Staying healthy in your car: Coping with illness and age

Is driving a right or a privilege? It depends on whom you ask. State agencies that issue licenses call it a privilege, but the average American male regards it as a right, even acting as if his car were an extension of his body. It's understandable, since driving is intimately related to a man's masculinity, independence, and self-esteem. That's okay as long as a man takes good care of his car and uses it wisely. But even if a man takes good care of his body, illness may strike and he will grow old. How do illnesses and age affect motor vehicle safety, and how can a man keep driving in good health?

Health factors

It's obvious that people with chronic medical conditions have an increased risk for becoming ill abruptly. And chronic illness itself boosts the chances of being in a crash. An Alabama study confirmed the link between chronic illness and crashes; heart disease, previous strokes, arthritis, and the use of various medications indicate increased risk, as does age itself. But that doesn't mean everyone with a pillbox should take the bus. Instead, there are ways to compensate for many problems.

Visual impairment. Every state requires an eye test for licensure; most require a visual acuity of 20/40 or better in at least one eye and a lateral visual field width of 140–160 degrees. It's a reasonable standard, but it may not go far enough. The ability to see contrasts, to compensate for darkness and bright lights, to see colors, and to perceive depths also contributes to safety. And most states won't check your vision more than once every 5 years. You can do better. If you're over 50, get your eyes checked annually, and ask yourself honestly if you have any visual problems on the road. A checkup will protect you from visual loss due to glaucoma, and it may reveal cataracts or other problems that can be corrected in time to prevent a crash. For example, an Alabama study of cataract patients ages 55–84 found that corrective surgery cut the risk of car crashes in half.

Hearing loss. While vision is much more important than hearing for safe driving, every little bit helps. If you have problems with your hearing in daily life, get your ears checked to see if you need help hearing traffic noises and horns.

Heart disease. Most men with heart disease can drive safely without any restrictions. In fact, an important study of 627 people who had been rescued from ventricular arrhythmias (irregular heartbeats that cause loss of consciousness and sudden death) found that these patients were actually less likely to have accidents than the general population. But all of these patients were getting expert medical care and were clinically stable. If your heart disease is important enough to require medication, it's important enough for you to discuss driving with your doctor. In nearly all cases, you'll get a green light. Even so, don't drive if you don't feel well.

Epilepsy. There is no law against driving with heart disease, but all 50 states have laws that regulate driving by people with seizure disorders. The usual requirement for a license is 6 consecutive months without a seizure. Fortunately, modern medication makes it possible for most seizure patients to meet these standards.

Diabetes. Compared with nondiabetic drivers, patients with type 1 diabetes have an increased risk of crashes, but those with the far more common type 2 diabetes do not, even if they are taking insulin. Still, all people with diabetes should try to keep their blood sugar levels under control while they drive, and they should always have candy available in case it dips too low.

Arthritis. Turn your neck, grip the wheel, or press a pedal, and you'll see how arthritis can put a driver at risk. But here, too, help is available. Medication can ease joint pain, and exercise can increase mobility and strength. Physical therapy and occupational therapy can be particularly helpful if they are targeted to improving the functions needed for driving.

Cognitive impairment. It's the big one. The minor memory lapses that occur with normal aging should not pose any problem. In contrast, the forgetfulness, impaired judgment, and loss of directional skills that may be signs of dementia are very troublesome. The danger is compounded because many people with cognitive impairment don't know they have a problem. In fact, one study found that nearly a quarter of senior citizens with cognitive impairment continue to drive — and that most doctors don't intervene.

Men who are concerned about memory should follow the example set by truckers (1-800-How's My Driving): Ask a relative or friend how you are driving, ask your doctor for an evaluation, or take the simple test below (see "Am I a safe driver?"). Often, though, it falls to a spouse to initiate the evaluation. It's never easy to give up driving (see below), but the American Academy of Neurology's guidelines say that persons with Alzheimer's disease should not drive, even in early, milder cases. The same is true for other conditions that cause significant cognitive impairment.

Other medical issues. Every medical problem requires individual care, both on and off the road. But some issues apply to everyone, and that includes the risks of prolonged sitting. Driving is particularly hard on the back, and prolonged immobility increases the risk of blood clots in the legs (thrombophlebitis). To protect yourself, be sure your driving position is comfortable and take frequent breaks to stretch and walk around. Men with enlarged prostate glands will also want to visit a rest room at every stop.

