride.

An Associated Press story January 17 noted that in Portland, Maine, unsafe elderly drivers are still “out on the road, though not behind the wheel,” thanks to the concept of trading in their cars for rides under the Independent Transportation Network.

Taxpayers benefit because the program operates with volunteers and donations. An annual campaign helps to meet the $250,000 budget, most of which goes to a director, an outreach coordinator, two dispatchers, and six part-time drivers.

Connecticut does not legally enforce an eye test or a mandatory driving test for older drivers, Dr Peters said. Other states, like Pennsylvania, not only require testing but also require physicians to notify the Department of Motor Vehicles (DMV) when a patient is deemed medically unfit to drive.

“Politically, it’s very difficult to talk about mandatory testing after a certain age. If we could identify the unsafe drivers and revoke their licenses, insurance rates would go down. But at the same time, more money needs to be spent on public transportation,” Dr Peters pointed out.

Most physicians, he added, are aware that they may be sued by a third party who is injured by a medically unfit driver under their supervision.

But not all states are on the same page on this issue.

“In Connecticut, a doctor may report a driver who is unsafe to the DMV. In Pennsylvania, he must report it.”

 

Signs Of An Unsafe Driver

“If everyone else on the road seems to be driving faster than you are, if you’ve had a few close calls, if you notice that you are being honked at, if you find yourself getting lost –– these are signs that there may be a problem,” Dr Peters said.

He listed the following areas of concern that a relative riding as a passenger with an elderly driver –– or the driver himself –– might pay particular attention to. They are cautions to any driver who senses a change or reduction in his or her abilities to drive safely.

Medications –– If the driver has recently had surgery or is on a number of medications, mental and physical abilities such as reaction time may be altered or impaired.

Vision –– There may be difficulty determining contrast, especially at twilight, or difficulty driving in winter when the sun’s low angle creates long shadows and glare. When whole chunks of vision are missing, this could be a sign of a silent stroke or early Parkinson’s disease. Ability to use peripheral vision or to drive with the help of side and rear-view mirrors may also be compromised.

Cognition –– Safe drivers do not need to use both feet to operate the gas and brake pedals. Constant braking or tapping on the brake is a sign of an unsure driver who senses that reaction time might be a problem. Hesitation or slow driving at an intersection is another sign of confusion.

Motor function –– Is there sufficient range of motion to allow shoulders, neck, and head to turn so that approaching or passing cars are readily seen? Is there sufficient leg strength to brake strongly or to maintain steady pedal pressure on the gas or brake?

A Simulator To

Assess Driving Skills

Associated Neurologists, located at 69 Sand Pit Road, Danbury, offers patients an office-based evaluation that uses a computerized simulator to measure an individual’s medical fitness to drive. It is the only such machine in the state with the exception of one owned by Easter Seals in Meriden.

Senior Technician Meghan Shanley, BS, has done research on driving simulators with the State Highway Department, and she works with Dr Peters in scheduling clients who opt to undergo the driving evaluation, or patients who are referred for the test. After a consent form is signed, she assists them throughout the testing session and writes up the results, which are sent to the client or patient with copies to the referring doctor if indicated.

The simulator looks like an auto console and three monitor screens replicate the changing view out the front windshield. Related visual cues are projected in the left and right rear view mirrors, also within easy sight.

“Most people feel at ease with the simulator and after a little training, they are ready to begin the test,” said Dr Peters.

During evaluation, the patient operates the steering wheel, the turn signals, a gas pedal, and the brake, while a dashboard tachometer records estimated road speeds. When the optimum highway test speed of 50 miles per hour is reached, the computer records responses to a number of on-screen situations.

Responses to variations in weather conditions and changing traffic patterns provide information about the subject’s abilities to brake and accelerate, about reaction time, field of vision, lane deviations, ability to use turn signals and check mirrors, yielding ability, turning left at an intersection, turning left at a four-way stop, ability to read traffic signs, maintaining speed, and the ability to comprehend directions.

“We practice first and take as much time as needed to feel comfortable before collecting data,” said Ms Shanley.

“A family member is urged to come along, and you don’t need a physician’s referral to schedule an appointment. We are usually able to see people within a week or two of their call,” she added.

The driving simulator test, which is not covered by insurance, is scheduled in the afternoon, and takes approximately one hour. It costs $300.

To schedule an appointment with Dr Stephen Peters or to ask about the simulator, call Associated Neurologists at 792-6125, extension 327 or 365.