from the NYTIMES:

[mimitabby]

July 17, 2006
Op-Ed Contributor
A Crash Course for the Elderly
By ANDREW L. HAAS

Armonk, N.Y.

ON a Saturday afternoon last July, I was riding my bike not far from my hometown, training for the Ironman World Championship in Hawaii. Training for the Ironman, which is reputed to be the most challenging single-day athletic event in the world, is almost like a second job. It requires three to five miles of swimming, 30 to 40 miles of running and 150-200 miles of riding each week. I was in fantastic shape and just three months away from competing against the best triathletes on the planet. That’s when everything came to a screeching halt.

I remember nothing of the accident. Local police and ambulance reports indicate that a 75-year-old man turned left and drove directly into me, cracking my bike in half and sending me to the operating room and intensive care unit, where for the next three months I fought for my life. My injuries included a fractured pelvis, 15 fractured vertebrae, multiple facial fractures, an open triceps laceration, two collapsed lungs and severe blood loss. While I was in a coma, my family was left to wonder whether I would survive, and how functional I would be if I did.

In the year since the accident, I have learned to walk again. The Ironman, however, is well beyond my ability. I cannot run down the block without serious pain, especially in my pelvis. Professionally, I missed almost a year of work, which forced me to restart my orthopedic surgery practice from scratch. I have a long way to go before I regain even a semblance of my former life.

But the driver who hit me has scarcely been inconvenienced. He was charged with failure to yield and issued a $128 fine. He is permitted to drive without restrictions and without any assessment of his competence. In all probability, he has had no legally mandated driver training since he received his driver’s license more than half a century ago.

Doctors are required to take continuing medical education courses each year in order to retain our licenses and hospital privileges. We must also take our board specialty examinations every 10 years to maintain our specialty certifications. We do this in order to reduce the risk to patients of injury or death caused by medical errors.

Yet there are few such precautions taken to reduce injury and death on American roads. Someone can get behind the wheel of a potentially lethal automobile without having had his basic competence tested in decades. Most drivers receive their last exposure to driver education and testing in their mid-teens.

This makes no sense. Given their great, and frequently proven, capacity to do harm, drivers should be required to take a continuing driver education course every 10 years.

Special emphasis should be placed on elderly drivers. Motor-vehicle injuries are the leading cause of injury-related deaths among 65- to 74-year-olds and are the second leading cause, after falls, among 75- to 84-year-olds. Older drivers have a higher fatality rate per mile driven than any age group except drivers under 25. The American Medical Association estimates that as the population of the United States ages, drivers aged 65 and older will eventually account for 25 percent of all fatal crashes.

Accordingly, it makes sense to recertify drivers at age 65 and require subsequent recertification, based on road testing, every five years thereafter. Yet only two states, Illinois and New Hampshire, require road tests for older drivers — and those only after age 75. Some states actually reduce requirements; in Tennessee, licenses issued to drivers over 65 do not expire.

More than 40,000 people die in auto accidents each year. Well over two million more are injured, some, like me, quite severely. In July 2003, an 86-year-old driver plowed through a crowd in Santa Monica, Calif., killing 10 and injuring dozens. Yet here we are three years and many tragedies later, and still nothing has been done to prevent this recurring nightmare.

Continuing medical education and board recertification are inconvenient and time-consuming, but doctors recognize that they benefit the profession and society. The nation’s 199 million drivers should receive the same level of attention that the nation’s 900,000 doctors do.

We should require continuing education for all drivers and licensing recertification and mandatory road testing for drivers age 65 and older. It would make the roads safer for all.

Andrew L. Haas is an orthopedic surgeon.

[emily_in_nc]

AMEN!

I can't think of anything else to say... :(

Emily

[SadieKate]

Absolutely. Dealing with this issue in my family now. Unfortunately, it is my MIL and I can only do so much. I haven't yet personally called the DMV but that is next on my list after this week's visit by one of the daughters. I think they finally got it when I convinced them that she had no ability to deal with the unexpected, that planning trips with right hand turns only and the inability to back out of her driveway in a straight line was a signal.

[Geonz]

An Illinois cyclist was killed by an elderly driver - who wasn't even fined a red cent or even given a ticket. I understand he's not driving any more. Still, fact is that he killed a mom.
I find it hard to believe that the driver was so utterly fragile that it would do him more harm to at least acknowledge that HE DID SOMETHING TERRIBLY WRONG. If he does, in fact, recognize that, then I find it hard to believe that he shouldn't be willing to at least pay a ticket or do community service - hey, go out and walk along the road and pick up some litter! Sweep off a bike path! I wasn't there so I can't assume this is so, but somehow I suspect that the reasoning was that well, he didn't *mean* to do anything, so we shouldn't do anything either. Or, he's from X family, and we don't want to make them mad.
My momma didn't let that be an excuse for me, any more than "she made me do it" would be. My momma shoulda been a judge.

