SENIOR POWER:Driven in the ‘golden years’

By Helen Rippier Wheeler
Friday February 08, 2013 - 03:45:00 PM

Studies show that elderly drivers can exercise their brains to prevent or delay age-related declines in their driving skills. Now scientists want to figure out how to apply that knowledge to help retirees preserve driving skills into their “golden years.” A University of Alabama, Birmingham researcher has already demonstrated that brain training does reduce the incidence of crashes among older drivers. 

Automobile accidents are a leading cause of injury-related death in people aged 65-74. Fifteen percent of all licensed U.S. drivers were age 65+ in 2007, according to the National Highway Traffic Safety Administration. In California there are 5.5+ million drivers over age 55; more than 2.5 million of us are 70+ years old. The California Department of Motor Vehicles’ website Seniors section, “California Senior Driver,” is worth reading.  

Some people contend that all drivers should be required to re-take driving tests (road-tests) when they reach age 75 and periodically thereafter, rather than having their licenses automatically renewed, in addition to the written tests and eye exams that are required after age 70.  

A legislative committee in New Hampshire is taking testimony on a bill that would require elderly drivers to take road tests to renew their driver’s licenses. Rep. Tara Sad (D-Walpole) suggests 85 as the age at which to start. The committee heard testimony from the widow of a motorcyclist killed last year when hit by a car driven by an 87-year-old man; the driver also died. WMUR-TV reports that such crashes have renewed the debate over whether older drivers should have to take road tests based on their age.  

Nebraska state lawmakers may require cognitive testing for drivers 80-years-old and older before they can receive a renewed driver's license. Officials with AARP say there are more than 60,000 drivers 80 and older in Nebraska. That number is expected to rise to nearly 130,000 by 2035. Currently, elderly drivers are required to take a vision test. The cognitive test would also make sure they are alert enough and healthy enough to take to the roadways. One eighty-year old, retired Nebraskan says he's fine with being tested on his cognitive skills. However, he is opposed to the state making the test. "The doctor that takes care of that person is a better judge than any test that the state of Nebraska can come up with."  

Since reaching age 70, I’ve several times been summoned to the DMV to re-take written and eye exams, but not the road test. I make an appointment. I get the current DMV manual. I study the online tutorial. So far, I’ve been able to pass both the eye (with glasses) and written tests without resorting to the re-take option. It is nevertheless a stressful experience. I’ve been relying on my aged VW beetle to get food, books, and meds. When I can’t pass one or both of the tests, I wonder how I will get to the supermarket, library, pharmacy, doctors… 

A physician I’ve known for years has also aged-- mainly a vision problem that precludes any driving. Surveys of physicians, published in the Archives of Ophthalmology, reported 87% of the participating physicians saying they always or often inquire about driving ability if a patient does poorly on an eye exam. Other common reasons were if a patient or family member asked about a driving problem. That I have never been asked about my driving, not even by my ophthalmologist, says a lot! Not so much about me as about the doctors. 

An AAA research analyst says older drivers are more likely to wear seat belts, they are less likely to drink and drive, and they drive slower, making older drivers among the safest on the roads. Driving is a function of ability, not necessarily a function of age, although certain conditions do come with age. Night driving, glare and reading signs are common challenges for older drivers. But the Insurance Institute for Highway Safety contends that too many people continue driving when it is no longer safe for them to do so. As a group, seniors age 80+ have the highest rate of fatal crashes per mile driven -- even higher than for teens. Drivers over age 65 perceive 30% less information from a glance at a scene than do younger drivers, on average, according to a Virginia Tech Transportation Institute research scientist. And as age increases, perception decreases even more.  

In the UK and parts of Europe, but not in the U.S., in order to have a driver’s license, one must be tested for central blind spots. Blind spots at the center of the field of vision, or "central field loss," are usually caused by macular degeneration, damage to the retina that occurs with age. According to a 2004 study, about 1.75 million people in the U.S., most over 65 years old, have this type of vision loss.  

