Part 2 of a series. 

LEWISTON — As they met for cribbage at the Lewiston Memorial Armory recently, seniors offer mixed reactions to talk about changes aimed at ensuring they are safe behind the wheel.

“Don’t take my license away,” Don Maillett, 76, of Turner said. He’s driving and said he’s having no trouble, thank you very much.

Across the table another man said the problem isn’t older drivers. “It’s teenagers who shouldn’t be driving. I don’t want my name used,” he said. “I don’t know why people think seniors can’t drive. There are more accidents caused by young kids than seniors.”

Linda Williams said no changes are needed; seniors should be left alone. “They’ve worked all their lives. They’re trying to enjoy their senior years.”

Others said that at some point — maybe 75 or 80, maybe when there’s been an accident — there ought to be some kind of testing by AAA or the state.

Bert Chenard, 84, of Lewiston, drives. His record is “very good,” he said. At some point people do need to stop, he said, bringing up “that 100-year-old who backed his car on two people in California. For him, no more driving,” Chenard said. “His license should be taken away.”

Chenard’s wife stopped driving because of failing vision, he said.

Jeanne Collette, 86, of Lewiston, said she gave up driving about 10 years ago on her own.

“My reflexes weren’t that good,” Collette said. “It wasn’t because I had an accident. I didn’t. I wasn’t with it enough.”

Collette doesn’t have trouble getting around. Her friend and fellow bridge player brings her to the armory. “She a good driver. She has good reflexes.” Collette also has three sons who provide her with rides.

Her friend, Constance St. Pierre, 82, of Auburn, drives. “Keep your eyes on the road and look out for others,” St. Pierre advised, but not before complaining about today’s “terrible driving from young girls.”

St. Pierre said she could see the need for some kind of testing. “You get to be 78 to 80; it may be a good time to have a road test or some test with AAA.”

During an interview at his home, Richard Smith, 75, said he didn’t like the idea of any testing or the “Senior Driving Summit” scheduled for Nov. 2 in Augusta by Secretary of State Charles Summers and AAA.

“That’s how it starts,” Smith complained.

His wife, Joanna, 74, gave up driving because of arthritis and vision problems. He drives for both.

For years, people have been killed and maimed on the roads, he said. On Sept. 18 in Hebron a 19-year-old man crashed head-on into a school bus carrying students. “The problem comes from every age group,” Smith said.

In some ways seniors are better drivers, he said. “When you’re elderly you have a lot of driving experience. You are more cautious.”

He’s avoided crashes more than once by watching others on the road, even when he has the right of way. At a four-way intersection, Smith said, he correctly suspected other drivers were going to ignore stop signs. “They breezed right by.”

Younger drivers are distracted, he said. Seniors don’t drive and text. “I don’t know how to text,” he said. “You don’t ever read about a car full of elderly people at 2 o’clock in the morning full of booze and drugs rolling over several times.”

Smith said he’s had a couple of heart attacks. “Every so often I have to have the doctor fill out a form” that says he’s safe to drive.

“Last time I told the doctor, ‘You better check the right box, otherwise you’re going to have to come over and take my bride and I out a couple of times a week to get groceries,” Smith mused.

He can see a need “to check people out,” ensuring older drivers are safe. “I can appreciate that. It depends on how restrictive they get.”

For many seniors, especially in a rural state like Maine, elder transportation is a huge need, experts say. A lack of transportation can lead to isolation and depression.

Taking away a license, Smith said, “is removing their lifeline to get out and get the groceries. When you take that away, they lose an awful lot.”

bwashuk@sunjournal.com

Quitting driving: Families are key, but doctors play a role

WASHINGTON (AP) — Families may have to watch for dings in the car and plead with an older driver to give up the keys, but there’s new evidence that doctors could have more of an influence on one of the most wrenching decisions facing a rapidly aging population.

A large study from Canada found that when doctors warn patients, and tell driving authorities, that the older folks may be medically unfit to be on the road, there’s a drop in serious crash injuries among those drivers.

The study, in Thursday’s New England Journal of Medicine, couldn’t tell if the improvement was because those patients drove less or drove more carefully once the doctors pointed out the risk.

But as the number of older drivers surges, it raises the question of how families and doctors could be working together to determine if and when age-related health problems — from arthritis to frailty to Alzheimer’s disease — are bad enough to impair driving.

Often families are making that tough choice between safety and independence on their own.

“It’s very scary,” said Pat Sneller of Flower Mound, Texas, who talked her husband, Lee, into quitting about a year after he was diagnosed with early-stage Alzheimer’s disease.

The couple had recently moved from California, one of the few U.S. states that require doctors to report drivers with worrisome health conditions to licensing authorities. Pat Sneller was stunned to learn Texas doesn’t require that doctor involvement, and health workers advised her to ride with her husband and judge his abilities for herself.

