It is not unusual these days for people in their Medicare years to drive thousands of miles to visit family and friends or escape summer's heat or winter's fury. One friend, in her mid-60's, has driven twice back and forth across the country, accompanied only by her dog. Another, in his mid-80's, drives with his wife, who is in her late 70's, from Minnesota to Florida and back every winter.

• By 2020, more than 40 million Americans 70 and older will be licensed drivers, and these older drivers are now driving more miles a year and at older ages than ever before.
• Compared with middle-age drivers, older drivers are about three times as likely to be involved in a crash per mile driven. They are also more likely than younger drivers to die as a result of a crash of similar severity.
• Everyone experiences physical and mental limits with increasing age. But while most older drivers adjust their driving routine- including giving it up altogether - to accommodate declining abilities, some do not recognize their limits and others refuse to stop driving despite them.
• Rarely is anything more than a vision test required to renew a driver's license, and renewal cycles vary widely from state to state. While most states require renewals every 4 or 5 years, in four states it is 8 years, in two states it is 10 years and in one (Arizona) no renewal is required until age 65.

Demands of Driving

Driving requires the ability to pay attention to several factors at once - to clearly see road signs, markings and hazards; to be alert to the movements of others on the road, including motorcycles, pedestrians and cyclists; to accurately judge distances and speeds of other vehicles; and to react quickly to changing conditions and unforeseen circumstances.

Complicating matters is the increasing complexity of modern vehicles that can distract from the task of driving: various dashboard displays and warnings, all manner of players, and now global positioning systems.

Though someone may have been driving - and even driving safely - since he or she was a teenager, the person behind the wheel at age 65 or older may be quite different physically and mentally. And those differences can have a major effect on the person's driving skills.

Driving ability can be affected by a host of changes that accompany age: deteriorating vision; reduced muscle strength and flexibility; slower reactions; arthritis and other disorders; and the use of medicines to control them.

For example, people with glaucoma or cataracts may see well enough during the day to pass a vision exam, but they are likely to have poor night vision. Many older people have diminished hearing, making it difficult to hear car horns or sirens, especially if the radio is on or passengers are talking. Those with arthritis or movement disorders like Parkinson's disease could have delayed reactions to traffic dangers.

People with insulin-dependent diabetes can experience sudden drops in blood sugar, impairing consciousness and coordination. They may also suffer a loss of sensation in their feet that can interfere with applying proper pressure to the brake or gas pedal. Drugs for various health problems can cause daytime sleepiness. Drivers should heed any label that warns against driving.

Perhaps most challenging of all are older drivers with problems caused by ministrokes or dementia. Those in the early stages of mental decline may recognize their impairment and adapt their driving accordingly, but as dementia progresses, denial and decreasing driving ability can result in disaster. Those with anything more than a slight cognitive impairment should be advised not to drive, according to an expert committee of the American Academy of Neurology.

Improving Driving Safety

Avoid distractions while driving, like eating, talking on the phone, listening to recorded books, engaging in emotionally draining discussions and disciplining children or pets. Stop in a safe place to take care of disturbances in your vehicle.

Adjust your driving by taking familiar routes, avoiding rush hours and night driving, keeping a safe distance (one car length for every 10 miles of speed) between you and the vehicle ahead, having a passenger serve as a second pair of eyes, making left turns where there are green-arrow signals (or making three right turns to go left) and looking as far down the road as possible to anticipate problems.

When driving in unfamiliar territory, use a map to plan your route in advance and write out the itinerary. Don't try to read a map while driving; pull off the road to refresh your memory or make route changes.

Make adjustments, too, in your vehicle. If you have physical limitations, choose a car with automatic transmission, power steering and power brakes. You may also benefit from a back or seat cushion or changes to the pedals. Your line of vision should be three or more inches above the steering wheel and you should not have to use your toes to operate the pedals.

Reduce or eliminate the driver's blind spot by adjusting your outside mirrors: Lean your head against the driver's side window and adjust the left mirror so that you can barely see the side of your car, then lean toward the middle of the vehicle and adjust the right mirror the same way.

Have your vision checked annually, including checks for glaucoma, cataracts and macular degeneration. Avoid glasses with arms that block peripheral vision, never wear sunglasses in low light, and do not use yellow glare-reducing lenses at night (they act like sunglasses). Always drive with a clean windshield, mirrors and headlights. Do not look at the blinding headlights of approaching vehicles; instead, glance toward the edge of the right side of the road.

When driving long distances, take frequent breaks - at least once every 100 miles or every two hours - to stretch, walk around and perhaps have a snack. Avoid driving after a big meal, when you feel sleepy or during hours when you are normally in bed.

Though you may deplore cellphone abuse, consider getting one for safety's sake. But use it only in emergencies and when you are not driving.
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