by David Hosford is worried about a big test coming up in December. That’s when the 87-year-old retired high school teacher will have his driving skills evaluated to see if it’s still safe to get behind the wheel.
Hosford was diagnosed with mild cognitive impairment about four years ago, but appeared fit to drive. However, recently his neurologist became concerned about some deterioration and suggested Hosford take a safety test and stop driving until that evaluation was completed.
So for now, Hosford and his wife, Diana, who doesn’t drive, are relying on neighbors and friends to take them to appointments, shopping and anywhere else they need to go. The wait time for overdue safe driving evaluations can be several months in Massachusetts.
“We live in rural Plymouth. The nearest loaf of bread is seven miles down the road,” Hosford said. “There’s nowhere to walk.”
Determining whether an older person can drive safely has become a third part of aging, as many people maintain their licenses much longer than a generation ago. At the same time, the proportion of fatal crashes involving older drivers nationwide has increased 73 percent since 2001, according to federal data. Now, two new studies by local researchers highlight the challenges ahead.
“Most health care professionals do not have the knowledge and training to assess driving skills,” noted Dr. Kirk Daffner, director of the Center for Brain and Mind Medicine at Brigham and Women’s. Hospital, in an October article in JAMA Neurology.
Daffner sees many patients with cognitive impairments who may eventually need a comprehensive driving evaluation through a specialized program, which often includes a practical exam. But many, like Hosford, struggle to afford the high price, which can exceed $800 in Massachusetts.
Medicare doesn’t cover the cost, meaning millions of seniors, many on fixed incomes, have to come up with the money. This policy, Daffner writes in JAMA, must change.
“Impaired drivers,” he writes, “pose risks to their safety, but also to that of the general public. »
But simply revoking older driver’s licenses shouldn’t be done in isolation, Daffner said, because it often leads to isolation.
“If we take away people’s keys or their ability to drive, then as a society we need to do a better job of providing them with alternative transportation,” he said. “It’s just cruel to say; “Well, you can’t drive anymore, and good luck.”
And although the number of fatal crashes involving older drivers has increased in recent years, the number of these crashes as a share of the older population has declined.
Still, Daffner and other health experts said they foresee problems ahead.
More and more drivers are keeping their licenses into old age. Federal data shows that 59 percent of people 85 and older still had their licenses in 2020, the most recent data available, up from about half in 2000. And about 17 percent of Americans over 65 — about 8.2 million people across the country – suffer from mild cognitive impairment and are at increased risk of accidents.
Age alone does not determine driving performance. But as the number of years increases, so does the risk of health problems that could impair the ability to drive, including reduced vision or hearing, slower reaction times, seizures, or heart problems that can produce dizziness.
Andrew Zullo, associate professor of public health at Brown University, recently studied medications commonly taken by older adults that could impair driving ability, such as medications to treat anxiety, insomnia, pain, depression and even high blood pressure, and found that most who had been in a car accident continued to take them afterward.
Zullo’s study, published this month in JAMA Network Open, noted that about 20 percent of drivers 65 and older who were involved in one accident will have another. He said these sobering statistics show that it is crucial for health officials to identify ways to prevent these accidents.
One obvious obstacle, he says, is that doctors often don’t know their patients have been involved in an accident unless they are seriously injured.
“In the United States, we don’t have robust systems for informing doctors,” he said. If doctors had such a system or if their patients felt comfortable confiding the information, their doctor could re-examine their medications and perhaps reduce the dose or switch to one less likely to impair driving automobile.
“I think a lot of older people worry if they are involved in a car accident, their family or other people in their lives might express concerns about their driving and put pressure on them to stop driving,” Zullo said. “It’s a concern for older people because it takes away their independence.”
Massachusetts law requires people 75 and older to renew their license in person and take a vision test. But After passing the road test required to obtain a license, often decades ago, the state relies on motorists themselves to determine whether they can still drive safely. It does not require health care providers to report patients they believe are not physically or medically capable of operating a motor vehicle safely, although it does provide a system for reporting concerns to the Registry of motor vehicles, which has a medical affairs unit to review reports. .
Dr. Sarah McGee, clinical chief of geriatric medicine at UMass Memorial Health, said that in her 34 years at UMass, she has resorted to reporting only one or two patients to the state . But she said she strongly advises patients who may be impaired to have their driving evaluated by an assessment program, explaining where those programs are located and how much they cost.
Sometimes driving evaluations reveal a patient simply needs a refresher course, she said, and they arrange a lesson.
“Some patients say, ‘I drive a lot less at night,’ or ‘I don’t like driving in the storm,’ or they don’t like taking the highway,” McGee said. “It’s very telling about what people share with you. Very often, people restrict their driving themselves.
Middle-aged children of older people are often caught in the crossfire, nervously watching a parent decline but unsure how to approach this thorny issue.
That would describe Anna Stern, a 45-year-old social worker who realized her mother, then 76, was driving around Somerville well below the speed limit, changing lanes without signaling and appearing uncertain behind the wheel. Stern contacted his mother’s doctor privately and asked him to broach the subject.
Her mother, who thought she was a good driver, failed the initial in-office evaluation at Spaulding Rehabilitation, one of the few inpatient driving evaluation programs in Massachusetts. She therefore chose not to take the practical test and abandoned her car.
“I was shocked,” Stern’s mother said, Tam Neville, now 80 years old. “I studied the AAA book and thought it would be easier than it was. My feeling is they don’t want old people on the road, probably for good reason.”
Neville is one of the lucky ones. She could easily afford the $300 for the initial assessment and she lives within a 10-minute walk of many of Somerville’s stores and restaurants. She also has a home health aide to help her with shopping.
Craig F. Walker/Globe Staff
But Hosford, the 87-year-old waiting for his driving test in Plymouth, is not so lucky. On a fixed income, the $300 bill on his credit card weighs heavily as he gazes longingly at his idle Ford pickup truck.
“I feel like a beggar when I have to ask friends and neighbors for rides,” he said.
Losing the ability to drive, said his wife, Diana, is like breathing. “You don’t think about it until you can.”
Kay Lazar can be reached at kay.lazar@globe.com Follow her @GlobeKayLazar.