[KnottedYet]

A friend's grandma hit a 10 year old girl on a bike and didn't stop. She drove home, and then called a daughter all upset because she thought something had happened when she was driving but couldn't figure out what.

The daughter did a court appearance and took guardianship of her mom and the whole works. Took away the car. Moved her into a nursing home shortly after.

She took the whole thing very seriously.

[DDH]

First let me say to you how sorry I am this happened to you. I am so glad that you are slowly recovering. This must be a very hard thing to have to go through.
I don't mean to open a can of worms here but I have to say, I agree to an extent with what you say, however there are always exceptions.
New drivers, teenagers cause more accidents than any group, however we do not intend or even suggest that we take away their priveledge to drive.
I agree with your statment that all should be recertified or some kind of re-testing every 10 years or so.
I wonder if we will all feel the same way as we get older though. A lot of time that is the last of the independance that the elderly have and when we take that away from them, they sit in their houses with nothing to do.
It's really a very touchy thing and should be looked at on an individual basis and not just a broad range of age be given the boot on when they have to stop driving. I know that is not what you had said, but a lot of the times when this gets brought up, that is the general consenses, "just take it away from all, say, 65 year olds" and I just don't think that is the answer.

I think the main thing I see these days is that people in general seem to think that they have some right to drive. The fact of the matter is, is that driving is a priviledge not a right. People seem to think that they own the rode when they are on it and by God everyone else better get out of their way.
I live in an overcrowded military town, and we don't have the big city traffic so to speak, but we have a problem with the roads not being able to handle the amount of traffic we have and it is causing major impatience problems and people being discourtious, rude and just plain taking way to many chances. No one knows what speed limits signs are for, or at least it doesn't pertain to them. Everytime I go to town, I see people do the rolling stops at stop signs, run red ligths because they just aren't going to wait through one more light cycle. I mean it is just down right scarry to drive. I try always to do all my running during non peak hours, and rarely go into town after dark, and I am only 42.
Okay, sorry, I didn't mean to get on a tangent. I'm done. I apologize really. I don't want to offend anyone or get any dander up it's just a sensetive subject with me. I have a mother and MIL that I have to do all running for because neither can or will drive and it takes a tole on me at times. I guess the good side is at least we didn't have to fight for the keys from them before they did hurt someone.

[Deborajen]

Regarding the article - well said!

But yes, as DDH says, there's more to it than just the elderly. I just went through getting my teenage son started driving. Personally, I'm really not in favor of unrestricted driving until at least age 18. Teach them, supervise them, and give them priviledges gradually - don't make it about convenience. Unfortunately, that seems to be the main concern about driving priviledges - at any age. It should be about getting there, but safely.

Driving is a huge responsibility. Cycling carries responsibility, too. The laws need to be enforced and everyone needs to take responsibility for the damage they can do, period.

Deb

[xeney]

New drivers, teenagers cause more accidents than any group, however we do not intend or even suggest that we take away their priveledge to drive.

Sure we do. Well, it depends on the state, but California keeps imposing more and more restrictions on teenage driving in response to the number of traffic fatalities in that age group. These days there are limitations on when kids can drive, how many other kids can be in the car, when they can drive without an adult present ... it's a long way from when I was 16 and suddenly had all the rights and privileges of someone who'd been driving for thirty years.

But laws won't do everything. Even if states restricted licenses for seniors, it might not help, because the same factors that make some people unsafe to drive could also make them unwilling to respect the fact that they no longer were legally permitted to do so. Families have to take responsibility, and that is much easier said than done. Elderly people have been known to actually steal cars. (Not that anyone I'm related to ever did that, ahem.)

I think the answer is probably for people to be aware of this issue when they are younger. Talk about it with your spouse, with your kids, with your doctor, so that you have more objective people around to let you know when it's time to give up the keys. And, from an advocacy standpoint, it is much easier for seniors to stop driving if they have other options ... which means public transportation.

[mimitabby]

Yes, in washington too; teenagers have restricted licenses. It's great.
lets them drive, but without 10 kids in the car.. by the time they
have matured, they have some experience driving and then are permitted to drive at night and with multiple passengers.

[Tuckervill]

In Arkansas, kids can get their learner's permit when they are 14.

