Driving In The Grey Zone

May 28, 2010 by Sharon Adams
 [ILLUSTRATION: SCOTT PAGE]

ILLUSTRATION: SCOTT PAGE

Myrtle Smith, 103, of Stanstead, Que.; Ottawa residents Dr. Bill Jeans, 91, and Al Sentance, 84; and Bob Cawker, 93, of Surrey, B.C.; have all been driving seven or eight decades, have had their drivers’ licences renewed in the past two years, and intend to continue driving as long as they are capable. They are part of a growing visible minority—senior, senior drivers.

Although medical conditions cause abilities of some to decline with age, others “remain perfectly capable to drive their whole lives,” says geriatrician Dr. Malcolm Man-Son-Hing, co-executive of Candrive, the Canadian Driving Research Initiative for Vehicular Safety in the Elderly. “Healthy older drivers are some of the safest on the roads. They don’t take risks as many younger drivers do, and they have experience.” The Ontario Ministry of Transport (MOT), which has the toughest regulations governing older drivers, lists judgment, experience, responsibility and adaptability among older drivers’ strengths.

There are roughly three million senior drivers in Canada now, a number expected to double by 2040. About a quarter of Canadians 85 and older have a driver’s licence. Statistics on drivers 100 and over are hard to come by, but 105 have licences in Ontario and Manitoba alone. In the 2030s, when baby boomers will all be seniors, it is projected there will be roughly 15,000 centenarians—approximately three times as many as today. It is likely that hundreds of them will have licences. “Several years ago you couldn’t mention driving and aging in the same sentence without public outcry to get those seniors off the road,” says Don Szarko, Alberta Motor Association (AMA) manager of advocacy and community services in Edmonton. But there’s been “an incredible cultural shift” to finding ways to keep seniors driving—safely—as long as they’re capable, and keeping roads safe for all who use them, regardless of age.

The greying of the baby boomers has caused a lot of thinking about aging and driving. The first generation of teenagers able to afford their own cars, these boomers remember hanging out at drive-in restaurants, being wooed at drive-in movies, listening to songs about little deuce coups and big, bright green pleasure machines. In adulthood, station wagons and minivans marked their dedication as parents, luxury cars their professional success and sports cars their forever-young attitude. Now that they’re on the cusp of retirement, can there be any doubt baby boomers see themselves driving into the sunset?

In a recent poll of Alberta drivers, “a quarter said they’re not contemplating ever hanging up their keys,” says Szarko. “And more than half think they’ll continue driving until age 85.”

The next generation of seniors “has come through the ’50s, ’60s and ’70s, a time of immense social change” when the size of their demographic bulge carried political clout, says Susan Eng, vice-president of CARP–A New Vision of Aging, formerly known as the Canadian Association of Retired Persons. “They understand in the public domain, you demand change, you don’t wait for it to happen.”

Change has already begun in government ministries, road safety agencies, seniors’ advocacy organizations and professions charged with assessing seniors’ driving capabilities. Now it is recognized, “you have to look at the road, the vehicle and the driver,” when considering how to curtail collisions, says Szarko. Road design is being adapted to accommodate older drivers. Vehicles are being designed with features that compensate for dwindling abilities: headlights that “see” farther ahead and systems to maintain a gap between vehicles, warn about lane drifting, detect vehicles in blind spots and advise drivers to stop at intersections. There’s encouragement for aging drivers to upgrade their skills and better testing measures—other than age—to sift out incompetent drivers.

“The issue is not age, it’s fitness to drive,” says Dr. Anne Doig, president of the Canadian Medical Association. A number of medical conditions can affect driving ability, including injuries, strokes, heart attacks, seizures and taking medications—and they can happen at any age. And although it is undeniable that aging increases risks of developing a condition that may affect driving, keeping seniors on the road is in the broader public interest because independent seniors are healthier and a lighter burden on health care, social services, volunteer systems and families, notes Dr. Man-Son-Hing.

