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.”
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.”
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
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.