Aging & Geriatrics

Older Drivers

NIA

Almost any adult with a driver’s license can remember that first trip alone in the family car, feeling completely free and independent. Those same emotions complicate the decision faced daily by many older Americans. They must decide whether to keep driving or give up their car.

Maybe driving is not fun any more. Some people may not drive at night because they have trouble seeing. Others might avoid driving on interstate highways. For many older drivers, these are the first signs that driving is becoming a problem.

But, driving is necessary for many. Gone are the days when most could walk a few blocks to the grocer or doctor. Getting around is a problem for the millions of older people who live in the suburbs or rural areas. In cities there are plenty of taxis and public transportation like buses and subways. However, buses and subways may be hard for someone suffering from arthritis or using a cane. Taxis may seem to cost too much.

In 1983 one out of every 15 licensed drivers in America was over the age of 70. By 1995 this had risen to one out of every 11 drivers. By 2020 one out of every five Americans will be over 65 years of age, and most of them will probably be licensed to drive.

As a group, older drivers are some of the country’s safest drivers. Fewer speed or drive after drinking alcohol than at any other age. However, compared to young and middle-age adults, people over 70 are more likely to be involved in a crash while driving and more likely to die in that crash. There are many reasons for this –– some can be changed, but others cannot.

How Does Age Affect Driving?

As we grow older, we do not turn into bad drivers. Some of us stay good drivers. Others simply have changes in their ability to handle a car safely. These include:

 

  • Changes in our bodies
  • Changes in the way we think
  • Health problems
  • Medications

Changes in your bodies –– As you age, your joints may stiffen, and muscles weaken. Turning your head to look back or steering and braking the car may become hard to do. Movements are slower and may not be as accurate. Your senses of smell, hearing, sight, touch, and taste might grow weaker.

Vision, being able to see, is a vital part of driving, but age brings changes in the lens of the eye. Eyes need more light in order to see and are more sensitive to glare. Your ability to see things on the edge of the viewing area, peripheral vision, narrows. Vision problems include cataracts, macular degeneration, and glaucoma.

 

  • In cataracts the lens of the eye becomes cloudy, causing problems with the ability to see.
  •  

  • Macular degeneration is a breakdown of material inside the eye that leads to a loss of vision in the central part of the viewing area.
  •  

  • The rise in pressure inside the eye that develops in glaucoma may limit the ability to see things on the edge of the viewing area.

Changes in the way you think –– You probably know your body may change with age. You may not be aware of changes in the way your mind works as you age. Some of you find your reflexes are slower. Or, you may have trouble keeping your attention fixed on one situation. You may have a hard time doing two things at once –– something you have to do to drive safely. When you drive, you have to take in new information from many sources and then react. Some of you react more slowly when you find yourself in a new situation.

These are all normal changes in how your brain works as you age. There are, however, two forms of mental problems that can also affect your ability to drive.

 

  • Depression, being "down in the dumps" for a long time, may happen to many older people, but it is not normal. It can, and should, be treated. The attention and sleep problems depressed people of any age sometimes suffer can interfere with safe driving. So can the medicine sometimes used to treat depression.
  •  

  • Dementia causes serious memory, personality, and behavioral problems that the person can not recognize. Someone with dementia may at first remember how to operate an automobile and how to travel to familiar places. However, at some point as the disease progresses, their driving abilities do become impaired. Unfortunately, people with dementia often cannot recognize when they should no longer drive.

Health problems –– Other illnesses common among older people can affect your ability to drive safely. For example, having arthritis, Parkinson’s disease, or stroke, makes it harder to handle a car safely. Sleep problems or fainting make you less alert at an age when you may already have a hard time focusing your attention. If you have an automatic defibrillator or pacemaker, your doctor might suggest that you stop driving. There is a chance that the device might cause an irregular heartbeat or dizziness while driving. Diabetes may cause nerve damage in your hands, legs, or eyes. The eye damage in diabetes is known as diabetic retinopathy. If you also have trouble controlling your blood sugar level and might be in danger of losing consciousness, you should think about giving up your license.

Medications –– Older Americans take more prescription medicines than any other age group. They often have one or more long-term illnesses such as arthritis, diabetes, high blood pressure, and heart disease and may be taking several different drugs. Their bodies may be more sensitive to the effects of medicine on their central nervous systems. The older body may not use up a drug as quickly as a younger body does, so the drug can be active in them for a longer time. Sometimes a combination of medicines increases the effects of each drug on the body.

Several types of medication can make driving harder because they affect the central nervous system. Drugs that might interfere with your driving include sleep aids, medicine to treat depression, antihistamines for allergies and colds, strong pain-killers, and diabetes medications. If you are taking one or more of them, talk to your doctor. Perhaps he or she could change your prescription, or help you decide if the medicine is affecting your driving.

Can I Be a Better Driver?

Perhaps you already know some driving situations that are hard ––night, highways, rush hour, and bad weather. You might avoid these types of driving and limit your trips to shopping and visits to the doctor. This lowers your chance of having an accident.

While driving, older drivers are most at risk while yielding right of way, turning, especially left turns, lane changing, passing, and using expressway ramps. Pay extra attention at those times. If there is not a left-turn light, look for alternate routes that do provide such lights.

Most of the advice for older drivers is helpful for all drivers. Plan your trips ahead of time. Stick to streets you know. Don’t drive under stress. Keep distractions such as the fan, radio, or talking, to a minimum. Leave a big space between your car and the one in front of you. Don’t drive when you are tired.

