ELDER MUSIC: 1961 Yet Again
Random Cancer Thoughts

Inequities in Elder Healthcare and Myths About Older Drivers

Two important topics in the realm of ageing that I bang on about from time to time turned up in separate, well-researched articles last week and both are important to elders, their families, people who care for them and to public policy. Let's take them one at a time.

OLD PEOPLE ARE NOWHERE NEAR ALL THE SAME
And this produces profound inequities in their healthcare compared to children and adults.

Writing in The New York Times yesterday, Louise Aronson, a professor of geriatrics at the University of California, San Francisco, points out that in the U.S. healthcare system,

”There are 17 subgroupings for children from birth through age 18. That makes sense because, of course, a 6-month-old has had little time to develop immunity, weighs far less than an 8-year-old and is exposed to fewer people than a teenager.

“There are five subgroups for adults. But all Americans 65 and older — including the two fastest-growing segments of our population, the 80- to 90-year-olds and those over 100 — are lumped in a single group, as if bodies and behaviors don’t change over the last half-century of life.

“You don’t need to be a doctor to see that this is absurd.”

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Although Professor Aronson's Op-Ed is specifically about vaccines, she makes it clear that not differentiating between the young-old and old-old makes all healthcare for elders questionable. Studies have shown, Aronson writes, that some common procedures in urological conditions, acute myeloid leukemia and chemotherapy treatment have much less efficacy in older patients.

”There are simply different risk-benefit ratios for older adults; the frailest and oldest often incur all the immediate harms of treatments, from prevention to intensive care, without seeing the benefits.

The sad fact is that we frequently don’t know how to best care for the old. Treatments rarely target older adults’ particular physiology, and the old are typically excluded from clinical studies.

“Sometimes they are kept out based on age alone, but more often it’s because they have one of the diseases that typically accompany old age. And yet we still end up basing older people’s treatment on this research, because too often it is all we have.”

Hear, hear - the inequities are obvious and can be deadly. Aronson concludes:

”In the 20th century, vaccines conquered many of the deadliest diseases of childhood. In the 21st century, when the number of older adults will surpass the number of children worldwide, we need to similarly target oldhood...

“Life is a three-act play. It’s time our medical system reflected that truth.”

No kidding.

MYTHS ABOUT OLDER DRIVERS
Many states have different driving license requirements for people 65 and older. Among the most common, according to ClaimsJournal website in 2012:

Must renew more frequently, from one to five years, in person only and pass a vision test

Require an optometrist's certification for vision or a doctor's certification that the driver is medically fit

A few states require a road test each renewal

Some states allow health providers, family and in one case even neighbors to report what they believe are impairments to driving

OlderDriver

These restrictions on renewals for older drivers have been increasing in recent years because it is widely believed, and hardly ever challenged, that old people cause more accidents than younger drivers.

That is simply not true as Cynthia Kuster, an elder care attorney with the law firm Lamson & Cutner recently reported from her research. Some excerpts:

”Let’s start with question a) – DO elderly drivers pose an increased risk to others?', writes Kuster. The short answer is: Not really.

“Even at their highest rate (for drivers 85 and older), the fatality rate for accidents caused by seniors is the same or lower than that for drivers 25 years old and under. The data indicate that even through the age of 84, older drivers caused fatalities to occupants of other vehicles and non-motorists at about the rate that 30-year-olds do.

“That is simply not a major danger. We’re certainly not stopping 30-year-olds from driving, and drivers younger than 30 are far more likely to cause the death of others than are 84-year-olds.”

As to whether old drivers are a danger to themselves, Kuster tells us that when the driver is at fault, a 76-year-old is as likely to die in an accident as a 26-year-old. But after age 83, driver fatalities rise significantly.

”However, the AAA study I looked at here cites a study, published in the Traffic Injury Prevention journal, that found that increased fatalities in elderly drivers are more common because the drivers are frailer, and injuries sustained in an accident are much more likely to result in death than they would be, were the driver younger.”

