The dangers posed by senior drivers — combined with the difficulty of figuring out when they have reached the point of posing a risk — are spurring unprecedented efforts to come up with solutions.
How To Improve Seniors' Driving Skills
These initiatives to improve seniors' driving skills include more self-limited driving, improvement classes, vision adjustments, physical rehabilitation, cognitive-skills enhancement and tougher licensing laws.
Here's a look at some of what researchers, insurers, not-for-profit associations, health-care organizations, government agencies and seniors themselves are doing in each area:
Many members of the over-65 generation limit their own driving as they recognize some deterioration in their capabilities. Typical self-limiting includes avoiding crowded thoroughfares and taking alternate routes, though this makes trips longer. Seniors also try to find intersections with protected left turns. Many decide to travel only a handful of close-to-home, highly familiar routes — and nowhere else — behind the wheel.
Other elderly drivers decide to give up driving altogether in the interests of their own and others' safety; more than 600,000 drivers age 70 or older do just that each year, according to a 2002 study published in the American Journal of Public Health.
A surprising surge in self-limitation seems to be behind the 21-percent improvement in the number of crash deaths among drivers 70 and older in a 10-year Insurance Institute for Highway Safety study. The declines were most dramatic for drivers 80 and older. If the fatal-crash involvement rates for older drivers had mirrored the trend for younger ones in the same time period, the Institute said, nearly 7,000 additional older drivers would have been in fatal crashes.
The older a driver is, and the more physically and cognitively impaired he or she is, the more the senior tends to self-limit driving, according to Institute interviews that accompanied the broader study.
The willingness of many aging motorists to regulate themselves prevents countless accidents. In fact, seniors' tendency to self-limit is one of the main reasons that insurance rates are generally only slightly higher for drivers 75 or older than for the generation just beneath them — and far lower than rates for teenage drivers. Another reason insurers don't see older drivers as a particular liability menace is that they tend to injure themselves more than others in accidents.
Driving Improvement Classes
Older drivers are finding more ways to gauge their own effectiveness behind the wheel. The American Automobile Association Foundation, for instance, has an online self-rating form for drivers 55 and older. Several other organizations are making similar resources available on the Web.
More seniors also are taking it upon themselves to improve their driving by attending self-help classes. The American Association of Retired Persons (AARP), for example, offers a driver safety program at sites around the country and online. The 8-hour class is for drivers 50 and older. Typically, participants can take their certificate of completion and show it to their insurance company to get a discount of 5-10 percent on their premiums, according to Jack Stegeman, a volunteer AARP instructor in Madison Heights, Michigan.
One emphasis of the classes is to urge seniors to step up to their own responsibility for driving. For instance, "We don't talk about 'accidents' but rather about 'crashes,' because an accident just says, 'It's too bad it happened,'" says Stegeman, a retired schoolteacher. "A 'crash' is where someone didn't see something or reacted inappropriately, and we need to get class members thinking that way."
Another theme stresses "taking a little more time to make decisions as you drive, because that's how our body functions as we get older," says Nancy Stegeman, a retired nurse who teaches with her husband.
The declining vision of seniors is the most difficult aspect of driving to mitigate. "Ninety to 95 percent of the information you get in driving is visual information," said Dr. Philip Hessburg, president of the Detroit Institute of Ophthalmology.
Yet many vision-impaired older people take a big swipe at the problem simply by declining to drive at twilight or later. Others realize major improvements after having cataract or other eye surgery. And some researchers believe that more diligent instruction of senior drivers actually can help them use their vision more effectively, even if they can't restore their eyes physically.
"A common problem with seniors is that they fail to scan appropriately by moving their eyes completely through the driving environment," said Richard Backs, a psychology professor who is developing a visual attention test for drivers at Central Michigan University. Seniors may spend too long focusing on changing lanes, for example, risking an accident by not shifting their attention to traffic approaching in their rearview mirror. Some seniors invest in the handful of devices that have proven to improve senior road vision, such as special eyeglasses that reduce glare and have a telescopic function.
