Driving Us Crazy

By Francine Russo

The first thing Peter Haugen noticed was that the dents in his mom's car were multiplying. Then the Osterville, Mass., software engineer learned that his mother, 85, had confused the brake and the gas pedal and ended up, unhurt, atop a stone wall. He pleaded with her to stop driving. He spoke to her doctor. He even persuaded her to see a geropsychologist.

Nothing worked. Like many older drivers, she clung to her license to preserve her mobility as well as her sense of independence and identity. But on July, 16, 2003, Haugen decided he had to do more. On that day, an 87-year-old driver made national headlines when he plowed into a Santa Monica, Calif., farmer's market, killing 10 people. "I told my sister," he recalls, "'We gotta get going on this. There but for the grace of God go we.'"

Enlisting the aid of their mother's doctor, her minister and the local police, Haugen and his sister persuaded their mom to get a driving assessment at the DriveWise program at Beth Israel Deaconess Medical Center in Boston. She failed. Mom was off the road, and--who knows?--perhaps another fatal accident was averted.

Haugen's call was one of a flood received by DriveWise director Lissa Kapust and other driving-safety centers around the country following the Santa Monica horror. For years, experts on highway safety and aging had been crying, "The boomers are coming! The boomers are coming!" But until Santa Monica, government and foundations had been sluggish in responding to the scary statistics. In seven years, the oldest boomers will turn 65; by 2030, 1 out of 4 drivers will be 65 or older. Not all older drivers pose safety hazards, but people 75 and older have more fatal crashes than any other group except teenagers. And drivers who are cognitively impaired--about 25% of the 65-and-older group--are 7.5 times as likely as nonimpaired drivers to be at fault in a crash, exceeding the rate for even drunk drivers.

After the Santa Monica accident, legislators, state departments of motor vehicles (DMVs) and others began putting a premium on older-driver safety. The push is occurring on several fronts: research to identify which drivers need testing, development of more accurate assessment tools, a greater focus on driver remediation and the creation of specialized licensing for the elderly. In addition, states and social-services agencies are starting or bolstering programs to support older people who have stopped driving, offering counseling and alternate transportation options. Backing up all these efforts, officials are launching public education campaigns to encourage testing of older drivers and counter their often passionate resistance to giving up driving.

New Hampshire and Illinois are the only states that require age-based road tests (for those 75 and older). Most states are wrestling with how to identify at-risk drivers scientifically without the difficulty and expense of testing everyone past a certain age. Maryland has been at the leading edge of research to determine the age at which large-scale screening of drivers makes sense. Preliminary results, says Dr. Robert Raleigh, chief of the Maryland Medical Advisory Board, indicate that 75 is the age at which screening at license renewal becomes most effective.

Currently, most state DMVs will call in any driver for assessment who has been reported to them by a police officer, a physician, a relative or any other concerned citizen. As a last resort, some adult children feel compelled to report their own parents. (Six states allow anonymous reporting.) Some complain that their parents' doctors are too timid about intervention. Linda Bryant, an administrative assistant in Orlando, Fla., was incensed when an eye doctor told her 76-year-old father that he was fine to drive. "I wrote the doctor," she says, "that if and when the accident happened, I'd send the victims to his doorstep as his liability."

Many new methods for assessing drivers are just now entering the market. Some are getting their first use at nonprofit senior-safety centers, whose numbers have expanded following the Santa Monica watershed. Florida has been at the forefront, having established five prototype driver-assessment centers in different cities. Each center uses DriveABLE, a system for examining drivers who are cognitively impaired because of dementia or complications of such medical conditions as stroke or diabetes.

DriveABLE was originally developed by Canadian neuropsychologist Allen Dobbs to help guide physicians in making driving-fitness decisions about patients with dementia. In a preliminary two-year study, Dobbs tested the performance of three groups of drivers: Alzheimer's patients, normal 65-and-older people and 30-to-40-year-olds. He found that the cognitively impaired drivers made different kinds of errors from normal drivers--errors that could prove deadly. He then created DriveABLE to help evaluators identify the most dangerous drivers.

The Senior Resource Center in Orlando was the first in the U.S. to be licensed to use the DriveABLE method. Aided by touch-screen computers, drivers are evaluated on judgment, decision making and attention shifting. Next, on a 40-min. road test--always the same course--a driving instructor marks each error a driver makes. A computer program then separates normal errors, like forgetting to signal a turn, from abnormal ones, like stopping at a green light. At the Orlando center, about 70% of those tested so far--many of them referred because of Alzheimer's--have failed. About 20% have been given remediation, which may include anything from larger rear-view mirrors for the car to cataract surgery for the driver.

Another assessment tool being developed is the driving simulator. An interactive simulator created by Northeastern University engineering professor Ron Mourant is currently being used at the University of Virginia's Driving Safety Laboratory. Equipped with a bucket seat and real car controls, the simulator offers drivers a virtual-reality road test. Some experts are worried that seniors' unfamiliarity with the high-tech setting may affect results, but others argue that simulators can project dangerous scenarios that would be unsafe on the road. Mourant views the simulator as a tool of persuasion: to help older drivers see their weaknesses and voluntarily stop driving.

The way older drivers are licensed is changing too. Iowa has introduced a requirement that drivers age 70 and older renew their licenses in person. If a DMV official suspects a problem, drivers may be asked to take a road test. They may then choose between taking the standard test or a newly devised "local" test. If they opt for the latter, an examiner will evaluate them on their usual route--to the store, to church, to the doctor and so on. Those who pass the local test are licensed only on that route and may also be restricted to lower speeds and daylight-only driving.

The local license has been a godsend to retired farmer Clair Leo Maguire, 74, of Danbury, Iowa, a town of 450. He loves driving to the restaurant, the newsstand and the post office, and he never goes outside his limits. "It's a pleasure to drive," he says, "but the farthest I go is five blocks to town--all paved streets."

Lola Barner of Monticello, Iowa, is not so fortunate. The retired schoolteacher, 72, failed her local test and has no way to get to her garden and crafts clubs. "It made me feel like I was hardly a person anymore," she laments. Although senior vans fill the gap in some communities and other alternate transportation programs are being created, their availability--especially in rural areas like Barner's--lags far behind the need. Her embarrassment at having lost her license, she says, holds her back from asking others for rides.

Iowa is among the states and national organizations seeking to instill the notion of "driving retirement" as a natural phase of life. Many in the field believe that older drivers must be taught to plan ahead for the time when they may no longer be able to drive. At a certain age, Raleigh of the Maryland Medical Advisory Board says, people should have their driving tested as routinely as they would have a colonoscopy or a mammogram. "Our goal," he says, "is to get people to realize that driving disability is like other diseases. If you pick it up early, you can make drivers safer longer and prevent terrible accidents." And when the disease becomes too advanced, older drivers need to accept, like Peter Haugen's mom, that the best remedy is to get out from behind the wheel.