Photo: Lynne Stickley of Florida’s Charlotte County Emergency Management, left, talks with Port Charlotte resident Tess Canja, a participant in the CarFit program to train seniors to drive more safely. (Copyright Herald-Tribune)
SARASOTA, Fla.--Wearing an orange safety vest, Michelle Harris stands behind Bill Peckham's car and holds up four fingers. Peering at his rearview mirror, Peckham hesitates.
"My back window's pretty dusty," he says. "Four?"
Harris helps direct a program for AAA called CarFit, aimed at helping keep drivers mobile in spite of the toll aging can take on their ability to safely negotiate traffic. Making sure car windows and mirrors are clean is just one extra task for drivers in that battle.
Such outreach efforts reflect a dramatic policy shift in this country on older drivers, long considered highway dangers who needed to be nudged off the road: Don't take away their keys unless absolutely necessary.
Life Without Wheels Hard for Seniors
Life without wheels in a car-dependent society has led to documented increases in isolation, depression and even malnutrition for older Americans. On the other hand, research has also shown that when elders learn safer driving techniques, they can significantly lower their risk for accidents.
Sheer numbers indicate the issue's growing importance: One in four Florida drivers is 65 or older, with the entire nation expected to reach that point in 2028. About 80 percent of Americans 70 and over had licenses in 2010, reflecting a 26 percent increase since 1997. Baby boomers are expected to accelerate that trend.
For the older population, being able to make simple trips to the grocery store or the doctor's office can mean the difference between remaining at home or having to move to a more costly assisted-living center.
"We never want to take any license away prematurely," says Sherrilene Classen, director of the Institute for Mobility, Activity and Participation at the University of Florida (UF).
"There are many options between having a license and giving the license up. There is self-restriction — where you basically simplify the environment, like choosing to drive only through the quiet hours of the day."
Now, Classen and others may have found a way to help ensure that able drivers remain mobile, by helping those who ride with elders measure just how safe they are.
The institute has even developed an online tool that caregivers can use to determine whether an older driver is still ready to roll.
When the Time Comes
Peckham, 80, lives in Arcadia, Fla., and takes the road less traveled whenever he drives to the coast. This is the kind of self-restriction that researchers believe accounts for a surprising drop in crashes involving older drivers between 1997 and 2010.
The sharpest decline, according to the Insurance Institute for Highway Safety, was among drivers 80 and up. Their fatal crash rate went down by almost 50 percent — causing a debate among researchers about whether aging drivers should simply be allowed to police themselves.
"Some feel that these drivers can self-regulate," says Lesley Ross, of the University of Alabama at Birmingham's Center for Translational Research on Aging and Mobility. "Another large group of researchers," she says, believes in screening older drivers with evidence-based tests.
Physical changes that begin in our 20s — and unfold so gradually that most drivers remain oblivious — include a reduction in contrast sensitivity, the eye's ability to see an object when the background or foreground is murky, like that dusty car window. Also affected are depth perception, reaction time and other skills.
The CarFit events — a collaborative effort by AAA, AARP and the American Occupational Therapy Association, funded in Florida by the state Department of Transportation — aim to let older drivers know how to adapt to physical changes.
CarFit volunteers measure the distance between a driver's chest and the steering wheel (the minimum should be 10 inches, to prevent airbag injury), and make sure he or she can see over the dashboard (the minimum is three inches above the steering wheel). They confirm that he or she can attach a seat belt, reach the pedals and controls, check blind spots and get in and out of a car easily.
Drivers are told about products they can buy online or at auto parts stores that can help them sit taller in the seat, swivel to get out, or reach up to grab the seat belt.
"This is simply a hunk of plastic that lets you reach the seat belt so you don't have to turn," says transportation consultant Fran Carlin-Rogers, demonstrating a seat belt handle. "It's a $7 solution to get somebody to wear a seat belt."
Greater longevity now means people can expect to outlive their ability to drive safely by seven to 10 years. Evidence shows that American men, especially, tend to drive well into their 90s. Peckham, who says he has had just one ticket for a moving violation in 60 years of driving, ponders the idea of living without his car.
"I've often asked that question because I've thought about it a lot," he says. "I hope I have the brains to give it up when the time comes."
At the recent free CarFit event outside the AAA office in Port Charlotte, Peckham and his vehicle passed all the tests, although his left side mirror needed adjusting.
"I let my grandson borrow the car," he said sheepishly.
The Passenger's View
While researchers agree that most older drivers can stay safe by addressing their limitations, the question remains how to tell exactly which of them should be separated from their keys.
The problem, say Classen and Ross, is that when it comes to assessing driving ability, we are the worst judges of our own performance.
"Even when provided with objective evidence, people still say they're a great driver," said Ross, the University of Alabama researcher. In a study by her center, 85 percent of people surveyed rated themselves as good drivers. Of the 15 percent remaining, 98 percent said they were average with only a handful labeling themselves as fair or poor.
"This does not imply that older drivers are worse than other ages at assessing their own driving," she said. "My guess is that we're all bad at it."
The vision test that Florida drivers 80 and older must pass to renew their licenses is also not very useful, says Ross.
"Driving has little to do with whether you can see," she said. "Driving has to do with whether you receive and process the information you need to drive. Divided attention has a huge impact. We need to be able to come up with a way to identify people who may be at risk so they could go in for further assessment."
Classen's team at UF believes it has found a way. The problem, she said, is that there are not enough trained driving evaluators — a subgroup of occupational therapists — to screen every elder who wants to stay mobile. Nor is there an adequate transit alternative, except in some large cities, to keep seniors active in their communities.
Often a neurologist or regular family doctor is stuck with the decision of whether a patient is fit to drive, but Classen said they're not much better at it than the drivers themselves. Mental tests do not measure the many physical interactions that happen behind the wheel.
"Medical doctors are not trained to rate older drivers," she said. "If you think about it, it's an interaction between the person, the vehicle and the environment. It involves motor and sensory skills and the dynamic aspect of being on the road, handling events that you can't anticipate."
The UF institute's idea was that caregivers who are regular passengers in their loved ones' cars are very good judges of their driving skills. So the team developed an online tool, a questionnaire that lets them rate the driver, and compared the opinions of 200 caregivers with those of professional evaluators. The institute reported its results in October to the state department of transportation, which funded the research.
Caregivers—The First Line of Defense
"We feel that the caregivers are sharing lived experiences with the drivers," Classen said. After studying the results, "we can quite confidently say that caregivers are adequate as a first line of defense. They can give a very realistic appraisal."
The online questionnaire asks about 54 "meaningful behaviors" involved in driving, such as being able to turn left across multiple lanes. Classen said caregivers should go through the assessment alone, and then print out the results and discuss them with the driver. If they indicate a need to limit driving or get some on-road training, the driver has the freedom to choose the next step.
"That is a richness embedded in this tool," Classen said. "It tells you, let's look at the areas where you have difficulty, and then decide what to do about it."
Barbara Peters Smith wrote this article for Sarasota’s Herald-Tribune as a John A. Hartford Foundation Journalists in Aging Fellow, a collaboration of MetLife Foundation, New America Media and the Gerontological Society of America.
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