Mobility is, and will continue to be, an important issue in healthy aging; it enables older adults to visit friends and family, participate in activities, attend school, dine, shop, and receive health care. Among the elderly, the loss of such mobility is often tantamount to a loss of independence that can effect social isolation. Throughout most of their lives, American adults have relied on themselves to drive, and this accustomed sovereignty is reflected in the growing rate of people age 65 and older who remain licensed drivers. Americans aged 65 and older now number 34 million, 13% of the total population, and this proportion is increasing. Since 1900, the percentage of Americans in this age group has more than tripled, from 4.1% in 1900 to 13% in 2000. In 1996 the 65-to-74-year-old age group (18.7 million) was eight times larger than it was in 1900, the 75-to-84-year-old group (11.4 million) was 16 times larger, and the 85-year-old-and-older age group (3.8 million) was 31 times larger. As the baby boom generation reaches retirement age, the population of older adults will continue to grow, with the most rapid increase expected between the years 2010 and 2030, at which time it is estimated that there will be approximately 70 million older adults constituting 20% of the American population. As this population increases, so does the number of injuries in this group, resulting from a decline in normal physiologic reserves that causes decreased muscle mass, fragility of bones, and diminished baroreceptor sensitivity. Additionally, functional decline affects both short-term and long-term survival after injury, and this circumstance, combined with the greater incidence of comorbidities, makes the elderly trauma victim difficult to manage. Of particular concern is heart disease that involves arrhythmias, which affects one in four Americans but is most common among those older than 65, and puts aging drivers at increased risk because of impaired cognition or loss of consciousness. At this writing, there are no standard recommendations in the United States that limit driving privileges of these patients. Discussions relating to driving capabilities are sensitive, not only for patients with heart disease but also for medical practitioners who provide their care. Although driving is listed by the American Occupational Therapy Association as one of the activities of daily living, it is not addressed in discharge planning and outpatient counseling. With the growing number of older drivers, a significant public health and safety issue exists regarding them, the passengers whom they may transport, and other motorists and pedestrians who may be injured or killed in motor vehicle collisions (MVCs). (Author/publisher)
Samenvatting