Some people are shocked by that and some people in Arkansas want to change it. But I think it's wonderful just like I did when I was 14 and got my permit (I started driving on the back roads when I was 13, in my own car, a red '67 Beetle that I had to park on a hill and pop the clutch to get going--we also turned in pop bottles to get 50 cents worth of gas. Man, those were the days.)

Back to my point...my two adult sons, aged two years apart, got their learner's permits at the same time. One was 14, one was 16. The 16 year old had his permit for 60 days, then he got his license and could drive everywhere (I trusted him and didn't worry about him). But the 14 year old had TWO WHOLE YEARS of practice with a licensed adult before he could drive. That's why I tihnk driver's permits at 14 are still a wonderful idea.

(Both of them are safe drivers and neither have ever had an accident, although they both had their share of speeding tickets. Now they both drive slow because they are cheapskates and don't want to waste gas or pay the "stupid tax".)

And if my kids had grown up in the same kind of tiny town like I did, with no local law enforcement to speak of, I probably would have let them drive as early as I did (I first drove the Beetle with my Dad when I was 10). I can imagine lots of rural farm kids learn to drive all kinds of farm vehicles, including the pick-up truck, early ages. It's not that kids can't be safe driving--it's that most kids are learning to drive in very, very heavy traffic, with thousands of possibilities for bad happenings.

Life gets so much easier when you have a kid in the house who can drive!!! ;)

Karen

[Imperfectstorm]

Most accidents are caused by the 18-33 yr old group, I learned that in a community policing class.

If you want justice, hire an attorney. Don't lump everyone into one narrow category.

[Deborajen]

Ageism? Sorry, I don't sympathize. With age comes experience and maturity to handle big stuff like driving. Eventually, these abilities deteriorate, too. And under age 18 (that's the age in my state, anyway) parents end up being held responsible for the under-age-18 kids' actions. If that means I'm a "bigot" for using "ageism" as an excuse for not wanting my son, or other people his age, to drive because their age is 17, so be it!

It's perfectly reasonable to have age-specific guidelines in this instance. And by the way, even attorneys can't get justice if the person being sued is legally too young to be held responsible. Better to have some common sense and statistically valid rules in the first place.

Deb

[donnambr]

A great way to avoid all accusations of ageism is to re-administer both written and road tests to all licensed drivers every 5 years without exception. Plenty of people who are not teenagers or senior citizens shouldn't be driving a car, and I have been one of them.

I'm 33 and the last time I had a driving test was when I was 15 to get my learner's permit. Michigan did not require me to take a driving test for my license because I had passed my permit test. The last time I had a written test was 10 years ago when I moved to Oregon. They did not require me to take a driving test because my Michigan license was in good standing. That's crazy! Sure, I haven't gotten into any car accidents or been pulled over for speeding since I was 19, but how the heck do they know what kind of driver I am? They sure don't know last month was the first time I drove a car in 2 years, and they definitely do not know it was because an ear tumor and subsequent recovery from the surgery to remove it gave me too many balance and depth perception problems to feel comfortable driving a car. I wasn't even up to riding a bike until 5 months ago. Those were my choices. My doctor didn't even suggest it. I know had I been driving a car during one of those dizziness/tilting spells, I could have killed someone. What if I wasn't the kind of person who always considers the consequences of my actions and who accepts my physical limitations? What a menace I would have been!

And - if you fail the road test, you should have to go to traffic school or some kind of refresher course. Thus, we finally give the automobile the respect it deserves as a deadly weapon and acknowledge that drivers are operators of a deadly weapon.

[pooks]

We went through nightmares to stop my mil from driving. She had three wrecks (fortunately, never hit anybody else -- just immovable objects) by stepping on the accelerator instead of the brake. The last time, she drove through the back of her house and did thousands of dollars worth of damage to her house AND her car.

State Farm refused to pull her insurance.

The State of Texas can't do anything unless a doctor says a person is medically incapable of driving. She was under a hematologist's care who said she couldn't write the letter because her anemia was under control and thus wasn't contributory to her driving. Her internist wouldn't write the letter. Fortunately, her cardiologist took it upon himself to write it -- after my mother-in-law giggled and told him she was still driving, and he couldn't do anything to stop her.

That didn't end the nightmare, though.

In Texas it is next to impossible to stop the elderly from driving unless they are reasonable enough to recognize when it's no longer safe. My mother only drives short distances even though she's never had a wreck. She is uncomfortable on the freeways and always gets somebody else to take her if she's going far.

There HAS to be a way to stop bad drivers of any age.

