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Senior Care: Driving for Seniors

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Senior Driving CarCan a person be too old to drive?

The answer to this question is not clear-cut and not one that should be applied across the board to all seniors. Nonetheless, with the current growth in our aging population we need to seriously review current and future policies on driving as they apply to seniors. As a community and society, we need to better understand the challenges / barriers and step in to mitigate. Policy review and changes is not something that affects seniors… it will affect our selves in the coming years. This is a delicate balance as we attempt to protect society from senior drivers we also need to ensure that we protect their rights and inevitably, our own rights as a senior citizen. Statistically speaking: Next to young male drivers, people aged 70 or older have highest accident rate

The New Retirement: In a recent, CBC News presented a series on life for people 60 years and older. Canadians Seniors are living longer than ever before, a fact that is radically changing the meaning of retirement. Many people see it as a time of reinvention, a time to try new things. CBC News is published stories on seniors who are doing remarkable things in the so-called twilight years. In one instance, a police officer pulled over a driver for driving too slow and impeding traffic. The officer glanced at the driver’s license and saw her age — 94 — and explained he wasn’t going to give her a ticket. But a couple of weeks later, she said she received a letter notifying her that her license was suspended for medical reasons.

“Never thought of not having a car, never crossed my mind,” explained Ellison. “When you can’t go out and get in your car and go where you want to go, it’s like having your arm cut off.”

According to the latest figures from Statistics Canada, three-quarters of Canadians aged 65 and older have a driver’s license. But research also shows that the older a person is, the greater risk they are on the road. StatsCan reports that other than young male drivers, people aged 70 or older have the highest accident rate. Furthermore, seniors are much more likely to be killed in collisions.

The loss of a driver’s license can affect quality of life: 

Those statistics don’t change the fact that once a person loses their license, it greatly affects their lifestyle and overall mental health. “It’s been demonstrated and said many times, that receiving the news that you will be losing your driver’s license has the same weight as being diagnosed with cancer,” said Sylvain Gagnon, a researcher for the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CANDRIVE). He explained the news of losing your license, can often be followed by depression and a significant loss in quality of life. Figures show that access to a car affects a person’s social habits. StatsCan found that seniors who primarily travelled via their car were the most likely to have partaken in a social activity in the past week, at 73 per cent. The StatsCan research shows that seniors who depend on others to get around are more likely to be reluctant when asking to attend leisure activities (rather than essential activities, like doctor’s appointments). Since losing her license, Ellison must now rely on her daughters and friends for transportation to her personal and social errands.

Life without wheels:

The loss of a license may be even more detrimental for seniors living outside urban areas. According to StatsCan, people aged 65-74 are slightly more likely to live outside urban areas. Of those seniors, a large number reportedly do not use transit because of a lack of service in their area, which may only further immobilize them.

According to Ellison, if you are out in the country and don’t drive, “you just might as well be dead”. — Peggy Ellison, Ontario Senior .

Ellison was 21 when she first got her license. She went on to two driving-related jobs, including parking cars at a garage and driving a bus for 20 years. She said that in the seven decades that she had a license, she was never in an accident. “I haven’t changed because I got old, at least I don’t think I have,” said Ellison. It is estimated that people make eight to 12 navigating decisions for every kilometre they drive. According to the Ontario Ministry of Transportation, even small changes as a result of aging can affect your driving. In Ontario, a person’s driver’s license can be suspended if a doctor or optometrist feels a person has a condition that may impair their ability to drive. Doctors are bound by law to report this condition to the Ministry of Transportation, which then reviews the information and acts accordingly. A doctor may take into account a number of factors when assessing a senior’s ability to drive, including vision, mobility and cognitive abilities. “You will never be able to tell in a doctor’s office whether someone is safe to drive,” said Gagnon, who is also a psychology professor at the University of Ottawa. Gagnon explained driving is a complex task, and there is no one single indicator of a driver’s competence. A doctor can only hope to narrow down the grey area of who is safe to drive. CANDRIVE is currently trying to come up with an instrument that could be used by doctors to assess older drivers.

