The Medical Minute: Independence versus safety concerning elderly drivers

July 23, 2003

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

Russell Weller, the 86-year-old California man who killed 10 people when he accidentally drove his car into a crowd last week, has triggered a heated debate. The tragedy has once again raised the issue of older drivers and safety.

In America we resist placing restrictions on people solely due to age, but with aging comes physical changes that affect the senses, strength and reflexes. The reality is that older drivers and the community at large may be placed in danger if decreased motor skills and de-sharpened senses lead to unsafe driving.

Seventeen percent of the country is over 65 and by 2020 that number may grow to 50 million people, with half of those over age 75. As a group, those over 75 have most of the traffic violations and more fatalities per mile driven than any group except teenagers. The two most common errors are failure to yield and to obey a stop sign. For those reasons, many states have moved to test older drivers periodically.

Driving means independence for many older people. Understandably, many may be reluctant to surrender their license and car keys. Having an elderly family member who doesn't drive puts an added burden on family and friends for transportation since most people do not live in large cities with extensive public transportation systems. The idea of becoming an unofficial chauffeur makes it difficult for children or spouses to suggest giving up driving. Family members may be reluctant to bring it up or may face significant resistance. In some cases the older drivers may make the decision to stop driving on their own. If not the person's physician may be asked to make the decision. In any event, facing the problem of an older driver with diminished skills is not easy.

The first issue for most people is how to decide if an older family member should stop driving. If someone has become lost a few times in a familiar area or has had fender benders or has been seen running a stop sign or failing to yield, these are all signals that suggest further evaluation is needed. Driving at inappropriate speeds -- too fast or too slow -- or getting angry or confused while driving may indicate poor judgment.

In many cases, the problem is not related to dementia, but rather to basic physical impairments that come with age. Normal aging includes slowness of reflexes and changes in balance, flexibility and strength, which can lead to poorly negotiated turns, loss of control of the wheel and an inability to monitor conditions on the back and sides of the vehicle. Age related visual deterioration can include macular degeneration and cataracts with impairment of vision in dim or very bright light. Reduced hearing is the third most common physical impairment in older adults and is a significant contributor to safety problems.

Medications can significantly impair driving skills for all ages but those over 65 face an increased risk. While just 13 percent of the population they receive 32 percent of the drugs dispensed or about 17 to 20 medications per year.
Traffic accidents increase by 50 percent in the weeks after drivers begin receiving sedatives and anti-anxiety drugs.

So what should older people and their families do about driving concerns? The first step is to ask some serious questions:
Has the person in question had trouble finding his or her way around?
Are stop signs not obeyed or turns made poorly?
Can the driver still park properly?
Is it difficult to turn the wheel, see behind the car or back up?
Can the person hear and see normally?
Have there been traffic violations?
Are there problems with drowsiness, falling or gripping objects?
Can the person get up from a chair, walk 10 feet, turn around, walk back and sit down in less than 15 seconds?

If these questions raise concerns families should have a serious discussion about voluntary restriction of driving. In cases where a family member should stop driving but will not, a medical evaluation is reasonable but more determined actions such as hiding the keys or removing battery cables may be necessary. While it may sound extreme, think of the potential consequences of allowing unsafe driving to continue.

A medical evaluation may help but Pennsylvania is among only six states which require physicians to report people whom they judge to be impaired for driving.

Another viable alternative is to encourage older drivers to seek a qualified driver education or assessment program for seniors. Such programs can help older drivers with diminished skills find ways to compensate. They can also serve as another voice to encourage unsafe drivers to stop driving.

The AARP offers a driver safety program called "55 Alive" which helps drivers over 50 refine their skills in two four-hour sessions over two days for $10. Details are at http://www.aarp.org/55alive/about.html

The National Highway Transportation Safety Administration provides an online booklet to help people assess their own or their relatives' safety and which offers tips for skilled driving at http://www.nhtsa.dot.gov/people/injury/olddrive/Driving%20Safely%20Aging...

Some accommodations to physical handicaps can be made in cars to improve handling the steering wheel or to improve the view in mirrors. Regular exercise and low level strength training can improve one's chances of competently operating a car in old age even if begun late in life. If physical or mental impairments are insurmountable, it is important for public safety that one recognizes these limitations and stops driving.

(Media Contacts)

Last Updated March 19, 2009