Wednesday, January 19, 2011
Most elderly people are not too happy when others start talking about their driving. It's a sensitive issue because being able to drive is a mark of independence, that is cherished by senior citizens. But there's no getting around the fact that physical issues like failing eyesight and slower reaction times can affect the ability to drive safely.
Now, several agencies are joining together here in San Diego to help evaluate senior drivers but their aim is not to get seniors off the road, the program's main goal is to extend the lifespan of safe drivers.
Dr. Linda Hill, UCSD Dept. of Family and Preventive Medicine
MAUREEN CAVANAUGH: I'm Maureen Cavanaugh and you're listening to These Days on KPBS. Most elderly people are not too happy when others start talking about $driving of it's a sensitive [CHECK AUDIO] cherished by senior citizens of but there's no getting around the fact that physical issues, like failing eyesight and slower reaction times. [CHECK AUDIO] to help evaluate senior drivers, but their aim is not necessarily to get seniors off the road. Joining us to talk about the effort to keep senior drivers safe is my guest, Doctor Linda hill, with the UCSD department of family and preventive medicine. And good morning, doctor hill, how are you?
HILL: Good morning.
MAUREEN CAVANAUGH: How, what is the goal of the program.
HILL: Well, we're a team of preventive medicine physicians and professionals. Of we collaborate with travel surgeons, and we feel that injuries, which [CHECK AUDIO] and are due to known risk factors and that these risk factors can be modified just like risk factors for heart disease and cancer. And driving is no exception to that.
MAUREEN CAVANAUGH: I see. So you're basically not necessarily on the look out for people to drag them off the road, but also to keep them safe behind the wheel and maybe teach them some new tricks?
HILL: Absolutely. Our goal is to identify problems before they occur or problems that can be handled in the early stages and manage them and keep people driving safely longer.
MAUREEN CAVANAUGH: Now, what are some of the cognitive and physical abilities that begin to diminish as we get older that can affect our driving?
HILL: The main causes of driving disorders due to aging are from visual impatient, frailty, and cognitive impatient. Other illnesses and medication side effects can also affect driving. Vision, for example, by age 80, 1 quarter of older adults have uncorrectable significant vision deficits. And you can imagine that not being able to see well interferes with driving.
MAUREEN CAVANAUGH: Not being able to see, yeah. So when you get to the point where glasses can't correct your vision, you're in some jeopardy about getting behind the wheel. What are some other things?
HILL: Well, cognitive impairment's also a concern with the older driver. Dementia increases with aging, and it's relatively rare before 65, but almost [CHECK AUDIO] even dementia has modifiable risk factors. Uncontrolled hypertension, [CHECK AUDIO] and smoking are all associated with a higher risk of dementia. So there are some things that we can do now.
HILL: Yes, absolutely.
MAUREEN CAVANAUGH: To make sure that we can drive a little bit longer.
HILL: Like we needed somebody to tell us not to smoke.
MAUREEN CAVANAUGH: Exactly. And is it also true there as you get older, lots of people take medications? Can they also interfere with driving safely?
HILL: Whys, medication side effects can definitely interfere with safe driving. You can knowledge imagine if somebody's on a narcotic analgesic or a psychoactive medication, [CHECK AUDIO] general frailty, you wouldn't think that being frail would actually have adverse effects on driving. But in fact it's been shown that people who have osteoporosis and decreased muscle mass which also occurs with aging not only do they have more problem driving safely but when they are in an accident in a crash, they are more likely to be badly hurt than their younger counterparts.
MAUREEN CAVANAUGH: And what are some of the actual physical risks that elder drivers encounter? In other words, how safe are older drivers on the road in comparison to the rest of the driving population?
HILL: Well, we know from studies that older drivers tend to decrease their driving mile annual. So that's somewhat protective. However, if we look on a per mile driven basis, [CHECK AUDIO] that are similar to teen boys who are the other group, of course, that have very high crash rates.
MAUREEN CAVANAUGH: But they -- but the older drivers tend to suffer more in those particular accidents; is that right.
HILL: Yes, if they're in an accident of the same force as a 20-year-old, your average 80-year-old is four times more likely to die from that crash.
MAUREEN CAVANAUGH: I want to invite our listeners to join the conversation if you have a question about elderly people driving, about things that can keep an older driver driving safely longer. Give us I call at 1-888-895-5727. So what's involved in this drivers' screening?
HILL: The MMA has provided guide an for physicians on how to make a systematic approach to assessing older drives. So we ease their recommended [CHECK AUDIO] not only visual acute, but visual fields. So you can imagine that if you can't see from the side and somebody comes up next to you or especially a danger for pedestrians who might come can out from the side. Also the AMA recommends testing for trait in three ways of one is the ability to walk ten feet and back in less than nine seconds, so even not being able to do that is associated with some driving impairment as well as range of motion and strength testing. But, AMA has two specific tests for testing for dementia or cognitive function. One's called clock drawing of it's pretty simple. You ask know individual to draw a clock like a child would. Of put the numbers inside, evenly spaced, and set the to my knowledge to [CHECK AUDIO] that's how the test has been standardized. And if any of those elements are missing, then that's very predictive of dementia. Of.
MAUREEN CAVANAUGH: Is this testing done routinely when a person gets to be a certain age and goes to a c or it justice done if somebody actually mentions that there is a problem with driving?
