- The Washington Times - Wednesday, April 18, 2001

FORT MYERS, Fla. — Steve Egidi is on the front lines with doctors, police officers and social workers who are addressing a difficult, even life-threatening, problem of national proportions: older people who keep driving despite diminished driving skills.
Mr. Egidi evaluates the driving skills of elderly people and others referred to him through the Health South Medical Center here.
Its not an easy task, for reasons both subtle and obvious.
Recently, Mr. Egidi worked with a 91-year-old man who seemed focused in ordinary conversation. But in a car, the mans mild dementia prevents him from paying attention to all of the details that driving requires.
Outside the car, "its not something youd pick up in a normal conversation with him, " Mr. Egidi said.
An 81-year-old man with a visual defect that affects his peripheral vision couldnt see the street signs and had trouble focusing on more than one thing.
"He was more concerned about the car in his rear-view mirror that had stopped. He wasnt able to refocus his attention to the road, and we were headed into a mailbox, " Mr. Egidi said.
Mr. Egidis focus is driver rehabilitation and keeping people on the road. But he said, "Sometimes youve got to be realistic with the person."
Joe Coughlin, director of the Age Lab at the Massachusetts Institute of Technology and co-author of an upcoming book on older drivers, calls it "an issue thats stuck in traffic."
"There are no solutions to address the problem, " Mr. Coughlin said. "No one gets a promotion for picking up a problem you cant solve."
For relatives who have to tell their parents and spouses to stop driving, its a difficult task, especially if an older driver has dementia or Alzheimers disease.
Jan, 61, realized her father had a problem six years ago when her parents moved into a condo close to her in Hartford, Conn.
"He had several stories to tell about ladies at the grocery store who hit him in the fender or banged him on the door. I said, 'Well, Dad, thats an awful lot of ladies," said Jan, who did not want to give her last name because it would identify her 85-year-old father, who is now in a psychiatric facility.
Rather than face Jans criticism about the driving, her parents moved back to Massachusetts, "and he went on his merry way bumping into people, but nothing really serious."
However, she said, "I used to have nightmares about kids getting killed. I was getting up screaming and I had never had a nightmare in my life."
After her mother died three years ago, she and her sister saw a chance.
"We went up there on a crusade to get him to go into assisted living, and he did. And we told him that they didnt permit cars. We dont like to lie, but its better than having to rip the keys out of his hand."
Jans fathers case is common, researchers say.
"People can drive a lot longer than they can walk, and they can drive a lot longer than they can use public transportation. Driving is often the last thing to go, " said John Eberhard, a senior researcher and psychologist with the National Highway Traffic Safety Administration (NHTSA) in Washington.
"Its a major public health issue. As they stop driving, they tend more and more toward depression. Social workers have told me that they have an easier time telling people they have terminal cancer than telling them they cant drive, " Mr. Eberhard said. "Stopping driving is death to these people."
But staying on the road can pose a more immediate threat. Statistics from NHTSA show that although older drivers have far fewer crashes than their younger counterparts, their injuries are much more severe because they are more frail.
The Hartford Financial Services Group insurance company has tried to address the issue by publishing a booklet for families. Titled "At the Crossroads: A Guide to Alzheimers Disease, Dementia and Driving," it includes warning signs for drivers with dementia, as well as a family agreement.
A driver can sign the agreement before dementia gets bad, designating a relative to intervene when the driver is no longer capable behind the wheel.
"It starts the conversation" about driving, said Maureen Mohyde, corporate gerontology director for the Hartford Group. "Most caregivers say, 'I dont know how to start the conversation."
At NHTSA, Mr. Eberhard and his colleagues are completing a national agenda on driving for the next 30 years.
The agenda calls for land-use changes so people can be closer to "their goods, services and friends," he said. It will also propose new road systems that are more "elder friendly," he said.
"This is not a federal government issue. Its a national issue," he said. "Everyones going to need to be involved to provide reasonable transportation as safely as possible."
For now, alternative transportation systems arent enough for seniors to willingly give up their car keys.
Dee Sonni, 71, said her local senior bus in Hartford is "wonderful" for when she and her husband, Gene, 72, take trips to a dinner theater or to another town to see a play or to Boston for a special occasion.
For the everyday stuff, Mrs. Sonni describes herself as a "co-pilot" for her husband, who is in the early stages of dementia. But what if the day comes when neither of them can drive?
"I really havent stopped to wonder what would happen if I didnt drive," she said. "Im not prepared for that."

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