People can be great drivers or bad drivers at any age. Generally, young, new drivers tend to have the worst driving records. Experienced, middle-aged drivers are likely to have the best driving records. Overall, older drivers make appropriate adjustments for their abilities and limitations and are pretty safe too. In fact, the total number of accidents that involve older drivers is lower than for any other age group. However, the number of accidents per mile driven goes up around age 60, and gets much higher after 75. By the age of 85, the risk exceeds that of the teenaged driver. In fact, crashes are the number one cause of injury-related death in people between 65 and 75.

It is important to recognize that old age alone does not lead to increased crashes! But old age is often associated with illness and medications that can increase risk of crashes. Many older adults take multiple medicines and have conditions that increase the risk of unsafe driving such as: Alzheimer's disease, vision problems, stroke, Parkinson's disease, arthritis, and diabetes.

Signs include:

• Merging or changing lanes without looking;
• Trouble staying in the lane;
• Turning from the wrong lane;
• Getting lost in familiar places;
• Stopping at a green light;
• Stopping when there is no sign to stop;
• Stopping in the middle of intersections;
• Mistaking the gas pedal for the brake pedal;
• Finding traffic signs and signals confusing;
• Running stop signs or red lights without realizing it;
• Hitting or nearly hitting cars, people or objects without realizing it;
• Getting lost in familiar places; and
• Moving from one lane to another without looking.

Although the risk of crashes and serious crash-related injuries usually goes up as people get older, there are many steps that can be taken at any age to drive more safely.

Steps include:

• Avoid driving at night, in heavy traffic, and on unfamiliar roads;
• Know the rules of the road. They can be found in a state driver's handbook;
• Take a driving class from a driving instructor or a rehabilitation specialist; and
• Take a refresher course offered by groups such as:
  • AARP (formally known as the American Association of Retired Persons);
  • The Automobile Association of America (AAA); or
  • The National Safety Council

Rehabilitation Centers (e.g., Vocational Rehabilitation Centers, Veterans Administration Centers) usually provide the best driving evaluations. Driving schools may help, but remember that they are not trained to recognize or diagnose medical problems. State licensing agencies also give driving evaluations.

It is very important that the doctor or other health care provider cares and listens carefully to concerns about driving ability. Once the issue is discussed, a thorough medical and medication review should be conducted. This will help determine if there are treatable problems that may be contributing to driving difficulties. Vision and memory tests are important. Finally, the doctor or health care provider may be able to suggest a driver's education/refresher class. A person may also be referred to a driving evaluation program.

This can be the hardest issue that caregivers face as an older person develops conditions that make them unfit to drive. It is important to recognize how important driving is to many older people. It allows them to go where they want. It is also a symbol of independence. Caregivers need to be very clear about the specific problems that they have noticed. Caregivers can look to health care providers for help. Doctors and other health care providers can help find out if there is a mental or physical problem that limits driving abilities.

Your health care provider can help the caregiver who is concerned about a loved one's driving. They may write a prescription, indicating that an older person should not drive. They may also send a report to the state driver's licensing agency. Many states respond to reports only when they come from a health care provider, or the police.

Often, local aging centers and agencies are the best source for information about local transportation programs.

For more information on driver evaluation, driver education, transportation choices, facts about older drivers, medical conditions and the laws in each state contact:

• American Occupational Therapy Association [301-652-2682]
  www.aota.org/olderdriver
  Excellent general information, self assessment and important links
• National Highway Traffic Safety Administration [1-888-327-4236]
  http://www.nhtsa.dot.gov/
  Has fliers about many medical conditions that affect driving
• Association for Driver Educators for the Disabled: [1-608-884-8833]
  http://www.driver-ed.org
  Helps you locate a certified driver evaluator in your area.
• Alzheimer's Association: [1-800-272-3900]
  http://www.alz.org/Care/
  Has practical advice for caregivers
• American Medical Association [1-800-621-8335]
  http://www.ama-assn.org/
  This is the Physicians Guide to Assessing and Counseling Older Drivers
• American Automobile Association Foundation [1-202-638-5944]
  http://www.seniordrivers.org/
  Tells you where to get a home assessment for driving
• AARP: [1-800-424-3410]
  http://www.aarp.org/research/
  Reviews policy and survey information
• National Safety Council: [1-800-621-7619]
  http://www.nsc.org
  Gives summaries of studies and links to their training program.
• American Association of Motor Vehicle Administrators [703-522-4200]
  http://www.aamva.org/drivers/
  This is the group that influences the state licensing laws and describes the role for the medical advisory boards in each state
• Insurance Institute for Highway Safety
  http://www.highwaysafety.org/
  Has the latest information on each state's licensing policies.