One of the toughest things I have had to do as a doctor–and that has ranged from merely difficult ones, like telling the happy parents of a newborn that their child had heart disease or parents of a nine-month-old that little Curtis was born with cerebral palsy, to the really bad moments when you have to say, "I'm sorry, she's gone"–was when I told one of my oldest friends, a man who had played football for T&T and led an enormously successful musical band, that I was not going to renew his driver's licence.
He was livid, got up and walked out of the office. It was some days before I could bring myself to contact him again, but with the support of his children, we were able to come to terms with my decision, although I don't think he ever forgave me.In fact, he had become a danger to himself and to others and my decision should have been made some years before.In societies around the world, driving is so important, it is perceived as a symbol of coming of age and of independence. Some would even say driving is a basic human right. Giving it up is hard.
Yet it is clear that if we live long enough, most of us will face increasing mental and physical problems that will affect our ability to drive. Teenagers and young adults have the worst crash statistics, as immaturity, inexperience and alcohol do their thing. But as experience grows, crash rates go down. Around age 75, the process reverses and fatal motor vehicle accidents involving elderly drivers rise markedly. The crash rate for drivers 85 and older is roughly the same as for teenagers.
In addition, because of the physical effects of age, no one is in greater peril in a crash than an older driver. Someone 80 years or older is six times more likely to die in a collision than someone 35 to 45 years old and the rate of fatal collisions per mile travelled is close to double that for teens.Yet many older drivers with declining skills fiercely resist giving up their licences. The reasons for this are obvious. Giving up driving can increase social isolation and raise the risk of depression, the first especially for women, the second for men, although the two are not entirely separate.
It can also restrict access to health care although that is less a problem here than in continental cities. There always seems to be someone around to take a sick person to the doctor or hospital. The day we lose that, we are indeed finished.Taking the decision not to renew an older person's driver's permit can have serious consequences. The loss of independence especially can be fatal. The elderly who stop driving are five times more likely to be put into a nursing care facility and four to six times more likely to die within three years. Some of that may be because many quit driving as their health deteriorates, but undoubtedly the depression, isolation and loss of control that come with giving up driving do cause health problems by themselves.
No one knows what to do abut this new predicament. There is no norm or international best practice. Cars have been around for the last 100 years but it is only in the last 50 years or so, perhaps less in T&T, that thousands of people have begun driving and now those very same people are aging. In many ways, older people make ideal drivers. They do the good stuff. They don't drink and drive. They wear their seatbelts and tend to stay within the speed limit. They are courteous. The problem is when age-related cognitive and physical changes start to affect the complex task of manoeuvring a one-ton vehicle through a maze of crazily speeding traffic. Erosion of vision, hearing, response time, mobility, strength and co-ordination, cognition and judgement are just some of the things that appear with age. Glaucoma, diabetes and dementia take their toll.
In addition, the drugs used to treat these ailments have side effects that cloud judgment and slow down reflexes. Some of these changes come upon you suddenly, others slowly and insidiously, so that you never realise what's happening until it's too late.The question is: can an approach to the problem be determined that, as has been said elsewhere, "honours the individual, doesn't disrespect them, but also keeps society safe"?A way to do that is to find ways to help older drivers make their own decisions about driving, including when to stop. In the meantime, shorter times between licence renewals, proper medical exams including mandatory eye and hearing testing from specialists (not GPs or paediatricians) and "self-regulation determinations" like avoiding busy streets and highways and driving at times when traffic is slow, but continuing to make short hauls to pick up grandchildren etc. may be the best way out.My friend is gone now. He died last week, 10 years after his family and I made that decision for him. Hopefully it was the correct one.