I think teenagers are allowed to drive too young. I think that should change. HOWEVER, the big difference between teenagers and the elderly is the asumption that teenagers will improve. The elderly almost without exception will not, and their driving abilities will diminish. This is a fact of life and there needs to be a legal way to deal with it.

After my mil drove through the back of her house (making excuses as to why it wasn't her fault, of course) and my husband took her keys away, it turned out she'd hidden extra keys all around her house in anticipation of such a day. She kept driving. People kept telling us all the things we should say to her, but the problem was, we'd said all those things.

When my husband said, "What if there had been a child in front of your car? What if you killed somebody?" she responded, "So be it."

How do you deal with that?

[mimitabby]

wow, Pooks, what a story!
I have a mil that needs to stop driving too. She's got alzheimers; which is really scary. She's only driving a few blocks now, to church and back, literally, but recently she got into an accident with a parked car and then forgot about it.
She's still driving..try reasoning with someone whose brain is gone!

[pooks]

Somebody has to stop her. It's that easy. And that hard.

Some people have no problem dealing with it -- taking the keys away and letting the poop hit the fan. My husband had a terrible time doing it.

My MIL has alzheimer's too. At that time it was not diagnosed and was pretty early on. Her real issue was all about independence. She loved driving, she claimed she paid for her car, she paid for the insurance, therefore nobody had the right to stop her.

When I caught her driving without a license and took the keys out of her hands, she called the police and told them that I'd stolen the keys to her car and to arrest me. (Mind you, without me she'd be up a creek, and she knows it.) But this was all about a single-minded panic at losing what she considered the last thread of her independence, and her focus narrowed down so tiny that NOTHING mattered to her but that she still be able to drive. Even other people's safety. She didn't even bother to claim nobody would get hurt. She just said she didn't care if she did hit somebody, because she'd probably be dead and wouldn't have to know about it.

And there was absolutely NOTHING we could do to stop her (unless of course my husband had been willing to take her keys and put up with the aftermath). When she had to go to take her test again (after her cardiologist wrote the state and said she shouldn't be driving) she failed the test five times (oh, the stories the testers told me, oy!) but insisted that everybody was lying because they just thought she was too old, because she knew she was a good driver. She decided they were discriminating against her because of her age, and called the DMV repeatedly, until finally I got a call from the Captain who was in charge of the place begging me to stop her from calling -- she was calling him 15-20 times a day to protest that she was a good driver and his testers were lying.

I felt like saying, "If a big guy like you with a gun and state police unit to back you up can't stop her, what am I supposed to do?"

(sigh)

[mimitabby]

Somebody has to stop her. It's that easy. And that hard.
she failed the test five times (oh, the stories the testers told me, oy!) but insisted that everybody was lying because they just thought she was too old, because she knew she was a good driver. She decided they were discriminating against her because of her age, and called the DMV repeatedly, until finally I got a call from the Captain who was in charge of the place begging me to stop her from calling -- she was calling him 15-20 times a day to protest that she was a good driver and his testers were lying.

I felt like saying, "If a big guy like you with a gun and state police unit to back you up can't stop her, what am I supposed to do?"

(sigh)
wow, what a story.In our case, I guess the whole thing is in my brother in law's hands, as HE lives with her 3 hours away from us. But this little drama of yours (and of ours) is being replayed all the time, all over the country. all the more reason to not
trust ANY cars EVER.

[pooks]

In my experience and that of my friends, women can handle this much better than men can, though I don't know why. I know several women who have stopped their moms (and in one case, a dad) from driving, even if it meant the mom got angry/hurt/etc.

I know more than one man who was not able to handle that.

[oldbikah]

My father had altzheimers and was clearly not safe to drive, but my mother would not act on it. I called the local police and was told to write to the state motor vehicle dept here in Maine. States will vary in their responses, I am sure, but they had an astonishing fast response. Within one week, they had sent a letter to him to report for a driving test. At that point, my mother just hid the keys and told him his truck would not run and that was the end of it. My name was mud for some time, but I could not let him continue until he killed someone.

[Bad JuJu]

Yeah, I had to tell my dad to stop driving, after he'd been diagnosed with alzheimer's. Fortunately, nobody got hurt--he just got lost a couple of times and the police called me to come and bring him home. I knew his memory was impaired but didn't realize that his sense of direction had been affected, which probably means that other faculties had been affected too.

He fought me some, but not as much as I expected. Soon after that, we had a major hurricane and he had to go live with my brother, so it wasn't as big an issue as it could've been.

I like the idea of regular re-tests for drivers. Might've helped me recognize my dad's impairment sooner.