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Aging puts brakes on some older drivers

(Week of May 26, 2011)

Photo: Angela Corridore and Dr. Silverman perform a strength test.

They sometimes get lost. Or they might be a bit careless on the road. Dings and dents can pockmark their cars.

Dr. Gary Silverman, a Vero Beach geriatric specialist, routinely sees patients who should give up the car keys.

“I think it’s a very big problem,” says Dr. Silverman, a Cornell Medical School graduate, about older people driving when they shouldn’t be.

The problem is about to accelerate.

The American Medical Association (AMA) says that by 2030, the number of people over 65 in the U.S. will double to about 70 million or 20 percent of the nation’s population. In Florida, people 65 and over could hit 20 percent in this decade.

The fastest growing part of that group is people over 80, a number expected to jump from about 3 million in 2010 to between 8 and 10 million over the next 30 years.

As people age, they often develop medical conditions, some that could impact the ability to drive.

That’s one reason the AMA issued 200-plus pages of guidelines last year in a report called, “The Physician’s Guide to Assessing and Counseling Older Drivers.”

The report examines health issues in older people that could impact their driving and deals with issues ranging from assessing patients’ functional abilities and physician intervention to the counseling of patients who need to give up their licenses and ethical issues.

In Indian River County, the percentages of older drivers are much higher than elsewhere, according to Karen Deigl, president and CEO of Senior Resource Association, which provides transportation for seniors as part of its duties.

Diegl says 20 percent of the county’s drivers are over 80. Some just don’t want to give up the car keys.

Dr. Silverman relates the story of one infirm patient he had been seeing. He asked the man how he got to the office that morning.

“I’m the driver and my wife tells me where to go,” the patient told him. “I follow my wife’s directions. Turn left here. Turn right here.”

Dr. Silverman estimates that about every six weeks, he notifies the Department of Motor Vehicles about a patient he believes should not be driving. “A doctor can’t take away a license, but can certainly make a recommendation,” he says.

Taking away a license often triggers anger over losing independence and damages self-esteem.

“We find that first of all the loss of independence – that last line of independence – makes them angry,” says Deigl, although some people voluntarily surrender their licenses or cut back on the time they spend on the road.

Martha Race, 91, of Indian River Estates, voluntarily gave up her license two years ago, citing problems with her legs and arthritis. She talked with her children about it.

Still, Race says her loss of independence was abrupt. “The first few months were like being in jail,” she says, noting she still manages to get around with planning.

“It was the right thing to do,” says Race, who drove for 73 years and now uses a scooter, a walker and Indian River Estates medical transportation.

Winifred Stuart, 94, another Indian River Estates resident, gave up her license a year ago. “I was well over 90,” she says.

 “I think you feel it,” she says of the decision not to drive. “You get a God-given feeling that you’re not what you used to be.”

Stuart said it was a tough decision. “It was very difficult,” she says. “Once I made up my mind, it was oksy.”

She said she experienced an “aftershock” of her decision when she realized she just couldn’t get in the car and go to Publix or Dillard’s. “I have to plan now,” she says.

Stuart says she hears many people say they won’t give up licenses, but she stresses older people have a responsibility to others on the road.

Even losing a license doesn’t necessarily stop older people from driving.

“In some cases, the license is taken away, but not the car keys,” Deigl says. “We find a lot of people still drive. That’s a big concern.”

Deigl relates the case of a legally blind man who could not get a license at one DMV office, but did get it from another DMV office. “How? We don’t know.”

In Dr. Silverman’s situation, the people he sees about driving issues often are brought in by friends or relatives.

Most of the time the person involved disagrees about his or her ability to drive. “They’ll say, ‘What do you mean I’m not a safe driver,’” he says.

Losing a license, Dr. Silverman says, can lead to depression. “They see it as a step toward nursing home placement,” he says.

That’s an overreaction in almost all cases, Dr. Silverman says, because a relative or a friend often will come to the rescue.

“That’s when the anger comes in,” says Deigl. “They are no longer able to go to the corner store. Being independent, they don’t like to ask for favors.”

In dealing with the issue, the children of older people now find their roles reversed, Deigl says. “Now, all of a sudden you have an aging parent and you’ve reversed roles. You always listened to your parents and when they say no they mean no.”

When assessing an older person, Dr. Silverman says he looks at motor skills, the medications they take and issues such as whether cardiac problems might cause a loss of alertness.

A person’s physical condition is the big issue.  “Age is not the criteria, he says. “There are very capable 90 year olds and some people who are 65 and don’t function as well.”

Older people also need their coordination, cognition and muscle strength tested. Their hearing should be tested every one or two years.

“If grip strength is not as good, can they turn the wheel,” Dr. Silverman says. “Can they shift quickly from (accelerator) pedal to brake?”

Chronic ailments also cause problems for older drivers, Dr. Silverman says. Arthritis in the neck hinders the ability to look right or left.

Dr. Silverman also says older people should be asked about their alcohol use. “It‘s an under-diagnosed problem in the elderly,” he says. “Taking medications and alcohol is not a good situation. When you get older your metabolism decreases and alcohol’s effects last longer.”

“Any time you’re on meds or multiple meds, that plays a part in the inability to drive,” Deigl notes.

Deigl says testing is something that needs to be instituted every year or two after 80 to make sure they can work a car correctly. “There should be something in place to help keep people on the roads safe,” she says.