LITTLE ROCK — North Little Rock’s Nichole Cox touched a few nerves with a March 2 letter to the editor, headlined “No driving over 60.” “I think that people over the age of 60 should not be able to drive,” Cox wrote, citing the possibility of older drivers falling asleep or having a heart attack behind the wheel, with a reference to such afflictions as Alzheimer’s and Parkinson’s diseases.
Also, “Older people tend to drive slowly and not pay attention to their surroundings. I have witnessed this.”
Hundreds, and maybe thousands, of drivers 60 and older - including at least one approaching 90 - peppered the paper with responses, defending their driving abilities, wondering how they would get to work if they couldn’t drive and even turning the writer’s recommendation on its head, suggesting “no driving under 20.”
At what point should someone give up the keys and get out from behind the wheel?
Some states require regularly retesting drivers who reach a certain age and restrict licenses if the driver’s vision or judgment is demonstrably affected.
Arkansas is not one of them. State law permits the suspension or revocation of the licenses of “incompetent” drivers. But it doesn’t define “incompetent.”
Arkansas Code 27-16-909 says the state Office of Driver Services, “having good cause to believe that a licensed driver is incompetent or otherwise not qualified to be licensed,” can require a retest.
Determining what is “good cause,” however, is the sticking point.
Anita Boatman, assistant administrator for the Driver Services office, says the “trigger” is usually a family member, a physician, a police officer “or a neighbor tired of having his mailbox knocked down.”
The department then sets up a meeting witha driver control hearing officer. (Not every county has its own officer, but Boatman says counties without one get a visit from a control officer at least twice a month, most as often as once a week.)
Unless he observes obvious limitations such as blindness or severe disorientation, the officer won’t make a direct judgment on his own, but instead provides a form for a medical professional to complete an evaluation.
Often, there’s no reason to take any action at all, Boatman says.
“Sometimes it’s just a matter of bad feelings in the family; the driver is clearly agile and sharp as a tack.”
If a physician’s evaluation indicates an impairment, Boatman says, the department can require a driver to retake the skills portion of the driver’s exam - the road test, not the written test. The driver has the right to a hearing to contest any decision to take away his license.
Boatman says her office conducted 340 “ability-to-drive” hearings in 2009, and that the state revoked 218 licenses that year for medical-related reasons - “Please keep in mind that not all of these would be age-related,” she says. That compares with 210 revocations for 2008, 193 for 2007 and 164 for 2006.
The state requires all drivers to pass a visual acuity test at a state revenue office when they renew their licenses every four years, which catches some drivers with visual disabilities, says Michael Munns, assistant commissioner of the Department of Finance and Administration for operations and administration, who once headed the Driver Services office.
However, Munns says, there are intermedi-ate options between letting an older driver back on the road without restrictions and lifting his license: “daytime only, or keep off certain roads, or a special set of controls.”
MAINTAINING MOBILITY
Shelia R. Cassidy, an assistant professor and clinical neuropsychologist at the University of Arkansas for Medical Sciences’ Reynolds Institute on Aging, shepherds the Regional Older Adult Mobility Task Force, which has brought together several community agencies to research and plan with the mission “to promote and enhance senior adult community mobility and safe driving.”
That task is growing more urgent with the aging of the population. For example, Cassidy says, 2006 federal Department of Transportation figures showed Arkansas had 349,188 drivers 65 and older, or a little over 17 percent.
“By 2025, it’ll be 22 [percent] to 25 percent; in other words, a quarter of the driving population will be over 65,” she says.
Among the goals is to come up with a standardized method for assessing a driver’s skills and determining at what point a driver can no longer function safely behind the wheel.
Some states have put in place a medical advisory board to establish such guidelines.
“We don’t have one in Arkansas, but all the states around us have them,” Cassidy says.
The panel would give doctors and state driver control officers a standard for decisionmaking, she adds. “It’s a very difficult determination, and it’s more related to capacitythan age,” Cassidy says. “We’ve seen people in their 90s with excellent reaction time and reflexes.”
Cassidy says the majority of older drivers aren’t cognitively impaired and are perfectly safe to be on the road, and those who are impaired often are “self-limiting”: They decide on their own not to drive at night, or to only drive to familiar places or for short distances; they avoid rush hour or driving in inclement weather.
But many won’t.
“They’ll say, ‘I’ll know when I’m not safe to drive,’ [but] they really don’t,” Cassidy says.
HARD ON EVERYBODY
Cassidy says loss of a license is hardest on the driver; the subsequent loss of independence also frequently results in social withdrawal, depression and loss of access to medical care, among other problems.
