By Joe Farrow, Deputy Commissioner, and Julie Likes, Senior Research Analyst, Special Projects Section, California Highway Patrol, Sacramento, California
alifornia Highway Patrol Captain D. R. (Ike) Iketani calls him the 350-mile man. He is a senior citizen who suffers from apparent dementia and should not have been driving. But he was, and that’s how he became a scenario in the peace officer training course developed by Iketani and a peer group convened by the National Highway Traffic Safety Administration to address police interaction with older drivers.
Growth in America’s senior population, proceeding now at a jog, will accelerate to a full run when the generation known as baby boomers, born between 1946 and 1964, begins to retire in 2011. By 2050 the population of older people in the United States will climb to 78 million, compared to 34 million in 1996. In California this explosion will see today’s total of about 4 million seniors (65 and older) approximately triple in the next four decades.
Such growth would have no special relevance to the overall traffic environment but for predictions that senior crash casualties will surge dramatically. The Transportation Research Board (an arm of the National Research Council) points out that this potential calamity had triggered early research that initially focused on whether older drivers were themselves the problem. The TRB publication Safe Mobility for Older Americans offered a clearer picture of older drivers:
- Most older drivers have good driving records.
- Older people are the most vulnerable to injury and death in a crash.
- Because age is a poor predictor of performance, age alone should not be the basis for restricting or withholding a driver’s license.
- In general, visual and cognitive performance on driving-related tasks declines with age, but there is a great deal of variability in performance among individuals (a finding corroborated by California Department of Motor Vehicles research).
- Mobility is essential to older persons’ quality of life, and the automobile continues to be the primary means of retaining mobility.
This information became the platform for initiating California’s stewardship of senior driving issues, which began with a fact-finding phase that produced an all-encompassing agenda of to-do items considered instrumental for achieving the broad goals of keeping seniors safely at the wheel for added years and helping seniors prepare for the time when they could no longer drive.
The Californian Task Force
In 2003 the Older Californian Traffic Safety (OCTS) Task Force was established to carry out the agenda. The California Highway Patrol volunteered to assume administrative responsibility because helping seniors remain safe in their vehicles is an explicit task force objective and because safety represents the bedrock responsibility of every traffic law enforcement agency. The OCTS Task Force is entering its fourth year and has well-established programs in seven target areas.
The task force itself includes about 43 members representing 11 state departments as well as local police and sheriff’s departments, Area Agencies on Aging, the Automobile Club of Southern California, the California State Automobile Association, the AARP, the American Society on Aging, the California Medical Association, the Board of Occupational Therapy, the California Association for Coordinated Transportation, the Center for Healthy Aging, and the Beverly Foundation, a research group that studies mobility issues.
Pilot Study of the Three-Tier Driver Evaluation Process
Perhaps the most visible task force enterprise to date has been encouragement of an emerging driver licensing process that the California DMV calls Three-Tier because it takes the applicant through three evaluation stages, if necessary. Success on the first tier precludes the requirement to complete tiers two and three, with the exception of the written knowledge test, thus combining effectiveness and efficiency.
In the first tier, a visual acuity test, a contrast sensitivity test (determines if an applicant can see a light car in the fog or a dark car in the shade), a structured but unobtrusive observation by the DMV field office staff (to identify physical limitations such as use of a cane, unusual tremors, or inability to walk without assistance), and a simple cognitive test (recalling one’s social security number) are administered.
The second tier consists of a test of the applicant’s knowledge of the standard rules of the road and a computer-based test that measures perceptual response time. If an applicant performs very poorly (what DMV calls an extreme fail) or is even marginally deficient on any tier one or tier two test, the drive test is administered. The licensing decision will be based on information gathered from all three tiers. At that point, DMV selects from a range of options, including revocation, issuance of a restricted license (which may confine driving to a defined perimeter, to daytime hours, to surface streets, to specific routes), or issuance of a conditional license that establishes a six-month window during which the senior can practice driving skills before returning to the DMV for reexamination.
The California DMV will pilot test the Three-Tier system in six northern California field offices beginning in the spring of 2007, and evaluate its impact on program operations and traffic safety. If Three-Tier proves to be successful, then the department may extend it to other offices statewide.
As one task force objective is to keep people driving safely for as long as possible, the system will help to achieve that goal not only for older people but for every driver, because the pilot test will be administered to people of all ages taking an in-person exam at one of these six offices.
Educational programs promoted by the OCTS Task Force include the Road to Driving Wellness, a classroom discussion developed by the American Society on Aging that encourages older adults to maintain the health, flexibility, and strength that are integral for continued safe driving over extended years. The American Society on Aging, in conjunction with NHTSA, has developed an older driver safety program, DriveWell, which is delivered by volunteers or peer facilitators. Other related programs such as CarFit (which fits the car to the individual by teaching proper adjustment of mirrors, safety belts, and seats; introducing adaptive devices such as pedal extenders; and arranging for evaluations by therapists) and Roadwise Review (a computer-based driving self-assessment program developed by the AAA Foundation for Traffic Safety) have been launched in California under the auspices of the task force.
Another major task force effort has been undertaken by the transportation safety work group, led by the California Department of Transportation. This group has steered the incorporation of recommendations from the Federal Highway Administration’s Guidelines for Older Drivers and Pedestrians into California’s highway design manuals. These guidelines recommend signs with larger lettering, enhanced street lighting, extended pedestrian walk signal times, and various engineering modifications that will not only aid senior drivers but also increase safety for all roadway users.
