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End of the RoadDung Hoang

End of the Road (continued)

In a study published in the Journal of Applied Gerontology in December, Jones and a team of researchers from CIRP, the Maryland Highway Safety Office, the Maryland MVA and others administered three standard computer-based cognitive and physical screening exams to 67 older Baltimore County motorists in a laboratory setting. Nine of the drivers, or about 13 percent, were unable to complete or failed two or more of the screening tests and were judged to be at high risk for a crash. (Another 20 were ranked as medium risk because they couldn’t successfully complete one of the screening tests.)

As a group, the nine older drivers judged at high risk had the most trouble with the test that measures the ability to process and sort information.

One of the goals in the study was to see how the high-risk group reacted to being told test results indicated they had a driving-related impairment and should seek medical advice. Jones and her colleagues wanted to learn what participants did with the information, if they would accept the results and seek medical advice or voluntarily stop driving.

From the public health perspective, the results were not encouraging. Of the four drivers who later agreed to in-depth interviews, all said they were uncomfortable with at least one aspect of the testing experience. One told researchers: “Trying to search for a proper word. Disappointed, I guess. Disappointed and [pause] I couldn’t understand why I failed because everybody tells me I’m a good driver.”

Importantly, none of the four who failed the tests disclosed the results to a physician, and only one surrendered his or her license. The one participant who voluntarily gave up driving said: “I think probably subconsciously it was the reason I gave up my car, because I realized that my reflexes were not as good as they were.”

Despite the small sample, Jones says the study demonstrates how difficult it is to deliver unwelcome news to older drivers in a way that encourages them to act. But she wasn’t surprised, because of the importance of driving to many older people.

When it comes to competency behind the wheel, gerontologists say that chronological age isn’t as important as what is called “functional age.” Steven Gambert, MD, director of Geriatric Medicine at the University of Maryland Medical Center and R Adams Cowley Shock Trauma Center and an authority on the mental and physical effects of aging, recalls testing a former military pilot in his 60s who, as a younger man, had landed a crippled plane armed with a nuclear weapon on the deck of an aircraft carrier. The man’s exceptional skills seemed unaffected by his age. “This guy had superhuman hearing and reflexes,” says Gambert. “He tested off the charts. We couldn’t believe it.”

While many older motorists are highly skilled, Gambert says, others experience a sharp decline starting around age 80. At Shock Trauma, he all too frequently deals with the tragic results.

While Gambert describes himself as an advocate for the elderly, he says that perhaps drivers at a very advanced age, starting in their mid-80s, should be subject to screening that goes beyond an eye test. Drivers with medical conditions or a record of accidents that raises concerns, he says, may need screening earlier. “The reality is, the older you get, probably you’ll get to the point where you’ll need a driver’s assessment,” he says.

Some drivers stay on the road long past the time when they should no longer be behind the wheel. When George W. Rebok, PhD, a professor in Mental Health, was a postdoc studying dementia patients at Hopkins in the 1980s, he discovered that some of his study subjects were driving guided by directions shouted at them by their passengers. Others manipulated the pedals while their spouses steered.

Rebok’s father, Jack Rebok, a retired nuclear power plant engineer, fiercely resisted surrendering his car keys after developing Parkinson’s disease in his early 80s. His family took away his keys, but he had extras hidden around the house. When the family disabled Jack’s beloved Plymouth sedan, a buddy helped him fix it. After Jack Rebok’s doctor reported his declining skills to the state, as required in Pennsylvania, Jack flunked the driver’s test three times and lost his license. But when George saw that his father had visited the barber several miles away, Jack admitted he was driving without a license.

Finally, Jack’s family hid the car and told him it was in the shop for repairs.

Comments

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  • Isabelle Kargon

    Baltimore, MD 10/11/2012 10:48:47 AM

    The only really efficient solution is the implementation of a decent public transportation system and a shift away from this country's car-based culture.

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