Special report: Elders behind the wheel

After Woodmere accident, evaluating risks posed by aging drivers

By Yaffi Spodek

Issue of Jan. 9, 2009 / 13 Teves 5769

By the year 2030, people age 65 and older are expected to represent 25 percent of the driving population and 25 percent of fatal crash involvements, according to the National Highway Traffic Safety Administration (NHTSA). This is in sharp contrast to the most recent data from 2006, when just 15 percent of licensed drivers were age 65 and older, accounting for only 11 percent of fatal crashes.

The NHTSA also reports that 6,017 people in that age range were killed in traffic crashes in 2006, representing 14 percent of all Americans killed on the road.

Several people are still recovering from injuries sustained during a Dec. 25 car crash in Woodmere, in which an elderly driver lost control of his vehicle, and it careened into a store full of parents and children celebrating Chanukah. The driver, 76-year-old Theodore Saretsy of Atlantic Beach, has not been charged.

As seen from statistics and other anecdotal evidence, elderly people are more prone to dangers behind the wheel due to their naturally declining health and resulting medical conditions.

“They generally have worsening vision and diminishing hearing, slower reflexes and less muscle tones,” said Dr. Meyer Cohen, who practices internal medicine in Boca Raton, FL, and counts many elderly patients among his clients. “They can also have more medication which can slow their reaction times. Their medical condition in general –– fainting episodes and other medical diagnoses –– render them unresponsive or not alert.”

“They don’t hear as well,” Cohen added. “Though most states require vision tests, what they should have is the hearing tests, since older people don’t hear sirens and you see that they just can’t get to the brakes in time.”

Despite this frightening reality, no state has yet established an age limit on drivers. Most states, including New York, require basic eye exams when applying for a license renewal, but these typically cannot detect a driver’s diminished physical capacity and cognitive awareness. Illinois and New Hampshire are currently the only states that require drivers over age 75 to pass a road test at the time of license renewal, a crucial way to identify incompetent drivers.

Other than the initial licensing exam and a vision test at the time of renewal, there is no other special requirement for getting or maintaining a license in New York.

“There are no specific laws that relate to a driver’s age,” said Michael Beer, an attorney in Woodmere who specializes in traffic violation and defense.

Though Beer declined to provide specific details about any of his cases involving elderly drivers, he acknowledged that vision is a significant problem that affects more seasoned drivers, “particularly night time vision issues,” he explained. “The eye tests that are given to drivers are only for straight line vision, but as you get older, the peripheral vision is what goes first, and that is not tested.”

Cohen confirmed that as well.

“In terms of peripheral vision, the difference is that an 18 year old driver has much better hand-eye coordination as a result of sharper vision and hearing,” he said. “Although a 70 year old won’t be likely to speed, they can lose peripheral vision. But as long as you can do the bare minimum [in passing the vision test], you can drive.”

Traffic violations are known as strict liability laws, Beer said, meaning that a person can be charged with no intent required to commit them. For example, if somebody has a restriction on their license requiring them to wear glasses, it’s a violation not to have the glasses on while driving, regardless of the reason.

“The law is not concerned with why you committed the violation,” Beer explained. “But, there are certain instances like emergencies that overrule that.”

He noted that there are situations where law enforcement can report somebody’s inability to drive properly and under certain circumstances they can be retested by the Department of Motor Vehicles. But, those reports are likely to follow as a result of an accident, rather than acting as a preventative measure for driving safely.

From his experience, Beer says he has seen more incidents where young, newer drivers have lost control of a vehicle, though he sees tickets issued to all drivers, irrespective of age.

“I would say, as a lawyer, that it would be illegal to hold only their age against them,” he pointed out, referring to elderly drivers. “You can’t discriminate against people based upon age or gender.

Cohen often advises his patients –– and more importantly, their relatives –– when the time has come to stop driving since their health condition can hamper their capabilities, endangering themselves and others on the road. He recommends that once a person reaches age 70, they should stop driving, or at least have a family member evaluate their condition and advise them accordingly. The American Medical Association also offers an Internet guide to help doctors decide whether their elderly patients are still fit to drive.

“I think it’s important to go driving with your relative,” Cohen suggested. “Go on a 15 to 20 minute ride and see if they can handle it.”

Though driving restrictions are only intended to protect those affected, elderly drivers often come to resent the efforts of those looking to limit their mobility.

“I deal with this all the time and it’s very difficult because the patients get very frustrated that you’re taking away their freedom,” Cohen explained. “They feel very restricted and often they feel that the doctor has deceived them in taking away their rights. You have to approach it properly and tell the patient that they don’t want to be the cause of someone dying.”

From his experience, Cohen says that these conflicts are usually resolved once he speaks to the patient’s family and explains the situation. However, he has on occasion contacted the DMV and requested that a patient’s license be revoked.

“Usually, if a patient understands their condition and the risks, they will stop driving,” he continued. “It’s often a battle with the family and the patient. You usually have to offer solutions, and point out that it may be cheaper if the patient uses a car service versus the costs of insurance, fuel and maintenance of a car.”

According to the Department of Motor Vehicles, each case of a driver with a possible medical condition is considered separately, regardless of age.

“The DMV does not consider the age of a driver in these cases,” according to the regulations outlined on the DMV web site. “The DMV acts when it has information that a driver has a possible condition that can affect driving skills.”

New York State law and DMV procedures identify conditions that require a driver to take a new road test. Medical conditions can come from different sources, including an accident report, a physician’s report, a police report or from a family member. If a physician reports a condition that can affect the driving skills of a patient, the DMV can suspend the driver’s license, until a physician certifies that the condition is treated or controlled and does not affect driving skills.

A physician can use form DS-6 (Physician’s Request for Driver Review) to report the condition. If a report is received from a person who is not a physician, the case is decided separately. The DMV can schedule a re-test for the driver, or an evaluation interview with a license examiner, which may require a vision test, a written test, a road test or all three.

A December 2008 report by the Insurance Information Institute highlighted the nuances in state driving laws. According to the data, New York remains among the more lenient states with regard to driving regulations. In contrast to other places, New York does not have an age limit on license renewal by mail, and does not require doctors to report medical conditions.

Some states limit the elderly to driving during daylight hours or on certain types of roads. Others require doctors to report any dangerous medical conditions that can impair a patient’s driving. California law specifically requires doctors to report a diagnosis of dementia.

Some 35 states require drivers to take vision tests at license renewal, regardless of age. About half of the states require a road test at renewal for any driver who has had a certain number of accidents or traffic infractions. At least 15 states mandate more frequent testing for older drivers at license renewal.

Eight states mandate that older drivers must renew their licenses in person. Ages at which this takes effect vary among these states from 61 years of age to 79.

The New York State Office for the Aging has developed a handbook to help families, friends and caregivers facing the dilemma of what to do when an aging loved one is at-risk driving.

“When You Are Concerned,” which can be accessed at www.aging.ny.gov, is a compilation of the experiences of families and others who have successfully resolved an unsafe aging driver situation. Their stories have been gathered through surveys conducted by the Older Driver Family Assistance Program of the New York State Office for the Aging. The information was compiled into the handbook by a committee of experts on aging, caregiving and driving issues.

“While many older persons know when to surrender the keys, there are others who continue to drive when they are at-risk,” the introduction reads. “The issue of what to do about an aging loved one who is at-risk driving can be both perplexing and paralyzing. Families who have been faced with the dilemma of what to do have often reported taking a year or more to act! Those who have intervened report it as being one of the most difficult things they have ever had to do.”