Published Mar/Apr 2005

Keeping seniors safe, connected and in control
begins with an important conversation
By Alicia Abell

While conducting a recent focus group of elderly drivers, Dr. Jean Shope, a research professor at the University of Michigan Transportation Research Institute, discovered a curious thing: “Some people in the group said they’d rather die than give up driving,” she says.

But if you think about it, the reaction isn’t so surprising. Driving isn’t just a matter of convenience in our society–it’s a symbol of independence, of competence, of being in control. Suggesting that a parent or older relative stop driving is “almost as tense an issue and potentially insulting as saying it’s time to move,” Shope says. “These are decisions that grownups like to make for themselves.”

“One of the problems for families is that no one wants to raise this issue, so while professionals say you should plan ahead, few people do,” adds Jeff Finn of the American Society on Aging. Instead of confronting this emotionally charged subject in advance, they wait for a crisis to occur.

Unfortunately, it’s a conversation that parents and children can’t afford to postpone: Although senior drivers are safe drivers in many ways–they are more likely to wear seatbelts and less likely to drink and drive than other adults–they have a higher rate of fatal crashes than any other group except teenagers. In fact, the fatality rates of drivers 65 and older are a whopping seven times higher than 25- to 64- year-olds. (Drivers do become somewhat more accident-prone as they get older, especially after age 75, but the main reason for this is increased fragility and susceptibility to injury.)

What’s more, there are about 19 million licensed drivers ages 65 and older in the United States, a 32 percent increase from a decade ago. By 2020, there will be more than 50 million Americans over 65, almost all of them licensed to drive.

So how and when should families discuss this touchy topic? Here are some expert recommendations–plus tips on how to get retired drivers where they need to go.

Affects of aging

First, it’s helpful for both parents and children to understand the physical and mental changes that come with age. This part of the conversation, if broached in advance, is easy to discuss without tension. It’s no one’s fault–these things will happen to all of us.

Ninety percent of driving is vision-related skill, so visual changes–cataracts, glaucoma, loss of peripheral vision–are particularly important to address. Because many of these problems occur gradually, older drivers should get their eyesight checked regularly, says Dr. Cynthia Owsley, a professor of ophthalmology at the University of Alabama at Birmingham and chair of the Transportation Research Board’s Committee on the Safe Mobility of Older Persons, who studies eye disease and vision impairment in older adults.

“The good news is that a lot of vision problems are treatable,” says Owsley. Cataracts, which cloud the eye’s lens and make night driving tough–and which affect 50 percent to 60 percent of adults ages 65 to 70–can be easily fixed with outpatient surgery, for example.

The decreased strength and flexibility that come with age also affect driving. Weaker muscles and diminished limb mobility can slow down reaction times and make it harder to check blind sots. Cognitive changes have an impact, too. As people get older, their processing speeds decline slightly–just slightly–but enough to increase the chance of accidents, says Essie Wagner of the National Highway Traffic Safety Administration (NHTSA) in Washington, D.C.

These cognitive shifts explain why older drivers are so much more likely than other drivers to be involved in crashes at intersections, particularly while making left turns, Wagner explains. “There’s a lot going on,” she says. You have to watch oncoming traffic, look beyond the other turning vehicles to see if more are coming, monitor the stoplight, check for pedestrians and then decide to turn.

What’s difficult, of course, is when a parent has a cognitive impairment such as Alzheimer’s or dementia. People with cognitive and mental deficiencies often don’t recognize their own problems, says Finn. “They don’t know that they don’t drive well, so that’s the hardest group to get at.”

In such cases–or when the driver is otherwise recalcitrant–it’s sometimes necessary to call for reinforcements. One option is to ask a family physician to talk to the person, although some doctors are reluctant to have this conversation with patients (both for fear of alienating them and because it’s sometimes unclear how medical problems translate to driving).

If this doesn’t work, there are more drastic alternatives. In most states, a physician, family member or law enforcement official can report a driver to the Department of Motor Vehicles, which can prompt a relicensing test. Some families resort to taking away the car keys, disabling the vehicle or having it sold. These measures, while less than ideal, are sometimes the only option.

