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Archive for Sunday, March 22, 1998

A MATTER OF FREEDOM

March 22, 1998

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— Aging Kansans hold onto their driver's license for as long as they can, sometimes too long.

Rose Long stepped out of her white ranch house to search heaven for signs of nasty weather.

At 74 years of age, she can no longer compete with icy roads.

Finding clear skies and dry streets, she settled into her car and pointed it south on Walnut. After a left turn onto 12th, she passed Spruce, Pine and Acorn streets before climbing a hill to the stop sign at Oak. A right turn and a quick two blocks to 14th ended her half-mile pilgrimage to Eudora Nursing Center.

For 11 months, Long has faithfully followed this path to a cluster of one-story brick buildings in the shadow of the city's mushroom-shaped water tower. It is here that she can be with Orville, her ailing husband of 55 years.

``I'm glad I learned to drive,'' she said. ``I see my husband ... and I go downtown to pay my bills. I don't drive any place but in Eudora.''

Long put the brakes on talk that she might one day have to surrender her car keys. She wasn't interested in contemplating the image of an elderly woman standing alone in an empty garage with life passing by on Walnut Street.

``I'm not going to think about that.''

Freedom vs. safety

Willingly or not, given the lethal potential of a mishandled 3,000-pound vehicle, an aging America is in the driver's seat of a complicated, emotional debate about the individual's right to mobility and the public's right to safety.

Ownership of a car and possession of a license to drive are pivotal to sustaining quality of life for seniors -- except for people living in big cities with comprehensive mass transit.

The average older person in the United States travels three miles to the nearest shopping area, six miles for medical care and four miles to his or her place of worship. In rural states, such as Kansas, those distances are typically greater.

It is common for folks without personal transportation to find themselves isolated and depressed.

For those most reliant on automobiles, the trauma has been equated to the death of a spouse.

``In our culture, the automobile is a powerful symbol,'' said geriatric nurse Linda Wright of the Center on Aging at Kansas University Medical Center in Kansas City, Kan. ``It's a marker. It says you are a functioning adult. It means you're able to get out of your own home and take care of your own needs.''

``It's even a more powerful issue in this part of the country, where we don't have adequate transportation systems.''

Impetus for Americans to consider the influence of elderly drivers can be drawn from a single demographic projection. By 2020, the United States is expected to have more than 40 million registered drivers at least 70 years of age. There are a mere 24 million such drivers now.

The expanding roster of older adults behind the wheel is noteworthy because age brings changes to the body that can affect driving proficiency.

Dr. Melvin Shipp of the University of Alabama in Birmingham said after age 65 people usually cannot see as clearly as they once did. Older adults find it tougher to assess road conditions, recognize objects under low lighting conditions and recover from headlight glare.

A 60-year-old needs 10 times as much light as a 20-year-old to see properly. It takes grandpa eight times as long to recover from headlight glare as it does his grandson.

All of this can affect a person's ability to see vehicles or pedestrians, Shipp said.

Self-restraint

To the extent that older individuals are aware of their conditions, many voluntarily limit their driving accordingly. Self-disciplined people drive fewer miles, reduce speed, skip alcohol, curtail night trips, limit entanglement with congested traffic and avoid bad weather.

Lawrence retiree Ed Dutton is a case study in restraint. He reads as much as ever, attends sporting events and goes anywhere in the city his 73-year-old legs carry him. He's also legally blind and leaves all the driving to his wife Betty.

``In the old days, I was a macho male driver,'' Ed Dutton said. ``I could get on the road and be free. It was Route 66. That's somewhat gone from my life.''

He likes to remind the younger generations that getting old has never been for sissies.

``Our lives become incrementally limited,'' he said. ``I'm more fortunate than others. You try to compensate.''

The ability of seniors to police themselves helps explain why National Highway Traffic Safety Administration statistics debunk, in part, the stereotype of the elderly as the most careless drivers. Studies show that this nation's younger motorists outnumber, out-travel, out-crash and out-die older drivers.

Dutton hasn't become a statistic for the simple reason that he won't get behind the wheel.

However, some adults with dementia or Alzheimer's disease who don't fully comprehend their condition stay on the road past their prime and expose everyone to greater risk.

And, critics point out, seniors do have the highest traffic fatality rate per miles traveled. That's because they drive less than other age groups and, when involved in accidents, their frail bodies have less ability to absorb violent impact.

It's these risk factors that inspire lawmakers to yearn for policies that reasonably protect the general population and, if possible, preserve the privilege of driving for citizens.

