Psychiatric Times
June 2005 Vol. XXII
Issue 7
There are currently 23 million automobile drivers over the age of 65 years. This number will increase by another 15% in the next 20 years, making the total number of older drivers equal to 25% of individuals on the highways (Fain, 2003). Of concern is the safety of our roadways as the effects of aging take their toll upon drivers nationwide. Organizations such as the National Highway Transportation Safety Administration are now considering potential solutions and fearing a problematic future (National Highway Transportation Safety Administration, 2002).
Certainly, there would be detrimental effects to prohibiting the elderly from driving. Depression and substantial physical inactivity may follow driver's license revocation. Driving may represent more than a means of transportation; for some it represents health and connection with family and friends--"therefore the loss of the ability to drive has both emotional and pragmatic consequences" (McGregor, 2002). In addition, the current transportation system is inadequate to meet the needs of the older population. While public transportation may be convenient and adequate for some, it may fail to provide the resources, pace and safety necessary for the older person.
Males 16 to 34 account for the majority of traffic accidents in the United States, but also drive the most miles per year of any group. In contrast, those 65 and older drive the fewest miles per year, but do so with a statistical risk factor similar to that of the just licensed teen-age group. On average, fatality rates (per 100 million miles driven) show teenagers with 17.9 deaths in comparison to 14.3 deaths in the elderly. There are, however, some differences between the groups with regard to the nature and type of traffic accidents. Juvenile drivers are involved in traffic accidents largely as a result of excessive speed or recklessness, whereas accidents involving the elderly driver commonly occur as a result of a physical malady or cognitive impairment. Furthermore, the juvenile driver's risk of causing an accident is predicted to decrease with additional experience behind the wheel, whereas the elderly person's risk to self and others is expected to increase with continued effects of aging (Howe, 2000).
Media attention was brought to this issue in an event occurring in June 2003 (Santa Monica Mirror, 2003). Russell Weller, age 86, drove his 1992 Buick through a crowded farmers' market, killing 10 and injuring 30. When detained and questioned regarding the event, Weller stated that he was unable to stop the vehicle. Witnesses told police that he appeared confused and disoriented during and after the event. Naturally, this tragedy has led to an investigation into Weller's mental and physical condition prior to the accident to determine if license revocation would have been proper. There has been concern as to whether there was negligence by the Department of Motor Vehicles (DMV), Weller's personal physician and Weller's family.
Age alone does not cause impairment behind the wheel; it is the mental and physical changes associated with aging that cause the problem. Currently, all drivers who suffer from a reported cognitive deficit are screened for a high-risk classification by the DMV. Screening test administrators are looking for four necessary mental requirements in the driver: proper integration and interpretation of sensory input, focus of attention, proper association of thought, and appropriate judgment. Failure in any of these areas may be cause for license suspension or revocation. The presence of mild dementia, however, is not necessarily a cause for a license revocation (as an elderly person may be able to drive safely in the initial development of such a state) (Ott et al., 2003). A clinical finding of Alzheimer's disease is almost always grounds for the revocation of driving privileges, as the nature of such impairment will rapidly render a person unsafe behind the wheel.
Rosen et al. (2002) found that only two-thirds of clinicians regularly utilize standardized tests when screening for cognitive deficits among suspected high-risk elderly drivers. Of those who do regularly test their patients, many find the Mini-Mental State Examination (MMSE) to be reliable in accurately predicting the future driving status of an elderly individual. (Adler and Kuskowski, 2003). The MMSE has gained popularity as a preliminary tool for assessing driving risk but may be insufficient for the assessment of overall cognitive status (Folstein et al., 1975).
