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Monday, March 25, 2013

Have you planned your retirement from driving?

When should drivers retire from driving? This question is always difficult to answer.  In our suburban car culture driving allows seniors to maintain their independence and prevents social isolation. However, at what point does it become unsafe for the elderly to drive and what are the risks?
One month ago my fit and about 80-year-old in-laws were involved in a serious car accident. A young man crashed into the passenger side back corner of their car on the highway as he shifted from right to left lane behind them causing them to lose control, and sending them head on into the concrete median of the highway.  He drove away, his car and him unscathed, but my in-laws were not so lucky.  Their car was totaled and they were taken to Grady Hospital in Atlanta. My father-in-law, who suffered a lumbar fracture and contusions, was released after three days. My mother-in-law had more serious injuries—she fractured all of her ribs on the left, her sternum, and subluxed her cervical spine to a dangerous degree requiring emergent decompression and fusion or the cervical spine to prevent spinal cord injury. She stayed in the hospital for one week, and then came to our home to convalesce for another three weeks, requiring physical therapy, home oxygen, a home health aide and multiple assistive devices to help with her activities of daily living. Fortunately, she has done very well, and recently has flown home to Michigan where she will continue to do physical therapy to try to regain her former functional ability, which was fantastic (just before the accident she was giving dinner parties and had planted pansies in my back yard).  My father in law was also in great shape—an avid gardener and retired physician. He maintains his medical license and stays current by reading the New England Journal of Medicine.
It would never have occurred to me to caution my in-laws not to drive, either as a physician or as a concerned family member, given their excellent physical and cognitive functioning.  However, the accident did cause me to reflect upon the issue of driving and safety for seniors.  There are two components of driving risk for the elderly:   the risk that a senior driver could present to another person on the road, and that which an elderly driver poses to his or herself. 
It turns out that with the aging process, changes in the architecture and mechanics of bones makes them more prone to fracture. Not only are bones more osteoporotic, but also the rib cage changes shape making it more susceptible to injury by frontal force.  Loss of muscle mass and subcutaneous fat increase the likelihood of serious injury.  My mother-in-law, the front passenger, restrained by a seat belt and cushioned by the airbag of her Hyundai Sonata, certainly was a victim of these physiological changes. 
According to the National Highway Traffic SafetyAdministration the elderly (persons 65 and older) make up 16% of traffic fatalities.  As we all know the elderly are a growing percent of our population. What will happen to travel patterns as our population ages? 
A study by the AARP in 2012 looked at the impact of the baby boom on travel and recommended research into strategies aimed to address the specific transportation needs of the senior population.
Debra Whitman, AARP Executive Vice President for Policy, quoted in the Huffington Post report on this study, said: “people who live past age 70 will outlive their driving years by seven to 10 years on average. The challenge will come when the generation that is turning the suburbs gray hangs up the keys.”
Often family members come to physicians asking for help with telling their loved one not to drive. I remember one patient who was 90 and had dementia and severe cardiovascular disease. I recommended to his family that he quit driving after he had several fender benders in town. However, I would have liked for him to stop before the fender benders. There are a variety of resources on line to help guide seniors and their family members on decision making about driving in the elderly.   In the case of my in-laws my feeling is that they, and many other octogenarians in similar shape should safely be able to drive. However, given their increased risk of serious injury, perhaps car design needs to evolve to better meet the safety needs of the elderly driver and passenger.
What is your plan for driving and transportation as you grow older? Have you given it thought? Are you confident that you will know when it’s time to turn over the keys? Just as middle-aged adults think about retirement, long-term care insurance, estate planning and advanced directives, they should also think about their plan for transportation as they grow older.  In turn there is a social need to address how to maintain safe and efficient transportation for our seniors, which enables our healthy octogenarians to maintain independent living for as long as possible.
Here are some helpful resources:
Older Drivers (National Institute on Aging)
Physician’s Guide to Assessing and Counseling Older Drivers (AMA)