Renewal process for seniors:

In the meantime, some provinces require that drivers be retested once they reach a certain age. For instance, in Ontario at the age of 80, drivers must renew their license and continue to do so every two years. They complete a vision test, a written test and sit in on a group education session. They may also be required to take a road test. In provinces such as Alberta, a driver needs to take a medical exam at the age 75, and again at 80 and every two years after that. Doctors are not required by law to report seniors who they believe are unfit to drive. However, the province has other safety measures in place. For instance, when drivers renew their license they have an obligation to disclose whether they have a medical condition that would affect their ability to drive. In Alberta, anyone can request that someone’s driving privileges be reviewed if they suspect that person is becoming a danger on the road. Trent Bancarz, a spokesperson for Alberta Transportation, said the majority of the requests probably come from family members. “If you do have someone in your family that either due to age or due to a medical condition is maybe not a safe person to be out there, it’s really hard to either confront them or to take their driving privileges away,” said Bancarz. But he said there should be no age bias involved with the decision to take away someone’s license. “Some people are better able to drive a vehicle at 82 then some other people at 45,” Bancarz said.

Seniors forced to change lifestyle:

Gagnon warned the recommendation to take away someone’s license should not be made lightly, because of the dramatic impact it can have on a person’s life. How a senior reacts to the news that he or she can no longer drive may depend on a number of factors, including a senior’s autonomy, how far away they are from their services and what the alternate transportation methods are.

The day after Peggy Ellison sold her Buick to a young man in town, she took out the Yellow Pages with the intention of buying a golf cart, a four-wheeled vehicle that doesn’t require a license. Her new ride was delivered to her home the next day. “There’s nothing like having a car,” Ellison says, “but it makes me feel a little bit of independence again since I got my cart. I love to have wheels.

This year, more than 3.5 million drivers over 65 will strike out on Canadian roads – the highest number in history. That fact is fuelling a simmering debate over whether Canada’s provinces ought to have tougher licensing criteria for elderly drivers. Most provinces require drivers aged 80 and up to renew their license and take a written test every two years. None have mandatory in-car driver tests. However, on a per-kilometre basis, seniors are the most collision-prone operators on the road. They are also subject to some of the highest insurance rates, on par with the rates levied on newly licensed young males. The problem with those statistics, experts argue, is that they belie much of the grey that muddies the senior driving issue. “The mere fact that you are old doesn’t mean you have a problem,” said Dr. Jamie Dow, the medical adviser on road safety for the Société de l’assurance automobile du Quebec, a crown corporation responsible for licensing drivers and vehicles. “The fact that you are older does make you more susceptible to having a problem.” Public health data supports this.

In 2010, two thirds of Canadians over the age of 65 were using multiple medications and nearly nine out of 10 suffered from a chronic condition; a quarter of adults in the 65 to 79 age group suffered four or more chronic conditions. In the over 80 year old group, the number jumped to more than a third, according to data from the Public Health Agency of Canada. “There is clearly a strong association between age and illness,” said Bonnie Dobbs, and Edmonton-based gerontologist who helms the Medically At-Risk Drivers’ Centre at the University of Alberta, a research centred devoted to studying the impact of medical conditions on driving. “Age is not the primary determiner of fitness to drive. [But] as we get older, we’re more likely to have one or more of the illnesses that can impact our ability to drive.” Nellemarie Hyde, an occupational therapist and program co-ordinator for Saint Elizabeth Driver Assessment and Training service in Ontario, regularly evaluates senior drivers with medical illnesses. The most common are diabetes, which can impact both vision and sensory function – think ability to gauge force on gas or brake pedals – Parkinson’s Disease with its hallmark physical tremors, stroke victims and people living with dementia and other mild cognitive impairments. “Mild memory deficits don’t necessarily affect driving directly,” she said, adding that she focuses more on a driver’s ability to concentrate, focus and multi-task. She also tests for strength, range of motion, co-ordination, sensation and visual perception. “We want the client to be able to continue driving safely,” she said, adding: “The challenge is when a medical condition starts to change how they drive.” Picking up on that condition is where policy makers struggle.

