Clinical Geriatrics

Most people have had a close call with another car, a person walking, or an object while driving.

Many people have also had car accidents. How do older adults and caregivers know when these situations are cause for concern?

Q. How old is too old to drive?
A. People can be great drivers or bad drivers at any age. Generally, young, new drivers tend to have the worst driving records. Experienced, middle-aged drivers are likely to have the best driving records. Overall, older drivers make appropriate adjustments for their abilities and limitations and are pretty safe too. In fact, the total number of accidents that involve older drivers is lower than for any other age group. However, the number of accidents per mile driven goes up around age 60, and gets much higher after 75. By the age of 85, the risk exceeds that of the teenaged driver. In fact, crashes are the number one cause of injuryrelated death in people between 65 and 75.

It is important to recognize that old age alone does not lead to increased crashes! But old age is often associated with illness and medications that can increase risk of crashes. Many older adults take multiple medicines and have conditions that increase the risk of unsafe driving such as: Alzheimer's disease, vision problems, stroke, Parkinson's disease, arthritis, and diabetes.

Q. What are some signs of unsafe driving?
A. Signs include:
Merging or changing lanes without looking;
Trouble staying in the lane;
Turning from the wrong lane;
Getting lost in familiar places;
Stopping at a green light;
Stopping when there is no reason to stop;
Becoming disoriented in the middle of intersections;
Finding traffic signs and signals confusing;
Running stop signs or red lights without realizing it;
Driving the wrong way against traffic;
Backing up when intending to go forward.
Nearly hitting cars, people or objects without realizing it;
Repeated fender benders or major crashes;
Mistaking the gas pedal for the brake pedal;

Q. What can people do to be safer drivers?
A. Although the risk of crashes and serious crash-related injuries often increases as people get older, there are many steps that can be taken at any age to drive more safely.
Steps include:
Avoid driving at night, in heavy traffic, and on unfamiliar roads;
Know the rules of the road. They can be found in a state driver's handbook;
Take a driving class from a driving instructor or a rehabilitation specialist; and
Take a refresher course offered by groups such as:
o AARP (formally known as the American Association of Retired Persons);
o The Automobile Association of America (AAA); or
o The National Safety Council

Q. Who can help figure out if driving skills are a problem?
A. Rehabilitation Centers (e.g., Vocational Rehabilitation Centers, Veterans Administration Centers) usually provide the best driving evaluations. Driving schools may help, but remember that they are not trained to recognize or diagnose medical problems. State licensing agencies also give driving evaluations.

Q. How can a health care provider he lp address concerns about driving?
A. It is very important that the doctor or other health care provider cares and listens carefully to concerns about driving ability. Once the issue is discussed, a thorough medical and medication review should be conducted. This will help determine if there are treatable problems that may be contributing to driving difficulties. Vision and memory tests are important. Finally, your health care provider may be able to suggest a driver's education/refresher class. A person may also be referred to a driving evaluation program.

Q. What can caregivers do if they are concerned about a loved one's driving?
A. This can be the hardest issue that caregivers face as an older person develops conditions that make them unfit to drive. It is important to recognize how important driving is to many older people.