Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, March 5, 1995                   TAG: 9503040043
SECTION: EXTRA                    PAGE: 9   EDITION: METRO 
SOURCE: CRISTINE RUSSELL THE WASHINGTON POST
DATELINE:                                 LENGTH: Long

DRIVING AMONG THE ELDERLY IS A GROWING SAFETY CONCERN

``We didn't get a scratch. Thank God, I didn't hit any other cars,'' said Kruger, who was wearing her seat belt when the crash occurred. She recalled being scolded by a state trooper who said, ``You're too old to drive.''

Kruger, 83, has since put the brakes on her own driving. She now drives only on short daytime trips to the grocery store or the post office in her home of Liberty, Ky., and never drives at night or out of town.

``I generally like to have my daughter drive me. I'm very cautious, but I do drive a little still,'' she said.

Driving among the elderly is a growing safety concern, as more senior citizens take to the roads and often continue driving at older ages than in the past. By 2000, one out of every three drivers in the United States will be over 55 years of age, according to the American Automobile Association.

Experts stress there is great variation in skills among older drivers and that their long experience in driving often can compensate for some age-related changes.

``In fact, drivers over 55 represent a wide range of abilities, and no individual should have his or her license jeopardized solely because of age. However, skills necessary for safe driving - vision, reflexes, flexibility, hearing - begin to deteriorate around age 55 with an even greater loss after 75,'' said a recent publication of the AAA Foundation for Traffic Safety. The elderly also are more easily affected by alcohol and prescription medications that could impair their driving performance.

The challenge is to figure out which age-related changes are most important to safe driving and how best to identify drivers who are most likely to have driving problems. At Yale University School of Medicine, a new research program is developing a screening method to help flag potentially hazardous drivers for further evaluation.

``People should not be judged on the basis of how old they are, but on the basis of individual characteristics that put them at higher risk,'' said Richard Marottoli, an assistant professor at Yale and researcher at the West Haven Veterans Affairs Medical Center.

The problem of older drivers' safety has drawn public attention in recent years because of a number of highly publicized crashes involving older drivers. In two 1992 incidents, older drivers lost control of their cars and drove into crowds of pedestrians: A 74-year-old woman driver killed five and injured 26 in New York City's Washington Square Park, and an 87-year-old man killed a girl after plowing into school children at Chicago's O'Hare International Airport.

But statistics point both ways in gauging the risk older drivers pose, experts said.

``Older drivers are as high as teen-agers in terms of the rate of crashes or fatalities per mile driven,'' said Allan Williams, senior vice president for research at the Insurance Institute for Highway Safety. But the number of car crashes involving the elderly is relatively small, since they tend to drive fewer miles, to be licensed less frequently and to drive closer to home at lower speeds with less alcohol use.

``We are concerned about the high crash rate in the elderly, but not alarmed by it,'' said Chuck Hurley, the institute's senior vice president for communication. The risks are greatest in drivers in their late 70s and 80s, officials said.

Older drivers involved in motor-vehicle crashes also face a higher risk of hospitalization and death. Public-health experts stress that older drivers should use their seat belts all the time. In a two-car fatal collision, if one driver is 65 years or older, the older driver is 3.5 times more likely to be killed, according to the AAA.

``They are less able to tolerate crashes that younger people can survive,'' said John Tongue, an orthopedic surgeon in Tualatin, Ore.

To some degree, the problem of unsafe older drivers is ``largely self-controlling,'' noted Hurley, with senior citizens and their families voluntarily curtailing driving if a driver has known problems or a history of minor accidents. But the loss of independence and mobility often makes the decision a struggle.

A recent study by Marottoli and colleagues identified several simple clinical measures that were closely linked with driving risks among the elderly. Research nurses interviewed and performed a basic physical and mental assessment of 283 elderly drivers ranging in age from 72 to 92 years. More than half reported driving daily, one-quarter every other day and 21 percent two times a week or less.

In a follow-up interview one year later, 38 drivers - 13 percent of the group - reported a motor-vehicle crash of some kind, a moving violation or being stopped by the police during that period.

Several national organizations have programs including instructional courses and self-tests to help older drivers improve driving skills.

At least 30 states have laws offering insurance-premium discounts or reducing infraction points for older people who take an approved driving course. The issue quickly becomes controversial, however, if efforts move beyond voluntary steps toward mandatory programs for the elderly that they must complete before they can get a driver's license.

State laws affecting older drivers vary, with considerable political and legal pressure in many states not to single out older Americans. Twelve states do have older-driver licensing requirements or restrictions, according to a recent AAA survey.

At least nine states, including Florida, allow license renewal by mail, said the AAA survey. All states allow citizens to report unsafe drivers of any age to state agencies, according to the AAA Foundation. However, a 1992 survey by the Massachusetts Registry of Motor Vehicles found that less than one-third of states mandate reporting of impaired drivers.

One of the most difficult problems is dealing with drivers with Alzheimer's disease and other dementias, particularly since the individuals or their families might not recognize the degree to which faculties are impaired.

Doctors are often asked by patients or their families for guidance, but it can pose a problem for physicians who intervene on their own initiative, noted George Waldman, a family practitioner in the small town of Madras, Ore. He was driving his pickup truck when he was run off the road by a Mercedes driven by one of his patients, a retired farmer in his 80s who had Alzheimer's disease.

``I called his son and said it was unsafe for his father to be on the road and I was going to report him to the department of motor vehicles,'' said Waldman. But the state never followed up and the patient and his family chose another doctor. ``They didn't think it was any of my damn business,'' he said.

When Waldman, president-elect of the Oregon Medical Society, sought to get state legislation, he said he was told it was ``politically unwinnable. ... Don't pick on the elderly.''

In contrast, California has a strong law that requires physicians to report persons diagnosed with Alzheimer's disease and related dementias to state officials.

``There is nothing like this elsewhere,'' said David Reuben, chief of geriatric medicine at the University of California at Los Angeles. The patient's driving license is generally revoked if the diagnosis is moderate or advanced dementia. In cases of early dementia, the driver is given a knowledge test, an interview, a vision exam and a special driving test.

Every effort is made to be ``very responsible and very fair,'' said Reuben, but he acknowledged there has been some reluctance on the part of doctors to report their patients.