Raising Cane
By Rob Perez
Sunday, December 9, 2001
Elderly isle drivers need
to know when to stopDoreen Emerson was surprised.
Even though her mother's driving had become increasingly erratic and dangerous, Emerson was shocked at the ease in which the then-68-year-old woman was able to renew her driver's license a year ago -- especially considering she suffers from Alzheimer's disease.
Even though Emerson told a licensing clerk about her mother's medical condition, about the speeding, the running of red lights, the weaving in and out of traffic, none of that made a difference.
The clerk told her that, short of a court order, the county could do little to reject the license renewal.
A year later, her mother almost ran over a cop.
The Mililani woman was cited several weeks ago for going 83 mph on the H-1 freeway, passing a vehicle on the right shoulder and refusing police orders to stop. An officer on the shoulder had to jump out of the way and barely missed getting struck.
Partly because of that incident, a judge ruled that Emerson's mother be involuntarily hospitalized because she was a danger to herself and others.
Emerson's story holds lessons for us all.
As Hawaii's elderly population continues to grow at the fastest rate in the country, family members, legislators, health-care providers, bureaucrats and others increasingly will have to address a question packed with many emotional and political pitfalls:
What do you do when an elder person becomes too impaired to drive but doesn't realize or refuses to acknowledge the problem?
For many older residents, that's not likely to occur.
"By and large," said Russ Rader of the Insurance Institute for Highway Safety, "seniors tend to screen themselves."
They typically curtail driving as their skills diminish. They drive short distances. They use familiar routes. They don't take the wheel at night. And they often give up driving altogether when they realize they no longer can do it safely -- and have alternative means of getting around.
The numbers bear that out.
Drivers over 65 have low crash rates per capita, especially when compared with teenagers, the group with easily the highest rates, according to Rader.
When viewed in the context of the overall population, "senior citizens are not a crash problem out on the road," he said.
But viewed another way, that's not necessarily the case. Considering only licensed drivers, accident rates per mile driven increase appreciably starting at age 70, according to federal statistics.
That's because people who drive into their 70s, 80s and 90s are more at risk of developing dementia and other age-related conditions that can affect driving abilities, the experts say.
Some simply refuse to give up driving because that would limit their mobility and independence and undermine their sense of freedom and self-worth.
"It's like a major strike in the heart of someone clinging to functional autonomy," said Max Vercruyssen, associate professor and gerontechnology specialist in the Geriatric Medicine Department at the University of Hawaii John A. Burns School of Medicine. "Families need to be very, very sensitive to what it means to give up a license. It's way, way more serious than many people assume. You're dealing with self-esteem, with self-image. These are issues that are tied into the very character of the individual."
A few states require physicians to report patients they believe to be impaired drivers to the local licensing agency, but Hawaii isn't one of them. Some doctors say mandatory reporting doesn't work and serves as a disincentive for people to seek treatment.
In Hawaii, drivers 72 or older must renew their licenses every two years. The renewal period for everyone else is six years. The only renewal test given drivers of all ages, however, is for vision.
Some believe older drivers should automatically be subject to additional testing, but groups like the American Association of Retired Persons strongly oppose such proposals. Their main arguments: Impaired drivers are found in all age groups and no single testing method can effectively determine who is a dangerous driver.
"You can't assume a person is going to be a good or bad driver on the basis of age," said Kailua resident Tony Lenzer, 71, an AARP member who still drives.
If a physician contacts Honolulu's licensing agency to recommend a patient not be issued a license, the case is reviewed by a medical advisory board, which makes a recommendation to the chief examiner, according to David Mau, the assistant licensing administrator.
The board also considers cases in which a licensing clerk believes an obvious physical or mental condition may impair an applicant's driving ability. In those cases, the applicant is asked to provide a letter from a physician, and the information is referred to the board.
After considering the board's recommendation, the chief examiner can revoke, suspend or restrict a license, such as limiting the person to daylight driving.
One challenge in determining who may be at risk behind the wheel is the difficulty in diagnosing dementia in the elderly.
It's not unusual for physicians to miss the diagnosis in the disease's early stages, when the patient often can seem normal in many situations.
After Emerson's mother had her car taken away following the freeway incident, the elderly woman managed to purchase two new cars on successive days from two different dealerships, paying premium prices for both vehicles. The cars eventually were returned.
Emerson said anyone who spent just a few minutes with her mother would've known she wasn't well and that the salesmen simply took advantage of her condition.
But several geriatric physicians said they wouldn't be surprised if the woman appeared to be relatively well to the salesmen, even if she wasn't a hard bargainer.
"It's conceivable she could've fooled them," said Dr. Patricia Blanchette, chairwoman of UH's Geriatric Medicine Department.
The key to dealing with elderly people who should give up driving but are reluctant to is providing practical transportation alternatives.
Free bus passes, reduced cab fares and nonprofit transportation agencies catering specifically to the elderly are among possible alternatives.
Hawaii does a good job of supporting older citizens who no longer drive, "but there's a lot more we could do," Vercruyssen said.
Star-Bulletin columnist Rob Perez writes on issues
and events affecting Hawaii. Fax 529-4750, or write to
Honolulu Star-Bulletin, 500 Ala Moana Blvd., No. 7-210,
Honolulu 96813. He can also be reached
by e-mail at: rperez@starbulletin.com.