In most provinces, doctors are legally mandated to inform licensing bodies when they suspect a patient is no longer competent to drive. However, most doctors are “totally unprepared to do it,” said Dow. “Most physicians have no training in evaluating drivers or the effects of medical conditions on driving,” he said, adding the subject is rarely touched on by medical schools. The result is that some provinces are deluged with declarations from physicians. In other cases, physicians barely report at all. Several efforts are under way to provide physicians with tools to easily and efficiently identify medically at-risk drivers without risking discrimination by age. Through the SAAQ in Quebec, Dow runs free seminars for doctors on which exam observations ought to trigger red, road-related flags. Last year, Quebec recorded 16,000 physician declarations, compared with just 1,800 in 2003. In Ontario, Shawn Marshall, an Ottawa-based rehab medicine specialist, is near the end of a five-year, multi-province study called CanDrive, which follows 1,000 drivers over the age of 65 and aims to produce an even more accurate tool. “You want to have a screening tool that is valid, reliable and has high accuracy. You don’t want to identify people falsely,” he said, noting it strains provincial systems and unfairly restricts individuals who belong on the road. “The average 65-year-old is a healthy person,” he said. “Driving is important. To maintain your independence in many places throughout Canada, you need to be able to drive.”

How Does Age Affect Driving?

More and more older drivers are on the roads these days. It’s important to know that getting older doesn’t automatically turn people into bad drivers. Many of us continue to be good, safe drivers as we age. But there are changes that can affect driving skills as we age.

Changes to our Bodies: Over time your joints may get stiff and your muscles weaken. It can be harder to move your head to look back, quickly turn the steering wheel, or safely hit the brakes. Your eyesight and hearing may change, too. As you get older, you need more light to see things. Also, glare from the sun, oncoming headlights, or other street-lights may trouble you more than before. The area you can see around you (called peripheral vision) may become narrower. The vision problems from eye diseases such as cataracts, macular degeneration, or glaucoma can also affect your driving ability. You may also find that your reflexes are getting slower. Or, your attention span may shorten. Maybe it’s harder for you to do two things at once. These are all normal changes, but they can affect your driving skills. Some older people have conditions like Alzheimer’s disease (AD) that change their thinking and behavior. People with AD may forget familiar routes or even how to drive safely. They become more likely to make driving mistakes, and they have more “close calls” than other drivers. However, people in the early stages of AD may be able to keep driving for a while. Caregivers should watch their driving over time. As the disease worsens, it will affect driving ability. Doctors can help you decide whether it’s safe for the person with AD to keep driving.

Other Health Changes: While health problems can affect driving at any age, some occur more often as we get older. For example, arthritis, Parkinson’s disease, and diabetes may make it harder to drive. People who are depressed may become distracted while driving. The effects of a stroke or even lack of sleep can also cause driving problems. Devices such as an automatic defibrillator or pacemaker might cause an irregular heartbeat or dizziness, which can make driving dangerous.

 Smart Driving Tips

Planning before you leave:

  • Plan to drive on streets you know.
  • Limit your trips to places that are easy to get to and close to home.
  • Take routes that let you avoid risky spots like ramps and left turns.
  • Add extra time for travel if driving conditions are bad.
  • Don’t drive when you are stressed or tired.

 While you are driving:

  • Always wear your seat belt.
  • Stay off the cell phone.
  • Avoid distractions such as listening to the radio or having conversations.
  • Leave a big space, at least two car lengths, between your car and the one in front of you. If you are driving at higher speeds or if the weather is bad, leave even more space between you and the next car.
  • Make sure there is enough space behind you. (Hint: if someone follows you too closely, slow down so that the person will pass you.)
  • Use your rear window defroster to keep the back window clear at all times.
  • Keep your headlights on at all times.

Car safety:

  • Drive a car with features that make driving easier, such as power steering, power brakes, automatic transmission, and large mirrors.
  • Drive a car with air bags.
  • Check your windshield wiper blades often and replace them when needed.
  • Keep your headlights clean and aligned.
  • Think about getting hand controls for the accelerator and brakes if you have leg problems.

