THE OLDER DRIVER
Posted by admin on November 2nd, 2008THE OLDER DRIVER
Safe driving involves the integration of complex motor, visual, and cognitive activities. A single traffic movement results from many decisions and reactions to myriad visual (and often auditory) stimuli.
In the USA, more than 13% of drivers are over age 65. Despite moderate deterioration of mental, motor, optic, and auditory functions, the elderly usually drive safely, probably because most driving patterns are learned and become second nature. Thus, performance is impaired only after considerable loss of function. Furthermore, the elderly tend to drive fewer miles, shorter distances, less at night, seldom in rush hours, and more slowly and cautiously. Average annual mileage declines steadily with age, decreasing 64% from age 65 to age 85.
Despite these compensations, elderly drivers have higher rates of traffic violations, collisions, and fatalities per mile than younger drivers. Two of the most common violations, failure to yield the right-of-way and failure to obey a traffic sign, probably result from functional deficits and often lead to collisions, mainly at intersections (see FIG. 112-1). Older drivers have higher collision rates per mile than any other age group, except for the youngest drivers (those < 24 yr), as shown in FIG. 112-2. However, these rates do not really begin to increase until age 70; after age 80, they increase rapidly.
Older drivers tend to fare worse in collisions. The collisions are more likely to involve multiple vehicles (which may reflect the patterns of driving, such as more daytime than nighttime driving) and to result in serious injuries and fatalities (which probably reflects underlying frailty, concurrent illnesses, and impaired recovery).
In assessing an elder’s ability to drive, the physician must consider both public safety and the patient’s independence. Many states have laws concerning the obligation of physicians to report impaired drivers. Yet an inability to drive means a loss of independence because public transportation is usually impractical for essential trips, such as food shopping and medical visits. Elders forced to stop driving rely more on their family for essential trips and reduce their social activities. These elders become depressed more often than those who continue to drive.
The elderly also require careful assessment before undertaking certain other potentially hazardous activities, such as piloting aircraft or boats. These activities are regulated by local, state, and federal authorities. Physicians must be aware of their legal role and their social and medical obligations before advising elderly persons as to their fitness to undertake such activities.
Evaluation of older drivers should include a functional assessment as well as a consideration of the impact of illnesses and medications on driving.
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