Older Road Users – Myths and Realities, A Guide for Medical and Legal Professionals.
A review by Joseph E. Badger

When I first saw the title, Older Road Users, a quick thought ran through my head. Is this a book about people who use older roads? Actually, no, the book’s subject is about the chronologically gifted motorist, that is, elderly drivers… old people who use public streets and highways. Morris Odell, Senior Forensic Physician at the Victorian Institute of Forensic Medicine in Melbourne, Australia, edited the book for Lawyers & Judges Publishing Co. of Tucson, AZ; however 13 learned authors also contributed to the text.

One of those providers is Carolyn Unsworth, who holds Professorships at various schools including Jönköping University in Sweden. She notes in her chapter “Assessing Older Drivers with Health-Related Problems” that “Medical advances have enabled people to live longer … [yet] the accident rate for older drivers per kilometer driven is higher than for all other age groups except young novice drivers.” I should explain that the authors are from Australia or Canada so the book uses British style and spellings (e.g., organisation, labour, ageing, licence) throughout.

If you think teenagers have a lot of accidents, consider what Jim Langford, Senior Research Fellow at the Monash University Accident Research Centre, points out in his chapter “Older Driver Crashes”: “In 2010 the first of the baby boomers will reach 65 years of age…” And worse yet, “By 2050, one-quarter of the combined population of all OECD countries will be 65 years and over, almost double the rate for 2000…” Langford did not explain the acronym OECD. Perhaps everyone in Australia already knows. But for the rest of us OECD refers to Organisation for Economic Cooperation and Development (www.oecd.org/). The OECD consists of 30 countries, from Australia to Canada to most European nations to Japan, Korea, Mexico, and the United States.

The 300-page Older Road Users is more of a human factors treatise than a discourse for crash reconstructionists, but after all, of the three elements necessary to have a traffic accident in the first place – Environment, Roadway, Driver – the latter is surely the most important. Whether you are a human factors expert or merely someone interested in traffic collisions involving our aging population, this book may be an eye-opener into areas you had not considered. It discusses older motorists’ driving behaviors and risks – actual and perceived – and delves into neurological, cardiovascular, physical and metabolic conditions. Then there are such issues as dementia, visual impairment, and the influence of alcohol and other drugs, including prescription medicine. Older Road Users also covers the difficult task of helping people cope when losing the right to drive when a family member takes away their keys. VicRoads – the trading name for Roads Corporation Victoria (www.vicroads.vic.gov.au) – commissioned this book in response to inquiries by the Victorian Parliamentary Road Safety Committee in 2003. Editor Odell anticipates the book will “give the reader an understanding of the entire spectrum of the problems surrounding fitness to drive of the aged.”

Professor Joanne Wood, School of Optometry, Queensland University of Technology, discusses issues regarding the “visual deterioration of the ageing driver” in Chapter 3. In her “Visual Acuity” segment she talks about “normal vision” being “6/6 visual acuity.” In the U.S., we use 20/20. The reason for the difference is that in the U.S. the length of our eye examination rooms (from patient to eye chart) is generally around 20 feet. In Australia and Great Britain, eye exam rooms are about six meters from patient to chart. Six meters is almost 20 feet (19.685 feet). Close enough.

Perhaps I should clarify just how old of a driver Older Road Users refers to. When I was nine years of age, anyone over 30 was old. In Table 1.2, “Driver Fatalities and the Contribution of Physical Frailty,” there are four age categories for males and females: 65-69, 70-74, 75-79, and 80+.

Toxicologist Olaf Drummer, president of The International Association of Forensic Toxicologists, in his chapter “Road Safety Effects of Prescription Drugs in the Older Driver,” talks about an analysis in the 1960s called the Borkenstein ‘Grand Rapids” study. (The references to this chapter lists a paper by “Borkenstein, FR.” That should be Borkenstein, RF. He invented the Breathalyzer in 1954. He was a captainwith the Indiana State Police before becoming a professor at Indiana University.)

Another of the Older Road Users authors, Trisha Dunning, Professor of Nursing at Victoria’s Deakin University, warns, “Increasing age is one of the most important reasons for the increasing diabetes prevalence is most societies.” Among other topics, she discusses Hyperglycaemia and Hypoglycaemia – abnormally high level of glucose (sugar) in the blood and abnormally low blood sugar usually resulting from excessive insulin, respectively.

I mention all this because as accident investigators and reconstructionists, it is not always just a matter of how a crash occurred, but why – the underlying contributing circumstances. This book should help acquaint the investigator/reconstructionist regarding effects to consider when working cases involving older drivers.

When should older drivers no longer be driving and become older pedestrians? The last chapter (no pun intended) of this book is titled “The End of Driving.” Chapter authors Nadia Mullen and Michel Bédard offer the grim reality: “The end of driving can lead to a range of negative emotions including feelings of loss, isolation and dependence.” I am reminded of my 94-year-old neighbor who, when her grandson suggested taking away her car keys, said, “You’ll be putting a nail in my coffin.” A license examiner once told me the hardest part of his job was disallowing elderly persons the right to drive. He said it is especially difficult when the person lives alone and a distance from family and friends.

This book will give you insight into many driving problems faced by senior citizens, facets to consider as part of your scrutiny regarding the whys in a collision.