Aging Begins at 30

"But Driving is My Life-line"

For most people, it takes until 85 or older to drive as badly as a teenager. An accepted standard for driving ability is accidents per million vehicle miles travelled. This is 29 at age 16-19, 6 age 70-74, 8 at 75-79, 15 at age 80-84, and 39 above 85. The lowest incidence is 3.7 at age 40-44.

The loss of a driver's license is likely to be the first compromise for an elderly person's autonomy. Maintaining a license is often crucial to avoid institutionalization.

Two hundred thousand drivers are 65 or older. Driving is a privilege which must be earned. Motor vehicle accidents are the leading cause of death in people aged 65-74 and the second leading cause of death in those 75 or older. Drivers over 65 make up 8% of all fatal crashes. Driving skills are unchanged in the healthy elderly, but illness can make a difference. In particular, diseases of the heart and blood vessels, central nervous system, and diabetes can cause trouble. Fairly far advanced Parkinson's patients had 79 motor vehicle accidents per million miles travelled. If Parkinson's patients are mentally clear their rate is 28 compared to 94 with a learning deficit.

Elderly drivers tend to drive shorter distances at lower speeds and drive less at night. They make fewer lane changes and avoid rush hours. Deficits in health creep up undetected. About 90% of the sensory information needed for driving is visual. Thirteen percent of people 65 and older have visual field deficiencies and half of these are unaware of it.

Common problems elderly drivers are failure to yield the right of way, improper turns, failure to read road signs correctly, problems with mixing traffic, and accidents at intersections. Reaction time is said to be poor in the elderly, but response time between seeing an obstacle and applying the brakes is comparable to that in younger people.

Technological improvements which elderly drivers should look for when buying a car are side-visibility of headlights, rear lights, and direction lights from the side as well as from front to back. Minimal windshield and dash board glare, rear view defrosters and wipers, gear shifts that avoid erroneous reverse, high mounted rear brake lights, antilock brakes, automatic shift and wrap-around rear view mirrors. Especially watch for "Wrong Way" signs on interstate entrances and in other situations.

Night driving presents particular problems. Fifty year-olds with good eyesight need twice the amount of light as twenty year-olds. Older drivers lose some of their depth perception and fatigue can lead to double vision in some people. One should develop a defensive attitude in night driving and decrease speed by ten miles per hour on super highways. Blinking the eyes helps, and the eyes thrive on motion. Look a little sideways occasionally, but most of all remember accommodation to darkness may take up to a half an hour. It takes between eight seconds and five minutes to adjust to blinding headlights. The distance maintained behind other vehicles should increase from 150 feet in daylight to 225 feet at night. Alcohol, smoking, barbiturates, antihistamines, and other sedatives which decrease attention and concentration should be avoided. Always have good wipers and a full wiper fluid container.

Dementia and driving after a stroke are a special problem. I have witnessed horror stories in the clinic. Once I asked a severely demented man how he got to the clinic. He said "I drove here." His wife interjected, "But I am always there to correct the wheel." "Are you able to drive by yourself, maam?", I asked. "No," was the startling response. I gently remind them that an accident could result in being sued for all they possess and perhaps kill someone. After a stroke, if you think you are ready to drive again, you should attend a special driving clinic to be evaluated by an occupational therapist. Your car may need to be adapted with a spinner knob on the wheel and left foot access to the gas pedal and brake. Be safe, be sure, be evaluated and accept the result.

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