Eventually her husband called home in a panic, lost while driving in unfamiliar Dallas for volunteer work. A long scrape on the car that he couldn’t explain was the final straw. In 2010, she persuaded him to quit driving, although the now-72-year-old’s license remains good until 2014.

“He still says occasionally, ‘I can still drive, you know,'” Sneller said.

By one U.S. estimate, about 600,000 older drivers a year quit because of health conditions. The problem: There are no clear-cut guidelines to tell who really needs to — and given the lack of transportation options in much of the country, quitting too soon can be detrimental for someone who might have functioned well for several more years.

It’s never an easy discussion.

“It did not go over so well,” Benjamin Benson recalls of the time when his sons told the 87-year-old they feared his reflexes had slowed too much for safe driving.

“I’ve never had an accident,” the Peabody, Mass., man said. His family’s response: “Well, do you want to wait for the first one?”

The retired accountant wasn’t ready to quit then, but he quietly began to analyze what would happen to him and his wife, who doesn’t drive, if he did.

His longtime doctor wouldn’t advise one way or the other. So over a few months, the couple tried online grocery shopping. They took a taxi to the dentist, not cheap at $38 round-trip. But Benson calculated that maintaining and insuring the car was expensive, too, when he drove only 3,000 miles a year.

A few weeks ago, Benson surprised his family by giving away the car, and he said he’s faring fine so far.

“Most people in our age group know that it’s inevitable and play around with the idea that it’s going to come and the only question is when,” Benson said. “I didn’t want to be pushed into it.”

Unlike in most of the U.S., doctors in much of Canada are supposed to report to licensing authorities patients with certain health conditions that may impair driving. Ontario in 2006 began paying doctors a small fee to further encourage that step — and researchers used the payments to track 100,075 patients who received those warnings between April of that year and December 2009 (out of the province’s more than 9 million licensed drivers).

They compared the group’s overall rate of crashes severe enough to send the driver to the emergency room before the warnings began and afterward and found a 45 percent drop, reported lead researcher Dr. Donald Redelmeier, a University of Toronto professor. While the study included adult drivers of all ages — for conditions ranging from epilepsy to sleep disorders, alcoholism to dementia — most were over age 60. A small percentage of the province’s licensed drivers have received warnings, Redelmeier stressed, and licenses are suspended by authorities between 10 percent and 30 percent of the time.

His study highlighted one reason physicians don’t like to get involved: About 1 in 5 of the patients who were warned changed doctors. There also was an uptick in reports of depression.

Doctors aren’t trained to evaluate driving ability, and the study couldn’t tell if some drivers were targeted needlessly, noted Dr. Matthew Rizzo of the University of Iowa. Yet he called the research valuable.

“The message from this paper is that doctors have some wisdom in knowing when to restrict drivers,” Rizzo said. His own research shows some cognitive tests might help them better identify who’s at risk, such as by measuring “useful field of view,” essentially how much your brain gleans at a glance — important for safety in intersections.

Today, the American Medical Association recommends that doctors administer a few simple tests in advising older drivers. Among them:

— Walk 10 feet down the hallway, turn around and come back. Taking longer than 9 seconds is linked to driving problems.

— On a page with the letters A to L and the numbers 1 to 13 randomly arranged, see how quickly and accurately you draw a line from 1 to A, then to 2, then to B and so on. This so-called trail-making test measures memory, spatial processing and other brain skills, and doing poorly has been linked to at-fault crashes.

— Check if people can turn their necks far enough to change lanes and have the strength to slam on brakes.

Dr. Gary Kennedy, geriatric psychiatry chief at New York’s Montefiore Medical Center, often adds another question: Are his patients allowed to drive their grandchildren?

“If the answer to that is no, that’s telling me the people who know the patient best have made a decision that they’re not safe,” said Kennedy, who offers “to be the bad cop” for families or primary care physicians having trouble delivering the news.

There are no statistics on how often doctors do these kinds of assessment.

“It’s this touchy subject that nobody wants to talk about,” said Dr. Marian Betz of the University of Colorado, whose surveys show most senior drivers don’t think their doctors know whether they drive. She is testing if an advance directive would help get older adults talking with their doctors about how to keep watch on their driving fitness before trouble arises.

More objective measures are needed — and to help find them, hundreds of older drivers are letting scientists install video cameras, GPS systems and other gadgets in their cars as part of massive studies of everyday driving behavior.

Identifying who needs to quit should be a last resort, Jon Antin of the Virginia Tech Transportation Institute said. He helps oversee data collection for a study that’s enrolling 3,000 participants, including hundreds of seniors, in Florida, Indiana, New York, North Carolina, Pennsylvania and Washington. The drivers undergo a battery of medical checks before their driving patterns are recorded for 12 to 24 months.

