What Should We Do About Grandma's Driving?

Many remember the dozens of deaths and injuries that occurred in 2003, when an 86-year-old man accidentally hit the accelerator instead of the brakes, hurtling through a farmers' market in Santa Monica, California. Just a few years ago, an 84-year-old woman killed an eight-year-old boy after she plowed through an elementary-school lunch room in Shiloh, Illinois — on her way to a driver-rehabilitation class.

Far from being isolated incidents, these examples of fatally bad driving by older people are supported by a growing body of evidence — both anecdotal and statistical — that has fueled an unprecedented urgency around the problem of unsafe driving by seniors.

And fortunately, the alarm may be having its own effects: Despite growing numbers on the road, fewer older drivers are actually involved in fatal collisions now than in years past, according to an important new study by the Insurance Institute for Highway Safety. "The findings are a welcome surprise," said Anne McCartt, Institute senior vice president for research.

In this first installment of Edmunds' senior-driving series, we'll outline the challenges posed by shaky senior drivers on American roads and the progress being made in addressing it. In subsequent articles, we'll explore:

• Why intersections pose the greatest difficulty for elderly drivers
• How self-limitation, occupational therapy and regulatory rigor are easing the senior-driving problem
• Which suitable vehicles and accessories can help senior drivers improve
• Hanging up the keys: how seniors can adjust if the transition is handled with sensitivity and practicality
• How Florida can teach other states how to address the challenge of senior driving

The Dimensions of the Problem

"Overall, older drivers are safer drivers because they're more cautious," said Anne Dickerson, chair of the occupational therapy department and a geriatric-driving expert at East Carolina University. "But there is a certain point at which someone shouldn't be behind the wheel anymore."

There's certainly no arguing with the numbers and trends:

• A total of 4,268 people aged 70 and older died in motor vehicle crashes in 2008. Though their crash rates are about the same as for teenagers, more seniors die because they're more fragile.
• Both licensure and mileage have been going up among seniors: 77 percent of people 70 and older were licensed to drive in 2007, compared to 73 percent in 1997 according to the Insurance Institute for Highway Safety.
• 75 percent of people 65 and older were licensed to drive in 1995, compared with just 63 percent in 1983, while rates for drivers of other ages remained stable, according to the Insurance Institute for Highway Safety.
• Older drivers are much less likely than younger ones to be involved in crashes related to high speeds or alcohol. But they are much more likely to crash at intersections, where their limitations often create a "perfect storm" of indecision and vulnerability.

At the same time, there's more statistical evidence of a hopeful trend that partially offsets the others: Crash deaths among drivers 70 and older fell 21 percent from 1997 through 2006, even as the population of people 70 and older rose by 10 percent. This decline in fatal-crash involvement was much larger than that among drivers aged 35 through 54.

The Inescapable: Death, Taxes — and Bad Driving?

Elderly drivers inevitably become poor drivers because of three close companions of old age: fading vision, diminishing physical dexterity and deterioration in cognitive abilities. Layer on top of those endemic problems the challenges faced by many individuals that are related to acute conditions and diseases, ranging from Alzheimer's to diabetes to arthritis. For a good number of seniors, the medications they take to combat such conditions can pose their own challenge to competent driving.

But simply taking away the keys isn't a panacea; it creates different problems. For a clear-minded and otherwise competent adult, hanging up the keys can seem like walking into a prison of immobile dependence. It can also put tremendous pressure on family and friends to provide transportation.

Elinor Ginzler, director for livable communities for the AARP in Washington, D.C., said, "We put immense emphasis on driving, because it has not only a symbolic but also a very real connection to independence." So while most states recently have put into effect rules that restrict driving for the youngest teenagers, it isn't as simple to put the clamps on drivers later in life.

Societal Response Begins to Catch Up

One unfortunate aspect of the problem is that American attitudes and institutions haven't kept pace with the mushrooming of the population of senior drivers. "Structures in society, from whole communities down to individual families, simply haven't caught up with the new reality and adjusted and figured out ways to deal with it," said Elizabeth Dugan, assistant professor of geriatric medicine at the University of Massachusetts Medical School, and author of the book Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families.

Fortunately, their own experiences and judgment are leading more elderly drivers to reconsider their practices and limit their driving at night, in bad weather and in other instances. That appears to be the overwhelming reason why fatal crashes involving the oldest drivers have reversed trend. Institute researchers are still trying to understand the factors behind the encouraging results of their survey, which was released in early 2009.

"They may just be more educated about the risks now," said McCartt, noting that there's also more awareness of the risks of driving on the other end of the eligibility spectrum, among teenagers. Yet in a separate, parallel Institute study, fewer than 1 percent of elderly drivers interviewed had been advised by family, friends or a doctor to give up driving.

Improved health of the typical, say, 75-year-old today compared with even a decade ago is another development contributing to the declining fatality rate, McCartt said. So is "the fact that older drivers have different lifestyles and patterns of mobility than older drivers in the past," she said. For instance, as the geographic footprint of Americans' lives continues to spread, seniors end up doing more driving on highways than before — which are the safest types of roads.

At the same time, self-limitation isn't a panacea. So grassroots political pressure — much of it arising in the wake of recent high-profile accidents around the country — has prompted some state legislatures to stiffen license-renewal requirements as drivers get older and lose faculties. Still other progress is being made in the research-and-development laboratories of automakers, as engineers find ways to make vehicles more senior-friendly. And as this problem appears on the radar of more policy-makers and politicians, government and not-for-profit agencies are making some gains at the community level.

Next Behind the Wheel: Old Boomers

Yet this problem will continue to present itself: The baby boom generation is just now beginning to reach retirement age and to see deterioration in its own physical and cognitive capabilities for driving. Today, one in seven licensed drivers is 65 years old or older, but within two decades that ratio will be almost one in four.

This huge demographic wave will compound today's senior driving problems, just as boomers have dramatically altered nearly every other collective experience. Safety analysts predict that boomers will be responsible for 25 percent of all fatal crashes by 2030, when all will be at least 65 years old, compared with 11 percent of fatal crashes involving drivers 65 or older in 2005.

"This is a huge number of people, and they are people who were all born and raised with cars in their families," notes Eero Laanso, human-factors engineer for Ford Motor Company. "They've led active lifestyles involving cars. And just because they reach a certain place in their lives, they're not going to say, 'I'm too old to drive now.'"