When to Take Away the Car Keys?

State highway officials, insurance experts and advocates for older people are struggling to find the best way to ensure the traffic safety of a rapidly aging population, without taking away the rights and independence of those people.

But while they're doing that, the statistics are piling up -- and they're enough to turn your hair gray.

For instance:

* One person was killed or injured in traffic crashes involving drivers over age 55 every 28.2 minutes in Missouri last year.

* Drivers 80 and older hit more pedestrians per 100,000 people nationwide than drivers in any other age group.

* More than 70 million drivers 65 and over are expected to be on the road in 2030, with fatal car crashes estimated to rise by 155 percent in that age group.

* Older drivers will account for one of every four drivers involved in deadly crashes in 2030; they will comprise only a fifth of all licensed drivers.

Despite the striking statistics, efforts to resolve the issue are just sputtering along.

Only Illinois and New Hampshire require mandatory road tests for older drivers (75 and up). Illinois drivers between 75 and 80 also must undergo a written test and an eye examination every four years when they renew their licenses. Those between 81 and 86 must be tested every two years; drivers older than 86 must be tested every year.

Illinois began requiring more tests for older drivers in 1990. About 14 percent of drivers over 75 fail the tests. The state has 439,597 drivers 75 and older. A spokeswoman for the Secretary of State's office said there have been no studies on the effect the testing has had on traffic accidents or fatalities.

California and Florida are reportedly studying the problem in their states, which have the highest populations of older people. Several states accelerate drivers license renewal times for older drivers. For example, the normal renewal time in Missouri is six years, but it's three years for those 69 and older (and 21 and younger).

Some states also require additional vision screening for older drivers.

In Missouri, a person can take a driver's test at age 16 and never take another test. A Missouri driver can be forced to take a driver's test if he or she is reported to the Department of Revenue for incompetence.

In such cases, the state sends a letter to the person saying that he or she has to get a medical release to be able to continue driving. Reports of incompetent driving can come from family members, doctors, police officers and license offices. Forms are available at license offices.

A crisis at hand

Peggy Barco, director of the St. John's Mercy Medical Center drivers assessment program, serves many older drivers who have been reported and then referred to the program by their doctor.

"It is truly a crisis," Barco noted. "It becomes such a struggle within the family to take the keys away from an older relative. Driving is so crucial to their independence."

Assessment results are sent to the referring doctor, who then decides whether the person is fit to drive. Barco said her assessments are thorough - covering the person's general health, including mental clarity, reaction times, depth perception, night vision and other factors that can impinge on safe driving.

Some diseases, such as dementia, are not readily observable but can lead to hazards for those on the road. Barco said people with dementia often have difficulty distinguishing between types of road signs, and might not know the proper response to the sign if they do recognize it.

She added that the last part of the assessment involves a road test, but that sometimes the would-be driver doesn't make it to the road.

"Sometimes our evaluation ends at the parking lot," Barco said, alluding to cases in which a person does something like put the car into reverse instead of drive, or steps on the gas pedal instead of the brake.

"It's a scary job," she noted, adding that the tester has a brake on the passenger's side of the car.

Barco said about half of those tested pass, and half flunk. The program costs $300, and she said that as of last month, Medicare won't cover the cost. Most private insurance also will not pay for it, Barco added.

The road-test debate

When the topic of mandatory road tests is raised, opponents contend that such tests would amount to age discrimination. Even those who study highway safety professionally don't back age testing. They say it would be logistically difficult if not impossible to perform the right kinds of tests.

Most also argue that such testing is unnecessary. They say older drivers aren't as much of a risk as they seem to be, and that they appear to be a greater menace because the media pay excessive attention when they cause fatal accidents.

"For every one of those there are 100 teenagers," said John Eberhard, senior research psychologist with the National Highway Traffic Administration. His office is in Washington.

Eberhard pointed out that while national statistics indicate drivers over 75 are in more accidents per mile driven than any other age group, they also drive about a third as many miles a year as younger drivers. The result is fewer accidents for the older age group overall.

He also noted the difficulty and expense states would incur if they tried testing older people for all the things that can influence their driving, such as physical strength, mental clarity, joint flexibility, muscular endurance and visual acuity.

Dr. Robert N. Butler, a leading authority on aging and president of the International Longevity Center, a New York-based think tank, said comprehensive testing for older drivers might result in a savings when the costs of accidents are weighed against the costs of the tests.

He also likes the idea of the designated driver for impaired drivers of all ages, and said the general view of older drivers as frail and insecure is "a stereotype and discriminatory."

The American Association for Retired Persons, which is opposed to mandatory age testing, supported a bill that became law in Missouri in 1999. The law allows family members, doctors and police to send confidential reports to the state if they suspect a driver's skills have deteriorated because of old age or physical ailments.

The bill was pushed by Sheldon and Karen Suroff of Creve Coeur. They lost their son, Jason, 21, in an automobile accident in 1993 caused by a 91-year-old driver with senile dementia who was driving his pickup the wrong way on Interstate 70. The Suroffs started off immediately after the accident trying to get a bill passed that required mandatory age testing of drivers every six years after age 45.

There was such widespread opposition that the legislative sponsor got death threats and the Suroffs were publicly castigated. Sheldon Suroff said the state also opposed the measure, citing too heavy a fiscal responsibility.

The Suroffs didn't give up, though. They tweaked the measure and worked with the legislature until a true compromise was reached, meaning that no one got exactly what they wanted. Suroff said he thinks the law would be effective in getting dangerous drivers of all ages off the streets if more people knew about it and used it.

Eberhard, of the National Highway Traffic Safety Administration, agreed the Missouri law could be effective in helping get dangerous drivers off the road. He likes that it takes the fly-swatter approach rather than the cannon, targeting bad drivers instead of older drivers.

In fact, national statistics show that teenage drivers, the youngest and most inexperienced, pose the greatest risk to themselves and others. But next to them, older drives are the most deadly.

Many of them, however, refuse to quit driving without intervention.

"When they lose the ability to drive, that's often the first step to a nursing home or some other type of assisted living," said Eberhard. "No one wants to stop driving. Everyone wants to drive forever."