As Kuster concludes:

”The AAA study summary states, 'Relative to other age groups, drivers aged 85 and older face the highest risk of their own death, whereas teens pose the greatest risk to passengers, occupants of other vehicles, and non-motorists.

“The Traffic Injury Prevention study cited in the AAA article stated: 'Older driver motor vehicle crashes are not a significant threat to other road users in vehicles or as pedestrians...”

“Focusing on how to make driving safer for seniors – or more importantly, how to make crashing less deadly for them – should be a focus of public safety advocates.”

As the first article above notes and as I have reported here for years, elders age at different rates. An individual 60-year-old may show dramatic signs of incapacity while an individual 80-year-old may not.

We each are reponsible to monitor our vision, reaction times and confidence behind the wheel and long before hanging up the keys, figure out how we will get around without a car.

Until then, don't let anyone tell you elders are worse drivers than younger people. Not to mention that There is more than a little ageism involved in each of these two issues.

Comments

I was so angry when our car insurance went up when we hit 65. Both of us have perfect driving records, yet we have to pay more. And next week we have to go in person to renew our driver's license and take an eye exam.

Well, OK. BUT I have seen and experienced poor driving by elderly drivers. I was almost run off the road by one a number of years ago. I know of one elderly gentleman who left significant damage to a car in a parking lot, saw it, and left.
My own mother quit giving blinker signals in her old age, and tended to drive too fast when she was agitated.

I think the closer supervision of elderly drivers is meant to catch those of us who simply should no longer drive. If we live long enough, we will have to give up
driving.

I think charging higher rates for people who have aged to 65 is dumb, however. At 65 most of us are years away from being impaired. This goes back to the first part of Ronnie's article. People aged 65 are vastly different than people who are 85. For many of us, old age will last around 30 years. Or more.

The reason why seniors continue to drive well beyond their ability to do so safely is the abysmal lack of transportation alternatives available to us. Even short trips to the mall or a restaurant becomes a major undertaking for us, and worse if we are disabled. Here at the ALF where I live, we recently lost our only means of reasonably priced transportation when a local charity decided that they no longer wanted to help us. Handicapped equipped buses charge $500 or more and can only take about 12 people at a time. No wonder we fight like hell to keep our cars.

I have had to stop driving. It was a painful decision but I knew it was time. Fortunately, my husband is an excellent driver and takes on all the driving responsibilities.

Since some of the most traumatic family moments involve pulling parents' licenses, which means curbing their freedom, this traffic data is immensely important. Thanks, Ronni.

I'm with Bruce -- the elder driving conundrum is about our having created a society which only works well for individuals who can drive individually owned vehicles. My own mother lost control of her car and killed someone when she was 89. This was in a grocery store parking lot! She wanted to do her own shopping. She could not imagine any other way to live. I wasn't about to live with her, so we saw no alternative but hoping nothing bad would happen. Obviously, that is not okay.

At present, I'm watching with horror the decline of an 86 year old friend who refuses to give up driving although her daughter is convinced she has become unsafe. Driving for her means freedom. She lives in an assisted living community, but due to the applicable state laws, neither the ALF, nor her doctor, nor her insurance company can get her to stop. They tell her daughter they can't move to stop her "until something happens." Let's hope the something that happens is a fairly harmless run off a rural road ...

And then I have other old friends who have driven much longer without incident -- I remember fondly being driven safely enough around the very complex neighborhoods of Pittsburgh by a friend who was 97 at the time!

Here where we live in California one has to take the written DMV test the first time a D.L is renewed after reaching the age of 70. Plus if vision impaired, a behind-the-wheel driver's test.

My husband, 76, had a blind spot on his retina in one eye since D.L was renewed last time so needed a special DMV form completed by his optometrist, and recently had to take both DMV tests. He passed but got a 2 year renewal only because the optometrist failed to check a box on the form (and we overlooked it).

We were both nervous about these tests; I passed the written test 4 years ago, at age 73, and have another year to go before my D.L. expires....no traffic citations, no accidents for both of us for many years, thank our lucky stars.

