Too Old to Drive?

On February 25, 1983, my mother drove out of the parking area behind the apartment building in Florida where she and my father lived. She suffered from gradual cognitive decline and should not have been driving. She didn’t notice an oncoming car and pulled in front of it. There was no initial sign of injury, but the next day she became acutely confused. The emergency room diagnosed a large subdural hematoma (bleeding between the skull and the brain). Twenty four hours later she was dead. Luckily the driver whose car she pulled in front of was unharmed.

What turned my mind to driving among over 65ers was my own recent experience of driving in the English countryside (Cornwall). Apart from the challenge of adapting to “the wrong side of the road,” the rural lanes – though beautiful – were narrow and curvy, with barely enough room for cars to pass each other. The thought “I’m too old to be doing this” entered my mind more than once!

According to a RAND study, by 2025 we over 65ers will constitute 25% of the US driving population. We’re 16% more likely to cause accidents that those between 25 and 64. (The most dangerous cohort on the road is 15-to-24 year olds, who are 188% likelier to cause accidents than non-elderly adults.)

The population elderly drivers put most at risk is ourselves. RAND found that in accidents involving an over 65 driver, there’s an almost 600% greater likelihood that the elderly driver or a passenger in the car will be killed! My mother was part of this statistic.

I haven’t been able to find epidemiological data about whether we’re more likely than younger drivers to cause injury to pedestrians or other drivers. We’re much less likely than under 65ers to speed or drive drunk. Only 5% of our accidents involve elevated blood alcohol levels compared to 25% in those who are under 65. But especially as we get into our 80s and beyond, our vision, coordination, speed at responding to hazards, and cognitive acuity progressively decline.

Whether or not we’re statistically likelier to pose danger to others, accidents in which elderly drivers cause injury have received tremendous attention, as when, on July 16, 2003, 89-year-old George Russell Weller plowed into a Santa Monica Farmer’s Market, killing 10 and injuring more than 70. As an example of how our dangerousness as drivers is seen, take a look at the November, 2003 “Grey Dawn” episode in the animated series South Park. It brutally satirizes elderly drivers as angry, self-centered, muddle-headed, and casually lethal.

 Giving up driving has significant implications for health and well-being. An Australian study showed that relinquishing driving was associated with depression and lower levels of social, volunteer, and family activity. This creates an ethical conundrum for family members, health professionals, and over 65ers themselves. Safe drivers who give up driving unnecessarily risk deterioration in health and life satisfaction for no good reason. But risky drivers who continue to drive create dangers to themselves and others.

The potential risks for elderly drivers and from elderly drivers will be an ever-larger global public health concern. In 2010 the planet passed the mark of one billion automobiles, with China and India leading the growth in automobiles in general and in the over 65 population in particular. Automobile design, improving road safety features, and developing alternative modes of transportation that allow over 65ers to preserve independence without depending on a car, are concerns all countries will need to address in the next decades.

James Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.