By EMILY SMITH
UNC Highway Safety Research Center
CHAPEL HILL -- Few people plan for the day when they outlive their driving ability, and that day often arrives with pain and confusion, according to a new study.
"No one's really planning -- neither younger drivers nor older ones," said project leader Dr. Jane Stutts, epidemiological studies manager at the University of North Carolina Highway Safety Research Center.
Last fall, investigators talked to older drivers and their relatives in 10 focus groups in St. Louis, Phoenix, Seattle, Boston and Raleigh. A national telephone survey of drivers 65 and older will follow later this year.
Five of the groups included seniors, ages 63 to 88, who were considering whether to stop driving or who had recently decided. The rest consisted mostly of their adult children.
"What we saw was that people found it difficult to plan for the possibility they may have to stop driving, even when faced with health problems which they know sooner or later will impede their performance," said Dr. Jean Wilkins, a clinical neuropsychologist in psychiatry and neurology at the UNC-CH School of Medicine.
Goals of the study, funded by General Motors, are to understand factors contributing to seniors quitting driving and ways to help them drive safely longer.
Most older drivers were in good health, although some had heart or vision problems. Many said they had changed their driving to compensate for declining night vision or discomfort with rush hour traffic. Others admitted they weren't as good at driving as they used to be and that their reflexes had slowed.
When asked how they would get around otherwise, most couldn’t answer. One 88-year-old said: "I'll cross that bridge when I come to it."
Almost universally, both seniors and their children said having a car and a valid license represented independence. Many were concerned about knowing when they should stop.
"My son keeps saying 'Mom, don't you think you ought to give up driving?'" an 81-year-old said. "Well, I don't know. Is it my decision, or should I leave it up to my children?"
Knowing when to give up the keys is never easy, but it's especially difficult when people have early signs of dementia, Stutts said.
The only people in the study who didn't appear to struggle with stopping were women who possibly never enjoyed driving and whose husbands typically liked to play chauffeur.
"There's no clear-cut point, even once you've been diagnosed with something as serious as Alzheimers to say: 'You can't continue to drive safely.' Diseases like Alzheimer's may impair a person's ability to recognize his or her own limitations," she said.
Most seniors said they'd be the first to know if they should stop. Just thinking about it was painful, however. "I've thought about it a lot," one 81-year-old driver said. "I've cried about it a lot. I got hysterical when my son told me to give it up."
Driver's license renewal procedures vary from state to state with some allowing up to eight years between re-evaluations, Stutts said. "The more alarming thing is that some states don't require in-person renewals unless you've been in crashes or cited for moving violations, and very few require more than a quick vision test."
One surprise was that everyone felt licensing was too lenient and that seniors should be evaluated more carefully, Stutts said. Strong evidence warrants more frequent testing as people age. Per mile driven, older drivers' crash rates decrease with age until about 65, after which they start to increase, especially after 80. Many senior drivers do a good job of limiting driving to times and conditions that are safest, Stutts said. For that reason, if one looks at older driver crash risk per licensed driver, seniors have far fewer crashes than others.
"Ideally, driver screening would be based purely on ability and not age, but the practical issue is that every additional bit of screening you might implement takes time and money," she said. "Practically, we'd like to pinpoint an age where problems start and that would be when you start more screening."
Many children of older drivers said they tried to let their parents decide.
"The thing that was very touching to us was how very aware the children were of what their parents were going through and how big a decision it was for them," Stutts said, adding that families across the country are struggling with the issue.
As baby boomers age, Wilkins and Stutts said that many more people will struggle with decisions about driving. According to U.S. Census Bureau projections, the number of people age 65 and over will nearly double by the year 2030 to reach 70 million. The majority of seniors will live alone due to the increasing mobility of the U.S. population and that generation's higher divorce and lower fertility rates.
One reason it's so difficult for seniors to give up driving when they are no longer safe is that alternative transportation options are so limited, Stutts said.
"We saw evidence that some seniors do continue to drive even though they worry that they shouldn't, but the bottom line is there just aren't that many other transportation options," she said.
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Note: Stutts can be reached at (919) 962-2202, Wilkins at 966-5770.
Contacts: Emily Smith, 962-2202; David Williamson, 962-8596