Evaluating abilities

The second key to a productive conversation about driving is to see it as a continuum, says Finn: It doesn’t have to be a drive-or-not-drive decision. Many older people limit their driving on their own, avoiding driving at night or during rush hour, for example. And most states offer restricted licenses, which allow people to drive only during certain times of the day or within a specified radius of their home.

Driver rehabilitation specialists, located at rehabilitation and geriatric centers around the country, can help set parameters. (See Resources at end of this article.) Such specialists evaluate driving skills and make recommendations, which usually fall into one of three categories: keep driving, stop driving or something in the middle–drive only in low-traffic areas or on familiar routes, for instance.

“Getting a formal driving assessment is the best thing you can do for a parent,” says Finn. “A son or daughter could say, ‘For my birthday, this is what I want. I’ll even pay for it.’” Most assessments cost between $200 and $400; they’re not covered by insurance, but financial assistance is often available.

Driving evaluations don’t have weight of law, but the results usually go to a physician. In the rare case of a person who fails an evaluation and refuses to stop driving, the physician can report the driver to the Department of Motor Vehicles. In some instances, the results go directly to the DMV.

Driver refresher courses are another option. (See Resources at end of this article.) Some insurance companies offer discounts for drivers who’ve completed these courses, although there’s no data showing they reduce crash risk. Even so, “for many people, there would be things to learn,” says Shope. This is especially true for people who learned to drive before driver’s ed existed–and when roads were less trafficked and highway systems less complicated.

An important conversation

Finally, experts say that the sooner parents and children address the driving question, the better. Obviously, if a parent makes poor judgments or narrowly escapes accidents while you’re in the car, it’s time to talk. And senior drivers themselves should be alert for signs of decreased driving ability: frequents traffic tickets, an increase in fender benders and even honking from other drivers are clues.

But the best time to talk about driving is when there’s no problem, says Finn. The worst? Right after a major accident involving an elderly driver, such as the Santa Monica crash in 2003, when an 86-year-old man drove through a farmer’s market and killed 10 people. “People are defensive then,” Finn says.

Nonetheless, almost every older person knows someone who’s unfit to drive, so the subject may come up naturally. If that happens, “it’s reasonable to say, ‘Maybe it’s a good idea for you to get checked,’” Shope says. “No one wants to hurt someone [because of their driving].”

One way to approach the topic is to ask your parents what they plan to do if they can’t drive for an extended period of time–if their car is in the shop, for example–says Wagner. “This is at least a way to think ahead,” she says.

Getting around without a license         

Once a person decides to retire from driving, how will he or she get around? That’s the logical next question, but the issue is broader than that. The real question is how to keep the person connected to the community, experts say.

It’s a concern that affects drivers and nondrivers alike. Research shows that even seniors who self-limit their driving can become isolated. By doing only the essentials–driving to the grocery store and doctor’s appointments, for example–they cut back on other activities, such as socializing with friends, that improve their quality of life. Consequences include depression and other health problems, not to mention increased medical costs.

Obviously, families can pitch in, but there’s only so much they can do. Public transportation is an option, but one that’s better in theory than reality. Subways and buses are part of fixed-route systems, so accessibility can be a problem. Stops aren’t always within easy walking distance, and getting on and off vehicles and up and down stairs can be difficult. “Often you can drive longer than you can take a bus,” says Finn.

Furthermore, increasing numbers of older adults are retiring to rural parts of the country, where public transportation options are limited. And even where public transportation is available, asking people to take the bus or subway when they’ve never done it before can be tough, says Shope. In many cases, “these are people who’ve always drive,” she says. In all, only about 3 percent of U.S. adults ages 60 and older use public transportation.

This is where creativity comes in. One solution is for a group of seniors to share ownership of a car and the use of a driver. Another idea is to look for “supplemental transportation programs” in your area. Offered by government agencies, church groups, geriatric providers and others, STPs complement public transportation with services that provide greater flexibility. Some transport individual riders; others involve ride-sharing. Some use paid drivers; others are staffed by volunteers. Most are fee-based, while others ask for donations. (See the AAA Foundation for Traffic Safety Web site, www.seniordrivers.org, to check for programs in your area.)