Both of my grandfathers gave up driving long after they lost their eyesight. My father had a chat with the insurance company to save a few lives.

I find that I have to focus much harder to avoid distractions, and I do not use a phone in the car.

From the number of young and middle age people I see going 70mph while looking at their digital devices, I assume this is likely the way I will die.

Metabolism slows and immune systems weaken with age -- at different rates in different people. This affects not only new treatments but also how we react to treatments and meds we've been on for many years. Good doctors are aware of the changes and will adjust accordingly for each individual. Good patients will watch for these changes and tell their doctors.

I gave up night driving some years ago but think I'm still a good daytime driver. I live in the suburbs, avoid heavy traffic and high speed roads as much as possible just for my own peace of mind. I expect my 5-year-old car to be my last, but I sure wouldn't mind having one of the new ones with a collision-avoidance system. It would be extremely difficult to give up the independence my car has always represented. It's a western mindset, I think, with mass transit not suited to covering the miles of urban sprawl and wide open spaces we inhabit.

My dear boyfriend did not give up his DL when he should have and his family did not hear me when I explained what he was doing. His vision was fine but he was in early dementia and got confused easily. Fortunately his accident was minor.

I know that young people also get confused and don't pay attention. Maybe we ALL should have to take classes and be re-tested more frequently. I just moved to an independent living facility where I can walk to a great many things because I intend to err on this side of giving up driving. Not everyone feels the same way. Loving family and friends need to step in.

I recently renewed my driver's license and now have "no restrictions." Previously, my license indicated that I needed to wear contact lenses while driving. Thanks to cataract surgery some years ago, my vision is now excellent.

I am quite fortunate in that I can drive to the supermarket or the mall or the local Starbucks any time I want.

Unlike many younger drivers, I've never driven stoned or drunk or sleep-deprived or distracted by my cell-phone.

One thing I noticed missing is the drivers who are starting into dementia. My husband still drives and I watch him like a hawk. I have to go along as 'co pilot' when it is out of our neighborhood as he will get lost.

Our doctor last year said in one or two years I will have to take the keys. So I worked to get him to give up his truck as it mostly sat, so now I only have one set of keys to worry about.

I really am not looking forward to not driving. So far so good.

The medical issues disturb me most right now. I have fairly severe lung disease and my doctor keeps pressuring to try a drug (Xolair) I don't want. One of its sometimes side effects is death, some people are allergic to it and there is no way to tell until someone takes it. It's never been tested on the over 65 crowd. I have many drug and chemical allergies and in my mind the benefits, not a guarantee, do not outweigh the hazards and the inconvenience of having to go to the hospital for weekly shots. The cost is outrageous. Financial assistance is available from the manufacturer, in my opinion, as pay for being a Guinea pig. Why do they keep pushing it? How many other drugs are being "tested" this way?

Bonnie, I have the same problem. For years now, my husband has done all the driving. I still have a license, but I use it only for ID, and won't miss it if it goes. He's a good moment-to-moment driver, still able to navigate well even in heavy traffic... whereas I get rattled too easily and would not trust my reflexes to keep me out of an accident. Yet, he is five years older than me, and the signs of early dementia are showing up. If we're going anywhere even slightly off his beaten track, he needs me along to navigate.

We've done our best to prepare. We downsized three years ago to a condo with excellent access to public transportation. I keep trying to figure out, every time we use the car, how we would meet that need if we couldn't drive. Most of the time, there are ways. It's still going to clip our wings in a big way. I worry that we'll leave it too late, and wind up with an accident, and maybe life-altering injuries.

What Bruce Cooper said times one thousand!

Seniors at the ILF where I bus tables, dread the thought of handing over their car keys.

It's like having their legs cut off.

It means less mobility, more sitting around making small talk with the same people, day in and out.

It's like being trapped on a desert island.

How many cribbage games can a person play?