Driving skills: Take a driving refresher class every few years. (Hint: Some car insurance companies lower your bill when you pass this type of class. Check with AARP, AAA, or local private driving schools to find a class near you.)  

Medicine Side Effects: Some medicines can make it harder for you to drive safely. These medicines include sleep aids, anti-depression drugs, antihistamines for allergies and colds, strong pain-killers, and diabetes medications. If you take one or more of these or other medicines, talk to your doctor about how they might affect your driving.

Am I a safe driver? Maybe you already know of some driving situations that are hard for you–nights, highways, rush hours, or bad weather. If so, try to change your driving habits to avoid them. Other hints? Older drivers are most at risk when yielding the right of way, turning (especially making left turns), changing lanes, passing, and using expressway ramps. Pay special attention at those times.

Is It Time to Give Up Driving? We all age differently. For this reason, there is no way to say what age should be the upper limit for driving. So, how do you know if you should stop driving?

To help you decide, ask:

  • Do other drivers often honk at me?
  • Have I had some accidents, even “fender benders”?
  • Do I get lost, even on roads I know?
  • Do cars or people walking seem to appear out of nowhere?
  • Have family, friends, or my doctor said they are worried about my driving?

Am I driving less these days because I am not as sure about my driving as I used to be? If you answered yes to any of these questions, you should think seriously about whether or not you are still a safe driver. If you answered no to all these questions, don’t forget to have your eyes and ears checked regularly. Talk to your doctor about any changes to your health that could affect your ability to drive safely.

How Will I Get Around? You can stay active and do the things you like to do, even if you decide to give up driving. There may be more options for getting around than you think. Some areas offer low-cost bus or taxi service for older people. Some also have carpools or other transportation on request. Religious and civic groups sometimes have volunteers who take seniors where they want to go. Your local Agency on Aging has information about transportation services in your area.

If you still have a vehicle consider a companion service that will keep you company as needed and provide you with a driving service, to and from where you need to go.  In Our Care – Home Care Services can do that, its effective, inexpensive, convenient and safe.

A Summary of Canada’s Aging Population

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Group of SeniorsA Summary of Canada’s Aging Population

An aging Canadian population is expected to present significant social, economic and political challenges over the next decades. Understanding the needs of seniors and addressing the barriers they face can promote successful aging and ensure that Canadian society benefits from the numerous contributions seniors can provide as engaged citizens and voters.

This research note is the first in a two-part series on seniors, defined as those aged 65 and older. This note provides a demographic profile of this age group, including information about their geographical distribution, lifestyles and socio-economic status. It also addresses some of the challenges that they face in various areas of life. The second note will focus on the electoral participation of seniors, including turnout in federal elections, barriers to voting and initiatives that can be put forward to reduce these barriers.

The qualifying age for seniors is generally 65 in developed countries. However, seniors do not represent a homogenous group, and there is significant variation in the circumstances of those aged 65 to 74, 75 to 84, and 85 and older. Therefore, each one of these three age categories will be treated as distinct where possible.

The Aging Population
A sustained decline in mortality and fertility rates during the twentieth century has resulted in a shift towards older populations worldwide. Canada, while somewhat younger than the average among developed countries, still has an all-time high proportion of seniors. According to Statistics Canada, between 1981 and 2011, the number of Canadians increased significantly amongst the three age groups:

  • For those aged 65 to 74, from 1.5 million (6% of the total population) to 2 million (8%)
  • For those between 75 and 84, from 695,000 (2.8%) to 1.6 million (4.9%)
  • For those aged 85 and older, from 196,000 (0.8%) to 492,000 (2%)

The number of seniors in all age groups is expected to continue to rise, and by 2041, seniors are projected to comprise nearly a quarter (24.5%) of the Canadian population, as compared to 14.8% today. Those aged 85 and over are expected to nearly triple to 5.8% of the total population by 2041.

The chart below illustrates the growth of the older population since 1921.