Think about taking a driving refresher class. Some car insurance companies reduce your payment if you pass such a class. The AARP (American Association of Retired Persons) sponsors the "55 ALIVE/Driver Safety Program." Call 1-888-227-7669 (1-888-AARP NOW) for details about courses in your area. The AAA (American Automobile Association) has a similar class called "Safe Driving for Mature Operators." Contact your local AAA’s office for class information. These are 8-hour classroom courses that talk about the aging process and help drivers adjust. You might also check with a local private driving school. Ask if they have an instructor who teaches older drivers. You might want to take such a review every few years.

Certain features on your car can make driving easier. Power steering, power brakes, automatic transmission, and larger mirrors are all helpful. Keeping the headlights on at all times and having a light-colored car helps other drivers see you. Hand controls for the accelerator and brakes might be of use to someone with leg problems. Keep the headlights clean and aligned, and check the windshield wiper blades often. A rear-window defroster is a good way to keep that window clear at all times.

Air bags have saved many lives. Advanced age is not a reason for disconnecting an air bag. However, the National Highway Traffic Safety Administration suggests that air bags may not be as effective in preventing serious injury or death in people over 70 years of age as they are in younger people. Older people are more likely to be injured in a traffic accident. Their bones and blood vessels may be rigid. They might break easily. If the accident is minor, emergency personnel may not realize the possibility of internal bleeding in time. People of any age should push their seats as far back as possible from the air bags in both the steering wheel and the passenger side. Of course, everyone in the car should always wear their seat belts.

Should I Stop Driving?

What if you are doing all you can to be a safe driver and still wonder if you should stop driving. This is a difficult decision. There are questions to ask yourself. Do other drivers often honk at you? Have you had some accidents, even "fender benders"? Are you getting lost, even on well-known roads? Do cars or pedestrians seem to appear out of nowhere? Have family, friends, or your doctor said they were worried about your driving? Do you drive less because you are not as confident about your ability as you once were? If you answered yes to any of these, you probably should think seriously about whether or not you are still a safe driver.

There are resources that may help you make this decision. Single copies of the AARP guide, "The Older Driver Skill Assessment and Resource Guide: Creating Mobility Choices," are available free by writing AARP Fulfillment, 601 E Street, NW, Washington, DC 20049, and asking for publication D14957. The AAA Foundation for Traffic Safety has several free books, including "Drivers 55-Plus: Test Your Own Performance," that may be viewed and ordered on their Web site. The Hartford company offers "At The Crossroads: A Guide to Alzheimer's Disease, Dementia & Driving." See Resources at the end of this leaflet for the telephone numbers and addresses.

There are currently no upper age limits for driving. Because people age at different rates, it is not possible to choose one age as the limit. Setting an age limit would leave some drivers on the road too long, while others would be stopped too soon. Heredity, general health, your way of life, and surroundings all influence how you age.

The hard question is whether older drivers should be tested differently and more often. A second question is what would those tests be. The usual road and written tests do not look at the problem areas for older drivers. The useful-field-of-view test is being studied as one possibility. This looks at the amount of viewing area in which someone can absorb information from two different sources and how quickly they respond to it. This area becomes smaller as we age. The smaller the area, the more likely one is to crash. Fortunately, this is a problem that can be improved by training. A doctor who could then certify the driver to the Department of Motor Vehicles would best perform this test.

The Mini Mental Status Exam is also a possible test used to decide if a person is no longer able to drive. This test looks at your ability to perform certain mental tasks. These tasks test those mental skills involved in driving, although they might seem different. You might be asked to copy a particular design or to count backwards from 100 by sevens. Like the useful-field-of-view test, this is not now used for testing drivers.

The aim of these tests is not to get every older driver off the road. Instead, if problem drivers can be identified, some of them could then receive training to improve their driving skills. Unfortunately, others cannot be helped by training and will have to stop driving.

How Will I Get Around?

When planning for retirement, you should think about how you’d get around if you were no longer able to drive. Some communities provide low-cost bus or taxi service for older people. Some offer carpools or transportation on request. Religious groups sometimes have volunteers who take seniors where they need to go.

If such services are not available in your community, taxis may seem too expensive to use often. Remember that you won’t have a car to maintain any longer. In fact, the AAA estimates that the cost of owning and running the average car is over $6,500 a year. By giving up your car, you might have as much as $125 a week that could be used for taxis, public transportation, or buying gas for friends and relatives who can drive you places.

You can contact your local Agency on Aging to learn about transportation services available in your area.

Resources

These organizations have information for older drivers.

Administration on Aging
330 Independence Avenue, SW
Washington, DC 20201
202-619-7501
Website: http://www.aoa.gov

American Association of Retired Persons
601 E Street, NW
Washington, DC 20049
202-434-2277
1-800-424-3410
Website: http://www.aarp.org

American Automobile Association
1000 AAA Drive
Heathrow, FL 32746
407-444-7000
Website: http://www.aaa.com

AAA Foundation for Traffic Safety
1440 New York Avenue, NW Suite 201
Washington, DC 20005
202-638-5944
Website: http://www.aaafoundation.org

Eldercare Locator
1-800-677-1116
Website: http://www.eldercare.gov

The National Institute on Aging (NIA) offers free information on health and aging. For a list of publications contact:

NIA Information Center
PO Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
Website: http://www.nia.nih.gov/

The booklet At The Crossroads: A Guide to Alzheimer's Disease, Dementia & Driving is available in English and Spanish. For a free copy write or call:

The Hartford
200 Executive Boulevard
Southington, CT 06489
860-547-5000
Website: http://www.thehartford.com/alzheimers/

 

National Institute on Aging
U. S. Department of Health and Human Services
National Institutes of Health
Revised 2002

This document sourced from the National Institute on Aging.




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