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  • Sun October 11 2009
  • Posted Oct 11, 2009
Marguerite Shiber of Des Moines needs a walker to maintain her balance as she makes her way to the 1979 Cadillac she relies on for transportation. But the 91-year-old retired laundry worker still has good overall health and regularly drives to the Southside Senior Center for group meals, to the grocery store for medicine, and to a few other places for errands. As with many Iowa seniors, the longtime widow values the independence that having a car and driving offer her. Shiber's friends vouch that she is a good driver, and court files show that she has no record of traffic violations. In April, she renewed her Iowa driver's license for two more years. But a debate swirls nationally around older drivers, many much younger than Shiber: Do they pose an exceptional risk to others and therefore should face additional restrictions, or would that constitute improper age-based discrimination? State Sen. Tom Rielly, D-Oskaloosa, who is chairman of the Iowa Senate Transportation Committee, said last week that he wants to review the state's policies for licensing older drivers. "I have no problem if a senior citizen wants to keep their driver's license, but obviously for public safety, I want to make sure they can pass physical and driving tests," Rielly said. "We don't want something falling through the cracks." The debate flares whenever an older driver is involved in a high-profile accident, such as Paul "Jud" McKinney, 79, of Winterset, who is accused of driving the pickup truck that struck and killed bicyclist Mark Grgurich of Des Moines in August. McKinney, who suffers from macular degeneration, a deterioration of his eyesight, was due to renew his driver's license later this month. The issue of older-driver safety takes on added emphasis in Iowa because the state ranks fifth nationally in its population of people age 65 and over. The percentage of these older Iowans is projected to increase from almost 15 percent now to 22 percent of Iowa's population by 2030, state officials said. In 54 of Iowa's 99 counties, at least 20 percent of the licensed drivers are already in the 65-plus age group, DOT officials said. Drivers ages 85, 75 and 65, respectively, represent Iowa's fastest, second-fastest and third-fastest-growing groups of drivers. Advocates: Focus on competence, not age There's no dispute that vision problems and reaction time increase with age, starting at about age 50. Advocates for older people, however, maintain that age isn't the issue; it's driver competence. They also contend there's no fail-proof screening method to determine when cognitive or physical impairment reaches the point that it makes a driver unsafe. "We have some people who are in great shape in their 80s and 90s and are perfectly fit to keep driving," said Elizabeth Dugan, a gerontologist at the University of Massachusetts at Boston, who has written a book, "The Driving Dilemma," about older driver issues. "Then we have some who are in terrible shape in their 50s. Without age as a clear marker for monitoring vigilance, then you move to ability, which is a little more difficult." Steven Gursten, a Michigan auto accident lawyer who has written extensively about driver safety, counters: "That right to drive ends when they become a threat of injuring or killing innocent drivers." He recommends requiring vision screening for older drivers, more frequent license renewals and some basic medical tests, such as a mini-mental state exam (a screening tool for dementia), and a basic test for physical dexterity and coordination. "What you will find is that by taking a couple of very common-sense steps, almost all of these accidents involving elderly drivers are completely preventable," Gursten said. "We as a society have to recognize that because of the process of aging, there will be some deterioration of peoples' basic coordination and perception." These changes can dramatically affect an older driver's reaction time, making his or her vehicle a dangerous weapon on the road, Gursten said. Rules for older drivers vary widely by state The conflict in perspectives over the rights of older drivers vs. the risks they present has resulted in a patchwork quilt of laws and rules nationally, according to a survey by the Insurance Institute for Highway Safety of Arlington, Va. Massachusetts prohibits discrimination by age with regard to licensing. In Minnesota and Nevada, age alone cannot be used as justification to require re-examination. In Tennessee, drivers age 60 and older have reduced fees, and licenses issued to people 65 and older do not expire. In North Carolina, people 60 and older are not required to parallel park as part of the road test. Other states, however, impose additional requirements for older drivers. Many begin requiring vision tests and increase the frequency for license renewals. In Illinois and New Hampshire, renewal applicants 75 and older must take a road test. In the District of Columbia, at age 70, a reaction test may be required. A doctor's statement is required that the applicant is physically and mentally competent to drive. Iowa takes a middle-ground approach. Starting at age 70, Iowans must renew their licenses every two years, instead of every five years. As is true for all ages in Iowa, all renewals are done in person, and a vision screening is required. Iowa doesn't require a road test for older drivers or require them to be checked by doctors to determine their medical fitness, but such