Tag Archives: technology

The Freedom of the Road

Yellow car with blurred backgroundDriving is regarded almost as a right by those of us in Michigan.  We like our independence and the freedom of the road. But driving requires complex skills such as fine and gross motor coordination, sensory acuity, the ability to judge distances and speeds, quick reaction time, joint flexibility, concentration, and sound judgement.  To some degree, normal aging diminishes all of these skills. Add to that the health conditions that often accompany aging, and older drivers can be an accident waiting to happen. 

Older drivers travel fewer miles but have more accidents per mile than younger drivers, However, according to The Highway Loss Data Institute, a 2014 study revealed their vehicle crash involvement rates declined between 1997 and 2012, while the number of older drivers increased significantly by during that period.  The Institute also reports that, relative to younger drivers, crash rates and fatal crash rates begin increasing by about age 70.  Physical fragility increases from middle age onward, which largely accounts for the greater involvement in fatal crashes by older people.  

States vary greatly in their licensing provisions for older drivers.  Some require more frequent renewals and/or renewal in person and/or a vision care provider’s statement of visual acuity and/or a medical review following driving incidents.  Individual assessment of driving ability is necessary because each person ages uniquely, and blanket measures or an arbitrary age cutoff to limit or prohibit driving among older adults would penalize some who retain skills longer, and miss others who lose skills sooner. 

Our attachment to our personal vehicles has also contributed to mass transit systems that are not widespread or robust, leaving those who cannot drive with few options for transportation.  Keeping track of bus schedules and figuring out bus routes can be complex and confusing for older adults who have always driven their own car.  Mobility limitations may require curb-to-curb or door-to-door service, and these services are less available even than fixed route bus lines, especially when crossing community or county borders.  When my father became blind, he tried taking the bus, which stopped only three blocks from his home.  He found the waiting, inclement weather, uncertain schedules, and unpredictable responses from drivers and passengers to be more than he could tolerate.  He resorted to taxi rides, an expensive alternative.  

Many older adults self-limit their driving when they observe that they are not as able as they once were.  They stop driving at night if their night vision is poor, or they don’t drive in bad weather, because they know their reflexes are slower than in the past.  They may cease driving on the expressway because it requires rapid processing of a great deal of information.  They may turn off the radio or ask not to have conversation in the car, because it distracts from attention to the road.  Some no longer make left turns, which require judging both distance and speed in order to safely execute, and go past the desired street then make three right turns to take the direction they want. These measures may be sufficient to assure safety.

However, some older adults lack the insight to objectively observe their driving performance or ignore the signs because they are afraid of giving up their keys.  In those cases, either a driving mishap brings the problem to light or friends and family members muster the courage to address the issue earlier.  It’s more helpful to have a number of conversations over time, preferably before there is a concern about safety.  When the topic of driving arises in some other context, family members can use the opportunity to ask whether the older adult feels comfortable about his or her driving ability, and whether they have thought about the possibility that they may not be able to drive at some point in the future.  Their verbal and nonverbal answers will give you an idea of their attitudes and emotions around the subject.

There are a number of helpful websites and publications to inform older drivers about how to drive more safely and to coach families and friends on conducting conversations on driving.  The Hartford provides several publications that offer guidance on family conversations, driving evaluations, and driving and dementia.  The National Highway Traffic Safety Administration (NHTSA) offers resources to assist with self-evaluation and regulation of driving as well as family discussions, as do the AAA and the National Institute on AgingAARP has an online seminar called “We Need to Talk” to walk family members through the conversation process.

When older drivers are resistant to family concerns, the older adult’s physician may be of assistance in evaluating the physical and cognitive conditions that can impede safe driving, as well as offering advice for improving safety.  There are materials available to assist doctors with this task.  A helpful example is a joint online effort of the NHTSA and the American Medical Association, entitled “Physician’s Guide to Assessing and Counseling Older Drivers”, which the physician can submit for continuing medical education credit.  Michigan Department of State provides an online form, “Physician’s Statement of Examination”, which can be used to document to officials the medical interview and examination.

Driver rehabilitation is a recommendation that the physician may make.  This could include strengthening muscles, stretching exercises, improving vision with corrective lenses or surgery, and referral to a driver rehabilitation specialist, usually an occupational therapist.  This professional conducts a clinical and functional driving evaluation, assesses the vehicle for possible modifications and equipment, and recommends measure to improve safety.  Alternatively, the specialist may provide concrete documentation of unsafe driving.

Michigan has no requirement for accelerated driving license renewal, special terms of renewal or additional testing.  There is a form, OC-88, Request for Driver Evaluation, that anyone can submit who observes unsafe driving.  The person submitting the OC-88 must provide the driver’s identifying information, as much as known, the reason for the evaluation, and the requestor’s information.  The requestor’s identity will be “kept confidential to the extent permitted by Michigan and Federal law”.  The State will then require the driver in question to participate in a formal evaluation to determine whether they perform safely enough to retain their license.

Clearly whether older adults should continue to drive is a complex question with no pat answers.  In our culture, which greatly values youth and independence, older people find it highly challenging to maintain self-esteem in the face of increasing dependence.  Quality of life, and even longevity, are intimately related to opportunities for activity and social interaction and to retaining a sense of purpose.  In addition, many of us continue to work or to make contributions to society in other important ways.  We need to be sensitive and sensible in our approach to limiting or curtailing driving access, to the benefit of everyone involved.

Sue Sweeney, Assistant Professor, Aging Studies Program, Madonna University

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NCOA Tools for Self-Management

The National Council on Aging has some online tools to promote chronic disease self-management.  One is a web site entitled “Re-Imagine Your Life“, which explains chronic disease self-management programs (CDSMP), provides a video on how the training works, guides the viewer to find in-person or online workshops, offers several testimonials from people who are using what they learned from the workshops, and an FAQ about chronic disease self-management.  The online version of the training is called, “Better Choices, Better Health”, and is currently available free thanks to a gift from sanofi-aventis to the NCOA.  The font used on the web site is large and very readable, and the graphics are soft. The whole web site is very friendly.

The other online tool is a web site for alumni of the classes which they call the Healthier Living Alumni Community.  It’s intended to provide a vehicle for support and reinforcement for implementation of the beneficial decisions that the participants initiated at the CDSMP.  We need lots of tools like this to help people manage chronic illnesses, stabilize their conditions, improve function, and prevent further disability.  It takes considerable effort to change a person’s lifestyle, but the benefits in quality of life, increased productivity, fewer days of work lost, diminished need for medication, decreased burden on families, and lower health care costs, taken together, are immeasurable.  Sue Sweeney, Chair, Gerontology Department, Madonna University