It's one of the knottiest issues faced by America's families - and by senior citizens themselves: When should the elderly give up driving?
This week's crash in Santa Monica, Calif., - when an octogenarian's car killed nine people in a farmer's market - has refocused attention on the appropriate time to take away the keys. Already in recent years, legislatures, car manufacturers, and others have been developing ways to make the roadways safer: More-sophisticated driving and vision tests, bigger car mirrors, better planned intersections, and laws that allow family members to quietly alert authorities about unsafe-driver concerns.
But with baby boomers aging - and with driving so tied to independence and quality of life in America's sprawling cities and suburbs - the topic may require even more attention. "In 10 to 20 years, the boomers will be right where that elderly gentleman was," says Joseph Coughlin, director of AgeLab at the Massachusetts Institute of Technology. "Unless we start planning personally where we live, and have more public debate" on the issue, there's a risk of seeing more of these kinds of tragedies.
In Santa Monica, Russell Weller drove away from a post office in his red Buick and was soon hurtling down Arizona Avenue. The street is usually open to traffic, but on Wednesdays it's closed for the farmer's market. Nine pedestrians were killed and up to 45 hurt in the mishap.
Initial tests on Mr. Weller found no evidence of alcohol or drugs. He does have a valid driver's license. But police say he recently crashed into his own garage. For now, they're treating the incident as a manslaughter case - but have said they suspect Weller was somehow confused or disoriented. "There may be some negligence as to his capacity to drive safely," said Police Chief James Butts.
Despite the incident's high profile - and many people saying they know seniors who drive dangerously - statistics show that older drivers aren't all that unsafe. Younger motorists - ages 16 to 24 - have accident rates of almost 120 crashes for every 1,000 drivers, according to federal data. Middle-aged drivers - 55 to 64 - have rates of less than 40 crashes per 1,000 drivers. Older drivers - 75 to 84 - experience about 30 crashes per 1,000 drivers.
One major difference: The elderly tend to drive far less. They don't commute. They often drive only when necessary, and, usually, not at night. With these factors taken into account, older drivers are statistically more dangerous: Among those 85 years or older, crash rates rise to more than 80 per 1,000 drivers.
The issue will likely only become more important. In 1995, 1 of every 11 drivers on US roads was over 70. By 2020, 1 of every 5 Americans will be over 65, and most will probably have licenses, according to the National Institute on Aging.
At present, licensing requirements vary widely from state to state. In many, drivers never have to set foot in a testing facility after getting their license at 16. In Illinois and New Hampshire, drivers over 75 must take a road test to renew their license.
Yet trying to change those laws can be politically difficult - especially when efforts target seniors. "The politics are less about what's safe than it is about balancing the values of freedom and independence on the one hand, and safety and health on the other," says Mr. Coughlin. "It goes nowhere."
The key, he says, is getting away from age as the criteria for testing. Unsafe driving isn't an age issue, Coughlin stresses. It's about drivers of any age who have impairments - and a transportation system that gives those drivers few alternatives.
The Santa Monica disaster, he hopes, will mobilize people to develop better testing for people of all ages, and transportation alternatives for those who don't make the grade.
But even before this week's accident, many groups nationwide were starting to focus on the elderly driving issue. The American Medical Association approved recommendations last month to help make doctors aware of factors that might impair the driving skills of older patients, and what assessment and rehabilitation options are available for those patients.
Even car manufacturers are beginning to put larger mirrors on cars - or devices that warn drives that they are too close to nearby cars. Congress, for its part, recently set aside $1.6 million to start a National Older Drivers Research Center to create better tests and train more driving rehabilitation specialists - people certified to help recognize driving weaknesses and to make the judgment call on when someone needs to get off the road.
Carol Blackburn, at Adaptive Mobility Services Inc. in Orlando, Fla., is one of about 300 such specialists. Often, her elderly clients have been referred by a doctor or family member.
"We can be the bad guys," she says, noting how tough it is for anyone to be told they can no longer drive. "It might mean they lose their home and have to go into an assisted living facility."
Sometimes, she'll find a middle ground to help people remain as independent as possible - restricting them to familiar routes or asking them to stop driving at night. Extra mirrors can also help.
But sometimes there's no other option, she says, remembering one elderly woman who was irate when told she could no longer drive - even though, during her road test, she had made a left turn in front of an oncoming car. "She said, 'I am not giving up my license! I am not moving in with my daughter in Atlanta.' It's not a pleasant part of our job, but if it takes somebody off the road who shouldn't be there, we need to do that."