Aging Population Chart-CanadaGeography
Canada’s senior population is distributed unevenly across the provinces, with the highest concentration in the Atlantic provinces. Nova Scotia has the highest proportion of seniors, at 16.6% of its population, followed by New Brunswick (16.5%) and Prince Edward Island (16.3%). Alberta has the lowest proportion of seniors at 11.1% of the population, while Nunavut has the youngest population overall, with only 3.3% over 65. Some regions are aging more rapidly than others. The Atlantic Provinces are expected to see the highest increase in their proportion of seniors by 2026, while Ontario has the lowest projected increase. Most older seniors (61%) live in metropolitan areas, reflecting the overall trend towards urbanization in Canada, while 23% reside in rural areas.

Gender and Ethnicity
Since women have a longer life expectancy, the majority of seniors are women, with the gender discrepancy increasing with age. In 2011, women made up 52% of seniors aged 65 to 74, 56% of seniors aged 75 to 84, and 68% aged 85 or older. This gap is narrowing, however, and the next decades are expected to see a relative increase in the number of older men as they catch up in terms of life expectancy.

Approximately 28% of seniors are immigrants, the majority of whom were born in Western Europe and Asia. Most immigrant seniors moved at a relatively young age and have been living in Canada for several decades. The proportion of Aboriginal seniors is low, with only 5% of the Aboriginal population over 65, and 1% over 75.

Living Arrangements
As shown in table 1: Most people over 65 reside at home, either with a spouse or alone. According to a study released in 2002 by Health Canada, three quarters of seniors enjoyed housing considered to be affordable, adequately sized and in good condition.

A small percentage of seniors live in institutions, including long-term care facilities and hospitals, though rates of institutionalization rise sharply with age. Reasons cited for institutionalization include increasing frailty and care needs that exceed the capacity of family or friends. In many cases, family and friends continue to provide care even after institutionalization.

Table 1: Where Seniors Live

Living Arrangements
% Of Seniors
Aged 65–74
% Of Seniors
Aged 74–85
% Of Seniors
Aged 85+
Institution
2.2
8.2
31.6
With Spouse
54.4
39.9
16.2
With Children or Grandchildren
18.9
16.0
15.8
Alone
21.5
33.0
33.7
Other
2.9
2.8
2.6

Employment and Income
As of 2006, nearly 15% of men and 5% of women over 65 were participating in the workforce. A smaller percentage of seniors in the 75+ age group were still working, with labour force participation rates of 7.5% for men and 2.4% for women. Self-employment and higher levels of education are associated with a higher likelihood that a person will continue to work after 65.

Post-retirement sources of income among retired seniors include transfers (such as CPP/QPP, OAS, EI, GIS), pensions, RSP withdrawals and investment income. Older seniors are often mischaracterized as impoverished. While they generally have only half the income of working-age households, they are often able to support a similar standard of living. This is likely due to lower expenses (for example, no mortgage or expenses related to child provision) and higher savings from which to draw.

Consumption and spending remain steady through the working years up to age 70, and then begin to decline. It is likely that this decline is voluntary, as gift giving and savings remain unchanged. Older seniors may be less willing or able to spend money; they may be saving for anticipated health care costs or to leave money behind for relatives.

Income aside, work is also important in defining personal identity. The loss of full-time employment, therefore, may present challenges to retired seniors, including lowered confidence, loss of perceived prestige and loss of purpose. Participation in various groups or organizations can ease the transition, and new challenges like volunteer activities may restore a sense of purpose.

Health and Quality of Life
Improved medical technology and public health measures have provided Canadians with a longer life expectancy and quality of life than in the past. Nonetheless, chronic health conditions are widespread among seniors, with four out of five seniors residing at home having a chronic health condition of some kind. The most common of these conditions are arthritis or rheumatism, hypertension, (non-arthritic) back pain, heart disease and cataracts. Alzheimer’s disease and other forms of dementia also affect significant numbers of older seniors and are expected to present a major social and public health problem as the population ages. In 2008, 480,600 people, or 1.5% of Canada’s population, suffered from some form of dementia. This number is expected to rise to 1.13 million (or 2.8% of the Canadian population) by 2038. Most dementia sufferers are 75 years of age or older.

