LA Times: Crosswalks are increasingly deadly for the elderly

New Yorkers cross at the corner of West 72nd Street and Brodway in Manhattan. As America ages, baby boomers retire and people walk more, planners are having to rethink streets and crossings designed for fast-moving traffic and younger pedestrians. (Carolyn Cole, Los Angeles Times / June 12, 2011)

Traffic planners start to rethink streets designed for fast-moving traffic as America ages and slower pedestrians take more time to cross.

By Tina Susman, Los Angeles TimesJune 11, 2011, 8:03 p.m.

Reporting from New York—

The wide avenues of the Upper West Side have some of this city’s handsomest neighborhoods, premier cultural venues and long stretches of green space. They also have a remarkably deadly history for pedestrians, a fact not lost on Joel Ruben as he ambled across Broadway.

Ruben, 88, stood on the sidewalk and looked north into four lanes of traffic heading his way. As other pedestrians inched into the street against the “Don’t walk” sign, looking to get a head start on the green light, Ruben hung back until he had the “Walk” sign. “I’m very careful,” he said after reaching the other side, a few seconds after “Don’t walk” began flashing red.

For good reason: At least a dozen pedestrians aged 66 to 93 have been killed within a 10-block radius of this spot since 2001, highlighting what transportation experts say is a nationwide problem confronting cities that for decades designed streets for fast-moving vehicles.

What they didn’t consider was the aging of America, a trend laid bare by the 2010 census and now presenting cities — especially pedestrian-heavy ones like New York — with a problem.

“Streets are no longer primarily for moving traffic as quickly as possible. That’s a very 1950s notion of middle America,” said Noah Budnick, the deputy director of Transportation Alternatives, a New York research and advocacy group. “Our streets are where we live in this city, and walking is the primary mode of how people get around. But older people simply don’t have enough time to cross the street.”

Transportation for America, based in Washington, highlighted the issue last month in “Dangerous By Design,” a study of traffic fatalities from 2000 through 2009. Nationwide, people 65 and older make up 13% of the population but represent about 22% of pedestrian deaths.

Both organizations link the disproportionate number of elderly victims to street plans that failed to anticipate a number of social shifts in the country: the first of the 78 million baby boomers turning 65 this year; more retirees moving to urban areas; people living longer; and walking being the main form of exercise for the elderly.

The 2010 census showed growth in the percentage of middle-aged and elderly people far outpacing those 45 and younger. By 2030, the 65-plus crowd is expected to account for 19% of the nation’s population.

“We’re going to see lots more people living to 85 and beyond,” said David Goldberg of Transportation for America. “The impact of having designed our communities so totally around being able to drive for your every need is going to be felt in a very significant way.”

Read the full article at the LA Times website.

NEWS: Driving With Early Alzheimer’s May Be Ill-Advised

By Ellin Holohan, US News and World Report
Read the article here.

Elderly people with failing memories often keep driving, but a study of Alzheimer’s patients suggests the risk of getting lost — even on familiar streets — may be greater than once thought.

Even with early dementia, there may be no safe period behind the wheel because the disease is unpredictable, said Linda Hunt, an associate professor in the School of Occupational Therapy at Pacific University, Oregon, and author of a new study.

“Alzheimer’s disease affects memory and navigational skills. These impairments may lead to getting lost, which is a life-threatening problem,” Hunt said. “Family members and friends of individuals with dementia need to recognize these impairments as serious threats to safety for anyone who has dementia.”

It is estimated that 30 to 45 percent of Alzheimer’s patients continue to drive after diagnosis.

About 5.3 million Americans have Alzheimer’s, the most common form of dementia, a progressive brain disease causing a variety of mental impairments that include memory loss, inability to recognize objects, problems with reasoning and judgment, and getting lost. As the population ages, the number of Americans with Alzheimer’s is expected to triple to 16 million by 2050.

The study, published in the March-April issue of American Journal of Occupational Health, looked at media stories published between 1998 and 2008 that involved Alzheimer’s patients reported missing.