exams can be requested if there is reason to believe they're warranted, said Kim Snook, director of the Iowa DOT's Office of Driver Services. Simply requiring older people to appear in person for license renewals - as opposed to renewing by mail or electronic methods - is linked to significantly lower fatality rates among the oldest drivers, according to study results reported in 2004 by the Journal of the American Medical Association. But more stringent state licensing policies, such as vision tests, road tests and more frequent license-renewal cycles, were not independently associated with additional benefits, researchers said. An academic study of Missouri drivers published last year said that voluntary procedures are highly effective, such as allowing professionals and family members to report medical or fitness concerns about drivers to state agencies. Of 4,100 individuals reported to Missouri officials between 2001 and 2005, 96.5 percent were removed from the road, the study said. The Iowa Department of Transportation has a voluntary reporting policy in which people can outline in writing their concerns about a driver's fitness. Most of the letters are from law enforcement officers. DOT employees investigate, and if the concerns are valid, a motorist can be asked to undergo a vision screening, a knowledge exam about driving and a behind-the-wheel test, Snook said. Older drivers a threat mostly to the elderly Just how dangerous are older drivers? They have a higher fatality rate per miles driven than any other driver age group except those under age 25, a review of statistics by The Des Moines Register shows. By age 80, female and male drivers, respectively, are three and four times more likely than 20-year-olds to die because of a traffic crash, state statistics show. But statistics also show that older drivers in Iowa are primarily a danger to themselves and other seniors. For Iowans ages 65 to 74, motor-vehicle injuries are the leading cause of injury-related deaths, according to the Iowa Department of Transportation. One key factor is that many older drivers are frail, making them more vulnerable to being hurt in a crash and dying from injuries. Eighty-seven people were killed in Iowa traffic crashes in 2008 involving drivers age 65 and older. Sixty-seven of the 87 crash victims were either the older drivers themselves or other people age 65 and older. Other crash statistics involving Iowa's older drivers are more mixed. Drivers age 65 and over comprised 17 percent of all licensed Iowa motorists last year. They were involved in only 14 percent of the state's 61,195 overall traffic crashes, yet the 87 deaths where older drivers were involved represented 21 percent of the 412 fatalities on Iowa's roads in 2008. Older drivers' pluses include being careful Experts say older drivers tend to be more careful behind the wheel than drivers in other age groups. They are less likely to drive at night or venture out in bad weather, and they typically avoid heavy traffic. They are also less likely to be arrested for drunken driving and for speeding, studies show. Shiber, the retired laundry worker, fits a common pattern of gradually self-limiting her driving. She primarily drives in the daylight, on familiar, low-traffic routes, to nearby sites. Like Shiber, Jesse Taylor, 84, of Des Moines stays off the street at night, when it's harder for him to see and when he's more fearful of crime. But the World War II Navy veteran and retired mailer who worked at Meredith Corp. wouldn't dream of being without his car to get around town. "I am old, but I am not senile," Taylor said, chuckling, while taking a break from playing cards at the Polk County Central Senior Center, 2008 Forest Ave. Taylor is proud of his older-model Cadillac, and he likes listening to music by the late Oscar Peterson, a jazz pianist, on his car's sound system. Taylor's adult daughter, Pamela Stewart, said she's comfortable with her dad's driving. He hasn't been cited for a traffic violation in a decade. His ability to drive allows him to remain active in politics and to be an advocate for senior citizens, she said. Restricted licenses try to limit drivers' risks The Iowa Department of Transportation has tried to make accommodations for older drivers by granting more than 9,000 restricted licenses that limit driving to daylight hours, specific geographic areas such as small towns or urban neighborhoods, and low-speed roads. Restricted licensing, sometimes referred to as "graduated de-licensing," seeks to preserve the driver's mobility while protecting the health of the driver, passengers and others on the road by limiting driving to low-risk situations. The DOT also plans engineering changes to make it easier for older motorists to navigate the state's roads. This includes better pavement markings, signs with brighter colors, and more rumble strips on road shoulders and center lines to alert drivers when they stray off travel lanes, said Tom Welch, a DOT safety engineer in Ames. One new approach in Iowa calls for the construction of so-called "J-turn" intersections, which help avoid collisions on major highways for people with trouble judging speed and distance. Crashes involving older drivers occur disproportionately at intersections and when making left turns. Drivers approaching a J-turn intersection from a side road won't be able to cross through the intersection or turn left. They must first turn right, proceed about a quarter mile, make a U-turn through the median and then head up the road. The first J-turn