Many seniors also have a disability or activity restriction that requires them to seek assistance with various activities. One quarter of older seniors require help with housework, while one in ten need help with personal care activities, such as washing, dressing or eating. Most assistance is provided by immediate family members, although friends and professional caregivers may help as well. Limitations increase sharply after 85, with mobility, sight, hearing and cognition becoming more restricted.

Despite the prevalence of chronic conditions and activity limitations, seniors generally perceive themselves to be in good health. As of 2011, 46% of men and women over 65 rated their own health as very good or excellent. Higher levels of educational attainment are strongly related to better self-reported health, as are greater independence, the absence of pain or barriers to communication, and the presence of strong social networks. Even seniors residing in long-term care facilities generally rate their health fairly highly, suggesting that they adjust their expectations for health relative to their circumstances and those of their peers.

Victimization, Abuse and Ageism
Elder abuse is gaining increasing recognition as an important issue. Abuse can be physical, psychological/emotional, sexual or financial in nature, or involve intentional or unintentional neglect. A random survey of seniors in Canada found that 4% reported experiencing maltreatment since turning 65. Older women and sponsored immigrant seniors are particularly vulnerable to elder abuse. This could be due to increased financial dependency, social isolation, cultural norms, familial status, disadvantage or disability.

Fraud against older people is also common. Seniors may be particularly vulnerable due to isolation and, in some cases, cognitive decline. Types of scams may include mail or telephone fraud, charity or lottery scams, or fake business opportunities.

Older seniors may also experience a type of discrimination referred to as ageism, defined as a “process of systematic stereotyping or discrimination against people because they are old, just as racism and sexism accomplish with skin colour and gender.” Ageism may be positive (for example, the belief that all seniors are wise or caring) or negative (one study shows that younger Canadians overwhelmingly assume that most seniors reside in an institution, suffer from dementia and are responsible for a large proportion of traffic accidents). Ageism can have implications for individuals whose competencies and merits are not acknowledged, and for society as a whole, which, operating under the assumption that everyone is young, fails to meet the varied needs of all of its citizens.

What Older Seniors Fear The Most
A recent study looked at some of the fears that seniors experience as they age. Losing their personal independence and going into a Nursing Home were among the their greatest fears… more so than death.What Seniors Fear Most

Social and Civic Participation
It is important for seniors to remain active in social networks, as this fosters a sense of belonging and connectedness, and is associated with better health and quality of life outcomes. Seniors who are socially involved are less isolated and tend to have more close friends.

As of 2003, 54% of seniors were involved in groups or organizations, such as social clubs, service clubs, sports leagues and religious organizations. This proportion is similar to that of adults under 65. For seniors over 75, the rate of group involvement dropped to 46%. Seniors with higher levels of education and those with a previous history of involvement are more likely to participate in a group or organization.

Many seniors also volunteer for charities or non-profit organizations. While they are somewhat less likely to volunteer than younger retirees or working people, they tend to contribute more hours when they do volunteer. In 2004, 39% of seniors between 65 and 74 volunteered, contributing an average of 250 hours of volunteer work – 100 hours more than the average for adults between 25 and 54. Volunteering decreases somewhat after age 75, health being the most widely reported reason for non-volunteering seniors.

Conclusion
The role of seniors in society warrants increased consideration as their share of the population grows. Currently, seniors have a good quality of life in Canada. Most enjoy good living conditions, adequate financial resources, and generally rate their health highly. While the majority of seniors are retired, many remain socially involved through participation in organizations or volunteer work. Nonetheless, seniors continue to face certain challenges and barriers. These include physical and cognitive health conditions, a lack of independence and negative attitudes.

Understanding the needs of seniors and addressing the barriers they face can promote successful aging and bring benefit to Canadian society from the numerous contributions older people can provide, including their participation in the electoral process.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at homecare@inourcareservices.com