Telling an older person he should no longer drive is difficult. This can be a devastating blow to the patient, who may resist the suggestion vigorously. No longer being able to drive takes away one’s independence and increases isolation, depression, risk of illness and a likelihood of placement in a nursing home. It is for those reasons that decisions about driving must be taken seriously, must be based on sound medical facts and must not rely on frantic family members (usually children) who are overly concerned about their parent’s safety.
Recently, an angry patient, whose family had forbidden him to drive, came to see me brandishing a report published by the RAND Corp. that showed that “seniors” are safer drivers than young adults. It reported that drivers older than 65 have fewer accidents than those younger than 25. The older group causes only 7 percent of accidents, compared with 43 percent for the younger group. “Of course I should drive,” this 85-year-old man insisted angrily.
Sadly, the RAND report was misleading. Lumping everyone older than 65 together fails to tell the whole story. Many older people elect to stop driving, drive shorter distances and do not drive at night. According to a report published by the National Cooperative Highway Research Program, the number of crashes per 1,000 licensed drivers averages 68 per year, whereas there are only 37 per 1,000 involving drivers older than 65. However, as there are fewer older drivers, a better way to assess risk is to evaluate the number of accidents in relation to the number of miles driven. If we use this approach, the safest drivers range in age from 55 to 64, averaging 3.2 crashes per 1 million vehicle miles driven, compared with 8.2 crashes for those ages 20 to 24, which happens to be the same rate as the one for drivers older than 85.
Of greater concern is the number of fatalities. In the United States, for every 1,000 accidents, there are two deaths. For those between the ages of 60 and 74, the number of deaths is 3.2 per 1,000 crashes, increasing to 8.56 per thousand crashes for those older than 85. Furthermore, the percentage of times the driver is at fault increases with age. Only 42 percent of 50- to 64-year-olds are at fault in fatal accidents. The percentage is 72 for those older than 85.
We all know of the sad story of the man with Alzheimer’s disease who crashed into a market in Santa Monica, California, killing 10 people. And recently, a patient in my office who has a physical disability slammed his foot on the accelerator instead of the brake, smashing into one of our nurse’s offices, creating havoc. Had she been at her desk, she would have been crushed.
There is no question there are many safe drivers who are older than 80, but just like the case with teenagers, the risk increases. Here it is because of declines in visual acuity, physical disabilities that can lead to longer reaction times and alterations in cognition that can lead to failure in judgment. Medications such as sleeping pills (including Benadryl), as well as other drugs, including alcohol, of course, also contribute.
Most people with physical and visual disabilities have the insight to stop driving if they feel unsafe. This often does not apply to patients with memory problems. Anyone who has gotten lost on more than one occasion, has been in a number of fender benders or is believed by family members to be a danger on the road should be closely evaluated. Studies have shown that patients with early Alzheimer’s disease who drive in familiar surroundings are not at increased risk of accidents. However, the ability to drive deteriorates as the disease progresses. If any question about driving ability exists, a driving test, either on the road with a tester or on a computer, should be done. In addition, every older person should consider taking courses offered by AARP to help improve driving skills.
Just as we relent and let our teenagers drive, we must ensure that we undertake due diligence before telling an older person not to drive. Only when this person is clearly a danger on the road should this serious step be taken.
Dr. David Lipschitz is the director of the Dr. David Health and Wellness Center in Little Rock. To find out more about Dr. David Lipschitz, visit www.drdavidhealth.com