When Marilyn, 87, decided to hang up the car keys several years ago, it wasn't an easy decision.

"I first realized I might have a problem when I was parking one day," she says. "I mixed up the gas and the brake and drove into the side of a building, fracturing my sternum. I drove for two years after that, but then one day I was parking and did the same thing again — hit the gas, not the brake. That same day a man in the States drove into a crowd and killed a number of people. I was scared I was going to run someone over."

Marilyn was wise enough to hang up the keys, but many older drivers find it a difficult step to take.

Warning signs

Non-driving cues:

• Trouble remembering how to do things done many times before.
• Difficulty getting to and from familiar places.
• Difficulty following a recipe or a set of instructions.

Driving cues:

• Difficulties entering and merging into traffic, making left turns at intersections without lights or left-turn signals, staying in own lane, keeping up with speed of traffic.
• Other drivers honking.
• Unexplained dents on vehicle, indicating possible difficulty navigating in areas such as parking lots.
• Getting lost while driving in familiar places.
• Forgetting the destination.

Prof. Bonnie Dobbs, an expert in the care of the elderly at the University of Alberta, says many older people continue to drive even when they're deemed unfit. "We did a study several years ago showing that out of 100 individuals who had failed their driving tests and were told by their doctors not to drive, 28 per cent continued to do so."

In fact, children of elderly parents often find themselves having to come up with innovative ways to keep parents from driving.

"We had to hide the keys from my father-in-law because he wasn't supposed to drive. My own father was on very strong painkillers for his illness and he wanted to drive but we couldn't let him. Even though he was incapable of driving, he would try sometimes and a strong family member would have to restrain him," said Shawna, who asked that her surname not be used.

Aging population

It's a problem that is expected to grow as baby boomers age. In fewer than five years, the first wave of baby boomers turns 65. By 2050, the number of drivers over the age of 65 will have doubled and the number over 80 will have tripled, says Dobbs.

"Baby boomers are likely to drive longer, and some of the projections of health status show that baby boomers will not be fitter or healthier than the current cohort of drivers," she says.

While older drivers have more experience driving and tend to have fewer accidents than their younger counterparts because they're on the road for shorter periods of time, their crash rates are alarmingly high for the number of kilometres they drive, according to the Canada Safety Council. Transport Canada figures show that between 1988 and 1998, fatal crashes involving drivers aged 65 and older rose by 6.3 per cent, while crashes resulting in injury increased by 10.7 percent. During the same period, the total number of crashes in the general population involving fatalities decreased by 28 per cent and the number of injury crashes decreased by 22 per cent.

Dobbs says that based on Transport Canada figures, there are projections those accident numbers will increase dramatically in the next several decades.

The problem isn't simply age, but rather, a result of certain age-related medical conditions, she says.

"I talk about the medically impaired driver, not the old driver," Dobbs says. "People with glaucoma and cataracts have double the crash rate, those with diabetes [low blood sugar, which can cause visual and cognitive impairment and reduced sensations to limbs], heart failure [reduction in cognitive functioning] and dementia are also at risk. The added difficulty with dementia is that not only does it impair a person's driving ability, but also their decision of whether they're safe to drive."

Due to the physical changes that come with aging, older drivers can experience poorer night vision, slower reaction time, difficulty judging speed and distance, and hearing loss.

Many seniors are on several different types of prescription drugs as well, which can cause a variety of dangerous symptoms and side-effects. For instance, sedatives, some older antidepressants and antihistamines can impair driving ability.

Preventative measures

Suzanne Robillard, a spokesperson for the Canada Safety Council, says steps can be taken — often simple ones — to help elderly drivers navigate the roads more safely.

"If there's a hearing issue, they can keep the fan on low, avoid listening to the radio, as well as lowering windows to hear sirens or train whistles at rail crossings," she says. "For vision, they should avoid driving at night or in poor weather. They can also improve flexibility necessary for shoulder checks if they do neck exercises. Special mirrors can also be added to improve vision. It's also a good idea to avoid difficult traffic scenarios, like rush hour."

The Canada Safety Council also runs defensive driving courses across the country that teach drivers how to adjust their skills to compensate for the changes of aging.

Dobbs points out that there has to be a balance between safety and mobility, because North Americans are so dependant on private automobiles. "We need to identify who is unsafe to drive and assess them fairly, but need to develop the support in the community that help them stay mobile and active."

However, if there are certain warning signs (see sidebar) indicating that any type of driving may be a safety issue, Dobbs says the senior should see a doctor who can identify possible problems and then send the person for an assessment based on a formal driving test.

And if it does come down to a situation where the keys have to be taken away?

"For a family member, spouse or child, it's one of the most difficult conversations they will have. However, it's better to have that conversation than having a family member involved in a crash resulting in fatalities or injuries," Dobbs says.

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