Helping Older Drivers Stay Safely Behind the Wheel

The balance between allowing older drivers to continue to enjoy their freedom behind the wheel versus taking away the keys because of safety concerns has long been a challenge for them and their loved ones. Too often, those discussions take place after driving skills have deteriorated badly. And, without proper planning for a transition from driving, people who suddenly find themselves without a driver's license are at high risk for increased isolation and depression.

But now, experts on older driver safety are pushing a new approach they hope will keep older drivers safely behind the wheel longer and help them with that often inevitable transition to when driving no longer is safe.

New guidelines released this year by the National Highway Traffic Safety Administration and The American Geriatrics Society take a more holistic approach that emphasizes earlier discussions about driving safety with older people — long before there are undeniable problems.

Previously, it was often the family doctor who had to play the heavy. Now, experts hope that bringing in more people — nurses, pharmacists, occupational therapists and driver rehabilitation specialists — will yield a less punitive approach to this sensitive subject.

"The idea is to get ahead of the game and start looking at this before people start losing some of their driving skills,'' said Dr. Alice Pomidor,  a professor at Florida State University College of Medicine and lead editor of the new guidelines. "There are a lot of things that can be done that people are not aware of."

In 2012, there were 36 million drivers age 65 or older and that number is increasing rapidly. Older drivers have a higher fatality rate per mile driven than any other age group except drivers under 25. That increased fatality rate is likely due to increased fragility, according to the federal guidelines. A study by the RAND Corporation concluded that drivers 65 and older may cause more accidents than those between 25 and 65, but they were much safer than those under 25. Still, each day, an average of 15 older adults are killed and 586 are injured in crashes.

Multiple studies confirm that older drivers are largely aware of the risks, and they already regulate their own driving. They often avoid highways as wellas rush hour or nighttime driving. But with the help of health care professionals or driving specialists, other interventions are possible.

One approach is to review medications. More than two-thirds of drivers older than 65 are taking two or more prescription medications. Some common medications — opioids, benzodiazepines and over-the-counter antihistamines — can not only impair driving, but also diminish insight, so drivers are unaware of their lowered capacity. That makes reviewing a driver's medications one of the top priorities when assessing safety issues.

Driving rehabilitation specialists also play a big role in the new guidelines. These specialists, many trained in drivers’ education and occupational therapy, can assess older drivers for weaknesses and identify coping strategies.

Some solutions are simple. A driver with arthritis may have difficulty turning her head to see the blind spot while changing lanes. But an enlarged mirror may be a quick fix.

Other solutions will be more complex. Drivers in the early stages of certain progressive diseases like Parkinson's or Alzheimer's may be safe to drive but will require vigilant monitoring. In some cases, keeping such drivers close to home and away from complex driving situations can buy some extra time of safe driving.

"Often we can clean up bad habits and teach compensation skills,'' said Gayle San Marco, a Los Angeles driving rehabilitation specialist with three decades of experience.

One success story of this new approach is Anne, a 64-year-old Southern California resident who agreed to speak about her experience if her last name was not used.

A retired high school English teacher, Anne has a complex medical history that includes chronic pain and bipolar disorder. Earlier this year, her driving became noticeably erratic. She felt weak and dizzy. She frequently could not park her car correctly, sometimes missing the curb by six feet.

One night, Anne drove her car over a median, causing significant damage to her car. When she called the doctor's office, they told her to stop driving. An initial assessment by a specialist showed she would likely fail if she went to take the state drivers license test.

Anne approached her driving safety in two ways. First, she worked with her psychiatrist to reduce her medications, cutting the number of pills she takes by more than half. Next, she took classes from a driving rehabilitation specialist that drilled into her safe-driving techniques.

She went on to easily pass the written and on-the-road tests.

"When I realized I might never drive again, and I would have to take the bus and public transportation all my life, it was horrifying,'' Anne said. "I can't tell you how important it is to try to tackle the problem before they are thinking of taking away the keys.''

This issue is never far from the minds of older people or those who love them.

During a recent visit to the Roseville Senior Center in a Twin Cities suburb, many older drivers had strong opinions. Some were quick to point out that distracted driving and texting among young people were just as serious concerns. But many said they knew of older drivers who might not be completely safe. Several talked about going to defensive driving classes and suspiciously eyeing some of their more frail classmates.

Connie Waterous, an 84-year-old retired financial analyst, described the difficulty she and her brother had years ago convincing their mother, who was then 90, that it was time to give up the keys.

"She could have afforded a limo driver, but it was the symbol,'' Waterous said. "The ability to drive is such a valuable thing in our society. It's really hard to give that up.''