The number of elderly persons who drive continues to grow, and an ever increasing percentage of elderly people have licenses. The age of drivers reflects the age demographics of our population at large. The population aged 65 and over is now growing more rapidly than any other age group. An acceleration of the growth of the older population will begin in 2010 when the baby boomers become part of the over 65 population. By 2020, 17% of the US population will be over 65, resulting in over 50 million elderly persons eligible to drive. Social changes will also increase the average age of drivers. The baby boom generation of women drivers will result in a substantial increase in the number of elderly women who drive in the next century. Improved functional status of the elderly will also swell the ranks of our senior drivers as Americans aged 65 today can expect to spend at least 2/3 of their remaining 15-year lifespan living independently. The elderly population has also become increasingly suburban as it "ages in place." This increases the dependency on the auto and keeps elderly drivers on the road and increases the number of miles driven per year. It is unlikely that other modes of transportation can provide anywhere near the level of mobility nor user-friendliness that the elderly want or need. Even in healthy ageing there are dramatic changes in metabolism, thermoregulation, immune response, cardiorespiratory endurance, muscle strength, neurologic ftinction, vision and hearing. Chronic medical illness increases in prevalence with increasing age. Of those older than 65, over 80% have at least one chronic disease; the majority have two or more. Cognitive impairment increases with age, with rates for Alzheimer's disease approaching 40-50% after age 85. Thus, as the age of the driving public increases so will the representation of people on the road with a variety of chronic medical conditions. We will increasingly be involved in counselling patients, families and public officials on limiting or terminating driving privileges in the elderly. Presently, physicians lack a standardised tool to evaluate driving risk in seniors and public policy makers have not decided where and how to implement procedures to identify impaired drivers. There is, however, a growing amount of information to help clinicians make reasonable decisions. (A)
Abstract