Of 207 drivers with Alzheimer’s who went missing while driving, 32 died and 35 were found injured, the research showed. Another 70 were not found at the time the data was analyzed. Some had driven for almost two days and covered more than 1,700 miles while lost. Most had set off on routine trips to the post office, store or a relative’s house.

Read more here.

Aging Population Means More Vision Issues

From the Practical Care Continuum newsletter

In 2010, an estimated 2.8 million Baby Boomers will celebrate their 60th birthdays, and within the next 30 years, the National Eye Institute estimates the number of blind or visually impaired Americans will double.

According to the AOA, 20.5 million people age 60 and over have cataracts, a leading cause of poor vision in the United States. The American Optometric Association (AOA) is issuing a reminder that early detection through a comprehensive eye exam can prevent or slow vision loss due to cataracts and other age-related eye diseases such as macular degeneration, glaucoma and diabetic retinopathy.

Read more here.

When Loved Ones Should No Longer Drive

Martin certainly appreciated his 88-year-old mother’s energy and independence. Engaged and mentally sharp, she continued to attend adult education classes, participate in church and community activities and regularly visit family and friends. Still he found himself worried about her safety when driving. It was the same anxiety he felt when his teenage daughter started driving. His mother drove her 10-year-old Cadillac everywhere, but over winter had been involved in two minor fender benders and a couple of near misses. In addition, he knew that she continued to drive on the interstate even though she was feeling increased anxiety about getting on and off the ramps.
He felt the time was fast approaching when she would have to quit driving. It was a conversation he knew he had to initiate, and one that he needed to do sooner rather than later. He was not sure what to say or, most importantly, how to say it in a way that would not insult her and yet have the desired effect of getter her to stop or seriously limit her driving.

Are Older Drivers At Risk?

In fact, seniors as a group are relatively safe drivers. The actual number of accidents involving older drivers decreases as age increases. Experts attribute this statistic to self-imposed limitations that include driving fewer miles and avoiding problematic situations like driving at night, during rush hour and on high speed roadways. That’s the good news. The bad news is that drivers over 75 have a higher risk of being involved in an accident for every mile they drive. The rate of fatalities increases significantly by this age – in fact, it is on par with teenage drivers.

So what can be done? According to AARP, ongoing conversations with family members can help. A survey of older adults found that more than half said they followed the suggestions of others, with women generally more compliant than men. They may prefer to hear it from their spouse (or from professionals like their doctor), but will listen to their adult children. Among individuals living alone, almost one third said they would prefer to hear about unsafe driving from their adult children (although another 15% ranked their children as the last ones they wanted to hear this from).
The survey found that one-quarter of all seniors reported responding with sadness when spoken to about their driving. While they may even agree with the assessment, they felt depressed at the thought of relinquishing this activity. After all the implications are significant – fewer trips outside the home, increased dependency on others, fewer social opportunities, and the fear of becoming a burden to others. Experts believe that while any discussions on driving are likely to be emotional for family members as well, they should not be put off. They suggest the following:
• Start with the appropriate conversation openers. Rather than tell a parent “you need to stop driving”, it is more effective to begin by talking about the importance of safety and health, other options that may be available to help them get around, the dangers of certain road situations, etc.
• Use mishaps or near misses, self-regulation, or health changes as a lead in. For example, praising a senior for choosing to limit driving during the daytime or discussing how taking a new medication may make them sleepy or less alert should be considered
• Observe the senior at the wheel. A conversation has far more meaning, when the senior’s driving is experienced firsthand. Seeing, for example, the senior become lost in familiar surroundings may be a sign of dementia and a reason to get the senior to stop driving. Studies have shown that people are more willing to listen to those who have driven with them.
• Investigate the alternatives to driving. Many seniors will see the loss of driving as the loss of independence and a blow to their social network. To make any decision more palatable, it is important to see what other options exist.
• Discuss your concerns with a doctor. A recommendation to stop driving that comes from a senior’s doctor usually carries more weight.
• If there is initial resistance, suggest that the older adult be tested for an assessment of their driving skills. These tests are commonly administered by rehabilitation centers, hospitals and the VA.
• Be supportive. Adult children need to understand that this is more than just the loss of their car, but a clear blow to their freedom and independence. The transition can be a difficult one.

