Assessing Elderly Drivers: Ability Means More Than Age

The ranks of elderly drivers are large and growing. About 33 million licensed drivers in the U.S. are over age 65, up more than 20 percent in 10 years, according to the Centers for Disease Control and Prevention (CDC).

Thanks to their sheer numbers, some stereotypes about the failings of older drivers are fading. Yet safety concerns persist, especially after news reports of elderly drivers' crashes, such as one at a farmers market in Santa Monica, California, in 2003, when an 86-year-old man drove into a crowd, killing 10 and injuring 63.

About 5,500 adult drivers age 65 and older die each year in vehicle crashes, according to the CDC. That's double the number of teens killed annually in vehicle crashes. It is understandable, then, that the question is still with us: When is it time to hang up the keys?

Experts say there is never an easy answer, nor one that will work for everyone. These days, however, there is much more help than in the past to guide you with the decision, whether you are the aging driver or the loved one of an elderly driver who may no longer be driving safely.

Experts know, for instance, which age-related changes most compromise driving, and what can be done to compensate for them. A variety of driving evaluations — in car and out — are available online and from specialists. Some states even step in to monitor older drivers, reducing the time between license renewals.

There's also a new approach to "the talk" that adult children have with an aging parent, and it promises to make everyone less uncomfortable and inspire a more productive conversation.

Think Abilities, Not Birthdays

Deciding how long a person should continue driving shouldn't be based only on birthdays, according to Jake Nelson, director of traffic safety advocacy and research for the AAA Foundation for Traffic Safety, a nonprofit organization.

"We believe driving safety is a function of driving ability, not your age," he says. What counts most, he says, is what he terms your "medical fitness to drive."

Jodi Olshevski, a gerontologist at The Hartford insurance company, agrees. "Usually if a person has a difficult time driving, it's due to some underlying health condition, not age," she says. "It's more about health, not necessarily the number of birthdays you have had."

Nelson says there is no baseline age at which drivers or those who care about aging drivers should start monitoring their skills. However, he suggests paying attention to warning signs of declining diving ability. These include frequent fender-benders, being honked at often by other drivers and frequently getting tickets for moving violations. A good time to assess driving, he adds, is when retirement planning starts in earnest.

The States and Older Drivers

Maryland's Motor Vehicle Administration has a medical advisory board that assesses medical fitness to drive in those who may be impaired.

Nelson says it's a model system. Drivers with certain conditions (including stroke, epilepsy and autism) must be medically reviewed. Doctors, family and concerned citizens can also request a review of drivers they fear are unfit to drive.

Other states, he says, have ''a patchwork of laws" on the question. As of April 2015, 20 states have shorter renewal period intervals for drivers older than a specified age,  according to a tally by the Insurance Institute for Highway Safety. In 19 states, older drivers must undergo more frequent screening or testing of their vision than younger drivers. Of the states that allow drivers to renew licenses by mail or online, 15 states and the District of Columbia do not allow older drivers to do so.

Maryland and D.C. require drivers 70 and older to get a physician's approval to renew their driver's license. And in Illinois, drivers older than age 75 must complete a road test each time they renew.

Texas, however, doesn't step up renewal intervals until drivers turn 85, when they have to renew every two years instead of every six. Many states require in-person renewals after a certain age.

Compensating for Challenges

Age does bring some declines that affect driving. Chief among them are night vision that is less sharp, declining mobility that can make turning around or craning your neck difficult, and slower reaction times.

Drivers can compensate for some of the age-related changes, Nelson and Olshevski agree. Being aware of the decline is crucial, of course. Research suggests that aging drivers, rather than being in denial, are aware of their physical shortcomings. They recognize, for example, that strength, reach and dexterity could be declining with age, making it difficult to turn around to check for traffic or pedestrians.

In surveys, Olshevski says, older drivers told her that driving at night was a big concern, due to the declining night vision that comes with age. The majority of older drivers, she has found in her research, will voluntarily modify their driving to stay safe. They'll cut out night driving, for instance, or make other changes such as avoiding heavy traffic times if that makes them anxious.

Besides modifying driving habits, paying attention to overall health can help aging drivers stay safe behind the wheel, Olshevski says. "Be a healthy driver," she says. "Get regular physicals. Assess the side effects of your medication."

Exercise also is important, Olshevski says. Older adults can ask their doctors about resistance or weight training to maintain the muscle tone and strength that safe driving require.

Automotive technology can help compensate, too, Olshevski says. Among those that are most useful for aging drivers are reverse monitoring and back-up cameras, blind-spot warning systems and other crash-avoidance technologies.

Technology "won't ever replace turning around and using the rearview mirror," she says. But it can help fill the gaps.

Older adults can enroll in a mature driver safety course to brush up on skills, Olshevski says. One example is the online AARP Driver Safety Course. As a bonus, auto insurance plans may give a discount on the premium for drivers who complete the course. Fees vary. In California, for instance, AARP members pay $17.95. For non-members, it's $21.95.

Having the Talk

No one looks forward to that talk with an aging parent or other loved one about whether they need to hang up the keys. However, approaching that conversation a bit differently can make all the difference, Nelson says. Forget the typical conversation starters, such as "Mom, it's time for you to stop driving."

Nelson suggests first riding with the person you are concerned about. While in passenger mode, take note of the positives and the negatives about your loved one's driving.

When you're ready to talk, focus not on whether the driver should hang up the keys, but on mobility and the continued need for it. Talk about where the person needs to go, and when. Talk about alternatives to driving, such as mass transit or cabs or someone picking them up.

Ideally, Nelson says, you should have the talk years before the declines that affect driving set in. It's a much more positive — and probably productive — approach, he says.

More help on broaching the subject is available in a downloadable booklet, "We Need to Talk," developed by The Hartford.

Getting Outside Opinions

It's difficult to be objective about a loved one's driving skills. Outside opinions can help everyone. Among the options is a do-it-yourself online test from the AAA Foundation for Traffic Safety.

Some occupational therapists and other driving rehabilitation specialists offer driving evaluations. These professionals have focused on driving assessments for decades, says Mary Johnson, an occupational therapist and certified driver rehabilitation specialist who runs a driver rehabilitation program at The New McLean, a senior living facility in Connecticut. She requires a doctor's referral, to ensure that the driver's physician is aware of the situation.

The three-hour assessment includes evaluation of vision, thinking, perception and motor skills. Johnson takes aging drivers on the road, too. She may refer them to other specialists such as physical therapists or eye doctors to address the situation that's hindering their ability to drive safely.

Costs for the evaluations vary greatly, but typically range from about $300 to $500,  Johnson says. Insurance or other programs don't always reimburse these costs, but Johnson says it never hurts to ask first.

For referrals to these driving rehab specialists, the American Occupational Therapy Association has a list of driving rehab specialists. So does the Association for Driver Rehabilitation Specialists.

"My goal is to keep people driving," Johnson says. Often that is possible, and her assessment and suggestions give the aging driver more years of independence. If it's not possible, she calls it like it is — and knows that she's given family members the peace of mind that comes with taking the right action.