How much longer can Margo talk about the 17 pills she takes daily? How long can Joe stare out his tiny livingroom window?

For some seniors, depression sets in, because their world has just shrunk to one building.

There has to be a better way for seniors to get around once they can't drive.

This is a most pressing issue for seniors.

Giving up driving is hard--there's no two ways about it. I was a safe driver from age 15 to around 80, and assumed I'd drive as long as I lived. My body failed me 4 years ago, and when I was cleared to resume driving, my car lease was up--I had hardly driven it for the 3 years of its duration--and it didn't make sense to commit to that expense for another 3 years that I again might not be able to drive. Wise decision, for within 2 years I was disabled to the point where I couldn't go out by myself. I miss it like crazy and always will. Being a photographer, I would grab my keys and go out for a few hours several days a week--now I have to rely on others and it "ain't the same." I have found various paid and free-of-charge systems (shopping for everything online, including groceries, and kitty litter) that work for me to an extent, but my biggest boon is that I have many younger friends, the age of my children or younger, who take me as many places as I have the energy to go. I marvel that they want to be with me, but as one of them said "You are livelier than most of my younger friends." And, too, over the years when I was doing favors for older friends, that was money I was putting in the bank to draw on later, albeit in a pay it ahead way. You who still drive, think about that, please, and offer to pick up an item at the store--you have no idea how much that means to a housebound person.

I have little energy to go about on my own. My husband does all the driving and has done for the past years -- I am too easily distracted to be a safe driver. However, now that he's been doing chemo, etc. if he wants to go out to eat, I agree because he NEEDS to go out and get his mind off his condition.

Lulu, a senior at the ILR drives a group of tenants to the grocery store once a week.

Lulu tells them to meet her in the garage at a certain time, and they pile into her car and go.

I see the group pushing their carts of food down the hall to the elevator.

Little gestures like this make me smile.


As I look for pre-ALF senior living, I find that most of the communities here (Arizona) are way out of town, requiring a fairly long drive to shopping and services.

Glad to see the focus on recognizing the differences in people -- important at any age -- certainly important in older people, too. It's all too prevalent to slap a label on someone -- whether its age, a disability, or their political view -- then assume that person fits all the criteria assumed to apply to the label describes that individual -- what they believe, how they think. This is and has been one of my pet peeves for years.

Disgraceful older people are basically lumped into one group. Think I'll copy your post and give it to my Dr. who has special geriatric training, but may appreciate this reminder. In fact, think further distribution to select others is a good idea if change is desired since it's really not enough to just read this here and agree if we do nothing.

I'm still driving in my early eighth decade without any indications of safety concerns, or my feeling uncomfortable doing so. I live in a small community about an hour's drive east of L.A. I deliberately have monitored senior services in my community for many years which has influenced my intent to be able to continue living here "in place". Sr Services offer reduced cost rides; other rides Go Go Grandparents; Uber, Lyft and taxi available. Also, I found an ad in our local paper for a Girl Friday I was pleased to use for a ride home after my most recent colonoscopy. She's available for other types of assist at a reasonable rate. Though I've not had to use her, I've added her to my future contact list. If someone wants to know what to gift older people, some of these aids might be an idea.

Another group, REAL Connections, has formed offering mutual support in many areas plus socialization requiring a monthly fee, but so far my limited needs are such that it's not cost effective for me. I would have been more actively pursuing our community offer some of these services -- talking to city leaders, others, trying to facilitate getting these, but others did so while I was still working. It's never too late to advocate for some in other communities, or get town to add a Sr Committee to their areas of problem solving. If we don't do it, who will?

FWIW friends in their mid-seventies have leased a vehicle with those latest automatic safety features including for blind spot, distancing from other vehicle, etc. Has enabled husband to safely and comfortably drive now, though he had been previously cleared to drive, but he had chosen to drive only on a limited local basis -- wife comfortable riding with him behind wheel now, too. They drive L.A.'s freeways, make long trips up the coast, prolonging their driving independence.