The advanced neovascular, or "wet," form of age-related macular degeneration (AMD), left untreated, is the most common cause of vision loss among the elderly and a leading reason for their loss of driving privileges. But results of a new study, published in the online version of the journal Ophthalmology, suggest that monthly injections of ranibizumab (trade name Lucentis) improve eye chart test results required for a driver's license, build driver confidence, and keep those with AMD driving longer.  

“Medical screening of older drivers is misguided because it is not evidence-based,” argues Professor Desmond O’Neill, Consultant Physician in Geriatric and Stroke Medicine at Trinity College Dublin. Older drivers raise traffic safety among other generations: the risk of serious injury to children is halved if driven by grandparents rather than parents. Recently, when the Danish government added a cognitive screening test to the medical screening test for older drivers, it did not reduce the rate of older people dying in car crashes but significantly increased the rate of older (but not younger) people killed as unprotected road users – that is, as pedestrians and cyclists!

Mercedes-Benz's active lane-keeping assist detects lane markings on the road and warns drivers before they leave their lane unintentionally. Active blind-spot assist uses a radar sensor system to monitor the side areas of vehicles. The Ford Focus park assist can basically park the car itself. New Infinitis can alert drivers to vehicles located in the blind spot area. Such features can be a great albeit costly help for drivers who are physically limited. Lane assist helps if, for example, one has trouble turning one’s head or poor peripheral vision. Wider doors can help with getting in and out of vehicles. One of the simplest of the new features is push-button ignition.  



Concierge medicine is a developing trend in healthcare. It is also known as “boutique medicine,” and some concierge physicians offer their services as “executive health plans” – in other words, health care for the patient who has plenty of money, but not a lot of time to wade through the bureaucracy of the health care system. Market Watch declares that concierge medicine will only get bigger!  

Prosecutors in southern California are going easier on assisted suicide among the elderly. Cases filed under California's assisted suicide law rarely go to trial. Legal experts note that jurors might be torn about convicting elderly defendants they see as legitimately bereaved if not entirely blameless. .  

The Centers for Disease Control and Prevention (CDC) recommends that people age 60+ should be vaccinated against shingles, or herpes zoster, a condition often marked by debilitating chronic pain. Shingles is caused by the varicella-zoster virus, the same virus responsible for causing chicken pox, which stays dormant in the body for 40-60 years, and comes out as a rash. Baby boomers born in the 1950s and 60s are starting to become eligible for the shingles vaccine; many should not skip it, because they probably had chicken pox as children.  

Shingles can lead to permanent pain—post-herpetic neuralgia. Consult your primary care physician about having the shingles immunization shot (which I recommend), regardless of whether they have had chicken pox as a child or herpes zoster as an adult! Chicken pox is more likely to cause complications when contracted in adulthood. While it is typically rare to have chicken pox as an adult, those who do get the disease when they are older account for disproportionately more deaths and hospitalizations from the disease. Adults with chicken pox have an increased chance of such complications as pneumonia, bone infections and even toxic shock syndrome.  

There are currently three main flu strains circulating nationwide. H3N2 is the predominant flu strain. It appears to be especially dangerous for the elderly. Seniors seem to get a weaker boost to their immune system following a flu shot than young people do, a small study shows. Experts say the findings essentially confirm what has been believed: The flu shot does not work as well for older immune systems. But they also caution that the vaccine remains the best defense against flu misery. 

House Democratic Leader Nancy Pelosi (D-Calif.) announced three appointments on February 6, 2013 to a newly formed, bi-partisan, long-term care panel that will study the best ways to cover long-term care such as nursing-home stays. Congress created the new board late last year as it formally repealed the CLASS program in President Obama's healthcare law, which was intended to cover long-term care but proved unworkable. Both CLASS repeal and the new panel were part the year-end deal to raise taxes and delay automatic spending cuts. Pelosi chose Bruce Chernof, president and chief executive of the SCAN Foundation; Judith Stein, founder of the Center for Medicare Advocacy; and George Vrandenburg, a philanthropist and former entertainment executive.