Age issues

About one of every seven drivers is older than 65; that's a total of 23 million senior citizens behind the wheel. Aging is a normal biological function, but driving is not. Advancing age increases the risk of developing an illness that affects safe driving (see above). But even normal, healthy aging is bound to take a toll on a man's reflexes, reaction time, muscular strength and flexibility, and sensory ability. Still, men who are driving at ages 70–74 will keep driving for another 11 years, on average.

You can't stop the clock, but you can slow its tick. Work with your doctor to reduce your risk of falling ill and to detect problems early and treat them appropriately. Stay mentally active to keep your mind sharp. Remember, too, that physical exercise will help your mind as well as your body.

Many of these tips have special significance for older drivers, but they can also help younger men drive safely.

First, find out where you stand. You shouldn't avoid checking your prostate or colon because you fear bad news, and you shouldn't shy away from a driving evaluation either. A few states already require road tests before drivers 75 and older can renew their licenses, and more are sure to follow.

You can beat them to the punch by arranging your own test. Some medical institutions offer 2- to 4-hour evaluations run by certified occupational therapists. They will check your observational skills and reflexes as well as your ability to control your speed, change lanes, and negotiate intersections, where left turns are a particular challenge for older drivers. Medicare will pay for some evaluations; check with the organizations listed in the box below (see "Safe driving information") to see if a testing program is available in your community.

Learning anything new will help keep your mind sharp, and learning age-appropriate driving skills and tactics can help keep you safe on the road. You'll also prolong your driving years. That's a lot of mileage from a little instruction. Written material can help, but hands-on instruction is even better. One option is the Driver Safety Program sponsored by the AARP. You can find the nearest course by calling 1-888-227-7669; check the resources in "Safe driving information" below for other possibilities.

Don't be too proud to refresh your driving abilities and learn new skills to meet your special needs. And you shouldn't be too proud — or stubborn — to adjust your driving patterns to fit new realities, even if they are unpleasant. For most men, it's a gradual transition. Often, the first step is to keep the car in the garage during bad weather. Next, a man may give up highway driving, then try to get his local driving done when traffic is light. Because night driving is more challenging, it's also wise to be especially cautious in the evening and then keep the ignition off after dark.

Many men can keep driving throughout their life, and most manage a gradual transition to restricted driving quite well. But even a noontime trip in the neighborhood can be too much for some older drivers. At low speeds, major injury to a car's occupants is unlikely, at least if they are wearing seat belts. Even so, the property damage and mental stress can be appreciable, and pedestrians are at considerable risk.

How will you know if it's time to give up your keys — or to persuade your wife or brother to stop driving?

It's a difficult and sensitive area without a single guideline that applies to everyone. Accidents and police citations are red flags. A string of accidents means it's time to stop; even a single fender-bender may be a warning that change is needed before someone is hurt. Memory loss is another possible indicator. Forgetting where you put your keys is no problem, but if you forget where you are going or why you left home, it's time to forget your keys permanently. Getting lost in familiar territory, whether in your car or on foot, is another sure sign of trouble. And people who need help with the simple activities of daily life are better off relying on others for transportation as well.

Giving up driving creates two problems: transportation and self-esteem. Many senior citizens anticipate the former by moving to places where services and friends or relatives are nearby. Because women usually age better (and live longer) than men, married gents can turn the keys over to their wives. When possible, get rides from other people. Even if it's available, public transportation can be difficult for seniors; fortunately, many communities offer special services for older people. You can also take a cab or hire a driver. Remember that even if you don't drive far enough to run up a big gas bill, it costs thousands of dollars a year to keep a car registered, insured, and running. You can often save money by giving up your car and hiring a driver.

Getting around without a car takes some planning, but it can be surprisingly efficient, even pleasurable. Getting used to the idea of life without a set of wheels is usually much harder. It's a particularly sensitive issue for Americans, who've grown up with the lure of the open road, and especially for men, who are used to being in the driver's seat.

If you have a friend or relative who should retire from driving, you can help. Emphasize the importance of his own safety and that of others. Help arrange alternative transportation. And do what you can to build his self-esteem, emphasizing his abilities and prerogatives that remain intact. Point out that driving is not synonymous with manliness and that transitions in driving are just one of the inevitable alterations in the cycle of life.

From a certain point of view, a man is lucky if he lives long enough and well enough to decide that it's time to hang up his keys. And he's even luckier if he can give his car to a grandson, passing on the romance of the road along with his name and heritage.