Health Officer Column
Nearly everybody over 45 has probably worried about a elderly parent or other loved one’s safety when driving. Crashes caused by older drivers are a significant public health issue, especially in Maine with its oldest median age of all the states, and its predominantly rural environment that lacks much public transportation. In those rural areas, like Vienna, nearly 20% of the population is already over 65, which the rest of the country is not predicted to achieve until 2030. So seniors who live here must have a car and be able to drive to get most things done they need to do, from shopping, to medical care, to entertainment, despite recent local improvements in those and other services. And we hear reports of crashes involving elderly drivers constantly in the news recently. So what are the issues and what can be done to diminish the risks without isolating our seniors?
Here are national fatality rates per mile driven by driver age group (graph #1) As you can see, at about age 70, these rates start to climb from younger adult rates but don’t exceed the teen rates until age 85. But not all this fatality increase is from increased crash rates; at least half is because older people are more fragile and break more easily in a crash. But older Mainers do have an increased rate of crashes with increasing age beyond about age 70 per mile driven (graph #2), though barely higher rates per driver, because most older drivers decrease and limit their driving more than younger adults.
Not everybody ages at the same rate, so age group definitions are unfairly limiting. And not all medical limitations prevent driving, at least with limits (fewer miles, day time, no throughways, in local areas, etc.). Older drivers with intact cognition usually self-impose those restrictions; the most troublesome group are those with early dementia, who are likely to progress over 1-2 years and must rely sometimes (not always) on others to suggest or impose limitations for their own and others safety. But the reality is that the average person has to retire from driving 5-10 years before they die. So we all need to plan for how to recognize and decide when its time.
Drivers themselves and their families must be vigilant to recognize serious limitations as they develop, like hitting the gas instead of the brake, minor or major car damage/crashes, failing to stop for stop signs or stop lights, trouble making left turns, driving too fast or slowly for the traffic conditions, and family feeling it is not safe for others (like grandchildren) to ride with the senior driver (hartfordauto.thehartford.com/UI/Downloads/FamConHtd.pdf). Family members can check by riding with or following the senior driver, or, if there is doubt, encourage self-screening with a very helpful on-line series of tests from the American Automobile Association called Roadwise Review (http://seniordriving.aaa.com/evaluate-your-driving-ability/self-rating-tool). Sometimes a road test with an occupational therapy department driving tester or with the Bureau of Motor Vehicles (BMV) may be necessary and can be suggested by the driver’s doctor on the BMV form usually filled out when there are potential medical issues. In the rare case where a senior driver appears impaired but will not engage in evaluation, anybody can report their concerns to the BMV, neighbor, family member, doctor or police. This will precipitate a re-evaluation.
And finally, to make the transition easier, planning for how the retired senior driver can get along without driving is crucial to making it possible. The Independent Transportation Network, which originated in Portland, now has programs all over the country and in other cities in Maine whereby seniors can get transportation on-demand in exchange for having donated their car, or they or their family having volunteered time. But in rural areas, the local Area Agency on Aging, churches, friends, and the rare public transportation systems may be all that is available. Rarely leaving the old homestead and moving to where such services are more available may be necessary.
These are scary but important issues, best confronted directly when they appear, or someone can get hurt. Drivers, families and friends proactively need to evaluate and prepare for driver retirement when and if it is finally necessary.
Dan Onion: 293-2076, firstname.lastname@example.org
Vienna Health Officer