Medical Driving Evaluations

Driving As You Age

Posted by Joan Cramer on Aug 29, 2019, 7:55:09 AM
Joan Cramer
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It starts with an increase in the number of close calls you have while driving down the road, or maybe a few minor scrapes and dents pulling into the garage or around the mailbox. You get lost a time or two driving to the grocery store. Then loved ones express concern that it may not be safe to let you keep your car keys, and soon, you too start to doubt if you should be behind the wheel. You know that you are getting older and your vision and reflexes aren’t what they used to be, but you still feel fairly mobile and independent, and the prospect of giving that up scares you or makes you feel like you have failed somehow.

Aging is a normal part of life, and if you’ve gotten this far along in years, rest assured, you haven’t failed, you’re actually succeeding! That being said, getting older comes with its share of challenges.  As we advance in years, our minds and our bodies begin to deteriorate and slowly lose their function. When this happens, there can be both a general decline in the various faculties needed to safely drive and an increase in health problems that can limit one’s driving abilities. Just because you have reached your senior years, however, doesn’t necessarily mean you have to retire from driving yet. Having a better understanding of the challenges you are going through, and what can be done about them can give you the tools you need to safely stay behind the wheel longer or to set up alternative transportation options that allow you to continue to live an independent life without a driver’s license.

What happens to our bodies as we age?

As we get older, changes start to happen at the cellular level. Throughout our life, our cells are constantly multiplying to replace dead, damaged, and worn out tissues.  This process, however, cannot go on endlessly. Studies have shown that many human cells can only split and double about 50 times before they cease to function. As our cells reach the end of their generative capability, the tissues they make up begin to lose their function. 

We see this in a variety of ways externally, as our skin becomes wrinkled, our hair greys, our eyesight worsens, and we become more prone to illness and chronic health issues. Under the surface, we also experience the breakdown of muscle tissue, bone loss, and a decline in the function of our organs. As the systems within our bodies begin to break down, this can have a variety of effects on our ability to drive.

How aging affects a driver’s cognitive abilities

The brain is affected by aging just like every other organ in the body. Blood flow may decrease within the brain, reducing its ability to function. Communication between neurons declines, and certain parts of the brain even begin to shrink at a rate of up to 5% a year after the age of 40. This is particularly true of the frontal cortex, which controls functions such as memory, judgment, problem solving and emotional expression.

The result is that drivers have more difficulty paying attention, especially to multiple stimuli such as traffic, weather, stoplights, and the radio. It may be more challenging for them to make a quick decision in reaction to other drivers or obstacles in the road, or they may even confuse which pedal they need to push to brake or accelerate. They may also more easily forget where they are going, where they are currently located, or have difficulty learning new driving routes, such as in the case of a construction detour.

An elderly driver’s brain may also take longer to process and respond to information, which can slow reaction times and lead to stopping, accelerating, or turning too late. They may also forget to maintain their vehicle, neglecting things such as changing its oil, purchasing gasoline, or replacing the brakes or windshield wipers as needed. Then again, elderly drivers may consciously decide to neglect these things if they are on a tight fixed income. 

For more information on how memory loss and Alzheimer’s disease affect driving, please see our article on that subject here.

How aging affects a driver’s physical abilities

As the various systems of the body experience a decline in function with aging, this can impact one’s ability to drive in several ways. 

One of the more notable body systems that can affect driving is the muscles. The body becomes weaker overall, and eventually tasks you once took for granted, like holding your arms up to the steering wheel, can become physically taxing. Overall stamina may decrease, so that even if you are physically comfortable driving around town, long road trips may become more strenuous. Muscle coordination also suffers and can make quick or precise movements more challenging. Tasks such as shifting a manual transmission, which requires both coordination and strength as well as a fair amount of mental concentration, can be problematic both physically and cognitively.

Aging can also bring on joint pain and arthritis, and tasks such as moving your foot between pedals or turning your neck to check for vehicles in your blind spot can become difficult. You can read more about these issues and how we address them here

Bladder and bowel control can be another issue for elderly drivers. Being stuck in rush-hour traffic while suffering from incontinence is not only embarrassing but can distract drivers from the road.

There are a plethora of health issues that can increase with age, such as heart disease, diabetes, and cancer, each of which can present their own unique challenges. Many of these conditions are treated with medication, some of which have side effects such as drowsiness that can make driving dangerous.

How aging affects a driver’s senses

As we get older, our five senses tend to dull. When it comes to driving, the two most relevant are the senses of vision and hearing.

Visually, a person may see a decline in their overall acuity, which can affect their ability to read street signs or clearly identify other objects on the road. They may begin to lose their peripheral vision, which makes it harder to notice passing vehicles or deer on the side of the road. Aging drivers can be more sensitive to glare, or have more difficulty differentiating similar colors, such as a grey car during twilight hours or a bicyclist with a green shirt along a grassy shoulder. Their vision may also be affected by cataracts or glaucoma. Regardless of how a person’s vision changes as they age, it can greatly increase the likelihood of them being involved in a collision. If you’d like to read more about this topic, follow this link to our article on Driving with Vision Challenges.

According to the National Institute on Deafness and Other Communication Disorders, nearly a third of Americans between age 65 and 74, and half of those 75 and older have some degree of hearing loss. It is usually a gradual onset, and many senior citizens do not realize the extent of their problem right away. When they are behind the wheel, they may have more difficulty hearing the horns of other motorists,  sirens on emergency vehicles, or the sound of a vehicle accelerating to pass them. They may also need to devote more focus to paying attention during conversations with passengers, and thus be less attentive to what is happening on the road around them.