Although transportation is under provincial jurisdiction, road safety is everybody’s concern. There’s widespread agreement in such reports as, The Aging Driver Strategy (Canadian Council of Motor Transport Administrators), The National Blueprint for Injury Prevention in Older Drivers (Canadian Association of Occupational Therapists and McGill University), and Senior Drivers and Highway Design (Canadian Automobile Association) that change is needed in driver assessment and retraining, road and vehicle design and maintaining seniors’ mobility after they stop driving.

Candrive is recruiting 1,000 senior drivers from across the country for a five-year investigation of seniors’ driving habits. The research, funded by a $5.5 million Canadian Institutes of Health Research grant, will determine factors key to safe driving, measure the effect of medical conditions on driving ability and provide information for development of a quick test to assess driving ability.

Research is already painting a fuller picture of aging and driving. Seniors drive less, and have fewer collisions than younger drivers, and statistics from Ontario show drivers aged 55 to 70 have the lowest fatality-collision rate among drivers of all ages. Research also shows that collision risk climbs steeply after age 75, but this is in conjunction with the rising risks of developing medical conditions that could affect driving.

At-fault crashes can be up to 3.5 times higher for drivers with a high-risk medical condition, and use of three or more medications per day has also been shown to increase crash risk at any age. “I’d like to see it become as socially unacceptable to drive while medically impaired as it is to be drunk and drive,” says Dr. Bonnie Dobbs, director of the Medically At-Risk Driver Centre at the University of Alberta. Simply having a medical condition does not of itself make a driver unsafe. “The challenge is to determine when disease has affected abilities to the point that it’s no longer safe to drive—and that’s where assessment is very important.”

In most provinces and territories, physicians are required by law to report medically unfit drivers to licensing authorities. But a 2008 study of 1,605 Ontario drivers of all ages involved in crashes over a five-year period showed reporting rates are low. While 37 per cent of those drivers had medical conditions that could affect their driving ability, including alcoholism, Alzheimer’s, seizure disorders and congestive heart failure, only three per cent had been reported.

Such research “allows for a review of strategies to improve identification of persons who may be medically unfit to drive,” rehabilitation specialist Dr. Shawn Marshall wrote in 2008. Marshall, who’s also co-executive of Candrive, noted that physicians risk lawsuits when failing to report an unsafe driver, regardless of age, who is subsequently responsible for a collision.

Reasons cited for low reporting rates include negative impact on physician-patient relationships; social isolation, particularly in rural areas and increased caregiver stress. Also, physicians are reluctant to report patients whose conditions or driving ability might improve. As well, notes an article in the Canadian Family Physician, “a physician’s ability to predict whether patients will become involved in (collisions) is overestimated by licensing authorities and the general public.” Physicians primarily assess operational skills like basic motor, sensory and perceptual abilities, but rarely assess compensatory driving behaviours and strategies.

Physicians and occupational therapists have been calling for a reliable, inexpensive user-friendly driver assessment tool. The Canadian Medical Association has a 130-page guidebook to help doctors make assessments, but “a big challenge is a person who comes in and they have not one, but two, three or four illnesses, and they’re taking a number of medications and those all commingle,” says Dobbs. “The guidelines don’t help predict which combinations of conditions and medications in which patients affect driving ability.”

As well, diagnosis of a condition that may affect driving ability is not enough to make a decision about capability to drive, adds Dobbs. “It’s not the presence of the condition, but rather what the condition does to the person’s functional abilities (and when it does it).” For instance, about a third of patients in the early stages of dementia are able to drive competently. “…Our challenge is: how do we identify people who are safe and unsafe and correctly revoke the licences of those who are unsafe?”

