Elderly Drivers and Fatal Crashes

It turns out that elderly drivers have a higher rate of fatal crashes when compared to younger people. In fact, they often get in nonfatal crashes as well with the elderly person being the driver. The rate tends to increase after the age of 70 years. Elderly people are more likely to get pelvic injuries, tibial and fibular fractures and closed head trauma. They can exsanguinate due to excessive blood loss in the pelvic region, especially if the fracture isn’t caught immediately or if the person isn’t found right away after the accident.
Closed head trauma can kill an elderly person within hours of the accident. Blood builds up and displaces normal brain tissue causing an increase in swelling of the brain. This can cause herniation of the brain through the foramen magnum at the base of the brain, which permanently damages the breathing and heart rate control of the brain over the heart and breathing centers and the person suffers a cardiac arrest. It is usually an unsurvivable injury.

Part of what causes elderly persons to crash their vehicle are changes in visual and motor skills, which tend to decline with age. The elderly person can’t see signs and other vehicles as well. They also don’t have the reflexes to turn the wheel to get out of the way of hazards on the road so they crash more.

Sometimes chronic disease can be the reason why the person crashes. They can suffer from a diabetic reaction with low blood sugar affecting cognition. If the person has high blood pressure, they can suffer from episodes of low blood pressure or from mini-strokes that temporarily affect vision and motor skills.

Interestingly, researchers have found that it isn’t the motor and visual changes that cause the elderly person to crash more than others but is rather their cognitive decline. They suffer from early stages of Alzheimer’s disease or Parkinson’s disease so that they make bad choices when they drive. Often the Alzheimer’s dementia isn’t picked up unless the doctor uses specific mini mental examinations on the elderly person so they end up driving without complete cognition.

Sometimes a physician is asked to prospectively evaluate an elderly driver for their driving ability. This is difficult to do because things like motor skills can vary over time. The best way to test a driver’s ability to drive is to evaluate their far vision capabilities and to do a mini mental status exam, which is very sensitive in detecting early cognitive decline in the elderly. A targeted history and physical exam may show evidence of a chronic disease that may impair a driver’s ability to safely drive.

Another way is to use one of the programs available through many state motor vehicle departments that test the driver’s written and driving skills in a specific way so the driver can relearn lost skills if possible and so that the driver and family can know whether or not the driver can really drive on the road safely.

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