Most of them keep their licenses longer

David Hosford is concerned about a major test coming up in December. That’s when the 87-year-old retired high school teacher will have his way driving skills assessed to check if he can still get behind the wheel safely.

Hosford was diagnosed mild cognitive impairment about four years ago, but seemed to be able to drive. Recently, however, his neurologist became concerned about some deterioration and suggested that Hosford undergo a safety test and stop driving until the evaluation was completed.

For now, Hosford and his wife, Diana, who doesn’t drive, rely on neighbors and friends to take them to meetings, shopping and elsewhere. The wait time for overdue safe driving evaluations in Massachusetts can be several months.

“We live in rural Plymouth. The nearest loaf of bread is seven miles away,” Hosford said. “There’s nowhere to go.”

Determining whether older person Safe driving has become the third cause of aging as many people keep their driving license much longer than most a generation ago. Simultaneously, percentage of fatal accidents Federal data shows that nationwide, the number of older drivers has increased 73 percent since 2001. Now, two new studies from local researchers highlight the challenges we face.

“Most health care providers do not have the necessary knowledge and training to evaluate driving ability,” Dr. Kirk Daffner, director of the Center for Brain/Mind Medicine at Brigham and Women’s Hospital, noted in the report. Article from October in JAMA Neurology.

Daffner sees many patients with cognitive impairment who may ultimately need a comprehensive driving assessment as part of a specialized program that often includes a roadside examination. But many, like Hosford, struggle to pay the hefty price tag, which can be as high as $800 in Massachusetts.

Medicare doesn’t cover the cost, which means millions of older people, including many on fixed incomes, have to come up with the money. This policy, Daffner wrote in JAMA, must change.

“Disabled drivers,” he wrote, “pose a safety hazard not only to themselves but also to society at large.”

But simply revoking older drivers’ licenses shouldn’t be done in a vacuum, Daffner said, because it often leads to isolation.

“If we take away people’s keys or their ability to drive, then we as a society need to do better by providing them with alternative means of transportation,” he said. “It’s cruel what I’m saying; “Well, you can’t drive anymore, and good luck.”

And while the number of fatal accidents involving older drivers has increased in recent years, the number of fatal accidents involving older drivers has declined.

Still, Daffner and other health experts say they see trouble ahead.

More drivers than ever keep their driving license into old age. Federal data shows this According to the most recent data available, 59 percent of people age 85 and older still had a driver’s license in 2020, up from about half in 2000. About 17 percent of Americans over age 65 — or about 8.2 million people in across the country – experience mild cognitive impairment and are at increased risk of accidents.

Age alone does not determine a driver’s performance. However, as you age, you also increase your risk of health problems that may impair your ability to drive, including impaired vision or hearing, slower reaction times, seizures, or heart disease that may cause dizziness.

Andrew Zullo, an associate professor of public health at Brown University, recently examined drugs commonly taken by older adults that can impair driving ability, such as drugs used to treat anxiety, insomnia, pain, depression and even high blood pressure, and found that most who were involved in a car accident continued to take them.

Zullo study published this month in JAMA Network Open noted that about 20 percent of drivers age 65 and older who were involved in one accident will have another one. He said these sobering statistics make it critical for health leaders to identify ways to prevent such accidents.

One obvious obstacle, he said, is that doctors often don’t know their patients have been in an accident unless they have been seriously injured.

“In the U.S., we don’t have robust systems for notifying physicians,” he said. If physicians had such a system in place, or if their patients felt comfortable sharing this information, the physician could review their medications and perhaps lower the dosage or switch to another that is less likely to impair driving ability.

“I think many older adults worry that if they are involved in a car accident, their families or others may express concern about their driving and may put pressure on them to stop driving,” Zullo said. “It’s a concern for older people because it takes away their autonomy.”

Massachusetts the law requires people 75 and older to renew their driving license in person and pass the vision test. But after passing the road test required to obtain a driving license, often decades ago, the state relies on drivers themselves to assess whether they can still drive safely. This not required health care providers to report patients who they believe are not physically or medically fit to operate a motor vehicle safely, although it provides a system for reporting concerns to the Registry of Motor Vehicles, which has a medical affairs unit tasked with reviewing reports.

Dr. Sarah McGee, clinical director of geriatric medicine at UMass Memorial Health, said that in her 34 years at UMass, she has resorted to reporting only one or two patients to the state. However, she said she strongly recommends that patients who may have driving problems get their driving skills assessed through an assessment program, explaining where the programs are and how much they cost.

Sometimes, after assessing driving skills, it turns out that the patient may simply need a refresher course and arranges a lesson.

“Some patients say, ‘I drive a lot less at night,’ ‘I don’t like driving in a storm,’ or they don’t like driving on the highway,” McGee said. “It’s very telling in terms of what people share with you. In many cases, people limit their ability to drive on their own.”

Often, middle-aged children of older people are caught in the middle, nervously watching their parent fall but unsure how to broach the sensitive issue.

This describes Anna Stern, a 45-year-old social worker who realized that her then 76-year-old mother was driving well below the speed limit in Somerville, changing lanes without signaling and appearing unsteady behind the wheel. Stern privately contacted her mother’s doctor and asked him to broach the subject.

Her mother, who thought she could drive a car, failed an initial evaluation at Spaulding Rehabilitation, one of the several cases of hospital driving assessment programs in Massachusetts. So she decided not to take the road test and gave up her car.

“I was shocked,” Stern’s mother said. Tam Neville, now 80. “I was studying the AAA book and thought it would be easier than it actually was. I feel like they don’t want seniors on the road, probably for good reason.”

Neville is one of the lucky ones. She could easily afford the $300 initial estimate, and many of Somerville’s shops and restaurants are within a 10-minute walk. She also has a home health advisor to help sort things out.

But Hosford, an 87-year-old waiting for his driving test in Plymouth, is not so lucky. On a fixed income, the $300 balance on his credit card weighs heavily on him as he looks longingly at his idling Ford pickup truck.

“I feel like a beggar when I have to ask friends and neighbors for rides,” he said.

Losing the ability to drive, his wife Diana said, is like breathing. “You don’t think about it until you can’t.”

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Kay Lazar can be reached at [email protected] Follow her @GlobeKayLazar.