HILL: Well, that's a really good question. We found in training over 500 health professionals that attention to driving had been somewhat neglected. And I can understand that. I've been in practice for 31 years and bringing up driving issues and rather thorny. It's not something necessarily that the physician or the patient enjoys very much. But the good thing about having a standard model that the physician can use is that they have some something to rely on. It's been standardized. They have the tools with which to council their patients once they finish testing.
MAUREEN CAVANAUGH: We're taking your calls at 1-888-895-5727. Bill is on the line from San Diego. Of good morning, bill, welcome to These Days.
NEW SPEAKER: Good morning and thank you very much. So my dad had dementia. And I was in the unfortunate position of having to actively take his keys away. And there didn't seem to be any mechanism for routinely assessing elderly drivers and helping the family out with that very difficult process. So what's done today if your parent is not otherwise going to the doctor?
MAUREEN CAVANAUGH: Thank you, bill.
HILL: Well, physicians do have a role and I would say that if you can find a physician who can help you with this transition, it would be very useful. Physicians are actually man dated reporters for patients who have disorders characterized by lapses of consciousness of so finding a physician who's willing to work with you and were who can then start a dialogue with the DMV is very important. There are a number of other things that you can do, though, when you begin to suspect that your family member might have a problem. If you're not sure, you can take that individual out on the road, but it sounds in like in your case, you already knew something was going on. It is possible to communicate directly with the DMV as a family member, and on their website, they have a mechanism on how to do that. .
MAUREEN CAVANAUGH: And as we reported on earlier in morning edition today, this program that is called the keys program, keeping everyone safe, which is a CHP program, it tries to education everyone, law enforcement, doctors, on how to drive safely, and the DMV also offers some customized driving programs for seniors of so doctor hill, the whole point of this is not necessarily to take the keys away from older drivers. It's to keep everybody safe; is that right?
HILL: Absolutely. Injury prevention is a public health problem and I -- you know, I would make the analogy to smoking. We've led the world in California in getting secondhand smoke reduced for the general public. And everybody's benefited. And I would look at this as the same way. Driving is something that doesn't happen in isolation. If we're driving unsafely, either under the influence or because of cognitive impatient. We put others at risk. And so we always have to find that balance between the needs and rights of the individual and the needs of the general public. I would say that as a physician, I am very careful about advising my -- when I advise my patient to quit smoking -- to quit.
MAUREEN CAVANAUGH: Driving.
HILL: Driving. I tell all my patients to quit smoking. We know that when patients give up driving, their social circle may shrink, they may develop some depression, and it's even been associated with increasing admission to chronic care facility. So my message to physicians is be very careful in your screening. And talk with the -- your patients and their family about how you can keep people engaged.
MAUREEN CAVANAUGH: We are taking your calls at 1-888-895-5727. Dick is on the line from Spring Valley. Good morning, Dick, welcome to These Days.
NEW SPEAKER: Good morning. And thanks for taking my call. Of.
MAUREEN CAVANAUGH: You're welcome.
NEW SPEAKER: She -- your guest --
MAUREEN CAVANAUGH: Doctor hill.
NEW SPEAKER: Yes, may have mentioned while I was talking to your staffer, the physiological impairment that sometimes restricts more senior drivers from doing some of the things that a younger driver would be able to do to keep them safe while they're driving. For example, turning their head from right to left far enough to make safe, for example, lane change movements and so forth. Maybe even in the torso not being able to turn their torso to the right or left to, again, to safely execute certain driving maneuvers. My mother was, oh, probably in her '70s at the time, had a minor fender bender in the neighborhood. And after she explained the situation to sounded to me like her lack of ability to move her head far enough from right to left in addition to probably some loss of peripheral vision to age had some contributing effects to the accident. Do you have any comment about that?
MAUREEN CAVANAUGH: Thank you for the call, Dick. Is that something that you see, doctor hill?
HILL: Yes. One of the reasons that we ask physicians to check for range of motion and strength is because you're absolutely right. Not being able to look over your shoulder and not having adequate strength to operate a vehicle is a risk factor for having a crash or an injury. Sometimes we find that those patients will respond to physical therapy or for treatment of the underlying condition and that they can be returned to safe driving situation. One little known professional who can both assess and improve driving safety is the driver rehabilitation specialist. Often these are occupational therapists who have been trained to assess and manage individuals with driving impairments. And they can do not only an on the road assessment, but they can help individuals accommodate their disabilities and extend somebody's safe driving time.
MAUREEN CAVANAUGH: So in other words, these professionals would actually drive with a senior driver and see how they maneuver around and whether or not they could look over their shoulder and what kind of impairments that they're dealing with and suggestions through therapies and perhaps through even changing driving routes and things of that nature?
HILL: That's exactly right. It may be for example that somebody has a peripheral field deficit, that the driving rehab specialist can help them accommodate. They may need mirrors, they may need some additional training to cope with that. But once that training's been done, they can again safely drive.
MAUREEN CAVANAUGH: And that sounds very helpful. How would somebody get in touch with a driving rehabilitation specialist.
HILL: Well, are there's an association of driving rehabilitation specialists, their number is 18002902344. And they also have a website which is ADED dot NET.
CAVANAUGH: That's fabulous upon I want thank you so much for coming in and speaking with us today about this. Doctor Linda hill, UCSD's department of family and preventive medicine. Thank you so much.
HILL: Thank you.
CAVANAUGH: And if you'd like to comment, please go on-line, KPBS.org/These Days. Coming up, a conference here in San Diego highlights the Maudsley approach in treating anorexia. That's as these continues here on KPBS.