WASHINGTON -- First, the elderly woman tried to drive between a delivery van and two people walking on a narrow Florida street. Then, busy chatting, she didn't notice a car stopping in front of her. At a stop sign, she pulled out in front of a truck.
This was a test to see if it was time for the 75-year-old to give up her keys -- and when driving specialist Susan Pierce emerged from the car, it was to break bad news.
"She stood up and literally pounded her fist on the table and said, 'I am not giving up my driver's license and not giving up my home,'" before storming out, recalls Pierce, an occupational therapist certified to assess driving skills. "That's probably the toughest part of my job, when I know I have to say 'no.'"
Losing the ability to drive can be a traumatic experience of aging -- and knowing when it's time to quit can be immensely difficult. Tests in doctors' offices aren't completely reliable. And nationwide there are only 300 specialists like Pierce certified to perform road tests and offer techniques to help some seniors stay behind the wheel a few more years.
Now medical and traffic groups are beginning some major programs to address the issue:
The American Medical Association will issue guidelines in July to help doctors tell when older patients' driving is questionable and get them help to stay on the road as long as it is safe. This fall, the AMA also will run a program to train doctors about medical fitness to drive.
The government recently earmarked $1.6 million to start a National Older Drivers Research Center. Run by the University of Florida and the American Occupational Therapy Association, it will train more "certified driving rehabilitation specialists" like Pierce, and create better off-road tests to screen drivers for problems.
As the baby boomers age, one in four drivers is expected to be over age 65 by 2030. Some 600,000 people age 70 or older give up their keys each year, estimates the National Institute on Aging.
Problems with vision, perception and motor skills increase with age.
Some are obvious, such as severe dementia. But many aren't. Diabetes can numb the legs and feet, making it hard to know if you're properly pumping the brake. Arthritis can hinder turning and checking for traffic.
Then there are problems like Pierce's student had: diminished reaction time, ability to judge spatial relations and juggle more than one task.
As for eyesight, the tests administered to get a driver's license only check visual sharpness. Yet seniors can lose peripheral vision; have blind spots from cataracts, strokes or eye diseases, or lack contrast sensitivity -- making it hard to see a dark car at dusk.
Seniors often deny problems, because losing their license is a giant blow, says NIA's Dr. Stanley Slater.
It's not just demeaning: Having no easy, reliable way to get to the grocery store or doctor's office can mean an end to elderly independence. Recall Pierce's student: She wound up having to move in with the daughter who'd insisted on the driving test.
The question is how to spot a problem before a crash, something that usually falls to worried relatives. Few states require more frequent license renewals or eye exams for the elderly.
The AMA guide will urge doctors to ask patients and their relatives about driving problems, watch for possible red flags and hunt medical treatments to help them drive as long as possible.
Occupational therapists increasingly are assessing driving skills with memory and other tests, and offering rehabilitation services to strengthen driving skills.
But ultimately, driving tests are the best tool, says Dennis McCarthy, co-director of the new National Older Drivers Research Center.
They're more complex than those parking-and-steering tests offered at driving schools, says Pierce, who performs them in Orlando, Fla. Nor is it always pass-or-fail: She often finds ways to keep people driving longer.
For example, unprotected left turns -- those without a turn-only light -- and unfamiliar roads can be big challenges. Some drivers merely need to restrict driving close to home and avoid risky intersections.
Avoiding night driving also helps. So can adaptive technology -- special mirrors or hand controls.
The cost for driving evaluations varies widely, from $250 to $800. Elder advocates are lobbying for Medicare coverage, today available in only a few states, Pierce says.
To find a certified driving rehabilitation specialist: www.aded.net.
Occupational therapist info: www.aota.org/featured/area6/docs/driver....
National Highway Traffic Safety Administration: www.nhtsa.dot.gov/
EDITOR'S NOTE -- Lauran Neergaard covers health and medical issues for The Associated Press in Washington.