“If you identify people at risk, maybe you can intervene to prolong the safe driving period,” agreed Dr. Shawn Marshall of the Ottawa Hospital Research Institute. He helps lead Canada’s CanDrive II, a project that’s tracking 928 drivers in their 70s for five years to see how their driving changes as they get older.

For now, advocacy groups like the Alzheimer’s Association and AARP offer programs to help families spot signs of driving problems and determine how to talk about it.

“I would like to think that my husband would say, ‘You really shouldn’t be driving anymore’ and I wouldn’t get mad at him,” said Sally Harris, 75, of Crystal Lake, Ill., who took AARP’s “We Need to Talk” program in hopes of broaching the subject with a 90-year-old friend who’s having driving problems.

Others turn to driver rehabilitation specialists, occupational therapists who can spend up to four hours evaluating an older driver’s vision, memory, cognition and other abilities before giving him a behind-the-wheel driving test. Some doctors and state licensing authorities order those evaluations, but programs can be hard to find, often have waiting lists and cost several hundred dollars that insurance may not cover.

Having a professional involved can keep family relationships intact, said Pam Bartle, a driver rehab specialist at Marianjoy Rehabilitation Hospital in Wheaton, Ill.

Still, “you could have the sweetest, nicest little old lady and she’ll turn on you on a dime if you tell her she can’t drive,” Bartle said. “It’s a desperate thing for people. They can’t imagine how they’ll manage without driving.”

How to know when it’s time to quit

If an older person feels increasingly uneasy about driving, or has a few close calls or small incidents, “that is a sign things are changing” and it’s time for the person to stop driving, said Katherine Freund, president of the nonprofit Portland-based Independent Transportation Network of America. She and other experts offered tips on when to know it’s time to hang up the keys.

— Scrapes on the sides of the vehicle, a sign older drivers aren’t parking their car as well as they used to.

— Confusing the gas pedal with the brake for any reason.

— Stopping at a green light.

— Getting lost driving in a familiar neighborhood.

One way to monitor driving ability is through AAA Northern New England’s website feature “Roadwise Review: A Tool to Help Senior Drivers Drive Safely Longer.” To use that at-home screening quiz go to www.seniordriving.aaa.com. For those without a computer, ask a friend or family member to help administer the Roadwise Review. For more information, call 780-6988.

Doctors and occupational therapists can also provide evaluations about the safety of someone continuing to drive. The American Medical Association has guidelines and recommendations for physicians. New England Rehabilitation in Portland has two occupational therapists specially trained to evaluate older drivers.

For more about Freund’s organization, go to www.itnamerica.org/about-itn/our-organization.

Network founded in Maine after boy struck by vehicle

PORTLAND — The Independent Transportation Network of America, a nonprofit that provides rides for seniors, was founded in Maine, beginning as a graduate school project at the Edmund S. Muskie School of Public Service in Portland.

Today it provides 16,000 rides to 1,000 members in the Portland area and exists in 20 states. On average, rides cost seniors about $11 each way, said ITN President Katherine Freund, who said no one likes to be dependent on anyone for rides.

ITN was created by Freund of Westbrook after her 3-year-old son was run over by a car driven by an elderly man 25 years ago. Her son survived. “He’s fine,” Freund said, adding her son helps her with the organization and recently celebrated his 28th birthday.

The man who ran over her son was 84. “He thought he hit a dog,” Freund said. “He was clueless. He had dementia and shouldn’t have been behind the wheel. He was a nice man. I met him. I hugged him.”

ITN works by volunteers driving elderly people to appointments and errands. On Sunday Freund drives seniors to church. Seniors pay a fee for rides. Volunteers get credit for their service, credit they can cash in when they no longer can drive. Seniors can also get credit by donating vehicles they no longer drive. Private companies and organizations, including grocery stores, insurance companies and medical associations, donate money. The network “matters to Hannaford. We bring them shoppers,” Freund said.

The service is available in Portland, but not in the Lewiston area, which does not have enough population to support it, Freund said. But her organization is working on developing a smaller, rural “ITN Everywhere” program where elderly driver services could be offered.

“We’re just finishing our research,” she said. “If there’s enough volunteers, it could work anywhere. In smaller communities it’s hard to find volunteers.”

Research shows that older drivers who decide to stop driving when it’s time enjoy longer lives, Freund said. “Women outlive their decision by 10 years; men who decide to stop outlive their decision by six years.”

There are too many people hurt by drivers who shouldn’t be behind the wheel, Freund said. “Think about that 100-year-old man who drove over the schoolchildren in Los Angeles. It’s still happening all over the country all the time.”

Everyone needs a plan on what they will do when they can no longer drive, she said. “Without that plan, people are far more likely to deny there’s a problem or to make excuses,” Freund said. “Continuing to drive when it is no longer safe is not an acceptable risk.”

For more information about ITN, call 207-591-6929 or to go www.itnamerica.org.