Helping Seniors Stay Safe on the Road

Helping Seniors Stay Safe on the Road by John H. Armstrong, MD, FACS

John H. Armstrong, MD, FACS

In 20 years, 1 in 5 Americans will be age 65 and older. That’s double the number today. In 2004, there were 28 million older licensed drivers, up nearly 20% from 1994. What are the facts about older drivers?

• The motor vehicle is the major form of transportation across all ages-to include 60% of adults ages 85 and up!
• Driving is a symbol of independence.
• The number of miles driven by older drivers is less than for all other age groups.
• Motor vehicle crash is the leading cause of injury-related death among ages 65-74, and second only to falls among ages 75-84.
• Fatality rate per mile driven for ages 65 and older nearly equals the fatality rate per mile drive for ages < 25.
• Older drivers are 12% of the population, yet account for 15% of traffic fatalities.
• Age causes fragility: an older body is less able to withstand injury from a crash.
• In a given crash, an older driver is 4 times more likely to die from the crash than a 20 year old driver.
• The chance of an 85 year old man dying from a car crash is 9 times higher than a 45 year old man in the same crash.
• Older drivers crash because of inattention (which affects all age groups) and slowed perception and response to driving cues.
• What challenges does aging create for older drivers?
• Driving ability declines as we age, yet driving fitness is about function, not age.
• Medical conditions themselves can reduce function for driving:
  1. Cataracts and macular degeneration reduce vision.
  2. Diabetes can reduce sensation of the feet on the pedals.
  3. Emerging Alzheimer’s disease can reduce awareness and response.
  4. Arthritis can make it painful to turn the steering wheel.
     • Medications for pain, muscle relaxation, and hypertension, have side effects, like drowsiness and blurry vision that can impair driving function.
• Safe driving requires three essential functions: vision, thought, and movement.
  1. Vision = 95% of driving sensory input
  2. Thought = memory, visual perception, selective attention, & decision-making
  3. Movement = muscle strength & endurance, joint movement & flexibility
• Alarms of driving impairment:
  1. Stopping in traffic for no apparent reason, difficulty making left hand turns, and confusing the brake and gas pedals.
  2. New scrapes and dents on the car, damage to garage walls and posts around the driveway.
  3. Difficulty getting in and out of chairs, dropping things, weakening handshake, difficulty seeing shapes.
• How can older drivers overcome these challenges to stay safe on the road?
  • Older drivers can adjust their own driving habits to accommodate physical changes of aging.
    1. Reduce mileage in general & long highway trips
    2. Avoid driving at rush hour
    3. Drive a route that avoids busy intersections
  • Crash prevention includes
    1. Optimizing the driver
       • “Annual 65+ check-up,” just like servicing the car at 65,000+ miles
       • Assessment of driving function, with physical and medication adjustments to bring impaired function to safe function
       • Driving rehabilitation specialists have expertise to improve the interaction between driver, vehicle, and road.
    2. Optimizing the driving environment
       • Change behavior on the road by driving lower speed roads in daylight hours
       • Engage communities in better traffic design with controlled intersections, larger & brighter signs and symbols, lower speed limits, and better reflective road lines.
    3. Optimize the vehicle
       • Improve ease of entry & exit from vehicle.
       • Place wide-angle rear view mirrors.
       • Make seats more comfortable.
       • Adjust dashboard displays with high-contrast symbols and letters
       • Enhance crash protection with reliable restraints, sequential airbags, and head rest adjustments.
       • Driving retirement means that adjustments cannot overcome functional decline.
         1. “What good is driving if you are going to get hurt or hurt others?”
         2. Alternate senior friendly transportation is available, accessible, acceptable, affordable, and adaptable.
         3. Community support is essential for viable alternatives to driving.

Summary

• Older drivers more likely to die in the event of a car crash than younger drivers.
• Vision, reaction time, and movement decline with aging.
• Recognition of aging changes can lead to interventions that keep older drivers safe on the road.

Resources:

AMA: www.ama-assn.org/ama/pub/category/8925.html

• Assessing and Counseling Older Drivers

National Highway Transportation Safety Administration

• Driving Safely While Aging Gracefully

www.nhtsa.dot.gov/people/injury/olddrive/Driving%20Safely%20Aging%20Web/index.html

-Click Traffic Safety tab and Older Drivers on side index

AARP

• www.aarp.org/families/driver_safety
• Driver safety on-line course

Copyright 2007 by John H. Armstrong, MD, FACS