Vol. 75 October 1, 2012 Is Great Grandma a Danger on the Road?

Drivers ages 80 and older have the 2nd highest fatal accident rate of any age group,
BUT the accident rate among drivers over 75  is half the accident rate for drivers who are between the ages of 35 and 44  and one fifth of the accident rate of drivers who are under the age of 19.
In the next 20 years, the number of elderly drivers in the United States will triple.
Should every state require doctors to report their concerns about the ability of older drivers to safely be on the road?
33 states do so now.

My two aunts, Aunt Nin and Aunt Do, were both looking forward to their day in court.

Actually, it was “Granmamere’s” day in court. She was 88 years old and had been involved in a car accident. No one had been injured, but she was cited by the police for some driving infraction or another. The twin aunts were looking forward to having the court take her license away, since they had been unsuccessful over many months to get here to give up driving.

“Granmamere” lived alone in an apartment complex in Newburgh, N.Y. Today we would call it “assisted living”, but that marketing term wasn’t yet created in the 60’s. She was hale and hearty and loved to drive, but her reflexes were getting slower. She had the means to hire a driver, and the aunts were increasingly concerned about her safety, and the safety of others, with her on the road.

She had to appear before the judge in Dobbs Ferry, a town just south of Newburgh and her old hometown.  She and her twins sat patiently in the hot, stuffy courtroom waiting for the court to plow through all the other cases. As the cases droned on and on that summer day even the judge’s majestically leonine head undeniably began to bob and nod above his stolid, black-robed pillar of authority as he, too, fought against the post-lunch doldrums.

Finally, “Granmamere’s” case came up.

“The State of New York vs. Pauline Ramsdell Odell”, intoned the bailiff.

The judge’s head immediately bolted upright and directed his now clear, piercing gaze directly at the defense  table, “Is that you Pauline?”

“Why yes.” was her quick reply.

“We will have a 15 minute recess, and the plaintiff is invited back into my chambers for a private conference”, announced the judge.

Having to remain in the courtroom my aunts could only guess what the judge and “Granmamere” were talking about.

“Case dismissed”, proclaimed the judge when court resumed.

“Oh shit”, thought Nin and Do.

“He was one of my high school flames”, chirped “Granmamere.”

“Granmamere” drove for another year without incident before giving up her license voluntarily.

She died peacefully in her sleep several years later.

A study from Ontario Canada in last week’s New England Journal (1) reported that a physician warning a patient over 18 yo. that they were at risk for a motor vehicle accident decreased the subsequent visits of “warned patients” to the ER for car accident trauma by 27%  for all ages. Only one-third of the patients in the study were over 75 y.o., BUT the decrease in event rate per 1000 patients after the physician’s warning was the greatest in this age group.

Of interest is that Ontario Province designated “warnings to unfit drivers” as an “affirmative duty” ( a requirement) of physicians in 1968. Compliance was very low until 2006 when they started paying physicians $36.25 to provide such warnings. Unintended side-effects of the warning may have been increased ER visits for depression and decreased return visits to the same physician.

References:
1. New Engl J Med 36;13 September 27, 2012, p.1228

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