Driver safety

Definition

As people age, changes occur in their mental and physical condition that may affect their ability to assess traffic situations and respond to them rapidly and appropriately. Having driven for many years, older individuals may not recognize these changes or the increased risk of accident associated with them. Driver safety assesses the ability of a driver, regardless of age, to control a vehicle and respond appropriately to changing traffic conditions.

Description

The population of the United States and many other developed countries is aging rapidly. People not only are living longer, they are also staying more active and independent in retirement. An important aspect of this independence is the ability to continue to drive a car. It is projected that by 2020, more than 15% of drivers in the United States will be over age 65. With more older drivers on the road, the safety of these drivers is of concern not only to their loved ones, but to policy makers, advocates for the aging, and society in general.

Most often a family member is the first to question an older person's ability to drive safely. The question of driver safety can also arise during routine driver's license renewal, a routine physical examination, or after a health problem such as a stroke or surgery. Various structured driver assessments have been developed to help provide an objective evaluation of the individual's ability to drive safely. They evaluate the effects of natural aging, diseases and conditions, medications, and cognitive functioning as

they relate to the individual's ability to operate a motor vehicle. Driver assessments can be conducted by an employee of a state motor vehicle department, a certified driver rehabilitation specialist, or a licensed driver training instructor in consultation with an occupational therapist, physical therapist , physician, or other health care professional.

Components of a driver safety assessment

There is no substitute for riding with individuals whose driving skills are being evaluated to observe how they respond to changing traffic conditions, judge distances, remain focused on the task of driving, and follow traffic rules. Even if an individual has no new health problems, a complete physical examination also should be performed. Often people do not recognize the degree of impairment that occurs naturally with healthy aging, because the changes in areas such as vision, hearing, reaction time, and strength are gradual.

Other aspects of a driver safety assessment are as follows:

• Driving history. This focuses on whether the individual recently has been involved in small “fender bender” accidents, received any moving violation tickets, or been involved in any near-miss accidents. Often new body damage to the car is a clue that small accidents have occurred.
• Medication history. A complete review of the medications the older driver is taking by a health care professional is useful because many common medications can cause lightheadedness, sleepiness, confusion, and slow reaction time. Some categories of drugs that potentially can interfere with the skills needed to drive include muscle relaxants, painkillers, antidepressants with sedative properties (e.g., tricyclic antidepressants), antihistamines, antipsychotics, and drugs used to treat glaucoma. Sometimes medications can be changed to reduce the risk of driving impairment.
• Changes in physical status. This is done in conjunction with a physical examination and evaluates whether any recent events such as a stroke or the development of cataracts or severe arthritis affect the ability to drive safely. Once evaluated, some conditions may be treatable and reversible.
• Mental status. Certain diseases are likely to cause confusion, dementia, forgetfulness, loss of attention span, and impaired judgment. These include cerebrovascular diseases that reduce the circulation of blood and oxygen to the brain, as well as diabetes mellitus, chronic lung diseases, and dementias such as Alzheimer's disease.

Viewpoints

On a personal level, no one wants a loved one to be injured or die or harm another person in a traffic accident. On a societal level, policy makers want to enact laws to keep citizens safe. As the population ages, society must decide what requirements or restrictions are reasonable to put on older drivers as a group. In the United States, state laws vary widely in conditions such as the frequency of re-testing and physical examinations needed for people over age 70 to renew their driver's licenses. Nevertheless, age by itself is not a reason to force an older person to stop driving.

Older individuals who wish to continue driving point out that:

• maintaining independence is an important part of staying physically and mentally healthy in old age
• alternate public transportation is not always convenient and can be physically stressful
• giving up driving may put an undue burden on other family members who have to make arrangements or provide transportation for the older individual to go to appointments, shopping, etc
• older drivers drive fewer miles, drive most often during daylight hours, and drive less in bad weather, thus reducing their risk of causing an accident
• adults over age 65 are less likely than any other adult age group to drink alcohol and drive
• older adults are more likely to wear seat belts than any other adult age group
• adults over age 65 are involved in fewer crashes where someone other than themselves dies than drivers ages 16–34. On the other hand, members of this age group is more likely to die or be seriously injured themselves in a crash because of their increased physical fragility.

Persons who are concerned about the risks older drivers pose should look for the following warning signs that indicate unsafe driving.

• repeated comments from someone close to the driver that their driving is unsafe or that they are having close calls and near accidents
• getting lost on familiar roads
• complaints of dizziness at any time
• tripping, falling, or other indications of vision or balance problems
• indecisiveness in making decisions about small activities or inconsequential choices
• repeated forgetfulness
• slow physical reaction times
• severe hearing loss to the point where it would impair hearing emergency vehicles on the road
• severe arthritis, difficulty walking, shakiness, or other physical symptoms that may make driving difficult

The suggestion or insistance that an older person give up driving is often emotionally difficult for a loved one to make and for an older driver to hear. The issue easily can lead to family disagreements. An objective driver's assessment done by an independent evaluator may make the suggestion easier to present and accept. Programs run by organizations such as the American Automobile Association (AAA) or the American Association for Retired Persons (AARP ) offer self-evaluation and driver re-education programs especially designed to help older drivers. In some cases, participating in one of these programs may substantially improve driver safety. The AAA also publishes a list of automobile features that may make driving safer for older drivers.

Resources

PERIODICALS

Carr, David B. “The Older Ault Driver.” American Family Physician. 61 no. 1 (January 1, 2000). http://www.aafp.org/afp/20000101/141.html.

Golden, William. “Assessment of Older Drivers.” Internal Medicine News 37 no. 15 (2004): 23.

OTHER

“Older Adult Drivers: Fact Sheet.” United States Centers for Disease Control and Prevention. March 12, 2007 [cited April 15, 2008]. http://www.cdc.gov/ncipc/factsheets/older.htm.

“Older Driving Safety Project Materials.” National Association on Area Agencies on Aging. undated [cited April 15, 2008]. http://www.n4a.org/older_driver_safety/materials.cfm.

“Smart Features for Mature Drivers.” American Automobile Association. undated [cited April 15, 2008]. http://www.aaaexchange.com/Main/Default.asp?Categor-yID=3&SubCategoryID=38&ContentID=363.

“When You Are Concerned: A Handbook for Family, Friends and Caregivers Worried about the Safety of an Aging Driver.” New York State Office for the Aging. 2004 [cited April 15, 2008]. http://www.aging.state.ny.us/caring/concerned/index.htm.

ORGANIZATIONS

American Automobile Association, Public Affairs MS 72, 1000 AAA Drive, Heathrow, FL, 32746, publicarrairs@national.aaa.com, http://www.aaaexchange.com/Main.

National Highway Traffic Safety Administration, 1200 New Jersey Avenue, SE, West Building, Washington, DC, 20590, (888) 327-4236 or TTY for hearing impaired (800) 424-9153, http://www.nhtsa.dot.gov.

Tish Davidson A. M.