Last month, a 91-year-old woman was charged with reckless driving in Denver Colorado after she failed to stop at a red light, starting a chain reaction that resulted in a fatality. What is more striking about this incident – that it occurred, or that a very old woman was charged with a crime? It is inappropriate and inaccurate to draw general conclusions about older adults and driving safety from one incident. After all, people of every driving age cause accidents, and the majority of older drivers operate vehicles without incident. However, this unfortunate event is a reminder that safety risks are linked to age. Both the very young and the very old driver are more likely to be involved in accidents than those in the middle (based on per mile driven).
One significant causal factor in automobile accidents is distractibility, or in more clinical terms, mis-attention (i.e., errors in sustaining attention). Research at the MIT AgeLab underscores the central role of attentional processes in driving safety, as two recent studies indicate that distractibility is a major risk factor for accidents by older drivers. Statistics complied by the U. S. Department of Transportation indicate that 20% of crashes involved errors in attention, and this statistic only captures what drivers reported, and likely underestimates the true percentage. It also is nonspecific with respect to age of the drivers. Formal assessment of attention has long been an essential component of comprehensive driving safety evaluations (see Useful Field of View test as an example), but rarely a feature of routine driving tests. This is particularly unfortunate for persons with dementia, since they are more likely to make attentional errors and are at higher risk for driving accidents.
We could do more to prevent accidents like the one caused by the older Denver woman. One place to start is with the Annual Wellness Visit (AWV). The Center for Medicare and Medicaid Services (CMS) has mandated an Annual Wellness Visit (AWV) for Medicare patients that include routine measurements of height, weight, blood pressure, a review of medical and family history, as well as a cognitive assessment. The AWV requires the provider (typically the primary care provider) to assess “an individual’s cognitive function by direct observation, with due consideration of information obtained by way of patient report, concerns raised by family members, friends, caretakers, and others.” There is a clear premium placed on using formal and validated cognitive screening tools for this assessment. Tools that are sensitive to attention and distractibility (like the BCAT and BCAT-SF) can identify older adults who are at higher risk for driving accidents.
Having conversations with “at risk” older drivers about giving up driving can be very challenging, and may be more successful with a team approach. This would include both the healthcare professional and the family working together. Physicians often rely on families to have these conversations, and families often have difficulty even beginning them. In a recent Liberty Mutual survey, 1,000 adult children who still had driving parents were asked if they’d broached the subject of driving with their parents. Twenty-nine percent of them said they were avoiding the conversation. Cognitive screening can play an important role in improving driving safety. Healthcare professionals can bring objectivity to the situation by sharing the results of cognitive screening. Patients with cognitive impairment can be identified as “at risk” for vehicle accidents, and a referral can be made for a formal driving evaluation. The relevance of driving safety for older adults will only increase. The national Census Bureau estimates that the number of older people in the U.S. will increase from 47 million in 2015 to 72 million in 2030.
So, it’s not really about the car. It’s about the driver.