It may be one of the most delicate topics a health professional can broach with an elderly patient — not sex, or even end-of-life choices, but driving.
Specifically, whether the patient’s physical and/or mental condition have reached a point where it’s no longer safe to drive.
The decision to give up the keys has major implications for the senior driver and the family and it is also a matter of public safety.
The rate of three fatalities per 100 million miles driven among drivers ages 75 to 84 is on par with that for teenagers; for drivers 85 and older, the fatality rate is four times higher than for teens.
People 65 and older currently make up 13 percent of the population, but account for 15 percent of both licensed drivers and traffic fatalities, according to statistics compiled by the National Highway Traffic Safety Administration (NHTSA).
The number of senior drivers continues to grow. The U.S. Census projects there will be 53 million Americans over 65 by the end of this decade, and 40 million will be licensed drivers.
By the time all baby boomers are looking back at 65, there will be 70 million American seniors — and some traffic-safety experts predict they’ll be behind the wheel in 25 percent of fatal traffic accidents.
Dangerous as driving may be, studies also suggest that giving up the keys has serious consequences for seniors’ health.
According to the National Institute on Aging, about 600,000 people 70 and older stop driving each year. AARP surveys show that a third of older non-drivers complain of feeling isolated from other people, compared to 19 percent of older drivers.
A study published last year in The Journals of Gerontology found that seniors who stopped driving were four to six times more likely to die within the next three years than seniors who continued to drive.
Of course, the health of the 63-to-97-year-olds who stopped driving may have already been on a downward spiral before they gave up their keys, but researchers led by Jerri Edwards at the University of South Florida took health status and other risk factors into account and still found an increased risk for mortality among more than 660 older adults.
“Traditionally, family members are concerned about how to get older drivers to stop driving, “ Edwards said. “We now see there are also bad consequences from driving cessation.”
Even with the stakes so high, doctors often don’t talk to patients about driving, and may not have the tools to assess whether someone is fit to drive and counsel them or family members.
Researchers at the University of Warwick’s Medical School in England recently tested more than 1,500 health professionals and found that while most were aware of government guidelines about fitness to drive, 75 percent didn’t intervene when presented with a patient who appeared unfit. Less than 8 percent correctly identified all drivers presented in a written exam as medically unfit, borderline or fit to drive.
In the United States, state laws determining fitness to drive vary widely — from mandatory road tests to more frequent vision checks to in-person license renewals. Rules on whether a doctor must report to authorities that a patient is an unsafe driver also vary from state to state.
Ultimately, the decision to stop driving is usually between seniors and their family. But physicians may see problems-- and possible solutions -- that loved ones don’t.
The American Medical Association and the NHTSA have a physician guide for assessing and counseling older drivers that includes considering changes in hearing, flexibility, reaction time and mental function.
“An eye exam doesn’t do anything,” said Robert Stern, an Alzheimer’s disease researcher at Boston University who is studying driving safety in the elderly and particularly among those with dementia. “You have to look at peripheral vision, movement and flexibility as well as cognitive abilities. You have to look at all the things we need to do to drive well.”
Edwards, an associate professor of aging studies at USF, is one of many geriatric researchers looking for new methods that can help extend seniors’ ability to function, such as a computer program that helps increase a driver’ s “useful field of view” -- the range of visual information that can be processed with a quick glance, like deciding whether it’s safe to make a left turn, for instance. “We can now train older drivers to drive more safely, longer,” she said.