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Prevention for Older Adults

This page will focus on one of the major causes of brain injuries in older adults: vehicle crashes.

The fact is that Americans are living longer than they once did and are enjoying better health longer also. The population group over age 65 (over 35 million in 2003) is expected to double by 2030. Of those over 65, only 5% live in nursing homes. At age 85 and over, only 25% are nursing home bound. The majority of the population is living in private homes, and often they live alone or care for an aging spouse. Some are even caring for grandchildren.

Since they do live on their own or with a spouse, driving is extremely important to their independence, their ability to care for themselves and their spouses, and their connection to other people. When an older adult loses driving privileges, often many people’s lives are disrupted.

The goal is to keep older drivers driving, but also to keep them safe behind the wheel. Age alone is not the determining factor of whether someone is capable of driving safely. Ability is what matters. Less than 10% of the population aged 65 to 100 are Alzheimer’s patients.

Factors which affect the ability to drive:

• Perceptual speed (ability to react quickly)
• Physical coordination (ability to look to the side or back)
• Muscular strength (ability to control the car)

• Grip strength is a good indicator of ability.

Warning signs that an older adult may no longer be able to drive safely:

• Poor nutrition
• Increased depression
• Limited physical fitness / activity

Realities of aging (many of these are related to health issues):

• reduced visual acuity
• more likely to have eye diseases (cataracts, glacuoma, etc.)
• more sensitive to glare
• narrowed visual field
• reduced ability to hear high or low frequencies
• background noise may be more distracting
• reduced hand grip, shoulder and back strength
• gradual decrease in muscle strength

Clean, healthy living and making good lifestyle decisions can help everyone maintain their ability to drive longer.  It is a myth that being old equals being sick.

When to stop driving?  Since there are many factors that could make driving unsafe, each person needs to be evaluated individually.  The NHTSA (National Highway Traffic Safety Administration) suggests these evaluation cues:

• Safe Operation Detection Cues
  
  Law enforcement officers must analyze a steady flow of cues when conducting any traffic encounter. Older drivers, those 65-years-of-age and older, present a mix of operational mobility cues law enforcement officers should recognize. Understanding these cues will assist the law enforcement officer in assessing the continued safe operational needs of the older drivers that they may encounter. Older operators can have an abundance of medical and non-medical barriers to safely operating a motor vehicle. A dialog with the person, as well as visual cues, will assist in determining if the person will require further evaluation of driving mobility.
  
  CUES
  
  - Does the driver know the current time, day, month or year?
  - Does the driver recall where they are coming from?
  - Does the driver know their destination?
  - Is the driver far from their residence?
  - Does the driver have difficulty communicating, stumble over words, or ramble in short, unattached, meaningless sentences or explanations of their driving ability?
  - Is the driver’s clothing disheveled, non-matching, incomplete or too much for existing weather conditions?
  - Does the driver exhibit poor personal hygiene?
  (EXAMPLE: Urine/feces stains on clothing, on the person, in the motor vehicle.)
  - Does the driver launch into accusations of perceived victimization by criminals?
  - Does the driver appear to be suffering from dementia such as Alzheimer’s
  Disease?
  - Is the driver wearing an identification bracelet or necklace indicating
  dementia that would affect safe driving mobility?
  - Does the driver have large amounts of prescription medicines, prescribed by different doctors, visible in the motor vehicle?
  - If the driver is out of the motor vehicle or exits the motor vehicle, do
  they have difficulty finding and removing driver’s license, motor vehicle
  registration, insurance card from wallet/purse or producing other requested
  documents?
  - Do they take a long period of time to walk a short distance, stumble/fall,
  shake excessively, or lack coordination when accomplishing simple tasks?
• Source: http://www.nhtsa.dot.gov/people/injury/olddrive/lawcues.html

How can children help?  Observe the older adult's driving, health and cognitive abilities.  When there are medical concerns, consult the individual's physician.  A referral for the older adult to a driving evaluation program, such as the one below, might be best to ensure the driver's safety.

Here's an excellent article on How to Help Older Drivers:

http://www.nhtsa.gov/people/injury/olddrive/OlderDriversBook/pages/AppndxB-How.html

Driving evaluations & education.  Ohio State University Medical Center offers an Older Driver Evaluation Program, with the following testing protocol, performed by an occupational therapist:

• Assessment of cognitive status
• Vision Screening (checks visual acuity, depth perception, visual perception, visual fields, glare acuity, color vision)
• Mobility Assessment (evaluates strength, balance, range of motion, endurance)
• Driving Simulation (tests reaction time, visual scanning, threat recognition, crash avoidance).  Note that some older adults are not comfortable with the simulation test, so it may be skipped.
• On-The-Road Driving Assessment (Developed in response to older driver research in a left-hand turn pattern. Multiple checks of gap acceptance, speed, path of travel, limit line and driving environment observation skills.)
• Referral line:  614-293-3833

Return to the Reference section on Older Adults.

* Development of this section of our website was made possible through a grant from the Ohio Department of Public Safety / EMS Division.