The light turns red and traffic stops. A mother eases her
baby's stroller off the curb and starts across. Without warning, a stopped car
roars to life and leaps into the intersection, missing her infant by a
The shaken mother confronts the driver, a woman in her 80s, who
is crying and in shock. The elderly woman had glanced at the green light
signaling the cross traffic and processed it as a green light in her direction.
Fortunately, this incident did not shatter the lives of mother and baby -- but
it might have acted as a wakeup call for that driver. Time to consider hanging
up the car keys.
Where to Begin?
It's time to start thinking of yourself as a caregiver when the following types of events occur:
A major health problem, or a collection of smaller ones, is starting to cramp your mother's style.
Financial problems (overdrawn checks, unpaid bills, huge credit balances) start cropping up.
Grandpa doesn't get out as much as he used to and seems less interested in what's going on around him.
Home maintenance is slipping: things that break around your parent's house...
Obviously, there are poor drivers in all age groups. Drivers 55
and over actually are less likely to be involved in crashes, according to the
National Center for Statistics and Analysis, and are also less likely to be
driving drunk. But, as the years roll by, the 70-and-up group is second only to
the 16-20 set in traffic deaths.
Contrary to popular opinion, cognitive impairments such as
Alzheimer's, and declining eyesight are less to blame than diseases such
diabetes, Parkinson's, and heart disease. Physical stiffness from arthritis or
osteoporosis can impair the ability to work the pedals. Older people also take
a lot of medications, some of which can impair driving. All of this is
significant because states that have passed or are considering retesting or
relicensing based on age usually target vision, which can be the least of the
David B. Carr, MD, a geriatrician and associate professor of
medicine at Washington University in St. Louis, says "drive or not to
drive" decisions might more cost-effectively be made on a case-by-case
basis. Even people with early stages of Alzheimer's, whose orientation and
other faculties beside memory are not affected, can drive safely. "We have
to decide if screening is worth it. Even if you take away a person's license,
they may continue to drive without it." (In one case, a man who kept
hitting a tree next to his driveway refused to surrender his license and
instead chopped down the tree.)
Role of the Family Physician
According to Richard A. Marottoli, MD, MPH, an associate
professor of medicine and geriatrics at the Yale University School of Medicine,
and chairman of the National Research Council's Safe Mobility for Older Persons
Committee, the vast majority of drivers who quit do so on their own hook.
"They experience uneasiness in certain situations and become progressively
more uncomfortable," he says.
In some cases, however, alarmed adult children or spouses
consult their family physician about the driver's condition. According to Carr,
the doctor should first take a detailed driving history both from the patient
and someone who has ridden with the person. Medications need to be reviewed. Of
course, if the patient has a history of an impairing illness such as stroke,
sleep apnea, alcohol abuse, illicit drug use, epilepsy, psychiatric disorders,
Alzheimer's, and others, this must be taken into consideration. The physician
will then check functioning, including complex reaction time, visual acuity,
divided attention (think cell phones), hearing, and the width of the useful