Balancing the Needs and Risks of Older Drivers

I went for a drive the other day inside a small room at new York University. My guide was William Schiff, a professor of applied psychology, and before I was done I managed to avoid a reckless school bus and make a safe left turn against oncoming traffic-but I did hit Mr. Schiff's daughter.

On the big television screen I was facing, she came out from between two cars in the shade, and I was slow putting my foot on the brake. Her father was understanding.

Mr. Schiff advertises his system-a sequence of filmed street scenes along with brake and accelerator pedals-as a fast, inexpensive way to alert older drivers, or motor vehicle departments, to the driving faults that can cause accidents.

Mr. Schiff is not alone. All across the country, dozens of researchers, urged on by states and Federal agencies, are developing and testing devices to identify unsafe older drivers. The issue of what to do about these drivers-the question of how to balance their need for mobility against the threat they pose to others-is on the front burner. It has been spurred, in part, by families of people who have died in accidents involving older drivers and by the cold logic of demographics.

The number of drivers ages 65 and over has more than doubled in the last 20 years, to 13 million; by the year 2020 there will be 30 million. Measured by the number of miles traveled, they have more crashes-and more fatal crashes-than most other age groups. Drivers between ages 70 and 74, for example, have five fatal crashes for every 100 million miles of travel-more than twice as many as drivers 40 to 49.

Yet, measured as a group, per licensed driver, older people have few accidents compared with younger drivers (In other words, they drive less but are more at risk when they do). And safety experts say that the higher mortality rate among older drivers reflect that they are more frail and that most older drivers are in fact no risk to anyone. "There is a small subset of impaired older people, under 20 percent, that brings the group's average down," said Karlene Ball, a researcher at Western Kentucky University in Bowling Green. "They have multiple accidents. The goal is to find some way of identifying them."

Putting age-based restrictions on license renewals is one tack, but only 12 states have such rules, down from 16 a few years ago. Testing is costly, and older-driver restrictions have been attacked as ageist. What's more, the traditional eye tests and rules-of-the-road examination don't seem to do the job.

That's why so much energy is going into finding better ways. On May 9, for example, the California Department of Motor Vehicles began an elaborate program to test the tests. Older motorists who have been referred to the department for re-examination, mainly because of medical conditions that might affect their driving, are being subjected to a battery of tests at one field office. The assessment techniques range from paper-and-pencil exams to automated devices to road tests, and they take up three hours over two days. The department will seek to determine which tests best predict motorists' performance on the road tests.

Some of the pressure for better controls on older drivers comes from families that bear scars.

Two years ago, Jason Suroff, a 21-year-old college student from Chesterfield, Mo., was killed when his car swerved to avoid a pickup truck going the wrong way. The 91-year-old driver of the pickup was later found to be senile.

Out of that tragedy, Suroff's family created an organization called Concerned Americans for Responsible Driving. At its urging, State Senator Irene Treppler of Missouri introduced legislation that would require driving and written examinations every three years after age 74 and every year after age 90. (Missouri requires all drivers to take a vision test every three years.)

"I had such pressure from senior citizens, you wouldn't believe," Ms. Treppler said. An amended version of her bill, supported by Responsible Driving, calls for these exams for all drivers every six years.

Sheldon Suroff, Jason's father, says that half the phone calls his organization receives come from children or wives of people who are so impaired they should not be driving. "They don't know what to do," he says. "One woman said her father was 83, had a cataract and was weak from cancer. When he had accidents, he paid off the other drivers in cash. People like this sometimes disown their children if they interfere."

Among the driver-control bills being considered around the country is one before the New York State Legislature that asks physicians to tell patients when their ailments make them unsafe drivers and to urge them to report their condition to the Department of Motor Vehicles. If the patients fail to do so, the bill asks physicians to do the reporting.

The measure also calls for the department to set up a graded licensing system that could restrict impaired drivers to, say, daytime driving in their immediate neighborhood. Other states have tried that approach, as a way to prevent drivers from being abruptly and unnecessarily removed from the road. It is supported by organizations like the American Association of Retired Persons when, as is usually the case, the bills are not specifically age-related. (In general, the association supports efforts to pinpoint impaired drivers that are based on performance, not age.)

Most older people don't wait for the state to tell them to limit or stop their driving. Recently, I went for a ride with Dorothy Pendleton, 72, a retired nurse. We were attending an American Automobile Association Mature Drivers Course at the Bristol Senior Center.

Each year, close to a million older drivers attend refresher courses, which are also offered by the American Association of Retired Persons and the National Safety Council. Connecticut is among 32 states where attendance at the courses leads to a discount on auto-insurance rates. In general, insurance companies do not increase rates for older drivers until they reach their middle or late 70's.

Ms. Pendleton smoothly managed challenges that flummox many older drivers, including in-and-out strip mall traffic and left turns at intersections. But she had no doubts that she needed the course. "I don't think I'm the same person I was when I got my license," she said, "and I keep my driving local."

But what about drivers who don't recognize or adapt to their limitations? What kind of screening techniques can be used to find them?

Researchers have come up with a wide variety of answers, though it usually takes years of tests before they can be proven both valid and practical. Ms. Ball at Western Kentucky University, for example, uses an automated test that measures the speed with which older drivers process what they see and their ability to ignore visual distractions.

In some studies, her test, which measures drivers' so-called useful field of vision, has proven remarkably effective in predicting their actual driving performance. Over the three years after testing, those who had shown a loss of more than 40 percent in their useful field of vision were 16 times more likely to be involved in a crash than those who were less impaired.

Dr. Richard A. Marottoli, a researcher at the Yale University department of medicine, asked a group of New Haven drivers, gaes 72 to 92, questions about their lives and put them through medical tests. A year later he interviewed them again, and 13 percent had been involved in an auto accident or moving violation. The strongest predictor of trouble turned out to be the drivers' inability to copy a simple design of two over-lapping pentagons.

Like Mr. Marottoli, many scientists believe their efforts to identify older drivers at risk can prevent discrimination based on age alone. But there are experts who oppose putting such emphasis on tests.

John W. Eberhard, a leading research psychologist at the Department of Transportation in Washington, is one. "If there were a good test, I'd support that, " he said, "but there isn't. Most of the tests are through the eyes. Yet, visual acuity has no predictability in terms of a crash. All that energy and money should go into making families and physicians smarter about recognizing the driver at risk and getting them to be more willing to report him to the D.M.V.

As it stands, Mr. Eberhard said, many older drivers see license-renewal tests as a threatening experience. "I'm against tests if they unnecessarily stop people from driving," he added. "That leads to people being institutionalized."

Most older drivers live in small towns and suburbs that lack public transport. Without cars, they lose mobility and their quality of life suffers. My Bristol classmate, Ms. Pendleton, yields to no one in her concern about unsafe older drivers. "When I read about an older person in an accident, going the wrong way on a street, I think it's criminal to allow such people to driver," she said.

But how would she feel if her own license were taken away? "If I didn't have the means to go somewhere when I want to go," she said, "I couldn't live that way."