Declining Health and Competence: Men Facing Choices about Driving Cessation

As long ago as 1971, at the White House Conference on Aging, transportation was ranked third in importance, after income and health, as a predictor of quality of life in the postrcrircment years (O'Neill, 2000). In the intervening almost four decades, for older people, owning and driving a motorcar has increasingly become a way of life. A major shift in perceptions about driving is that it is seen as a "right" rather than a privilege (Brayne et al., 2000). Although the gender gap is narrowing as more women are driving in later life, older men in particular relinquish a driver's license with great reluctance. Since I started researching for this article, I have been regaled with numerous stories about older people and their driving, from the positive-"My mother at the age of 85 is still a great driver, and always was better than my [late] father"-to the negative-"We had to hide the keys and tell him there was something wrong with the engine and we were going to get it fixed. If we have our way, he'll NEVER drive again! " My favorite, however, was told by a granddaughter. "My Mom begged Dr. F to persuade Gramps to give up driving, which he said he would. A few weeks later Gramps was still driving, so Mom asked what the doc had advised. 'Well, he only said he thought I should give up, but I don't think he's right. '" These stones highlight some of the dilemmas faced by physicians, carers, families, and, most important, older people themselves about driving in old age. Deterioration in health status is the most common reason given for cessation of driving, but the question of who decides when and where the boundaries lie has proved to be slippery and challenging. This article looks at some of the background and statistics about older drivers, principally referring to data from the United States and the United Kingdom. The data measure the importance to men of private transportation, not just in logistical and practical terms, but in terms of masculinity and self-identity and how this issue relates to their aging. Last, the data suggest implications of health status, competence awareness, and technological advances for driving in later life, particularly for older men, who will constitute an increasing proportion of drivers as the baby boom generation ages. Rates of car ownership have risen globally, and, in the more developed world, increasing longevity has meant that the average age of car drivers has also risen. This increasing age is markedly apparent in the U.S., where between 1994 and 2004, there was a 17 percent increase in the number of older licensed drivers, compared to 13 percent in the general population (National Highway Traffic Safety Administration [NHTSA], 2006). Men over the age of 65 years are more likely than women of that age to be licensed drivers, to have driven for more years, and to be the main or sole driver in laterlife relationships. However, these older men are also more likely than women drivers of the same age to be involved in road traffic accidents, both fetal and nonfatal (NHTSA, 2006). According to the European Conference of Ministers of Transport (Conference Europeenne des Ministres des Transports [CEMT], 2001), older drivers are not involved as often in single-vehicle accidents as are younger drivers, but older drivers tend to be at fault when they are in collisions: The dominant accident type in which an older driver is involved is at intersections where the older driver is turning against oncoming traffic on a main road that has right-of-way. The cause of the accident is rarely speeding or careless or aggressive behavior, but rather is reduced ability to process complex traffic situations quickly. Indeed, cautious driving may cause other, more impatient road users to have an accident. Much media attention is paid to driving aberrations of older drivers: "Annie Dunlop, 76 . crashed into seven vehicles when she forgot her hearing aid and did not hear her engine revving;" (Webster, 2007), and "George Weller, 89, killed ten and injured sixty-three people in Santa Monica, Calif. …