The Family Health Guide

Staying healthy in your car: Coping with illness and age

About one of every seven drivers is older than 65; that's a total of 23 million senior citizens behind the wheel. Illnesses and age can affect motor vehicle safety. An Alabama study showed that heart disease, previous strokes, arthritis, and the use of various medications indicate increased the risk of crashes. But taking a few precautions can help prevent accidents and injuries.

Every state requires an eye test for licensure; most require a visual acuity of 20/40 or better in at least one eye and a lateral visual field width of 140–160 degrees. It's a reasonable standard, but it may not go far enough. If you're over 50, a checkup will protect you from visual loss due to glaucoma, and it may reveal cataracts or other problems that can be corrected. If you have problems with your hearing in daily life, get your ears checked to see if you need help hearing traffic noises and horns.

Arthritis pain can make it difficult to perform common driving maneuvers (turning your neck, gripping the wheel, or pressing the pedals). Medication can ease joint pain, and exercise can increase mobility and strength. Physical therapy and occupational therapy can be particularly helpful if they are targeted to improving the functions needed for driving.

Most people with heart disease can drive safely without any restrictions. If your heart disease is important enough to require medication, it's important enough for you to discuss driving with your doctor. In any case, don't drive if you don't feel well.

The minor memory lapses that occur with normal aging should not pose any problem with driving. In contrast, the forgetfulness, impaired judgment, and loss of directional skills that may be signs of dementia are very troublesome. One study found that nearly a quarter of senior citizens with cognitive impairment continue to drive — and that most doctors don't intervene. It's never easy to give up driving but the American Academy of Neurology's guidelines say that persons with Alzheimer's disease should not drive, even in early, milder cases. The same is true for other conditions that cause significant cognitive impairment.

Even normal, healthy aging is bound to take a toll on a person's reflexes, reaction time, muscular strength and flexibility, and sensory ability. A few states already require road tests before drivers 75 and older can renew their licenses, and more are sure to follow, but you can arrange your own test. Some medical institutions offer 2- to 4-hour evaluations run by certified occupational therapists. They will check your observational skills and reflexes as well as your ability to control your speed, change lanes, and negotiate intersections, where left turns are a particular challenge for older drivers.

Knowing when it's time to give up your keys is a difficult and sensitive area without a single guideline that applies to everyone. For most people, it's a gradual transition, beginning with not driving during bad weather, as well as avoiding traffic and night driving. Accidents and police citations are red flags. A string of accidents means it's time to stop; even a single fender-bender may be a warning. Memory loss is another possible indicator. Forgetting where you put your keys is no problem, but if you forget where you are going or why you left home, it's time to forget your keys permanently. Getting lost in familiar territory, whether in your car or on foot, is another sure sign of trouble.

November 2005 Update