"But even with any of those, you really have to work with your doctor and maybe a low-vision specialist and with a driving instructor," said Judy Scott, director of the Center on Vision Loss for the American Foundation for the Blind.
The elderly can actually improve their driving skills and help stave off decline through various types of exercise and physical therapy.
New research by the Yale University School of Medicine, for example, found that even a moderate regimen of physical therapy specifically designed for the task — only 15 minutes of exercises a day — could significantly improve flexibility, coordination and speed of movement of extremities in drivers 70 years old and older who were afflicted with various limitations such as arthritis. The success of the therapy, in turn, is projected to improve driving performance by at least an 8 percent lower crash occurrence over two years.
"Our hope was to make small improvements in several areas of physical functioning that, taken together, were meaningful, and that's essentially what we found," said Dr. Richard Marottoli, associate professor of medicine at Yale. "Next, we want to look at whether people who might not yet have these limitations could relatively easily incorporate some of these activities and prevent [driving] problems down the road."
Drivers' cognitive capabilities are the hardest to test but probably the most important to strengthen for continued driving. State-sponsored research in Maryland has shown that if a driver fails a cognitive test, he is 25 percent more likely to be involved in a crash.
Cognitive abilities important to driving can be prolonged and even rehabilitated. The brain gets lulled by routine, which does little to stimulate new cell growth. But challenged to adjust to new locales and situations, cognitive abilities can recover somewhat, even in the aged, some scientists believe.
That's the premise, for example, behind Golden DriveFit software, a Web-based simulation program. Mainly harnessing the movements of abstract objects instead of depictions of vehicles, the subcription-based software pushes the user to improve speed estimation, for example.
"These exercises challenge the same areas of the brain that you use in actual situations," said Shlomo Breznitz, a psychology professor who founded the company in Haifa, Israel. "Those parts of the brain that become more active in the simulator tasks become more effective after some training and can do better in actual driving."
A new entrant in the field is DriveSharp, a brain fitness program claiming clinical proof that it helps drivers react faster and cuts crash risk by 50 percent. The improvement in physical and cognitive health of today's seniors may be another major factor in the 21-percent improvement in the crash-fatality rate that stunned Insurance Institute researchers. "This trend has some important implications," said Anne McCartt, Institute senior vice president of research. "For instance, if older drivers are healthier and more physically fit, they may be driving differently — but also may drive different places and have different travel patterns, such as spending more time on highways, which are the safest types of roads for them."
Tougher Licensing Laws
Although it seems like the most obvious solution, no state has imposed an absolute limit on the age of drivers. Only Illinois and New Hampshire require road tests for older drivers to renew their licenses, though other states are mandating written or visual tests or proof of medical fitness after a specific age.
The reason this approach isn't more common is that states simply haven't been able to establish general standards for determining when seniors should be kept off the roads without being unfair to more capable older drivers. "If we're going to retest older drivers, shouldn't we retest drivers of all ages every time you renew your license?" asked Jason King, vice president of the American Association of Motor Vehicle Administrators. "Who knows what's happened to anybody, physically or mentally, since last time they were tested?"
And so, while everyone wants to toughen up licensing, the entire field has concluded that it's better to evaluate drivers individually rather than sweep away drivers of a certain advanced age with a broad brush. In fact, forcing seniors to appear at motor-vehicle departments in person to renew their driver licenses is the only measure that has been statistically proven to lower the rate of fatal crashes involving elderly drivers, according to the Insurance Institute for Highway Safety, citing a 1995 study in the Journal of the American Medical Association.
Maryland has put together what some call a model for the nation with its multitiered program of driver screening and assessment, coupled with a broad-based program of education, counseling, training and remediation. Medical advisory boards in Maryland review an average of 7,000 cases a year for medical fitness to drive.
But this system works in Maryland only because state-paid physicians serve the advisory boards full-time. In many other states, the evaluators are part-time only, and there are other inconsistencies that currently undermine effectiveness. As the elderly population grows, said King, "There's a pretty good chance that you're going to see other states end up following the model that Maryland has created."
Below are links to all of the installments in this series.
Dale Buss is a journalist and author based near Detroit.