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Elderly Ex-Drivers Will Face a Transportation Roadblock

Nation underprepared to shuttle those who give up driving

MONDAY, July 29, 2002 (HealthDayNews) -- Each year, some 600,000 Americans age 70 and over will hang up their car keys for good and turn to friends, relatives, or public transportation for help getting around.

But that number is sure to grow as the population grays, and the nation is unprepared to deal with the burdens it will place on the country's mass transit system, according to a new report by government researchers.

"Our public transportation services are not well suited for older people because the reasons they quit driving are health-related and won't be compatible for [travel] on buses and subways," said Dan Foley, an epidemiologist at the National Institute on Aging and lead author of the study, which appears in the August issue of the American Journal of Public Health.

The situation is similar to what American long-term care looked like 20 or 30 years ago, said Foley: a one-lane road.

"Decades ago, when older people were very sick the only option they had was institutional care. We managed to do pretty well with plugging in community based long-term care services for older people," he added.

When it comes to making transportation systems more adaptable for the elderly and infirm, "I suspect we can have the same success," he said. "It's just a matter of recognizing that there's a large demand that's looming on the horizon."

Although city dwellers have access to public transportation, the rural and deep-suburban elderly are unlikely to be near such services, Foley said. How to meet their needs is a particular challenge.

In 1993, government figures show, 13.7 million Americans age 70 and older were driving. That accounted for 82 percent of men and 55 percent of women in that age group.

Foley and his colleagues drew their results from a survey of 4,699 elderly drivers first contacted in 1993 and followed up again two years later.

People still behind the wheel between the ages of 70 and 74 can expect to keep driving for another 11 years or so. But men in this group will live 17 years more, on average, while women are likely to live 21 more years -- leaving six and 10 years, respectively, of dependence on others for transportation.

Nearly 10 percent of the nation's drivers are 65 or older. However, that share will grow sharply by the year 2030, when 20 percent of Americans will be over 65. By then, 10 million people, and maybe more, will be at least 85 years old, the year at which Foley found the highest rate of driving drop-off.

An estimated 400,000 drivers over 65 die each year. But many more are pulled over by poor vision, memory trouble, and health problems that affect their ability to eat, bathe, and otherwise care for themselves. These people are the ones whose needs frequently go beyond what public transportation can provide.

Unlike new, teen drivers, who tend to take risks, the elderly generally respect prudence and bow to their physical limitations.

"I'm not sure that people are driving longer than they should, with the exception of those with Alzheimer's disease, which robs them of their judgment," Foley said. "People tend to recognize their physical and visual impairments and its relation to their driving much more readily than they would their cognitive problems."

No state currently has a sunset age at which elderly drivers must cede their licenses. However, many require older motorists to be renewed more frequently than younger drivers. In Hawaii, for example, most drivers' licenses are good for six years, but people age 72 and above have to get their permit renewed every two years. Florida, on the other hand, has no such provision for its senior citizens.

The problem with driving laws based on age is that there's no reliable screening test to sort the good drivers from the risky ones, said Russ Rader, a spokesman for the Insurance Institute for Highway Safety. "There's been decades of research, but no screening test has yet been identified that could determine who should be on the road," he said.

The National Highway Traffic Safety Administration has begun paying special attention to older drivers. While the highest rates of crashes occur in teens, the risk of wrecks for seniors does start to climb above those of other adults, officials said.

Elderly motorists are also much more likely to die in accidents than are younger ones, perhaps because they're less able to withstand the trauma they sustain, Rader said.

NHTSA figures show nearly three deaths per 100 million vehicle miles traveled for drivers ages 70 to 75, compared with 0.7 deaths among drivers in their 40s. The rate is even higher among motorists in their 80s, and reaches nearly eight deaths per 100 million miles for those 85 and up.

Since health problems are the leading reason people give up driving, the agency is studying whether doctors' offices might be a reasonable place to evaluate an older patient's road readiness.

Also of interest to agency researchers is the impact of prescription medications on driving ability. It's not known, for example, whether these drugs -- and very often seniors take combinations of pills -- impair reflexes and reaction times the way alcohol or marijuana have been shown to do.

NHTSA recently funded a pilot program in Maryland to monitor older drivers' reaction times, field of vision and other skills at motor vehicle licensing facilities and two senior centers, rather than rely on road performance. Results from the project should be available by the end of the year.

Jason King, a spokesman for the American Association of Motor Vehicle Administrators, said if that program proves a success, it could help other states standardize their procedures for re-licensing aged motorists.

Until it's possible to do so, King said, his group doesn't support an age limit for drivers.

"It's very tough for us to support age-based testing because people age at different rates," King said. "Your driving privilege is really your key to independence."

What To Do

For more on issues older drivers face, try the National Highway Traffic Safety Administration. To learn some safety facts, steer your mouse toward the Insurance Institute for Highway Safety.

SOURCES: Dan Foley, M.D., biostatistician, National Institute on Aging, Bethesda, Md.; Russ Rader, spokesman, Insurance Institute for Highway Safety, Arlington, Va.; Jason King, spokesman, American Association of Motor Vehicle Administrators, Arlington, Va.; National Highway Traffic Safety Administration; August 2002 American Journal of Public Health
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