Leonard J. Hansen

When to hang up the car keys? Perhaps later rather than sooner

By Leonard J. Hansen - health correspondent, drkoop.com

When is it time to hang up the car keys and drive no more? To many younger people it is when you show the first sign of gray hair. To adult sons and daughters it may be assumed the first time you misplace something in their presence. To society at large it should be at age 65. The fact is that none of the above are true for the vast majority of mature adults. Age itself is not a determinant of driving ability. There are people in their 100s who hold licenses and drive well while there are others who are near incompetent behind the wheel in their 60s. Most of the problems in mature driving are medical or health related, and most can be treated or corrected. Accidental path First the bad news. Based on actual miles driven, persons over the age of 65 are second only to those under age 25 in having or causing automobile accidents. The incidents involving mature adults tend to be worse and cause more injuries than those involving younger generations. According to the Merck Manual of Geriatrics, the accident rate does not really increase “until age 70; after age 80, the rate increases rapidly.” Most common driving violations for those 65 and older are for failure to yield the right-of-way and failure to obey a traffic sign. Impaired function Chronological age is not the cause of bad or dangerous driving; impaired function is. To be better drivers mature adults can, in most cases, correct the impairments. And the causes of impairment may be surprising to younger and older alike. Impaired driving ability may be caused by: loss in vision; slowed reaction time due to reactions or side effects from medications; reduced strength; chronic conditions with debilitating or episodic limitations. Taking away or putting up the keys Taking away the driving ability of a mature adult can be traumatic, whether done by adult children or the senior citizen himself or herself. What seems to be a simple act can be a negative hit at the person’s independence. And by removing independence the mature adult may experience depression, even serious depression. Therefore, exploring ways to correct the possible causes of driving problems may be the most important first step. Vision problems and correction Vision is key to driving safely. Your eye specialist should be the authority regarding visual ability for driving. A regular and thorough vision examination is important. Provide the ophthalmologist or optometrist with a list of medications being taken so that he or she can check for side effects which may hamper vision. Diseases such as diabetes and heart conditions can cause vision problems, some irreversible. Diabetic retinopathy and age related macular degeneration (ARMD) may be certain causes to giving up driving, while cataracts and glaucoma may be effectively corrected, particularly if diagnosed and treated early. The new development of miniature biopic telescopes on eyeglasses may even extend the driving ability of seniors with ARMD. Here are other recommendations: Visual acuity may be reduced so that twilight or nighttime driving should be reduced or eliminated. Sunglasses should not be worn at night. And, when given a choice such when buying or renting a car, opt for the auto without tinted windows. As part of the aging process, peripheral vision may reduce from 170 to 120 degrees. If the balance of vision is acceptable, the mature driver’s simple solution is to move the head left and right regularly to recapture the periphery. Eat more healthfully and exercise. Recent research documents that proper diet and exercise are important to having and retaining the best vision. For example, vitamins E, A and other anti-oxidants are now prescribed for stopping or slowing the formation of cataracts. Ask your eye specialist for recommendations. Chronic conditions Alzheimer’s Disease and other forms of dementia should be recognized as valid cause to giving up driving. So can physical limitations from a stroke. But misplacing something should not be the reason for adult children to take away the keys. If the elder puts the keys in the oven then there, perhaps, is reason to call for a medical examination and functional asssessment. Diabetes can be causal to driving problems, but hypoglycemic reactions (low blood sugar) can be moderated based on medical advice. Heart conditions which may be suddenly threatening should cause concern about driving ability. But, more problems in driving are caused by: Reactions or side-effects to medications for chronic conditions, either as a direct result of one medication or as in polypharmacy, the often serious conflicts of multiple medications. Typical side effects may include slowed reaction, drowsiness and/or lack of mental focus. Assume that antidepressants or other mood-altering medications may have such side effects; but you’ll often find similar reactions from drugs for heart disease and other problems. Ask your doctor to explain predictable and possible side effects of any prescription or over-the-counter medication he or she recommends. And read the information in the package to learn if side effects may include “drowsiness,” “disorientation” or worse. Polypharmacy often happens when drugs are prescribed by different doctors without knowledge of other medications being taken. Ask for an analysis of single or multiple drug side effects from your primary care physician or pharmacist. Reducing activity and exercise. A study by Yale University documents that sedentary lives and not age are key to accidents by those 72 to 93 years of age. Their recommendation: if you want to drive safely in the mature years, take a walk for exercise every day (not a walk from the couch and TV set to the refrigerator). Reduction in strength and mobility. From lack of exercise, many seniors lose the strength, movement and stamina for effective control of a car through traffic conditions and avoiding accidents. Lack of fitness, not aging, is often the problem in driving. The long-held assumption that retirement is the time just to rest and rock in a chair is probably the most predictable path to impaired driving ability. Even the long-held prescription of rest as treatment for arthritis has been buried in the past as new and effective treatment calls for daily range-of-motion and other exercises. Hand strength is important for controlling the wheel (at least 35 pound strength is recommended), and can be maintained through simple exercise. Learning anew Some accidents by mature adults are caused because they have not observed the changes in road conditions or traffic over the years. And a person is never too old to learn. Safety exerts recommend that you go back to school, to the 55Alive AARP driver training program, locally-available driving courses offered by community colleges and adult schools, frequent courses offered by automobile club local offices, or by the National Safety Council. Check your newspaper for announcements, the telephone book for local office listings, and/or do an Internet search. About Gray Driving Many older adults will have illness-caused limitations to their driving ability, but the number is in the minority of problem mature drivers. Ninety percent of mature adults do not have Alzheimer’s disease, and less than half of those evidence noticeable symptoms. The key to continuing or returning to safe driving should start at your physician’s office and/or at the pharmacist’s counter. Don’t assume the worst until this has been done. Chances are that the cause of the driving problem may be moderated by less, not more, medication, and a prescription for more exercise.. Take your questions to the medical and pharmaceutical practitioner before hanging up or taking away the car keys.