THE ACCIDENT involving an 86-year-old Randolph man who ran over an 8-year-old girl outside her elementary school recently has prompted calls for mandatory road tests for Massachusetts drivers over age 65. As the state begins to consider its options, it's important to keep in mind a few key points.
State governments rely on two regulatory mechanisms, license renewal, and medical reporting procedures, to identify drivers who are unfit to drive due to functional impairments. Medical reporting is a policy in which a professional (e.g., physician) reports information to the Registry of Motor Vehicles about a driver they believe is no longer physically or medically capable of operating a motor vehicle safely. Across the nation, states have implemented various medical reporting policies, with markedly different requirements and procedures, and in fact, some states have no such policies. Recent events have made clear this will have to change.
As a gerontologist I know that I will probably outlive my driving fitness by seven to 10 years. But, with the exception of a few successful programs scattered across the country, there is little being done to address the real and growing transportation needs of older adults.
The driving dilemma is just a symptom of what the late Dr. Matilda White Riley called a "structural lag." That is, our systems (regulatory, medical, educational, etc.) lag behind the new reality caused by recent gains in human longevity and the aging of the baby boom cohorts. Driving, housing, long-term care, nutrition, volunteerism, crime, and retirement financing are just some of the issues threatening to become crises if they are not addressed. Governor Deval Patrick should convene an advisory group to help chart the course given the challenges and opportunities related to an aging commonwealth. The output of such a group could serve as a model for the rest of the nation.
In regard to the firestorm about older drivers, biomedical research has proven that humans age at vastly different rates. Most of us can think of someone in their 80s or 90s who is healthy, happy, active, and mentally fit, just as easily we can think of someone who is in terrible shape in their 50s or 60s.
The problem with age-based testing and retesting, as proposed by Senator Brian Joyce, is that it ignores the fact that we age at different rates. That may be a compromise we are willing to make in order to get something done, but we should recognize age-based testing will unfairly burden people who age well. Second, research in this area has been severely underfunded; as a result there aren't yet effective, practical, and inexpensive tests available to determine driving fitness. It isn't clear if vision tests are sufficient to screen all impaired drivers or what should be done in regard to the cognitively impaired. There are some guidelines for the functional assessment of driving fitness, but the question remains whether they can practicably be administered in the Registry of Motor Vehicles setting.
Finally, we need to understand that implementing mandatory age-based testing is going to cost a lot of money. These may be costs that are viewed as worthwhile because of a gain in public safety, but a full reckoning of costs should be considered before policy changes are made.
Representative Kay Khan has filed a bill to improve the reporting of medically unfit drivers by healthcare providers. While it could be debated whether mandatory requirements are necessary, the great strength of this bill is the provision of immunity to protect physicians who report in good faith from unwarranted lawsuits.
Even so, increasing the medical reporting of unfit drivers will also lead to increased costs in the regulatory process. For example, more staff will be needed in the Medical Affairs Division of the registry to handle the increased number of reports and computer systems will need to be developed to track reported drivers.
I applaud policymakers and the public for starting the discussion about an important symptom of structural lag. We have to begin the difficult process of addressing the impending challenges of our rapidly aging population, including driving safety. Accidents like the recent one are a tragedy, and will probably happen again if there are no changes.
However, in order to ensure personal autonomy and public safety, our response to such accidents must take into account the complexities of solving the driving dilemma and other related issues.
Elizabeth Dugan is author of "The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families."
