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Cognitive test for older drivers tied to more safety for them, study shows

Japan instituted a policy requiring older drivers who fail a cognitive impairment test to visit a physician before they renew their license. It led to increased safety for older motorists and more injuries to older pedestrians, research says.

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Myrna was aging but active, a socially active woman who would crisscross the Los Angeles area in her beloved Mercedes on her way to and from the market, concert halls and friends’ homes.

But today, the car doesn’t leave the 85-year-old’s Encino garage. After a dementia diagnosis, she was advised by her doctor to stop driving — and her children told her it was time to give up the keys.

“I tried to put the fear of God in her, but she was very adamant” about wanting to drive, her daughter, Cindy, says.

Myrna, whose last name is not being published to protect her privacy, is not unique. It can be difficult to help older adults transition from the driver’s seat, experts say.

Japan, though, found a way in March 2017. The government enacted a policy requiring drivers 75 and older who fail a cognitive impairment test to visit a physician before they renew their license.

In the six months after the policy was implemented, physicians’ tests showed that over 30,000 drivers had signs of dementia, and 674 had their licenses revoked, the Japan Times reported at the time.

An increase in motorist safety and pedestrian injuries

The policy led to safety increases for older motorists, a new analysis shows. But injuries to older pedestrians and cyclists rose at the same time.

Researchers looked at police-reported data about motor vehicle collisions and pedestrian injuries between July 2012 and December 2019.

Crashes among drivers 75 and older had been increasing until the policy was instituted, the analysts write in the Journal of the American Geriatrics Society. Afterward, they dropped, with about 3,670 fewer collisions than expected. The rate fell substantially for men between the ages of 70 and 75, the study shows. Women did not see as steep a decrease, but their collision rate fell, too.

The study also found a corresponding rise in road injuries for both pedestrians and cyclists, 75 and older. There were 959 more such injuries than expected during the study period after the policy was implemented, with women more likely to be injured than men.

“Policymakers focus on just reducing motor vehicle collisions, without realizing the potential harm for older pedestrians and bicyclists,” says Haruhiko Inada, a physician and epidemiologist who is a co-author of the study, which was conducted during his postdoctoral research at Johns Hopkins Bloomberg School of Public Health.

He and his team write that they see “strong evidence” of age-based cognitive screening associated with increased road safety for older drivers. They were unclear, however, why road safety increased for the drivers after the policy was instituted. They surmised that older adults may have driven differently or voluntarily surrendered their licenses instead of continuing to drive after the policy came into effect.

The researchers also were unclear why the risk to older pedestrians and cyclists rose. It was probably because of a shift to “walking (and cycling) among older drivers after they stopped driving,” Inada said in an email.

The researchers say future studies should look at ways to make these alternative forms of transportation safer for older people.

Medical conditions, not older age, linked to more accidents

This kind of policy targets drivers of a certain age group, and data shows that older age is not linked with more accidents, says Anne Dickerson, an occupational therapist and professor at East Carolina University, who has spent much of her career researching older drivers.

Drivers 65 and older are involved in fewer accidents per driver than their younger counterparts, according to the National Highway Traffic Safety Administration. As a group, though, older drivers are less likely to survive a severe crash, and studies show they are particularly vulnerable in intersections involving left turns.

“Older drivers are not as dangerous as you might think,” Inada said.

Some medical conditions, though, put older drivers at risk. A 2018 report from NHTSA called out eight medical conditions as presenting “particular concern in their relation to driving impairment” to older drivers: diabetes, dementia, glaucoma, hepatic encephalopathy, macular degeneration, obstructive sleep apnea, Parkinson’s disease and stroke.

That report cited a study that found that the crash rate of older drivers with mild dementia was higher than that of control groups of older adults who are healthy and who have very mild dementia.

How to help people adjust to not driving

Many people have to give up driving because of medical conditions, age-related issues or other reasons. Here are ways to make that transition smoother.

Know when to find alternatives: Most families wait too long to find alternatives for aging loved ones with medical conditions such as cataracts or Alzheimer’s disease. “If an older adult can’t manage their money or their medication, they probably shouldn’t be driving,” Dickerson said.

Have those difficult conversations before a crisis: States have different systems for identifying potentially unfit drivers. Many states have instituted medical boards that review drivers’ fitness to drive and can suspend or revoke their licenses.

According to NHTSA’s most recent count in 2017, 32 states have such boards, though their qualifications and authority varies. Just six states reported they had laws that made it a crime to not report a driver with impairments that could affect their ability to drive safely.

Much of the onus for identifying unfit drivers falls upon doctors, law enforcement officials and family members.

“It’s the hardest conversation a family can have,” Dickerson said.

Cindy said she asked her mother’s doctor to intervene after noticing some telltale scratches on her car. Her mother threatened to fire the doctor and dug in her heels before relenting.

It took Myrna months — and the knowledge that her doctor had reported her to her state’s medical board, which is legal in California — to come around to the idea of giving up driving. In 2012, the most recent year tracked by NHTSA, there were 92,235 such referrals, a full 20 percent of which came from family members.

“It’s the pits,” Myrna says of life after driving, citing an unwalkable neighborhood and fears she won’t be able to get away during a fire or other emergency. Her daughter has been ferrying her to social engagements and helping her feel less isolated, but Myrna says she’s lost a cherished sense of freedom and spontaneity.

That doesn’t have to be the case, Dickerson says.

Plan for future transportation needs: When you make retirement plans, consider transportation needs. With funding from NHTSA, Dickerson developed the Plan for the Road Ahead, a website that helps people create a “driving retirement plan,” experiment with new forms of transportation such as ride booking and access information about research related to older drivers.

Push for better screening for all drivers: “We need a better way to assess all drivers,” Inada says. State laws vary, but screening can involve testing eyesight, on-road performance, knowledge of traffic laws and a review of medical conditions. In some states such as Florida, Alabama and Massachusetts, drivers with dementia are allowed to continue driving unless their physician reports they are unsafe.

Work toward equitable transportation: People of all ages need to think of ways to provide equitable transportation for all, Inada says. That involves having long-term conversations with family members, looking for ways to help extend older adults’ “driving life expectancy” and addressing transportation inequities, he says.

Meanwhile, Dickerson says, drivers of all ages should take advantage of technologies that make it safer to stay on the road. “Healthy older adults should get as much technology on board as they can,” she says, and learn how to use features such as blind spot monitors to avoid crashes.

Cindy says her contentious relationship with her mother’s desire to drive shifted after a conversation that left the daughter thinking about how she’d feel in the same position. “Imagine if all of a sudden you just had to stay at home,” she says. “Imagine that.”

After that exchange with her mom, she says, “I kind of got it.”

Myrna continues to attend the symphony, go out to dinner and maintain a social life, thanks to rides from family members and friends. But she won’t give up her Mercedes. “I’m kind of hanging onto it,” she says. “I feel better when it’s there.”

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