Government intervention

Gov. Bill Graves said members of the Kansas Legislature searching to harness reckless teen-age drivers ought to also study options for improving safety of elderly drivers. Perhaps a requirement that seniors pass a physical driving test to receive a Kansas license might snare people who can no longer drive safely, he said.

``My dad is one of them,'' Graves said. ``He's 84 years old and probably should either not be behind the wheel or have some testing to verify his ability behind the wheel.''

``I say that not out of some desire to restrict somebody's mobility,'' the governor said, ``but out of a desire to make sure somebody is not injured or hurt, much like the people who are concerned about young drivers.''

Illinois, New Hampshire and Indiana already require road tests for license renewal after a certain age, ranging from 70 to 80. Nearly a dozen states mandate seniors renew licenses more frequently than younger motorists. A handful of states have laws that direct doctors to report patients with impairments that affect driving safety.

Kansas has none of these requirements.

Because of the populist spirit in many areas of the country and strength of groups such as American Association of Retired Persons, which considers testing based solely on age to be discriminatory, few states have had the political will to make older drivers demonstrate driving skills before issuing a new license.

Dr. Richard Dubinsky, KUMC associate professor of neurology, conducts computerized, interactive driving performance studies in his laboratory using a 1981 Dodge Aries. He's studied healthy elders as well as those with Alzheimer's disease, Parkinson's disease and epilepsy. He's examined what occurs when medication and alcohol are added to the mix.

``There are definite changes ... in reaction time and perception,'' he said.

He said periodic testing of the elderly population would be expensive. Testing also might not accurately predict who would have an accident. And, if testing is based on age, he said exams might miss some Alzheimer's patients, since it is a progressively debilitating disease that can first strike when people are in their 60s or 70s or 80s.

``There are normal elderly people out there who drive as well at 90 as they were at 50,'' Dubinsky said.

Doctor's advice

Dr. Robert Potter, a physician in private practice and an associate at the Midwest Bioethics Center in Kansas City, Mo., said families come to him begging for help with relatives who refuse to quit driving.

They say: ```You've got to find a way to get dad off the street!'''

When moral obligation draws Potter into the fray, he warns families he won't violate anyone's self-autonomy and self-determination. In other words, Potter won't call the sheriff if someone refuses to listen to his advice.

In a best-case scenario, Potter said, anyone responsible for a relative who won't voluntarily give up driving should try to avoid implications that the end of a driving career is the consequence of an individual's personal failure.

Potter's first approach: ``You know, Grandpa, the roads are awful fast these days. On my way to work today, I had some fool cut in front of me. If I hadn't reacted, I would have had a wreck. You know, at your age ... you might have had a wreck.''

If that doesn't work, his second take is more direct: ``Well, you're a threat to yourself, other drivers and others on the street.''

If unmoved, he raises the bar: ``Sir, you are not fit to drive. Your judgment, reflexes, strength, vision ... are simply not adequate. I strongly recommend you sell the car to your grandson and let someone else do the driving.''

Even at this stage, Potter said, feeble drivers resist. They'll talk about having driven for 50 years without an accident. They'll promise not to venture far from home. They'll cry. They'll vent about loss of personal freedom. They'll criticize relatives for putting a good doctor up to such treachery.

``Their argument is hard to penetrate,'' he said. ``Some continue ... until they have a wreck.''

Dreaming of home

William ``Smoky'' Breshears of Lawrence could be a poster boy for drivers loath to give up the last vestige of transportation independence.

He was just a kid when he first drove a car on the dusty back roads of the Missouri Ozarks. His affair with the automobile began in a Model T and came to an abrupt end about 10 years ago in an AMC Gremlin.

A doctor had reported to a state agency that Breshears was no longer physically capable of driving safely. But this stubborn Lawrence retiree, who earned his nickname by ignoring warnings and smoking cigarettes for more than 60 years, wasn't willing to casually forfeit the freedom derived from a car.

He cruised streets and highways in his Gremlin until Lawrence police pulled him over.

``He had me in handcuffs,'' said Breshears, sipping coffee in a plastic cup at Douglas County Senior Center.

He hasn't driven since.

Breshears, 74, relies on friends to get where he needs to go locally. His reality is defined by an inability, which has grown over the years into an unwillingness, to drive.

His greatest regret is that he cannot travel at will to a place he can easily reach in his dreams. It's a dot on the map 15 miles south of Warsaw, Mo., near the Lake of the Ozarks.

``I'd like to go home. Family there. I'd like to visit every now and then.''

-- Tim Carpenter's phone message number is 832-7155. His e-mail address is tim@ljworld.com.

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