Health, Happiness, and the Older Driver

By age 70, Americans begin to become a danger behind the wheel. This month scientists and policymakers gathered to discuss how to identify risky older motorists, while allowing safer seniors to stay on the road.

Last year, an Oklahoma woman, 87, caused two accidents while cruising the wrong way on the interstate for at least 7 miles (11 kilometers). This spring, a 76-year-old Massachusetts woman, who had lost her license for medical reasons, backed out of a handicapped space in a supermarket parking lot and ran over her husband, who had just finished loading their station wagon. He died in the hospital later that day. His grieving wife did not remember the accident.

Stories like these are bound to pop up more often as baby boomers live longer and remain behind the wheel. Older roadsters are the fastest growing segment of the driving population. According to the National Institute on Aging, in 20 years, one out of every five Americans will be over 65, and most will probably be licensed to drive.

Mile for mile, seniors have the highest crash and fatality rates: An 85-year-old woman is as dangerous behind the wheel as her teenage grandson is. Yet age itself might not account for this statistic. More relevant is whether older people can recognize when health problems impair their driving--and either compensate for their disabilities or stay off the road--according to research presented this month at a daylong symposium on safety and the older driver. Participants at the conference, held at the Massachusetts Institute of Technology (MIT) in Cambridge, grappled with new ways to assess the risks posed by older drivers and the costs of balancing personal mobility with public safety.

Concern about older drivers has idled at state and federal levels for decades, said symposium organizer Joseph Coughlin, director of the MIT AgeLab, which works on new technologies and policies to promote healthy, independent lives for an aging population. The issue revs up about once a year and then stalls due to opposition from older adults, absence of transportation alternatives, and ambiguity about how to define older drivers and how to identify unsafe motorists. That lack of action leaves the driving decision to the older person. "Self-regulation has been heralded as a great success," said Coughlin. "But there is very little practical research on how individuals make the choices to drive that day or find practical alternatives."

The high crash rates of older drivers suggest that the voluntary self-restriction strategy is not working, at least for motorists who might not realistically assess their declining abilities, said gerontologist Bonnie Dobbs, associate director of the Rehabilitation Research Centre at the University of Alberta in Edmonton. Dobbs suspects that this cognitively impaired subset of drivers is responsible for the age-related upswing in accidents and deaths, she said.

In support of this hypothesis, she and her colleagues found that normal seniors tend to underestimate their driving abilities and restrict their trips accordingly: They drive more slowly and less often, avoid going out in bad weather or in rush-hour traffic, and stay home after dark.

In contrast, adults with dementia or other neurological problems generally think of themselves as fine drivers. "They don't see the problem," Dobbs said. So when it comes to devising rules to restrict or revoke licenses to protect public safety, "we shouldn't be talking about 'older drivers,' " she said, but about drivers with impaired judgment. Common age-related medical problems other than cognitive disease might also turn older drivers into potential road hazards. In a study of 188 older volunteers, only 33 people had stopped driving, despite having a formidable list of medical conditions and taking an array of medications that could put them at increased risk of an accident, said geriatrician and internist David Carr, associate professor of medicine at Washington University School of Medicine in St. Louis. He also found that a surprising number of people over 78 were not only driving but averaging about 5000 miles (8000 kilometers) a year.

Many seniors, however, gradually modify their driving habits as their abilities and health decline, according to preliminary results from a nationwide survey of 3824 drivers over age 50 conducted by researchers at the MIT AgeLab and the Hartford Financial Services Group. Two-thirds of the people reported changes in their driving style, increasing with age, such as avoiding night driving, freeways, heavy traffic, long distances, and unfamiliar areas. Thirty-eight percent of people in poor health reported that they had "pretty much stopped driving," said Maureen Mohyde, director of the corporate gerontology group at the Hartford. Many infirm motorists, however, tended to ignore doctors' recommendations to stop driving.

This reluctance to park the car for good is not surprising. For most Americans, "transportation means more than getting from point A to point B," Coughlin said. "Transportation is the glue that strings together all the activities we call life. It's about independence. It's about freedom. Wheels are the key to doing anything."

What's more, because cars connect people to friends and activities, the end of driving can mean decreased activity--and increased depression, said Yale geriatrician Richard Marottoli, director of the Geriatrics and Extended Care section at the VA Connecticut Healthcare System. Several studies have linked depression and reduced activity with increased illness, disease progression, and death--which is one reason that physicians hesitate to eject a patient from the driver's seat, said geriatrician and lawyer Michael Cantor, clinical director of the New England VA Geriatric Research, Educational, and Clinical Center in Boston.

People might have an easier time turning in their keys if they have a chance to emotionally adjust to the idea, suggests Cynthia Hellyar, a gerontologist with the Hartford. For many seniors, driving might have less to do with piloting a car than with staying active in their communities and not feeling isolated.

In the meantime, making the call about when to take the passenger seat will continue to challenge seniors--and their families, physicians, and political representatives. "There are no simple solutions," says Mohyde. Instead of asking how we can get older drivers off the road, she says, we should look to the legions of seniors who have successfully adjusted their driving to their skills and support efforts to encourage the kind of voluntary good judgment that will keep drivers safe for a lifetime.

Carol Cruzan Morton is a science writer in Belmont, Massachusetts. Walking is her preferred mode of transportation, but even that can be dangerous, as she discovered when she broke her leg while hoofing it to work over an icy sidewalk .

For further advice about deciding when to stop driving, people with Alzheimer's and their families can consult a practical planning guide called "At the Crossroads," developed by the Hartford and the MIT AgeLab.