intersection is planned near Springville in Linn County on U.S. Highway 151. In addition, two J-turn intersections are proposed on U.S. Highway 65/Iowa Highway 330 between Des Moines and Marshalltown. "We have to look for innovative ways to improve safety," Welch said. "These changes will benefit all motorists, but they are motivated by the fact that we have an aging population." For now, decision rests with drivers, families Barring legislative changes, the "When do I stop driving?" decision primarily rests with individuals and families. Many older Iowans battle increasing frailty with a fierce determination to keep driving. Velva Rogers, 88, of Des Moines broke her hip and both arms in falls a few years ago, so she uses a cane when she walks. But she said she's in good shape again, and she uses her car for errands during daylight hours. She's been a diabetic for about 30 years, but said it doesn't affect her driving because she watches what she eats. "I like driving in traffic," added Rogers, who worked at hotel banquets until just a few years ago. "I will tell you something I have learned. When you are old, you have to make a decision fast. If you are turning in front of a car, or if you are crossing a street, you can't stop and hesitate." Rogers' daughter, Valinda Coker of Norwalk, said her mother is still a capable driver. She and her husband sometimes tease her mother about going a little too fast as she coasts down hills on Fleur Drive in Des Moines. "To me, age is a very individualized thing," Coker said. Challenges faced by older drivers Around age 50, drivers may begin to feel limited by vision changes, slower reaction times, chronic health problems or side effects from medications. VISION: Aging drivers need more light to read road signs and require more time to see signs and hazards clearly. They also experience a reduction in their depth perception and peripheral vision, which affects the ability to judge distance and speed. Tips: Schedule regular eye checkups. Avoid driving at night or in adverse conditions. REACTION TIME: Older drivers can take twice as long as younger drivers to react, because of changes in the brain that occur with aging. Tips: Concentrate on driving rather than multitasking. Avoid complex driving situations. Reduce distractions. MOBILITY: Men and women lose muscle mass (strength) beginning about age 30. Stiffness in joints, ligaments and tendons may increase the difficulty of turning to look for traffic and using brakes in response to an unexpected situation. Tips: Engage in activities and exercise to maintain strength and flexibility. Seek a doctor's advice on nutrition and exercise that will work best. MEMORY: Even mild forgetfulness can result in failing to respond to a stop sign, forgetting to switch on a turn signal or neglecting to watch for changes in another driver's actions. Tips: Concentrate on driving. Limit distractions. MEDICAL PROBLEMS: An accumulation of injuries and disease can cause additional changes in strength, response and flexibility. Medication can also cause lethargy, drowsiness and confusion. Tips: Watch for changes in strength or response. Assistive devices can sometimes compensate for diminished physical abilities. Seek a doctor's advice on adjusting timing or combinations of medications to reduce side effects that impair driving. GENERAL TIP: Consider trading for a smaller car. Many seniors drive older, low-mileage cars, which can be hard to steer and maneuver. It's difficult to know where the corners of the bumpers are. Seniors also may find themselves sitting lower in the seat, so the dashboard and steering wheel might be limiting sight. Source: "Choices Not Chances" pamphlets, Iowa Department of Transportation Where to get help Defensive driving courses are available for Iowa's older motorists from AARP, formerly known as the American Association of Retired Persons, the AAA Minnesota-Iowa motor club, and other groups. In addition, "car-fitting" events are held to help older drivers make adjustments to car seats, mirrors, seat belts and other equipment, to allow them to safely operate their vehicles. For many drivers, the state stipulates outside rearview-mirror usage. The state required Paul "Jud" McKinney, a driver accused of hitting a bicyclist, to have a left outside rearview mirror on any vehicle he drove because of the vision problems in his left eye, according to the DOT. Larry Neppl of Marion, state coordinator of the Iowa AARP driver safety program, said his group works with about 850 to 950 drivers annually."Unfortunately, we are a well-kept secret," he said. The Iowa Legislature considered a bill earlier this year that would have required insurers to provide a 10 percent auto insurance discount for any motorist 55 and older who completed a driver safety program. Some insurers already provide such a discount, but the measure failed to win legislative approval. Crashes linked to aging changes The crash rate for older drivers is related to physical and mental changes associated with aging. With younger drivers, vehicle crashes are often due to inexperience or risky behaviors. With older drivers, crashes tend to be related to inattention or slowed perception and response. Older-driver crashes are often multiple-vehicle crashes occurring at intersections and involving left-hand turns. The crash is usually caused by the older driver's failure to heed signs and yield the right of way. Source: "Choices Not Chances" pamphlets, Iowa Department of Transportation

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