Excerpt: 'The Driving Dilemma'

ByABC News via logo
October 31, 2006, 3:58 PM

Nov. 1, 2006 — -- More aging men and women in America means more elderly drivers on the road. It won't be long before one in every four drivers in the country is over the age of 65.

With the increase in older drivers comes safety issues. Dr. Elizabeth Dugan answers many of the questions older drivers and their loved ones have about the effects of age, medical conditions and medications on driving in her new book, "The Driving Dilemma."

Assessing Fitness to Drive

Your aunt is 86 and has just returned from a care facility whereshe had stayed to recover from a fall. She walks very slowly and hasdiffi culty with stairs, but she insists she is a safe driver and hasn'thad any kind of traffi c accident in more than 20 years. Still, youwonder, should she be driving?

Your father is 72 and is in relatively good health, but while drivingwith you recently on the highway, he strayed to the left-handshoulder, then overcorrected with a sudden jerk of the wheel. Thisleft you frightened and him defensively arguing that it wasn't a bigdeal. Is he at risk?

Your mother is 75 and you've noticed that in the past couple ofyears she has been repeating herself -- sometimes telling you thesame story twice in a conversation. You notice some dings on thebumpers of her car, and a scratch on the right side. When you askher about them, she seems surprised and says they must be fromother people bumping into her car while it was parked at the grocerystore. Should you be worried about her driving?

These very common situations all confront you with a similarchallenge: How do you know if an older adult is fi t to drive? Sinceage alone is not a reliable indicator, what should you be lookingfor? And, if you are an older driver, what should you be looking forin your own driving habits that might signal a need for some kindof change?

This chapter describes the most common warning signs of drivingrisk and gives you some tools to assess whether a real drivingproblem exists. Specifi cally, I explain what the indicators of drivingfi tness are, what signals a problem, how to categorize the severity ofproblems, how to conduct a home assessment, and what's involvedin a professional assessment. Appendix 1 includes assessment formsthat can be used either by an older driver for self-assessment or by afamily member or friend. Appendix 2 contains forms to help you toimplement changes by talking with your physician about specifi cfunctional concerns related to driving that may need some medicalintervention.

Driving safety involves factors related to the vehicle, the roadways,the weather and other conditions. Above all, driving safetyinvolves the driver. This chapter focuses primarily on driversand on determining their fi tness for driving. Although it is importantto ensure that a vehicle is in proper mechanical condition,that issue is beyond the scope of this book. I'm workingfrom the assumption that the vehicle is in good working condition.Also, other factors play a role in how safely a person canoperate a vehicle: the conditions of the roads and a driver's familiaritywith them, the weather, and the time of day all can affectdriving safety. Obviously, all possible conditions can't beaddressed here, but they should be taken into account when determiningdriver fi tness. If you are concerned about a driver'sfi tness, you will want to observe his or her driving fi rsthand andkeep a written record of your concerns. The forms in Appendix1 should help you.

Driving Fitness and Age

At the most basic level, driving requires that we have the ability toproperly see, think, and move. Limitations in any of these threekey functions may signal a worrisome threat to driving fi tness. Illness,age, and even signifi cant life events can all impair your abilityto see, think, and move. Signifi cant life events, such as the lossof a spouse, may be so distressing that they contribute to physicalchanges that, in turn, affect driver safety. For example, the physicalsymptoms of fatigue and slowed thinking are common ingrief. While these symptoms are perfectly normal, they can impairyour ability to drive safely. See Chapter 2 for more informationabout common age-related changes and medical conditions thatmay impair driving fi tness.

Contrary to what many people believe, age, by itself, does notdetermine driving fi tness. What matters in driving are threefundamental functions: the ability to see, think, and move. Theseabilities change at different rates for different people. Some peoplein their 90s and beyond are more healthy and fi t for drivingthan some people in their 50s or 60s. Thomas Perls, M.D., M.P.H.,a professor at the Boston University School of Medicine, becameinterested in this phenomenon when he noticed that some of hisoldest patients were some of his healthiest. Dr. Perls directs theNew England Centenarian Study and is widely regarded as one ofthe world's leading experts studying adults aged 100 years orolder. His research shows that centenarians age relatively slowly,and seem to have delayed or entirely escaped diseases associatedwith aging such as heart disease, stroke, cancer, and Alzheimer'sdisease.

I spoke with one of Dr. Perl's study participants, Ms. NedinneParker, aged 104. Ms. Parker is a devoted baseball fan (she rootsenthusiastically for the Kansas City Royals), still lives independently,and drives once a week to her volunteer job at a local hospital.She is a remarkably healthy, active, witty woman who is stillable to see, think, and move well enough to drive safely. Ms.Parker is modest about the fact that she still maintains her drivingfi tness. She also realizes that she has some limitations and thatothers may be skeptical of her driving skills. During our conversation,she quipped that she doesn't have many friends or relativesclamoring for a ride: "Well, to be honest, I don't know if I wouldbe too quick to jump in a car with a 104-year-old gal!" She haslimited herself to driving only on local, familiar roads and onlyduring daylight hours. As a result of these self-imposed limits shehas been able to maintain her driving fi tness. Similarly, Mr. EdwardRondthaler still lives independently and is driving aroundupstate New York at 100 years of age. Mr. Rondthaler doesn'tdrive as much as he did when he was 80 (he drove across thecountry then), but he still enjoys driving around town and is doingso safely. These drivers remind us that it is not age but functionthat determines driving fitness.

Warning Signs of Driving Risk

If driving fi tness isn't determined by age, then what are the signsof impaired driving fi tness? Listed below are warning signs ofimpaired driving fi tness based on research and guidelines developedby advocacy groups such as the American Association ofRetired Persons (AARP), the American Automobile Association(AAA), and the American Medical Association (AMA).

To help you remember them, I have categorized the warningsigns by level of risk into red, yellow and green. "Red" signs point tothe highest level of safety risk. Having one of the red risks is a signalto immediately begin the conversation about driving and to seek aprofessional assessment. "Yellow" signs point to a somewhat lower,but still signifi cant safety risk. Having one yellow risk is cause forconcern, and having two or more is cause for concern and shouldprompt further assessment. "Green" signs point to safety risks thatare usually easily corrected and, if corrected, can allow a person tocontinue to drive safely. If you are concerned about your driving orthe driving of a loved one, the time to start talking is now. I can'tstress this enough -- being proactive and informed helps everyone.Honest and open communication is the best way to develop a planthat respects the needs, wants, and safety of all involved.

RED SIGNALS OF RISK