Roger Heyroth spent his career as a professional driver, sometimes behind the wheel of a truck, other times a cab.

He knows his abilities well and can feel his reactions starting to slow.

"I'm just not as quick as I once was," said Heyroth, 80, of Madison, one recent day at the Madison Senior Center.

He'll stop driving when he concludes that he could endanger others, but giving up the convenience will be "devastating," he said.

Deciding when to quit driving, whether due to age, a medical impairment or both, can be one of life's most difficult but necessary decisions given how quickly things can turn tragic, experts say.

Two weeks ago, Mary L. Martin, 78, of Madison was charged with two felony counts of causing great bodily harm due to reckless driving and a third misdemeanor count after she crashed her car into another vehicle and then two pedestrians in Downtown Madison in May.

One pedestrian suffered a serious brain injury. The driver of the vehicle she hit required two surgeries for broken leg bones.

At her initial court appearance last week in Dane County Circuit Court, Martin, who has told police she is diabetic, used a walker and seemed befuddled at times by Court Commissioner Daniel Floeter's questions. She declined to comment afterward but told Floeter she has voluntarily given up her driver's license.

State can intervene

Martin's husband told police the crash was the third time she's totaled her car, according to the criminal complaint.

Her blood sugar level was low at the time of the May crash, a condition she also suffered from last November when she rear-ended a car with such force on Stoughton Road in Madison that the second car crashed into a third car, according to police records. Low blood sugar can cause confusion and difficulty in thinking.

The state Department of Transportation (DOT) tries to monitor potentially unsafe drivers through its 10-person medical review unit. On a typical day, the unit gets 15 to 20 referrals from law enforcement officials, medical professionals and citizens concerned about possible health-related driving impairments, said Matthew Brelie, the unit's team leader.

If a referral from a doctor or an advanced-practice nurse prescriber recommends that a patient no longer be allowed to drive, the person's driver's license is automatically canceled, Brelie said. In other cases, state employees review the referral and follow up, often requiring the driver to be evaluated by a doctor.

Even if a doctor says the person meets medical standards for driving, the state can order the driver to retake the state's written driving exam and road test, Brelie said. Ultimately, it's the DOT's call on whether to cancel a person's driver's license, he said.

Brelie said statistics were not available on how many licenses are canceled each year due to medical impairments. He also could not say whether Martin had been the subject of a referral, citing patient confidentiality laws.

All states have a mechanism such as a medical review unit to deal with drivers of any age who no longer meet the standards for licensure because of physical or mental infirmities, according to the Insurance Institute for Highway Safety in Arlington, Va.

Age not only factor

Age alone doesn't determine whether a driver is safe on the roads, but people acquire health problems as they age that can reduce one's driving ability, said Anne Fleming, a spokeswoman for the Insurance Institute.

However, concerns about elderly drivers are sometimes overblown given that their sheer numbers are relatively small and those with licenses typically drive fewer miles than the average driver, she said.

"In the broad scheme of things, it's really not that big of a problem because there just aren't that many 85-year-olds out there driving," Fleming said.

In 2008, 61,312 Wisconsin residents with driver's licenses were age 85 or older. That's about 1.5 percent of all those in the state with licenses, according to the state DOT. Ninety-six people with still-valid driver's licenses in 2008 were 100 or older. The oldest was 107.

Wisconsin does not require a shorter renewal period for the elderly or impose any special vision or road tests on them, said Patrick Fernan with the state DOT. That puts it with a majority of other states.

However, 18 states have instituted an accelerated renewal time line as people age, according to the Insurance Institute. Hawaii, for example, requires people 72 and older to renew their licenses every two years instead of every eight. North Carolina goes to every five years for people 54 and over instead of eight.

Some go even further. Illinois requires anyone 75 and older to take a road test when renewing. In the District of Columbia, anyone 70 or older must provide a statement from a physician certifying the applicant to be physically and mentally competent to drive.

Many states institute a mandatory vision test at a certain age or stop allowing older drivers to renew by mail or electronically, but Wisconsin is already tougher in this area.

Wisconsin law requires all drivers, regardless of age, to go to a Department of Motor Vehicle office once every eight years to renew a driver's license. A vision test is part of the renewal process.

Teens still riskiest

By almost all measures, teen drivers are still the riskiest on the road, but growing old does bring with it some serious driving challenges.

Crash rates in general — and fatal crash rates in particular — increase starting at age 75 and jump sharply after age 80, according to the Insurance Institute. However, older drivers are most dangerous to themselves, not others. Their frailer bodies are less likely to survive crashes.

Winn Parent, 90, considers herself extremely lucky. Five years ago, she was attempting to return to her Madison home from a nearby salon when she became confused and lost. At 3 a.m. the next day, she merged onto Interstate 39-90-94, just 12 miles from her house but more than 11 hours after she left hair appointment. She was driving at such a slow speed that a truck rear-ended her, flipping her car.

"I felt I was a good driver, but at that age, I guess I just wasn't capable of it," said Parent, who was largely unharmed and gave up her driver's license at the state's request.

Her daughter, Patti Callaway of Stoughton, said her mother hadn't had any driving problems prior to the crash and self-limited her trips to just a few miles in daylight on familiar roads. The episode illustrated how just a small variable could upend everything, she said.

"On this day, her hair appointment was later than usual and it was winter, so it got dark earlier," Callaway said. "The more concerned she got about where she was, the more mixed up she got."

Getting help

In many parts of Wisconsin, public transportation is scant, making it even harder for older drivers to give up their car keys, said Jennifer Baier, a program specialist with AARP Wisconsin.

"They know they'll need help from other people, and it's hard to ask someone for a ride everywhere you go," she said.

The organization offers help to keep older drivers safely on the road and to help them transition to other transportation:

• We Need to Talk - Conversations with Older Drivers: These volunteer-led workshops, held occasionally around the state, are targeted primarily at children of older drivers to help them broach difficult driving topics. There's also a companion booklet with the same title.

• CarFit: These events allow older drivers to bring in their vehicles and have specialists make sure their cars are properly adjusted for them, from mirrors and seats to steering wheels and seat belts.

• Driver Safety Programs: Senior drivers learn new road rules, defensive driving techniques and how to operate a vehicle more safely during these four-hour refresher courses.

For more information on any of the above, contact AARP Wisconsin at 1-866-448-3611 or go to www.aarp.org/states/wi/.

Many hospitals, driving schools and senior centers also offer workshops and programs for older drivers.

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