It wasn’t long after he received his Parkinson’s diagnosis a few years ago that my old pal Leo decided to give up his car keys. It can’t have been an easy decision; he enjoys a very active social life. I’m guessing (he really doesn’t like to talk about it) that he weighed the risks of driving against the chances that he’d lose touch with his wide network of friends. He eventually concluded that we’d reliably answer the call when he needed to get from point A to point B.
There’s the occasional glitch, of course, when one of his regular chauffeurs becomes suddenly unavailable. He called me on Memorial Day, for instance, and asked if I’d drive him to the grocery store. His cupboard was bare, he lamented, and the guy who usually ferried him there was on vacation. For the most part, however, he still gets where he needs to go with less difficulty than you might imagine.
Leo’s willingness to give up driving probably makes him a bit of an outlier among seniors, who generally surrender their keys only under persistent pressure from family and friends concerned about their safety. It’s not that they put themselves and others in harm’s way solely because of their age — younger drivers are far more prone to collisions. The problem is that many older adults suffer from chronic diseases that make driving more hazardous.
Research published last week in JAMA found that older drivers with ADHD, for example, are much more likely than their more focused peers to drive erratically — as measured by traffic citations and collisions. Young drivers with ADHD face some of the same risks, notes lead study author Guohua Li, MD, a professor of epidemiology at Columbia Mailman School of Public Health, but those risks become more fraught when a senior is behind the wheel.
“Young adults with ADHD tend to overestimate their driving ability and performance since this disorder can lead to diminished self-assessment and awareness,” Li writes. “Older adults with ADHD might have similar issues in evaluating their own driving behaviors due to impaired executive functioning, thus leading to higher driving risks. Drivers with ADHD may have difficulty remaining alert and have a decreased reaction time, resulting in a higher likelihood of collision with obstacles.”
The same is true of seniors with diabetes, dementia, glaucoma, hepatic encephalopathy, macular degeneration, obstructive sleep apnea — and, yes, Parkinson’s — according to a 2018 report from the National Highway Traffic Safety Administration. But there are few established protocols to help family or friends prevent unsafe older drivers from taking to the road. Medical boards in some states have the power to suspend or revoke a senior’s license if they exhibit dangerous driving habits, but identifying these drivers tends to fall to doctors, law enforcement officials, and family members — few of whom welcome the chore.
“It’s the hardest conversation a family can have,” Anne Dickerson, PhD, an occupational therapist and professor at East Carolina University, tells the Washington Post.
Convincing them to give up their keys, however, can save lives. The Japanese government in 2017 began requiring drivers 75 and older to pass a cognitive test before renewing their license. In the six months that followed, more than 30,000 drivers displayed some sign of dementia during the exam, and nearly 700 of them lost their driving privileges as a result.
Haruhiko Inada, MD, PhD, MPH, an epidemiologist at the University of Tokyo, and his team scoured police records of vehicle collisions and pedestrian injuries between July 2012 and December 2019 and found the tougher licensing policy significantly reduced accidents. Prior to the testing policy, Inada reports in the Journal of the American Geriatrics Society, collisions involving older drivers had been rising; once testing was established, car crashes among seniors dropped by an estimated 3,700 incidents.
Inada suspects the reduction may have resulted from more older drivers voluntarily handing over their car keys. What surprised him about the data, however, was the increase in pedestrian and bicyclist injuries among seniors once the policy was in place. Nearly 1,000 more injuries occurred, mostly affecting older women. It could probably be explained by an increased amount of “walking (and cycling) among older drivers after they stopped driving,” he tells the Post.
Leo can’t walk a city block without taking a rest along the way, and I can’t even imagine how my frail octogenarian pal would manage to climb aboard a bicycle — much less propel himself forward. So, I’m not concerned that his decision to stop driving will lead to some street-level tragedy. I’m more worried about his ability to keep enough food on hand.
That’s why I’ll be driving across town on Saturday to pick him up for our monthly lunch and a trip to the grocery store. I know he appreciates the help, though he tends to bristle a bit when I ask him — for the umpteenth time — when he’s going to get around to selling his car.
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