What if all these steps fail to get the desired response? Experts say that if a high-risk driver refuses to stop driving, the family may have no choice but to sell or disable the car or file down the keys.

Meanwhile, Martin has started discussions with his mother, and has convinced her to eliminate her night driving and any driving on the interstate. She recently told him that she would consider selling the car – which thrilled Martin, until she added that she wanted to buy a car that got better mileage. He realizes it’s an ongoing process.

When Is It Time To Stop Driving?

From John Hopkins

For most of us, driving is not only a symbol of our independence, but a practical tool of everyday living. So it’s no surprise that taking away a patient’s driving privileges is among the most difficult and potentially divisive decisions for the Alzheimer’s caregiver. In this Health Alert, Dr. Peter V. Rabins, Medical Editor of The Johns Hopkins Memory Bulletin, answers questions about driving and the Alzheimer’s patient.

Q. What signs should an Alzheimier’s caregiver watch for when determining a loved one’s driving competence?

A. While there are no set criteria for determining when a person with Alzheimer’s disease should be prevented from driving, there are warning signs. Keep in mind that in some states, driving privileges are based on the stage of the Alzheimer’s disease assigned by the physician.

The following are some common indicators that a person’s Alzheimer’s is making it difficult for them to respond safely while driving. Whenever you notice such problems, record the date and time when these behaviors occur, and discuss them with the person and his or her doctor:

* Not signaling for turns or signaling incorrectly
* Confusion at exits
* Hitting curbs when trying to park
* Parking inappropriately
* Driving at inappropriate speeds
* Delayed responses to typical and atypical situations
* Getting lost along a familiar route
* Getting unexplained dents on the car
* Confusing the brake and gas pedals
* Stopping at a green or flashing yellow light
* Having near misses with pedestrians and other cars
* Getting citations for poor driving
* Having accident(s)

Q. When should a driving evaluation be sought?

A. If any of the above has occurred and the person will not voluntarily give up driving, then a formal evaluation by the motor vehicle bureau or private driving instructor should be sought. Most caregivers will restrict driving after a loved one has accumulated one or more of the warning signs listed above but many people with Alzheimer’s disease will deny any problems and, when asked to limit their driving or stop driving altogether, will be highly resistant. Some people who have the early stages of Alzheimer’s recognize that they are having changes and go in for testing on their own initiative. I always encourage and support this.

An evaluation by a driver rehabilitation specialist can be of great value in helping to make the difficult decision of taking away the car keys. A driver evaluation will assess the components of driving that may be compromised by this progressive condition. Areas assessed should include: attention, processing speed, visuospatial functioning, decision making, judgment, planning, memory, and behavior.

To find a certified driving rehabilitation specialist in your area who can perform such an evaluation, contact Driver Rehabilitation Specialists, ADED, 2425 N. Center Street #369, Hickory, NC 28601; Tel: 828-855-1623, or toll-free in the U.S. and Canada: 866-672-9466. Email: http://www.driver-ed.org

AAA Introduces Senior Safety and Mobility Web Site

AAA, North America’s largest leisure travel and automotive-related service organization, recently unveiled a new senior safety and mobility Web site, http://www.AAASeniors.com, designed to help families of older drivers overcome mobility challenges and ensure safety on the road.

The site provides advice from experts on how aging affects an individual’s ability to drive safely; a step-by-step guide on how to open a dialogue with an older driver and work together toward transitioning from driver to passenger; and various resources such as educational brochures, driver improvement courses, tips on choosing a vehicle and skills assessment tools.