In the meantime, families should advocate for public policy changes to keep seniors safe and mobile. Urging your community to adopt the federal Highway Design Handbook for Older Drivers and Pedestrians as well as Guidelines and Recommendations to Accommodate Older Drivers and Pedestrians (see www.fhwa.dog.gov for details) is a good place to start. In Detroit, for example, the AAA club recently sponsored a road improvement program that configured some 140 intersections to conform to these guidelines, installing larger street signs; bigger, brighter stoplights; and more left-turn lanes. Injury crashes for drivers 65 and older have decreased some 35 percent at these intersections as a result.

According to Dr. Bella Dinh-Zarr, AAA’s director of Traffic Safety Policy, “AAA is now trying to get some nationwide policies in place using AAA Michigan’s experience as a model.”

Parents and children can also encourage their communities to examine how mobility-friendly they are, Finn says. Try getting around your city or town for four days without a car, he advises. See what kind of transportation options exists, and lobby for services to fill the gaps. “We really need to begin to have community conversations about this issue,” he says.

If families and communities can work together on this issue, maybe older drivers won’t feel so devastated about turning in their keys. And by being open and honest in our conversations, children can help keep their parents connected and in control–whether they’re in or out of the driver’s seat.


General Information

• AAA Exchange: aaaexchange.com. Go to “Senior Driver Safety and Mobility.” Includes information on senior-friendly road design, driver-screening tools, educational programs, vehicle safety improvements and alternative transportation options.

• AAA Foundation for Traffic Safety’s Senior Driver Web site: seniordrivers.org. Comprehensive Web site on senior driving, including self-assessments, driving tips and senior transportation resources.

• American Association to Motor Vehicle Administrators’ GrandDriver Program: granddriver.info. Information on aging and driving.

• National Highway Traffic Safety Administration: nhtsa.gov. Click on “Injury Prevention” and scroll to “Older Road Users.” Includes information on physical conditions and diseases that affect driving.

Alternative transportation

• AAA Foundation for Traffic Safety: (202) 638-5944, seniordrivers.org/STPs/profiles.cfm. Supplemental transportation programs listed by state.

• Beverly Foundation: (626) 792-2292, beverlyfoundation.org. Information on senior-friendly transportation.

Driver rehabilitation specialists

• American Occupational Therapy Association: aota.org/olderdriver. Go to “Find a Driving Rehab Specialist.”

Licensing renewal

• Insurance Institute for Highway Safety: iihs.org/safety_facts/state_laws/older_drivers.htm. State-by-state list of licensing renewal procedures for older drivers.

Refresher courses

• AAA Safe Driving for Mature Operators Program: aaaexchange.com. Click on “Senior Driver Safety and Mobility,” then “Safe Driving for Mature Operators.”

• AARP Driver Safety Program: aarp.org/life/drive.

Author Bio:

Former editor for the Washingtonian, Abell has written for “U.S. News & World Report” and “Health” magazines. She remains a contributing editor for the Washingtonian and is the author of Digital Rush, about Internet startups in the ’90s, and a book on business grammar, style and usage. “Keys to Independence” was first published in AAA World magazine and is reprinted with permission from the author and AAA Mid-Atlantic.

 Case Study #1

Restricted License

After a stroke almost completely paralyzed the right side of his body, “I felt that life as I knew it was over,” says Marvin Davidson, a 78-year-old former real estate appraiser from western New Jersey. Reduced to a wheelchair, Davidson was unable to perform most of the daily activities he considered second nature–walking, writing and driving among them.

Intensive rehabilitation gradually gave him back the ability to walk and talk, but his right arm remained practically useless. For close to four months, Davidson relied on his wife to drive him everywhere, including almost daily trips to the rehabilitation center nearly 40 miles away. “It took half a day to go there and back,” he says. Nothing in the small, rural area where he lived was within walking distance, and driving with one hand was impossible.