Driving = independence for me since I was 16, and it will be very difficult to surrender my keys if/when I must. At 80+ I drive locally almost every day, selectively and carefully. I avoid unfamiliar routes or areas and high speed freeways if I can. I don't often drive at night although my vision is O.K. My cellphone stays firmly in its case when I'm on the road.

My husband is 87 and in basically good health except for some balance issues, a cataract on one eye and not-great night vision. He no longer drives much, by his choice, and I'm the designated driver if we must be out after dark . So far it's working, although I'm certainly aware that it won't if something happens to me. Public transportation in our suburban area is reportedly pretty good, but we've never used it and I'd rather not test it in old age.

As I climb into the driver's seat, I rarely have a very faint, but fond, memory of a more sexist time when men almost always did the driving (as dangerous as that was when a questionably able relative still drove in his 80s; I was a young passenger). Traffic congestion in our area is among the 5 worst in the nation, so I must admit that I appreciate not having to deal with it every day any more.

I'm 73 and will continue to take my 4,000 to 5,000 mile summer road trip as long as I can. There's nothing like the freedom of the road, but know one day it'll be in the past.

Cars are a pain to own, I think. Gladly gave up driving years ago and now get about by bus. Here in St Paul the service is good and inexpensive.

Walking is doable if I have places to rest every two or three blocks, and my neighborhood provides that. I just wish the wider area did too. More outdoor seating would be great - for all ages.

I firmly believe that there are people of ALL ages who should not be driving, but I agree that targeting old people is just an easy out. I live in a place where thanks to public transportation the fact that I don't drive is not a big issue, but when I go to the US not being able to drive is a HUGE issue.

Another important blog post, Ronni. And again the comments are as informative as the post it's self.
I had my first outing post broken foot last weekend, drive for the first time in 2 months, having 'Ubered' to and from the doctors and PT appointments. I found Uber or Lyft to be lifesavers as my usual family helpers were on vacation. It's a good option and the drivers were quite helpful, the cost manageable.
I drove to my first post break 'March' in support if the woman who died over the weekend protesting white supremistist.
I have a nice walker with a seat and did surprisingly well. The walker is a lifesaver in a crowd, my cane just isn't enough to call attention to there being a person with some mobility issues in the group.
I've been under the impression that I 'should not drive at night' for many years. So I simply haven't, taking the light rail system downtown all the time. However I discovered that I had NO PROBLEM with the night driving.
I think it was my eye doctor who made that suggestion when I commented on the difficulties I was having on occasion.
I just took it as something that occurs during aging and gave it up.
I had a new eye exam a couple of months ago and got new glasses. Compared to my old prescription, my new one is much much weaker then it's been for decades!
The new, younger doctor, was amazed that I'd been wearing those old RX glasses for years!
No wonder I couldn't see! The prescription had changed and I actually only need glasses for reading now. I drive sans glasses for the first time since I was 25!
Since my drivers license says' Must wear corrective lenses' I'm going to have to get that changed.
The eye doc said my vision change is a frequent occurrence in seniors. Senior Sight is what he called it.
My daughter doesn't believe it.
She's sure I'll kill someone if I drive at night because I've had to be carted around for evening occasions for so long.
I'm very happy with this sight change and with the security that I CAN drive at night if I want to.

Ronni - how to put this - perhaps, I hope tomorrow turns out better than expected?

Many good thoughts for you.

I started noticing the tendency to make all "non-young" people exactly the same.

Forty-five, to me, is really not the new 85. However, try telling that to hairdressers, clothing merchants, and all the people that condescendingly say, "Young lady," meaning--I finally realized--me.

Twenty years on, I see improvements, but as this post makes clear, there's lots still to change.

At the age of 90 my grandmother, who had long since stopped driving, received a renewed driver's license in the mail. She took a cab down to the DMV, patiently waited her turn, stood on her tip-toes (she was all of 4' 9" tall) at the counter, and gave the clerk her new license saying, "I really don't think you want me to have this." If only all of us were this honest about our capabilities.

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