Unsafe at Any Speed

Last week, when 93-year-old Louis Vesprini accidentally drove his car through the front entrance of a Wal-Mart in Danvers, it was the fourth time in nine months that a Boston-area driver over the age of 80 had lost control of his vehicle and seriously injured a pedestrian. The Wal-Mart crash, which fractured the skull of a one-year-old sitting in a stroller, renewed calls for legislation requiring elderly drivers to pass regularly scheduled tests of their driving abilities.

But according to Robert Stern, a School of Medicine associate professor of neurology and codirector of the Alzheimer’s Disease Clinical & Research Program, any such legislation would be dead in the water, stalled by opposition from the powerful AARP (the American Association of Retired Persons), which claims that the proposed law is ageist.

Stern, recently awarded a $240,000 grant from the Alzheimer’s Association to study driving safety in the elderly, agrees that laws requiring all persons over a certain age to take driving tests are ageist. But it doesn’t matter whether the laws pass, he says, because the proposed tests fail to measure what really matters when it comes to driving, such as the ability to make rapid multiple decisions based on constantly changing information.

BU Today made a quick decision to talk to Stern about what should be done and about why taking the keys away from Dad is always about more than simply taking the keys away from Dad.

BU Today: Is there a real problem with elderly drivers or is the perception of a problem ageist bias?
Stern: Here are some statistics: one out of two people 85 and over has Alzheimer’s disease. At some point everyone with degenerative dementia will be cognitively impaired enough to not drive safely.

Sounds like a real problem.
It’s complicated. Not everyone with dementia early on is an unsafe driver. And just like not all old people are unsafe drivers, not all old people are safe drivers.

What makes an elderly driver unsafe?
There are ophthalmologic reasons, and there are movement disorders. Arthritis alone can make someone an unsafe driver. And the brain plays a role. As the brain ages, one of the things that happens is a slowing of reaction time. That is one of the main things that makes someone unsafe.

Is getting lost an indication that it’s time to stop driving?
This is not about memory. If you have degenerative disease and you get lost, that’s fine. My concern is the ability to do the things that driving requires: paying attention, being able to multitask. You need the ability to react quickly and have adequate judgment and awareness.

Is it possible for elderly people to track the loss of their own abilities?
A lot of older people do self-monitor. Those are people with enough self-awareness to know they shouldn’t be driving at night or shouldn’t be driving long distances or shouldn’t be driving anyone around. The problem is the person with dementia who loses the ability to have that awareness. If you don’t have that awareness, you think you are doing just fine. It ends up being a huge catch-22: the person who is the most unsafe is also unaware that he is unsafe.

Taking the keys away from Dad is one of the greatest challenges between generations. Why is it so hard?
It’s not just about the keys. Driving is not just about transportation. It’s about independence. From the age of 16, it gives us a new way of living. It’s not just about going to the grocery store. The decision to stop an elderly person from driving most often comes down to a family member, and it is one of the most difficult decisions we have to make.

What can we do to make it easier?
One important thing is to start the conversation early. You can sit down and say, “You know, Mom or Dad, there may be a time when you are not driving safely, and I want us to be very honest with each other about stopping before you hurt someone. So let’s come up with a plan.” It can help to have a written agreement, so there is something on paper for people with memory problems. We should also not simply say, “You have to stop driving.” We should observe and see if we can identify warning signs.

Like what?
Like hitting the curb and having a hard time making left-hand turns. Left-hand turns require very special skill and good reaction time. And you have to be able to do it with someone talking to you in the car or with a police car in the rear-view mirror. It’s a very hard thing to do.

Realistically, what can we do to stop elderly people from losing control of their vehicles?
What is needed is a balance between public safety and personal independence. If we were talking only about public safety, we could have laws that say anyone over 65 should not be driving or anyone with a diagnosis of dementia should not be driving. If we are talking only about independence we would say that only someone who has a significant at-fault accident that was related to a medical disorder should be taken off the road. The solution is to make a balance, and that balance is costly, from an economic standpoint.

So what do we need?
A meaningful examination of every individual’s ability to drive safely, not just an eye test but a full assessment of driving safety. I’m not talking about the quick test the police do when you get your license. I’m talking about a real evaluation. Right now that kind of evaluation costs a minimum of $500 and is not covered by Medicare. The DriveWise program at Beth Israel Deaconess Medical Center is a good example, and I’ve been working with the Hartford Insurance Company and with the MIT AgeLab. An eye exam doesn’t do anything. You have to have a base assessment of skills designed to be predictive of on-road driving performance. You have to look at peripheral vision, movement, and flexibility, as well as cognitive abilities. You have to look at all the things we need to do to drive well.

To learn more about Robert Stern’s research, read “Driving and Dementia: Balancing Independence and Safety.”

Art Jahnke can be reached at jahnke@bu.edu.