Then the occupational therapist at his rehab center suggested something: a “spinner knob” that would attach to the steering wheel of Davidson’s car and allow him to control the car with one hand. (Davidson remembered spinner knobs from his youth, when everyone had them; now they’re illegal unless you have a physical handicap.) After a few weeks of practice, he took a road test at the Department of Motor Vehicles. He failed the first time but passed a week later.

Now Davidson has the knobs, which cost about $10 each, installed in both his and his wife’s cars. They’re removable, so his wife simply takes oft the knob when she’s driving. Davidson’s leg is strong enough to use the gas and brake pedals, so the knob is the only modification he needs.

Davidson has a restricted license–he can drive as long as he uses the knob–and the freedom to go anywhere he pleases. “Hopefully, with ongoing therapy, the ability to bike and do shop work may return,” he says. “If not, at least I am driving.”


Case Study # 2

Alternative Transportation

For Nicholas Varga, the decision to stop driving was all about common sense. “As a driver, I always put safety first,” he says. So a few years ago, when he backed up in a parking lot and lightly tapped another car, he took note. When the same thing happened the following day—and then a third time—“I realized my judgment wasn’t good and might be a danger to others,” the 80-year-old says.

His son Colin, already worried about his father falling asleep at the wheel on the way home from dialysis, made another point: Putting the brakes on driving might make good financial sense. Varga and his wife, who had retired her keys the year before, didn’t use their car much to begin with. “It was just sitting there a lot of the time,” Colin says. For the amount of money Varga was paying in car insurance—not to mention the cost of tires, maintenance, gas and repairs—he could just as easily take taxis.

Since giving away his car, Varga relies on the taxi services provided by his retirement community to get to regular appointments at the doctor’s office and Loyola College in Baltimore, where he used to be a professor of history and now acts as archivist. Family members take him anywhere else he needs to go. Although he misses some of the convenience of driving, the adjustment has been an easy one. “I never saw the car as an extension of my personality,” he explains. “It was a transportation unit.”

As for Colin, he thinks a gentle approach to the topic was key. “I felt the harder my siblings and I pushed, the more my dad would push back,” he says. “I knew he would have to make this decision for himself.”

Case Study #3

Passing the Test

Many of the conditions that affect driving–visual changes, slowing reflexes, medical problems such as strokes and Alzheimer’s–come as we grow older, but whether someone should be driving depends on ability, not age, experts say. Lester Henninger proves their point.

About six months ago, the 91-year-old Philadelphian suffered a fainting spell. Doctors found nothing wrong with him, but a neurologist suggested he undergo a driving assessment before getting back in the car. “I wasn’t too happy about it,” says Henninger, but he followed the doctor’s recommendation anyway.

Tom Kalina, who directs the driver rehabilitation program at the Bryn Mawr Rehabilitation Hospital, took Henninger through a two-part assessment. First, he tested Henninger’s vision, general mobility and reaction time. To check the latter, Kalina had Henninger operate a machine with a gas pedal and brake; every time a red light went on, Henninger had to move his foot from the gas to the break.

For the second part of the assessment, the two men went out on the road, where Kalina watched Henninger drive in a variety of situations. The verdict? Henninger passed with flying colors. “If I’m still driving as well as he is at age 90, I’ll be very, very happy,” says Kalina.

It might not have been strictly necessary, but Henninger is glad he got evaluated. Not only is he confident that it’s safe for him to drive now, but his daughter, who was worried about him after the dizzy spell, feels better, too. “It might be a good idea for all seniors to get themselves checked,” he says—no matter what their age.

AAA ‘Roadwise Review’

by Karen Price Hossell

Developed by AAA and TransAnalytics, a traffic safety research organization, “Roadwise Review” is a software program senior drivers can use to evaluate their driving skills. The package includes an instruction booklet and a CD-ROM users can install on their computers. The program tests eight skills that studies have indicated are important to avoiding vehicle crashes. These skills include leg strength and mobility, head/neck flexibility, high- and low-contrast visual acuity, working memory, visualization of missing information, visual search and useful field of view.