Dobbs has developed an assessment tool, now in peer review, prior to publication in an academic journal. Once published, SIMARD (Screen for the Identification of Medically At-Risk Drivers) will be available online to physicians and driver-screening professionals. A user-friendly paper/pencil test, “it takes five to seven minutes to administer and it’s easily scored,” says Dobbs. Based on eight years of research, “it has a high predictability in terms of whether the person is safe to drive, unsafe to drive or needs to be referred for driver evaluation.”

But it’s time drivers themselves began seriously shouldering responsibility for skills upkeep say driving safety experts. Mature driver refresher courses, like the Canada Safety Council’s 55 Alive program and workshops offered by the Canadian Automobile Association and its provincial affiliates, do more than talk about changes in rules of the road. They explain changes in vision, hearing, physical ability, cognitive functioning and frailty and ways to compensate for them. They talk about high-risk driving situations and how to avoid them. They encourage self-assessment and help in developing a plan for driving cessation.

That plan should include voluntary re-education sessions and assessments if there’s any question about ability to drive. “Take a driver refresher course—and don’t wait until you’re 80 to do it,” advises George Smith, traffic safety and training manager for the Canada Safety Council. “Upgrade your ability on an ongoing basis,” since it’s prohibitively expensive for licensing authorities to regularly assess and test all drivers. “If you’re behind the wheel of a car, you have a lethal weapon in your hands,” adds Dr. Man-Son-Hing.

Meanwhile, many drivers might be tempted to make driving retirement plans if they knew they’d still be able to get around after hanging up the car keys. A survey of 4,900 CARP members, most 65 or older, shows nearly 80 per cent of seniors are very dependent on their cars. Public transit is not an option because it’s lacking where 28.4 per cent live and 20.8 per cent say it’s inadequate. Poor city service and non-existent rural service opens a new role for CARP in advocating expansion of service and subsidies for public transit.

Provinces are only now beginning to grapple with the issue of continued mobility, and what’s needed are more innovative alternatives. Better use could be made of mostly idle school bus fleets, says Laurette Lafleur, president of Kwictech Interactive Inc. in Almonte, Ont. David Dunne of the BCAA Traffic Safety Foundation likes the Independent Transportation Network growing in the United States. “It’s based on a credit system, so you can do things like trade in your vehicle and get a credit value which you can draw down on in exchange for rides. It’s a network, so a daughter who’s a volunteer driver in Edmonton gets credits that can be used by her mother living in Victoria.”

Although most drivers gradually cut back and modify their driving as they age, “we’re outliving our driving ability by seven to 10 years,” says Dunne. “For the vast majority of people, at some point they will have to stop driving.” We should plan for retirement from driving as carefully as we plan retirement from work.

“No one should (have to) tell you when to give up your licence,” says Lafleur, a 55 Alive driving instructor who’s taught thousands of mature drivers over the last decade. “You need to decide when…if you make a wrong decision, you’re going to get hurt and people around you are going to get hurt.” Mature driver courses help people plan for the day they should retire, and recognize it when it comes, she says.

Drivers interviewed have all modified their driving habits, but only one has driving retirement plans. Former teacher Helen Sentance, Al’s wife, gradually cut back due to vision problems and stopped after a heart attack five years ago. Like the rest, Dr. Jeans no longer drives at night; centenarian Smith has also stopped winter driving and Gisela Maier, 74, of Ottawa doesn’t drive in rainy weather. Only Jeans has a retirement plan. Running his car costs about $3,500 a year, “Money,” he says, “that would pay for a lot of taxi and bus fares.”

The CARP survey showed senior drivers are prepared to take responsibility to limit their driving habits for safety and it’s time licensing regulators in all provinces recognized this with graduated licensing for seniors which stipulate conditions under which they could not drive, according to their medical condition. This could go a long way to reducing seniors’ apprehension about screening and testing, says Eng. In some provinces it’s black or white, you’re either able to drive everywhere in all conditions or not at all. Why require a senior to pass a road test involving high-speed highway driving, if they avoid such roads?

