Senior Technician Meghan Shanley, BS, watches while a client
operates the simulator as part of the Associated Neurologists'
Driving Evaluation Program. The simulator replicates actual
driving situations, permitting an objective, written assessment
of visual, cognitive, and psychomotor abilities. --Bee Photo,
Evans
Family members and their older relatives alike both dread the
moment.
But sooner or later the issue of driving safety arises, and it
becomes advisable for the elderly driver to surrender his or her
car keys.
Sometimes there are warning signs. The driver in question may be
going slower than traffic, having difficulty making quick turns,
or coming home with dents in the car. Then he or she wisely
decides not to drive at night and not to drive on the highway.
But eventually there is the growing realization that the time has
come to stop driving altogether, hopefully before an accident
occurs and people are hurt, or worse.
More often than not, families wrestling with this life-changing
decision involving a loved one are turning to physicians and
community health providers to help them make the call.
Dr Stephen Peters, chief of Neuropsychological Services at
Associated Neurologists in Danbury has sound advice about
initiating that difficult conversation.
"It's a touchy subject. No one wants to be the bad guy. You have
to consider the balance between a person's safety and the need to
maintain independence," Dr Stephens said, speaking December 13 at
a Danbury Hospital Medical Town Meeting.
He suggested the use of direct language, while reassuring the
person that you have his or her safety in mind.
"Be sure you tell them you want to help them drive safely for as
long as possible. The elderly population is doubling compared to
other drivers, yet seniors can be the safest drivers of all since
they usually don't tailgate, they don't go out in bad weather,
and they don't drive at night.
"Yet, we're diagnosing Alzheimer's and dementia more and more
often. And looking at the projected rate of growth of this
segment of the population, we know that over time safe driving
will definitely become a concern," Dr Peters said.
He also predicted that before long, it will become a national
health issue.
A Doctor's Duty To Warn
"In 2001, 16 percent of drivers on the roads were over the age of
65. This is a problem because drivers over age 75 have a nine
times greater risk of accidents. The most staggering statistic,
however, is that 98 percent of elderly drivers suffer health
problems severe enough to impair driving. Yet they believe they
are driving normally," Dr Peters said.
"Giving up the license represents a turning point for the
elderly," he added.
It brings up a whole new set of issues such as how to get to
doctors' appointments or therapy sessions, how to run errands,
pick up medications, do business, or visit friends.
"The decision to relinquish the keys must be fair and not
arbitrary, and the subject must be broached in a sensitive,
nonconfronting way," he said.
In the best of circumstances, a mutually-arrived-at decision
includes all parties and is followed by exploration of
alternatives so the individual can begin adjusting to new ways of
living without operating a car.
In the greater Danbury area, such ways include use of the Hart
buses, calling for groceries to be delivered by Stop & Shop's
Pea Pod service, asking FISH volunteers for transport to doctors'
appointments, taking a cab, hiring a regular driver, or
occasionally asking a friend or relative for a ride.
An Associated Press story January 17 noted that in Portland,
Maine, unsafe elderly drivers are still "out on the road, though
not behind the wheel," thanks to the concept of trading in their
cars for rides under the Independent Transportation Network.
Taxpayers benefit because the program operates with volunteers
and donations. An annual campaign helps to meet the $250,000
budget, most of which goes to a director, an outreach
coordinator, two dispatchers, and six part-time drivers.
Connecticut does not legally enforce an eye test or a mandatory
driving test for older drivers, Dr Peters said. Other states,
like Pennsylvania, not only require testing but also require
physicians to notify the Department of Motor Vehicles (DMV) when
a patient is deemed medically unfit to drive.
"Politically, it's very difficult to talk about mandatory testing
after a certain age. If we could identify the unsafe drivers and
revoke their licenses, insurance rates would go down. But at the
same time, more money needs to be spent on public
transportation," Dr Peters pointed out.
Most physicians, he added, are aware that they may be sued by a
third party who is injured by a medically unfit driver under
their supervision.
But not all states are on the same page on this issue.
"In Connecticut, a doctor may report a driver who is
unsafe to the DMV. In Pennsylvania, he must report it."
Signs Of An Unsafe Driver
"If everyone else on the road seems to be driving faster than you
are, if you've had a few close calls, if you notice that you are
being honked at, if you find yourself getting lost -- these are
signs that there may be a problem," Dr Peters said.
He listed the following areas of concern that a relative riding
as a passenger with an elderly driver -- or the driver himself --
might pay particular attention to. They are cautions to any
driver who senses a change or reduction in his or her abilities
to drive safely.
Medications -- If the driver has recently had surgery or is on a
number of medications, mental and physical abilities such as
reaction time may be altered or impaired.
Vision -- There may be difficulty determining contrast,
especially at twilight, or difficulty driving in winter when the
sun's low angle creates long shadows and glare. When whole chunks
of vision are missing, this could be a sign of a silent stroke or
early Parkinson's disease. Ability to use peripheral vision or to
drive with the help of side and rear-view mirrors may also be
compromised.
Cognition -- Safe drivers do not need to use both feet to operate
the gas and brake pedals. Constant braking or tapping on the
brake is a sign of an unsure driver who senses that reaction time
might be a problem. Hesitation or slow driving at an intersection
is another sign of confusion.
Motor function -- Is there sufficient range of motion to allow
shoulders, neck, and head to turn so that approaching or passing
cars are readily seen? Is there sufficient leg strength to brake
strongly or to maintain steady pedal pressure on the gas or
brake?
A Simulator To Assess Driving Skills
Associated Neurologists, located at 69 Sand Pit Road, Danbury,
offers patients an office-based evaluation that uses a
computerized simulator to measure an individual's medical fitness
to drive. It is the only such machine in the state with the
exception of one owned by Easter Seals in Meriden.
Senior Technician Meghan Shanley, BS, has done research on
driving simulators with the State Highway Department, and she
works with Dr Peters in scheduling clients who opt to undergo the
driving evaluation, or patients who are referred for the test.
After a consent form is signed, she assists them throughout the
testing session and writes up the results, which are sent to the
client or patient with copies to the referring doctor if
indicated.
The simulator looks like an auto console and three monitor
screens replicate the changing view out the front windshield.
Related visual cues are projected in the left and right rear view
mirrors, also within easy sight.
"Most people feel at ease with the simulator and after a little
training, they are ready to begin the test," said Dr Peters.
During evaluation, the patient operates the steering wheel, the
turn signals, a gas pedal, and the brake, while a dashboard
tachometer records estimated road speeds. When the optimum
highway test speed of 50 miles per hour is reached, the computer
records responses to a number of on-screen situations.
Responses to variations in weather conditions and changing
traffic patterns provide information about the subject's
abilities to brake and accelerate, about reaction time, field of
vision, lane deviations, ability to use turn signals and check
mirrors, yielding ability, turning left at an intersection,
turning left at a four-way stop, ability to read traffic signs,
maintaining speed, and the ability to comprehend directions.
"We practice first and take as much time as needed to feel
comfortable before collecting data," said Ms Shanley.
"A family member is urged to come along, and you don't need a
physician's referral to schedule an appointment. We are usually
able to see people within a week or two of their call," she
added.
The driving simulator test, which is not covered by insurance, is
scheduled in the afternoon, and takes approximately one hour. It
costs $300.
To schedule an appointment with Dr Stephen Peters or to ask
about the simulator, call Associated Neurologists at 792-6125,
extension 327 or 365.