But it can also be very hard on the driver’s adult children, who often must assume the responsibility for transporting an elderly parent.
“When you tell them they can no longer drive, that hurts,” Cassidy says. “Especially if their family members live a distance away. And their kids may be in a sandwich generation, where they’re still driving their own kids around.”
Some towns in other states have so-called Supplemental Transportation Programs for Seniors, in which volunteers agree to drive people to go shopping or to the doctor, Cassidy says. The programs are particularly useful in midsize cities, where cabs are expensiveand/or service is irregular, and where public transportation is limited.
“Geriatric folks like this,” Cassidy says. “They don’t liketaxicabs.”
Things are harder still in rural areas, where alternatives are even fewer.
“We have to ... involve members of their social network, or their church, or their friends,” Cassidy says. “They won’t have the total freedom to get in the car and go where they want any more; they’ll have to schedule rides ahead of time.”
Cassidy suggests that even young people planning for someday-retirement need to take into account how they might cover the costs of getting around without a personal automobile.
IMPROVING INSTRUCTION
Glenn Ballard, director of rehabilitation at the Reynolds Institute on Aging, says discussions had begun with the A-1 Thompson Driving School about providing on-road instruction for older drivers, but that has temporarily fallen by the wayside during a period of tight budgets at UAMS.
Bennett Thompson, manager and instructor at the school (his mother, Peggy, is the owner), says the school does offer adult driving lessons, but doesn’t get that many takers.
“There have only been a handful,” he says. “We get some senior adults - some who need to learn how to drive; their spouse has died and they’ve never driven.”
Thompson says the school lists driver training for adults among the course offerings on its Web site, A1Thompson. com, but otherwise doesn’t advertise it.
Older drivers can also use what Thompson calls a “check ride” to get an evaluation of their driving skills. However,“our insurance won’t allow us to say whether they’re good drivers or not. We can suggest that they need more instruction.”
AARP offers in-classroom drivers refresher courses through its Driver Safety Program, which is designed to help drivers 55 and older refine their skills and develop safe, defensive-driving techniques, according to the Web site, aarp. org/family/housing/driver_ safety_program.
The four-hour classes cost $12 for AARP members, $14 for nonmembers. Michael Zelhof, marketing specialist for AARP’s safe-driving program and an instructor based in North Little Rock, says the state mandates that graduates of the class receive a discount on their auto insurance premiums, anywhere from 5 percent to 20 percent.
The classes are particularly important in Arkansas, Zelhof says, because according to AAA, 95 percent of the state’s drivers 55 and older have never taken a driver’s ed class.
And, “I’ve had patients in their 80s who never took a driving test,” Cassidy says. They started driving when the state just handed out licenses.
You can find a class near you at the Web site, aarp.org/ VMISLocator/dspLocations. do. AARP also offers an online course at aarp.org/families/ driver_safety/driver_safety _online_course.htm, which costs $15.95 for members and $19.95 for nonmembers.
MORE REFERRALS
For the most part, Cassidy says, most of the nonmilitary doctor driver’s evaluations in central Arkansas are handled by Baptist Health Rehabilitation Institute in Little Rock.
John Johnston, an occupational therapist and one of theinstitute’s two driver rehabilitation specialists, says he has been getting a lot more referrals in recent years, most of them from the Reynolds Institute but also from geriatricians at St. Vincent Infirmary Medical Center.
“Some of them are young, but most are in their 70s and 80s,” he says. Many have had strokes, or have some level of dementia or memory loss.
The process starts with predriving assessments - tests of general vision, peripheral vision and visual acuity, reaction time and so on, Johnston says, as well as cognitive tests such as seeing and recognizing road signs and tests of mental flexibility.
“Then we get into a car and do an on-road assessment,” he says. The car has a passengerside brake, similar to a drivereducation car.
When he started doing this job 23 years ago, the institute had a 1987 Chevrolet Celebrity.
“We have a new one now,” he quips, “a 1998 [Chevy] Monte Carlo.” The need, he explains, is to have a two-door car without a center console, in part to accommodate people in wheelchairs, “and this was the only one we could find” that also had air bags and other modern safety equipment.
The road test, anywhere from 45 to 90 minutes, basically involves driving around town; “if everything goes well, we get on the freeway,” Johnston says.
Afterward, using the state’s driver control evaluation form, if he decides the driver needs to restrict or quit driving, he makes that recommendation - to the referring physician or directly to the Driver Services office.
“Now we have the driver sign an informed consent form” so he can report it directly to the state, he says. “Some of them flat refuse.”
Family, Pages 31 on 04/07/2010