At least seven provinces and territories have conditional licensing that may include time of day, type of road and vehicle, distance from home and maximum speed. “Most seniors are willing to accept limitations that keep them safe and mobile,” said Eng. Graduated licensing not only recognizes people’s individual preferences, but ensures “they have the freedom they need, but no more or no less than they need.” Ontario, which has nearly 9,000,000 licensed drivers, is now debating a private member’s bill proposing conditional licences—but based on age rather than medical condition, which critics see as discriminatory.

“Our policy is to keep seniors driving for as long as they can safely do so,” says Emna Dhahak of Ontario’s MOT. Everyone over 70 convicted of a crash-related driving offence is called in for a vision, knowledge and road test. Since 1996, everyone over 80 has had to renew their driver’s licence every two years; each year 85,000 do so.

The fatal collision rate for drivers 80 plus fell by 40 per cent between 1997 and 2006 from the period 1988 to 1995, says Dhahak, and Ontario is dedicated to lowering it further.

Knowing why collisions occur is the first step to finding out how to prevent them. Research shows senior drivers tend to have more collisions when turning left across oncoming traffic at intersections and when judging gaps for changing lanes, passing or merging in traffic. Compared to younger drivers, older drivers are 3.2 times more likely to be at fault and 2.4 times more likely to be killed in left-turn crashes. Forty per cent of fatal two-vehicle collisions involving drivers 70 and older occur at intersections, says a 2007 study by the Traffic Injury Research Foundation.

Transportation ministries across the country are taking such research to heart. For example, left turns are being made safer by incorporating dedicated left-turn lanes, providing advance protected turn signals and adding secondary signals to serve left-turn lanes. Provinces are improving visibility and legibility of signs and road markings. “Alberta is applying a number of those techniques,” says Szarko. “They’re not high cost,” yet save thousands of dollars in damage. “The engineers realized they had to deal with it systemically…don’t just look at the left-turn lane, but the design of the entire intersection” and the safety of everyone who uses it. The beauty and the irony of making roads safer for seniors is that all drivers will find them easier to use and everyone will be safer.

Five Things That Erode Driving Ability

  1. A decline in perception, mobility and understanding brought on by illness and/or medications may affect your ability to drive and assess your driving performance.
  2. Failing eyesight, poor night vision or depth perception can make it difficult to judge distance, tolerate glare or drive at night.
  3. Hearing problems may prevent you from hearing horns, sirens and brakes.
  4. Reduced flexibility and movement make it hard to check your blind spot, back up, park or merge into traffic and see pedestrians.
  5. Physical weakness may deprive you of strength to control the steering wheel or to quickly depress acceleration and brake pedals.

Ten Signs It May Be Time (for you or your parents) To Give Up Driving

  1. Bumping into curbs, garbage cans, concrete dividers
  2. An increase in near misses
  3. Fender benders and minor accidents
  4. Traffic tickets
  5. Difficulty staying in lanes
  6. High cost of maintaining a vehicle, given kilometres driven
  7. Problems backing up
  8. Confusion at highway entrances or while merging
  9. Unexplained dents or scrapes on the vehicle
  10. Arriving late or getting lost

Driver Refresher Courses

The Canada Safety Council’s 55 Alive course updates drivers on traffic laws and new technology, improves awareness of traffic hazards, teaches drivers how to anticipate actions of other drivers, identifies and corrects bad driving habits.  Phone: 613-739-1535 and press 0. Website: http://safety-council.org/training/55-alive-driver-refresher-course/

DriveWise, developed by the Ontario Provincial Police, is a free seminar giving senior drivers in Ontario concrete advice for avoiding the most likely causes of collisions. Phone: 416-398-8257. Website: www.drivewise.ca

Mature driving courses and workshops are available through provincial affiliates of the Canadian Automobile Association.

Interested in volunteering for the Candrive study? Call the recruitment number 1-866-233-1133.

Email the writer at: writer@legionmagazine.com

Email a letter to the editor at: letters@legionmagazine.com

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