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Should Doctors Play a Role in Determining Who’s Fit to Drive?

When to take grandma's keys away: In the United States, this question treated is largely treated as a family matter.

Photo: ## Katv##

But that is not the case in Canada, where the government requires doctors to report to licensing authorities when their patients start showing signs that, behind the wheel, they might pose a danger to themselves or others. A recent study from the New England Journal of Medicine has raised the question about what role physicians should have in helping determine fitness for driving.

Researchers found that a group of 100,000 Ontario patients identified by doctors as potentially unfit to drive were involved in 45 percent fewer severe road crashes following the doctor's warning -- whether they stopped driving altogether, drove less, or simply drove more carefully. Licensing agencies revoked licenses between 10 and 30 percent of the time when alerted by a doctor.

But even the study results highlight what a sensitive matter retiring an elderly individual's driving privileges can be, especially in a society where, in so many residential locations, losing the ability to drive can mean a near total loss in independence.

The study also found an increase in mood disorders, like depression, among those who were singled out by doctors. In addition, one in five such patients switched doctors -- a fact that might help explain why U.S. doctors have not necessarily been eager to interject on this issue.

According to Transportation for America, about four in five seniors live in rural or suburban communities that are largely car dependent. But some seniors may find that alternatives to driving aren't as insurmountable as they might seem. NPR reports that 87-year-old Benjamin Benson was unhappy when his family suggested he hand over the keys. But he soon realized it wasn't a death sentence:

He quietly began to analyze what would happen to him and his wife, who doesn't drive, if he did.

His longtime doctor wouldn't advise one way or the other. So over a few months, the couple tried online grocery shopping. They took a taxi to the dentist, not cheap at $38 round-trip. But Benson calculated that maintaining and insuring the car was expensive, too, when he drove only 3,000 miles a year.

A few weeks ago, Benson surprised his family by giving away the car, and he says he's faring fine so far.

"Most people in our age group know that it's inevitable and play around with the idea that it's going to come and the only question is when," Benson said. "I didn't want to be pushed into it."

According to the U.S. Department of Transportation, "at age 75, older drivers begin to be markedly overinvolved in crashes." Drivers over 80 are more likely to suffer fatal crashes, per mile driven, than any age group except teenagers. (Of course, frailty and other medical conditions make them more likely to die from injuries.)

The American Medical Association recommends a few tests for doctors to determine their patients' fitness for driving, reports NPR. Among those is an order to walk 10 feet down the hallway, turn around, and come back. Driving problems have been correlated with patients for whom that task takes longer than nine seconds to complete. Other important questions for medical professionals are whether older drivers can turn their neck far enough to check the "blind spot" when changing lanes, or whether they have the strength to slam the brakes. Even if states or the federal government aren't willing to require medical supervision for elderly drivers, some counseling from physicians could help families begin delicate discussions, NPR concludes.

U.S. states have different policies for older drivers. Many states, like Florida and Maine, require them to take a vision test for their license renewal. Illinois requires a road test for drivers 75 and older. A few states, like Tennessee and North Carolina, however, actually make it easier for older drivers to renew their licenses. In Tennessee, drivers who are older than 65 do not have to renew their license at all. And, according to the National Institute for Highway Safety, many states have prohibitions on special requirements for drivers of advanced age.

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