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Chapter One

Assessing Fitness to Drive

Your aunt is 86 and has just returned from a care facility where she had stayed to recover from a fall. She walks very slowly and has difficulty with stairs, but she insists she is a safe driver and hasn't had any kind of traffic accident in more than 20 years. Still, you wonder, should she be driving?

Your father is 72 and is in relatively good health, but while driving with you recently on the highway, he strayed to the left-hand shoulder, then overcorrected with a sudden jerk of the wheel. This left you frightened and him defensively arguing that it wasn't a big deal. Is he at risk?

Your mother is 75 and you've noticed that in the past couple of years she has been repeating herself—sometimes telling you the same story twice in a conversation. You notice some dings on the bumpers of her car, and a scratch on the right side. When you ask her about them, she seems surprised and says they must be from other people bumping into her car while it was parked at the grocery store. Should you be worried about her driving?

These very common situations all confront you with a similar challenge: How do you know if an older adult is fit to drive? Since age alone is not a reliable indicator, what should you be looking for? And, if you are an older driver, what should you be looking for in your own driving habits that might signal a need for some kind of change?

This chapter describes the most common warning signs of driving risk and gives you some tools to assess whether a real driving problem exists. Specifically, I explain what the indicators of driving fitness are, what signals a problem, how to categorize the severity of problems, how to conduct a home assessment, and what's involved in a professional assessment. Appendix 1 includes assessment forms that can be used either by an older driver for self-assessment or by a family member or friend. Appendix 2 contains forms to help you to implement changes by talking with your physician about specific functional concerns related to driving that may need some medical intervention.

Driving safety involves factors related to the vehicle, the roadways, the weather and other conditions. Above all, driving safety involves the driver. This chapter focuses primarily on drivers and on determining their fitness for driving. Although it is important to ensure that a vehicle is in proper mechanical condition, that issue is beyond the scope of this book. I'm working from the assumption that the vehicle is in good working condition. Also, other factors play a role in how safely a person can operate a vehicle: the conditions of the roads and a driver's familiarity with them, the weather, and the time of day all can affect driving safety. Obviously, all possible conditions can't be addressed here, but they should be taken into account when determining driver fitness. If you are concerned about a driver's fitness, you will want to observe his or her driving firsthand and keep a written record of your concerns. The forms in Appendix 1 should help you.

Driving Fitness and Age

At the most basic level, driving requires that we have the ability to properly see, think, and move. Limitations in any of these three key functions may signal a worrisome threat to driving fitness. Illness, age, and even significant life events can all impair your ability to see, think, and move. Significant life events, such as the loss of a spouse, may be so distressing that they contribute to physical changes that, in turn, affect driver safety. For example, the physical symptoms of fatigue and slowed thinking are common in grief. While these symptoms are perfectly normal, they can impair your ability to drive safely. See Chapter 2 for more information about common age-related changes and medical conditions that may impair driving fitness.

Contrary to what many people believe, age, by itself, does not determine driving fitness. What matters in driving are three fundamental functions: the ability to see, think, and move. These abilities change at different rates for different people. Some people in their 90s and beyond are more healthy and fit for driving than some people in their 50s or 60s. Thomas Perls, M.D., M.P.H., a professor at the Boston University School of Medicine, became interested in this phenomenon when he noticed that some of his oldest patients were some of his healthiest. Dr. Perls directs the New England Centenarian Study and is widely regarded as one of the world's leading experts studying adults aged 100 years or older. His research shows that centenarians age relatively slowly, and seem to have delayed or entirely escaped diseases associated with aging such as heart disease, stroke, cancer, and Alzheimer's disease.

I spoke with one of Dr. Perl's study participants, Ms. Nedinne Parker, aged 104. Ms. Parker is a devoted baseball fan (she roots enthusiastically for the Kansas City Royals), still lives independently, and drives once a week to her volunteer job at a local hospital. She is a remarkably healthy, active, witty woman who is still able to see, think, and move well enough to drive safely. Ms. Parker is modest about the fact that she still maintains her driving fitness. She also realizes that she has some limitations and that others may be skeptical of her driving skills. During our conversation, she quipped that she doesn't have many friends or relatives clamoring for a ride: "Well, to be honest, I don't know if I would be too quick to jump in a car with a 104-year-old gal!" She has limited herself to driving only on local, familiar roads and only during daylight hours. As a result of these self-imposed limits she has been able to maintain her driving fitness. Similarly, Mr. Edward Rondthaler still lives independently and is driving around upstate New York at 100 years of age. Mr. Rondthaler doesn't drive as much as he did when he was 80 (he drove across the country then), but he still enjoys driving around town and is doing so safely. These drivers remind us that it is not age but function that determines driving fitness.

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Excerpted from The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families by Elizabeth Dugan
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