When a person begins to lose just one sense, they may rely more heavily on others. For example, they may be more observant visually to make up for hearing loss, or visa versa. But when they suffer from both, they can be unable to pick up on hints in their environment that could alert them to possible dangers on the road.  

What you can do to prolong driving in your old age

One of the primary things you can do to stay on the road longer is to stay fit. Exercise, a healthy diet and adequate sleep go a long way towards overall fitness. Avoiding tobacco and excess alcohol can also help prevent health conditions that could force you to retire from driving sooner.

Make sure you schedule regular checkups with your doctor. Go to your annual physical, and make sure to get your vision and hearing checked every year. If you are prescribed corrective lenses or hearing aids, use them.

It is also possible to schedule a defensive driving course or meet with a private driving instructor to learn how to better manage distractions, respond to other drivers and anticipate possible problems while on the road. For many older drivers, it may have been over half a century since they originally learned the rules of the road, and it doesn’t hurt to have a refresher now and then.

Even if you do not feel you need an official course in defensive driving, you can still take steps to be a more defensive driver. These include paying more attention as you approach intersections, avoiding distractions like cell phones, trying to maintain the same speed as the flow of traffic, and allowing adequate distance between you and other vehicles to stop suddenly.  To know if you are far enough back, count how long it takes your car to reach the spot on the road that the car ahead of you just passed. Most guidelines say that if it takes less than two or three seconds, you are following too close. This distance increases in bad weather or when roads are wet or icy.  

Another practical step you can take is choosing the proper vehicle for your situation. An automatic transmission requires much less effort to drive than a manual transmission. Many newer vehicles also come equipped with enhanced safety features such as backup sensors and cameras, collision avoidance systems that brake if a possible impact is detected, and self-parking systems that will pull into parking spaces and even parallel park for you. These automated systems can assist you when you need them and help you stay on the road safely.

Finally, make sure to listen to your loved ones. They have your best interest in mind, and while they want you to enjoy your independence, they don’t want to see you hurt.

If you or your friends and family are concerned about your ability to drive, you can schedule a consultation with our Certified Driver Rehabilitation Specialist (CDRS). They can help you evaluate your unique situation and determine an appropriate course of action.

Who decides when a driver is too old to keep driving?

There is no hard and fast rule saying that people must retire from driving at a certain age. Really, what it boils down to is whether you still have the cognitive, physical, and visual abilities to safely operate a motor vehicle.

In Connecticut, the DMV does require that drivers age 65 and older apply in person to renew their driver’s license every two years, and during this appointment they will have a vision screening. The state also encourages physicians, police, and anyone else concerned about a driver’s abilities to file a report that may lead to the revocation of the driver’s license or the implementation of restrictions, such as no driving at night or on the freeway. If you are concerned about the driving of a loved one, you can submit a report to the Connecticut DMV’s Driver Services. You can find their contact information at https://www.ct.gov/dmv/cwp/view.asp?a=813&q=507054 or call them at 860-263-5723 for more information.

You can also contact Next Street for a consultation with a CDRS, and we can help you determine if operating a motor vehicle is still a safe option for you or your loved one.

 

What Next Street looks for when assessing seniors for driving

We work with each patient on an individual basis to determine what may be needed for them to continue to drive or to help them make the transition into retirement from driving. We check the patient’s vision, assess how perceptive they are of stimuli, and measure the speed at which they react to stimuli. We also help determine how well they are physically able to function in the different ways needed to operate a motor vehicle. We check how well they can move their joints and test their balance and reflexes. Finally, we will give them a behind-the-wheel evaluation.

Possible Driving Outcomes

Depending on what we discover in our assessment of the patient, there are four main possibilities for their future as a driver.

Drive on

If the patient still seems to have healthy cognitive, physical, and visual abilities, we may clear them to return to driving as they had been before, though maybe with some tips or training to help them maintain safety on the road.

Restricted driving privilege

If the patient is experiencing increased difficulty in certain areas but is still highly functioning, they may be able to continue driving with some restrictions. They may not be allowed to drive at night or on the highway if this would be too difficult for them. It is possible that they will need to undergo special training to learn to compensate for their deficits or break certain habits.

Adaptive Driving Devices

Patients who are feeling the effects of aging more seriously may not be able to drive a vehicle normally but may qualify to have special adaptive driving devices. These can include equipment such as steering wheel knobs to help arthritic hands grip the wheel better, or pedal extenders to aid in reaching the gas and brakes. With the help of these accessories, they can extend the years that they are able to stay in the driver’s seat. This can be an expensive option in some cases, and the driver may need to meet certain criteria from the DMV to maintain their license, so careful planning and discussion with a CDRS are needed to proceed with it.

Retirement from Driving

Sadly, the process of aging will eventually progress to the point where every driver will have to hand over the keys. Fortunately, when this happens, it does not necessarily mean an end to one’s independence. Transportation plans can be developed that involve making use of family members, public transit, and ride services like Uber, Lyft, and Metro Taxi. No matter where you are, we will work with you to determine the best course of action to help you keep an active life.

 

 

Topics: Safe driving, Adult, driver, aging, elderly

Driving is Important

We Are Here to Keep You Safe Behind the Wheel

Our Driver Rehabilitation program works with patients whose change in health may affect their ability to safely drive. We have a team of Certified Driving Rehab Specialists that will work with patients on evaluating your driving abilities. We also have a team of professional instructors to help you gain or regain the skills you need to drive. We created this blog to talk about the various diagnoses we experience and how they may affect your experience behind the wheel. 

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