For an elderly couple I know who live in rural Florida, driving represents far more than everyday independence and freedom. It means survival. With no one else to get their food and medicine, and no public transportation, he drives while she tells him where to go. Both are approaching 80, the wife paralyzed from a stroke, the husband legally blind.
Thishealth-vs.-mobility predicament - familiar to older people nationwide - reflects the complexity and controversy surrounding elder drivers in America. More seniors are behind the wheel than ever - 19 million over age 70, according to the US Department of Transportation.Within two decades, this number is expected to climb to 30 million, as people live longer and remain active in their later years.
Since an 86-year-old motorist plowed into a farmers' market in Santa Monica, Calif., in July - killing 10 and injuring dozens - some commentators have suggested older drivers are an irresponsible menace with no business on public roadways. Given the growth in the senior population, the national debate on how - or whether - to regulate driving privileges for the elderly is really only just beginning.
Most older motorists I met during eight years of working in hospitals were safe drivers who restricted their own travels, such as driving only in the daytime. Indeed, when it comes to deadly road behavior - speeding, driving while intoxicated, running red lights, using cellphones, road rage - research by the government, the AAA, and the insurance industry shows the majority of perpetrators are younger drivers.
That said, advanced age definitely is a risk factor in driving safety. Problems with vision, hearing, reaction time, medication use, cognitive impairment, and physical ailments can spell roadway disaster. I also have known elderly drivers who are in deep denial about their diminished driving capacity. While people over 70 comprise about 10 percent of licensed drivers, federal transportation data show they are involved in 13 percent of all fatal traffic accidents.On a per-mile-driven basis, they have higher accident rates than all but the youngest drivers.
Furthermore, it is often elder drivers themselves who don't survive crashes. Seniors who are physically vulnerable are far more likely than younger drivers to die of a comparable injury, according to the American Medical Association. By age 85, their auto fatality rate is nine times that of drivers aged 25 to 69.
Something needs to be done, most people agree. But what?
Most important, we must dismiss the notion of a single, simple solution. Elder driving cannot be viewed in a vacuum - nor can the lack of concrete action taken to address the issue.
The problem is an example of America's reluctance to face its rapidly "graying" demographics.
Rather than quick fixes, we need a comprehensive national agenda:
• First and foremost, invest heavily in public transportation to reduce dependence on automobiles. It is an inhumane recipe for disaster to insist that a senior stop driving without offering an affordable, reliable transportation alternative.
• Design roadways and cars to accommodate the reduced vision and slower reflexes of elder drivers (safety measures that would aid younger drivers as well). For example, add larger road signs, wider highway lanes, and bigger car mirrors.
• Publicize the warning signs of diminished road competence for aging drivers so they and their families can better identify them and take action before tragedies occur.
• Increase physician education about medical conditions that can impair older patients' driving skills. Though it could strain doctor-patient trust, physicians should be required to refer seniors for further evaluation when a clear risk to personal and public health exists.
• Develop comprehensive, objective, technologically sophisticated driver evaluations to replace simplistic vision and road tests. Given the tremendous variation between individuals and degree of impairment, it should not be age or diagnosis alone that determines whether drivers can keep their licenses.
• Expand driver rehabilitation programs and laws that grant restricted licenses, allowing seniors to keep driving as long as safely possible.
• Address the adjustment problems faced by the 600,000 older persons forced to stop driving each year - a number that will mushroom in coming decades. Significant social isolation and depression are common among these people, and that, in turn, can trigger major health problems.
Some will argue that these recommendations are too costly to implement. I suggest that unless large-scale action is taken now to accommodate our rapidly aging population, we will pay far more in years to come, both in dollars and in lost lives.
• Ezra Ochshorn is a social worker at the Florida Mental Health Institute in Tampa.