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Trading the Car Keys for a Bus Pass

Older Drivers

WebMD Feature
Reviewed by Gary D. Vogin, MD

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 hair.

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.

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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 problem.

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 visual field.

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