Elder Driving: Emotional and Physical Toll
of Surrendering Keys & Model Program

Gaps in Service

It’s the spur-of-the-moment trips that June Casler misses most, the spontaneous decision to catch a 7 p.m. movie or to pick up a coveted book at the library. The octogenarian hung up her car keys for good in June. Casler has since discovered that the local Council on Aging van doesn’t run nights or weekends and requires 24-hour advance notice.

Deciding when to surrender the keys and license has become the third rail of aging. A spate of car accidents involving elderly drivers in Massachusetts earlier this year prompted proposals for mandatory testing after age 75. Yet the emotionally charged debate, here and around the country, has largely ignored the rest of the equation: Then what?

Physical and Emotional Toll

When elders give up driving, a cascade of physical, emotional, and practical concerns often follow. There is an increased risk of depression, isolation, and even, studies suggest, of ending up in assisted living. A 2006 study of roughly 1,600 seniors over age 65 in suburban Maryland found that those who had given up driving were nearly five times more likely to end up in long-term care after eight years than those who were still driving, even when researchers accounted for various health problems. They found that the seniors who had depended on another driver in the home and lost that support were nearly twice as likely to go into long-term care, as compared with elders who were still driving.

The researchers did not study the reasons for the strong link, but coauthor Ellen Freeman, an assistant research professor in ophthalmology at the University of Montreal, said lack of transportation is a likely culprit. As increasing numbers of baby boomers face the driving dilemma with their elderly parents - a scenario that will become far more common as boomers themselves age - there is growing urgency to establish more comprehensive transportation alternatives.

Some studies, most notably by geriatrician Richard Marottoli, an associate professor of medicine at Yale University Medical School, have found an increase in depression and a drop in out-of-home activity levels among older adults after they surrender their license.

Model Program: Independent Transportation Network

That’s the thinking behind the Independent Transportation Network, a 24-hour driving service run by volunteers, which started in Maine’s greater Portland area and has spread to communities in 10 other states, though not yet any in Massachusetts. It works like this: Seniors who surrender their car to the network get the equivalent of the vehicle’s value in free rides, or they can join without the trade-in, and pay by the ride. The average fee is about half of what a taxi would charge for the same route, because the networks usually raise private funds from area businesses to subsidize the full costs. Passengers who schedule rides in advance are given discounts. Volunteer drivers can bank future rides for themselves or a family member.

“We have done about 280,000 rides nationally,’’ said Katherine Freund, who started the network in 1995, seven years after her 3-year-old son was seriously injured by an elderly driver.

After that accident, Freund said she started studying the issues surrounding elderly drivers, such as declines in eyesight, hearing, and reaction times. Initially she thought there should be a requirement that older motorists be tested to maintain a license. But after further scrutiny, she said she decided a more pragmatic approach to getting elders from behind the wheel would be to offer an alternative that most closely resembles “the emotional and psychological freedom of cars for older people.’’

It takes about $125,000 to start a network, which goes toward a minimal staff, office space, and equipment and maintenance on the vehicles, Freund said. After start-up costs, the programs are usually self-sustaining within five years, she said, but many also often require a change in state law, to prevent auto insurers from raising premiums for volunteers who use their own autos.

The idea has so intrigued Representative Ronald Mariano, a Quincy Democrat who faced a driving “battle’’ with his own dad several years ago, that he invited Freund to Boston this month to find out more about the network. “We want to see if this model can translate to life in Massachusetts,’’ Mariano said. “We can’t afford to put any money into a new program and so we are always looking for creative ways that are low or no cost to the Commonwealth.’’

-From “Off the road- For seniors who give up driving, the emotional - and physical - costs of surrendering independence can be high” by Kay Lazar, The Boston Globe, December 21, 2009 http://www.boston.com/news/health/articles/2009/12/21/the_emotional_and_physical_costs_of_giving_up_driving/ retrieved 12/2109.

 

12/09