A benefit of the program is that seniors can use it in the privacy of their own home, and the results are revealed only to them. “There has not been a tool that’s been this easy and state-of-the-art that people can use at home,” says Bella Dinh-Zarr, director of Traffic Safety Policy for AAA. “It’s a screening tool, like a blood pressure test. It’s based on the idea that there are a lot of things you can do to adapt yourself or your car to aging.”

If users find they are weak in one of the eight areas, the program provides information about what steps should be taken to improve that weakness. These might include visiting an optometrist or an occupational therapist to correct poor vision or receive exercises that could help head and neck flexibility.

“Roadwise Review” can be purchased through your local AAA office or online.


Supplemental Transportation Programs

by Karen Price Hossell

One reason senior drivers hesitate to turn in their keys is that it means losing much of their independence. While public transportation alternatives such as buses, subways and taxis exist in many urban and suburban areas, these can be costly and often are not senior-friendly. In response to the need for transportation that accommodates seniors, some communities sponsor programs called “supplemental transportation programs,” or STPs.

The AAA Foundation for Traffic Safety conducted a nationwide study of some 400 STPs in 2001 and updated the study in 2004. The Foundation determined that to meet the needs of seniors, programs should score high in what it calls “The Five A’s of Senior-Friendly Transportation”:

• Availability – Transportation exists and is available when needed.

• Accessibility – Transportation can be reached and used.

• Acceptability – Transportation meets standards of cleanliness and safety.

• Affordability – Transportation costs fall within range of what seniors can afford.

• Adaptability – Transportation can be modified or adjusted to meet special needs.

In addition, the Foundation learned most seniors appreciate STPs that provide rides not only for what are called “essential” visits, such as to the doctor’s office, but also those that are considered “nonessential.” These might be social visits or trips to the hairdresser, grocery store or library.

STPs use a variety of vehicles, including vans, automobiles and buses. More than half do not charge riders–funding comes from government grants and donations. Most pick up and discharge riders at their doorstep, and nearly half can provide escorts who accompany riders to their destination. The majority of the programs require riders to make reservations more than two days in advance. Nearly 30 percent, however, can provide same-day transportation.

STPs keep older people connected to the community and enhance their quality of life. But the programs are intended to supplement transportation options for seniors, not become the only option, and they are a partial solution to what is becoming a growing need.

To view a database of STPs, visit the AAA Foundation’s dedicated Web site: www.seniordrivers.org. Click on “Not Driving” on the left side of the page.

AAA’s screening tool
for senior drivers

Just as you would screen for high cholesterol or high blood pressure, AAA has introduced an innovative, scientifically validated tool to help seniors screen for their driving health: “Roadwise Review: A Tool To Help Seniors Drive Safely Longer.”

Developed by AAA and Trans-Analytics, a traffic safety research organization, “Roadwise Review” is a software program senior drivers can use to evaluate their driving skills. “Roadwise” is a CD-ROM users can install on their computers. The program tests eight skills that studies have indicated are important to avoiding vehicle crashes, including leg strength and mobility, head/neck flexibility, high- and low-contrast visual acuity, working memory and visual search.

Seniors can use it in the privacy of their own homes, and the results are revealed only to them. If users find they are weak in an area, the program provides information about what steps should be taken to improve that weakness, such as visiting an occupational therapist to learn exercises to improve neck flexibility.

To purchase a copy of “Roadwise Review,” which AAA has made available for only $5 (including postage and handling), call AAA at 1-800-222-7623 ext. 6300. Or buy the program online. AAA members also can borrow a copy of the program through AAA’s free-loan video library. Visit the “News For You” section of the Web site or call 1-800-222-7623 ext. 6312. The only cost for the free-loan CD-ROM is the return postage. The program is recommended for PCs running Windows® XP, 2000, ME, or 98 with a 633 MHz or faster processor.

AAA has a variety of other videos and materials available for senior drivers, including a series of pamphlets called “Straight Talk for Mature Drivers” that focus on senior driving issues. For copies, send a self-addressed, stamped business-size envelope to AAA, Straight Talk for Mature Drivers, 12901 N. Forty Drive, St. Louis, MO 63141.

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