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Pressure Mounts to Test Elder Drivers
By Peter Schworm, The Boston Globe
June 8, 2009
Pressure is building on state lawmakers to monitor elderly drivers more closely, renewing the heated, politically sensitive debate over whether seniors should have to prove their continued fitness to drive.
Massachusetts, like many states, does not have testing for older drivers, other than universally administered eye tests. Advocates for the elderly have sharply opposed age-based oversight as discriminatory, and noted that the state prohibits age discrimination in licensing.
But with more seniors on the road than ever before - people over 65 will make up 25 percent of all drivers by 2025, according to the Insurance Institute for Highway Safety - calls are growing for more aggressive regulation.
"The time is ripe for change," said Rachel Kaprielian, who heads the state's motor vehicle registry and speaks at senior centers across the state about the issue.
Governor Deval Patrick last week threw his support behind legislation introduced on Beacon Hill that would require drivers 85 and older to pass a road test and eye test every five years to have their licenses renewed. A Massachusetts coalition of advocate groups for the elderly, Safe Roads Now, is urging lawmakers to bolster retesting for all drivers to improve road safety.
Two high-profile accidents last week involving elderly drivers intensified the pressure. Seven people were injured in Plymouth after a car driven by a 73-year-old woman jumped a curb and ran into a crowd gathered at a war memorial. It was the woman's third accident since turning 70, authorities said.
In Danvers, a 93-year-old man drove his car into the entrance of a Wal-Mart, injuring six people, after he mistook the gas pedal for the brake.
"The reality is we need to do something," said state Senator Brian Joyce, who filed the legislation. "This is a growing problem, and I hope we act before another tragedy forces us to."
Massachusetts drivers must renew their licenses every five years, but are required to take an eye test only every 10.
Nationally, there is little consensus on whether - or at what age - drivers should be required to be screened. But a growing number of states have imposed additional requirements for seniors renewing their licenses. About 20 states have more-frequent renewal cycles. Rhode Island, for example, requires that drivers 75 and older renew every two years.
Yet just two states, New Hampshire and Illinois, mandate road tests for drivers 75 and over.
"There's great resistance to bringing people in for testing just because of their age," said Adrian Lund, president of the Insurance Institute for Highway Safety.
"It's not clear there is some level of rejection rate that would justify bringing in millions of people."
Researchers say that drivers begin to pose a greater risk around age 70, with crash-rates increasing markedly after age 80. Older drivers are also more likely to be involved in fatal accidents than other age groups, researchers say, although many attribute that to frailty.
Demographics are magnifying the problem, supporters of greater oversight say. Drivers are hanging on to their licenses longer, and driving more miles, surveys show.
"It's a national debate," said Elin Schold Davis, who coordinates the American Occupational Therapy Association's older driver initiative. "We've had a 'don't ask, don't tell' policy, but that's not going to work any more."
Most road-safety advocates agree that states are not doing enough to prepare for the shift, and urge them to require more frequent renewals.
"There's a political reluctance to even address the issue, but we can't continue to ignore this," said Peter Kissinger, president of the AAA Foundation for Traffic Safety. "We clearly know that as we age, our functional performance and cognitive abilities decline."
At the same time, fatal crash rates for elderly drivers have sharply declined in recent years, a trend that researchers are at a loss to explain.
"Despite the high-profile crashes that get a lot of media attention, there is almost no basis for singling out elderly drivers as being a menace to others out on the highway," said Russ Rader, a spokesman for the insurance institute.
Simply requiring seniors to take a road test, Rader said, does succeed in weeding out unfit drivers, who realize they would not fare well and simply let their license lapse.
In a few states, doctors are legally obligated to report when patients' medical conditions pose a driving danger, but in Massachusetts it is voluntary.
Massachusetts does require a doctor's assurance that a driver is safe when issuing disabled parking placards, and requires medical and road tests when drivers are cited in crashes. Last year, the registry reviewed medical records of 8,000 drivers who were flagged as risks by doctors or family members.
But some of those interviewed doubt the registry could handle administering more road tests, and said decisions on when to take someone's car keys away will remain a personal, and often deeply painful, family matter.
"It's the single issue that brings people to their knees," said Lissa Kapust, a clinical social worker who coordinates a driving safety program at Beth Israel Deaconess Center.
Kapust and others who work with the elderly say that many limit their own driving by making only short trips, avoiding highways, rush hours, and nighttime.
At New England Rehabilitation Hospital in Woburn, therapists work with patients to prepare them for a return to the road, using simulators to hone their reflexes, depth perception, and other skills in a two-hour program.
Susan DeCarlo, a 57-year-old from Lexington who lost mobility on her left side after suffering a stroke in March, said she is learning to drive one-handed with the help of adaptive tools, such as a directional signal extension she can reach with her right hand.
Having applied for a handicapped placard, DeCarlo needs medical clearance from the hospital to resume driving.
"I'm sure I'll be fine," she said. "I need to drive. If I couldn't, I'd lose all my independence. I'd have to impose on everyone else."
About eight patients a week attend the program, which culminates with a road test. It costs $450 and is not covered by health insurance, but gives many patients peace of mind that they are safe to drive.
Sherry Rodrigues and Keith Poulin, therapists in the program, said they support more frequent testing of older drivers, who often find it hard to accept that their abilities are declining.
"A lot are in denial," Poulin said. "The kids usually have to get involved."
DeCarlo faces the same issue with her father, who is 81. He doesn't drive much, and only takes a couple of well-worn routes. But a couple of times he has gotten lost, and DeCarlo suspects his driving days may be nearing an end. For now, she's content to kick that conversation down the road.
"It would kill him," she said. "I've mentioned I'm worried, but he laughs and says, 'I made it home, didn't I?' "
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