Health Care Professionals
Physicians and other health care professionals play a large role on the task force. The health services work group is raising physicians’ awareness of their patients’ driving capability. A one-page pocket card based on the American Medical Association’s Guidelines for Counseling and Assessing Older Drivers was produced by the group specifically for physicians and health practitioners to use when seeing their senior patients. The group also seeks to encourage occupational therapists to become certified driver rehabilitation specialists who can best serve as an assessment resource when a physician suspects his or her patient’s driving skills may be dwindling or pose a threat to roadway safety.
The work group collaborated with the California Medical Association (CMA) House of Delegates to secure adoption of a resolution committing CMA to promote physician awareness of mobility issues, recognize the availability of referral points for driving remediation, encourage continuing medical education on driving and mobility issues, and seek inclusion of driving-related medical issues in medical school curricula.
As with any effort that seeks broad social attention, public information is especially important to raise awareness in the short term and effect behavioral changes in the long run. The task force’s public information work group has been instrumental in conducting a host of supportive activities. After the governor proclaimed October 22–28 as Senior Safe Mobility Week, the public information work group arranged a one-day summit that showcased knowledgeable safety and mobility experts from local, state, and national organizations. Two pamphlets have been produced, and a video designed to counsel people concerned about the driving capability of a senior family member will be completed in early 2007.
Safely Keeping Seniors Mobile
As the task force progressed, it became apparent that senior safety is inextricably linked to mobility because some seniors will eventually lose the ability to drive but will never lose the need to remain engaged in their environment. Adding that concern to the task force agenda meant formation of a mobility work group, which was accomplished in early 2006. The group consists of representatives from various transit organizations whose goal is to ensure that older adults can remain independent despite being unable to drive. The group is working to expand a program in which instructors work with individuals to demystify the use of public transportation.
Other group efforts include wide identification of inexpensive supplemental transportation programs that exist in many California communities. These programs will be compiled into a master listing available to the DMV and other social service organizations, enabling them to assist seniors who face transportation challenges anywhere in the state.
The 350-Mile Man
For the task force police services work group, the realization that traffic stops will increasingly involve older people suggested the value of making interaction between peace officers and senior citizens both upbeat and constructive. Captain Iketani’s involvement with the NHTSA effort to build a solid training program therefore complemented his task force responsibility, because the objectives of both groups were similar.
The NHTSA team found that peace officer on-road contacts with seniors tended to produce one of two results: physical arrest or cite and release (or the occasional warn and release). The saga of the 350-mile man (an actual incident) illustrates the point. His odyssey took him that many miles without a specific destination and no planned route. The subject was pulled over and cited or warned three times by officers in different jurisdictions. When the man’s car finally ran out of gas he was forced to stop, confused and unaware of his location.
The officer who found him managed to sort out who he was and where he had come from. And then, after considerable investigation, the officer also learned about the three previous stops.
The NHTSA team asked this question: Should each of the intervening officers have recognized they had a special problem situation on their hands and taken precautionary steps to prevent possible tragedy? Maybe not, they realized, because these officers had no specific training to rely upon. The possible affects of aging—declining vision, hearing loss, arthritis, and dementia—on driving are not well understood. Nor are the tactical intricacies of dealing with a senior. Iketani displays a picture of an officer with folded arms (the stern I’m-in-charge-here look) to illustrate the difference between confrontation and empathy.
A Training Program
The NHTSA team developed a three-hour training program, supported by videos and divisible into modules, with the intent to achieve five objectives:
- Illustrating why officers should care about senior safety
- Improving interactions with seniors
- Teaching how to conduct a traffic stop of an older person
- Making appropriate referrals
- Comparing enforcement needs with community relations
A key word for the NHTSA team was empathy, the necessity to understand the challenges of aging and what enforcement response would be most beneficial—not sympathy because seniors do not want or expect that. Recognition is another key word. Peace officers need to recognize that, first, the special problems of aging demand a discerning response, and second, seniors typically experience physical limitations that interfere with behavior but may have no impact on safety. An example is arthritic hands, an impediment to extracting the driver’s license from wallet or purse.
Iketani and the NHTSA team demonstrate the effect of physical limitations on driving with a simulation package that requires officers to wear garden gloves, stuff cotton in their ears, don glasses smeared with oil, and place pebbles in their shoes. These illustrate four common senior physical limitations, namely, vision decline, hearing loss, arthritic hands, and walking difficulties. These may or may not interfere with driving, but they often interfere with communication, and police officers need to be aware of and compensate for them.
Dealing with driving problems is a core element of the training package designed to take officers well beyond the standard responses of citation or custody. The team assigned heavy emphasis to the referral process, which in many states will mean seeking a DMV retest. In California, police can ask the DMV to reexamine any driver exhibiting potentially hazardous behavior, with the option to make the retest a priority if the person appears to be at imminent risk. In this event the driver must contact the DMV within five working days or be subject to possible suspension. Police use of the retest process was significantly simplified when the task force work group coordinated with DMV in developing a check list (see illustration) that allows officers to make standardized indications of observed behavioral failures that interfere with driving. Three-Tier eventually could become incorporated in this retest process.
Referrals also include other sources of assistance (such as health care professionals for assessment and possible remediation) and, in the event of impending loss of license, information about transportation alternatives. In the event the senior must be taken into custody for his or her own protection, referrals can become a lifeline.
The police package is complete and ready for distribution. In California the highway patrol plans to take the added step of seeking certification from the Commission on Peace Officer Standards and Training, the official stamp of approval. Then the training will be marketed to police agencies throughout the state.
The OCTS Task Force has made a promising start on what will be an arduous assignment: helping seniors make the right choices to extend their safe driving years and guiding seniors and their families through the decision-making labyrinth that leads to driving cessation. Neither is a simple process, but the task force accepts the responsibility to build a solid program for the long term, bringing diverse resources and disciplines into the process. The large and rapidly growing number of seniors deserves no less. ■