Roadkill: geezers, texters at the wheel

His father-in-law, aged 91, got a new 5-year driver’s license from the State of California, with zero proof of intact driving skills. The family was worried, but without much power. According to an op ed piece by Santa Cruz, CA writer John Moir, the community was saved from potential disaster at the hands of an age-challenged driver only when a mild heart attack prompted his physician to order him away from the wheel.

Meanwhile, a nationwide population of licensed drivers young enough to be his great-great-grandchildren are navigating our roadways with one eye on the intersection and full attention on a text message in progress. Another op ed piece not long ago, this one by the Atlanta Journal-Constitution‘s Cynthia Tucker, told of accidents caused by phoning/texting drivers that are estimated at close to a quarter of a million per year. There is a growing movement to address this truly scary problem. And it is scary: if you walk in cities much you know how often only your own wits (Can’t make eye contact? Don’t trust that driver) keep you alive. In Nebraska, for example, activist teens, largely motivated by the horrific BBC YouTube video now gone viral, are pushing for a state ban on phoning/texting while driving. A national organization, FocusDriven, was started by a group of individuals who had lost loved ones to drivers on phones; they offer support for victims and tips for advocacy. FocusDriven is patterned after MADD (Mother’s Against Drunk Driving.)

But the issue of geezer drivers gets sticky. My own father was fond of pointing out, well into his 80s, that he had never had an accident. We bit our tongues not to comment on the disasters that probably followed in his wake. But the Commonwealth of Virginia continued to renew his license and none of his four out-of-state daughters was able to convince him that his driving was not in others’ best interest. It took a family friend, who pointed out how much money could be saved on gas, upkeep and insurance coverage, to get my father to sell his car.

The primary problem with aging drivers is the ease with which they are (in California, at least) re-issued a five-year license. Not long ago, at the ripe age of 75, I renewed my own. My eyes tested just fine — although prescription distance glasses make me way safer behind the wheel, especially at night. I studied for the written test (same test as anyone gets at any age) because it is full of trick questions, often concerning factoids that have little to do with public safety.  Presumably, if one is not mentally acute one would fail the written test — but you can retake it the next day. There was no road test of any sort, so if I were becoming prone to miss road signs, clip corners or misjudge parallel parking distances nobody would know. (I hope I’m not.)

Mandatory age limits for driving, such as commercial pilots have, probably aren’t going to happen, and probably shouldn’t. Many seniors must drive their own cars for endless reasons. Time and manpower required for road tests may put them beyond what states can afford these days. But why aren’t other answers possible?

Why couldn’t AARP put its considerable muscle and money behind a volunteer training program that would set in motion volunteer-led senior driving sessions? Why couldn’t states then require completion of such sessions before licenses were renewed after a certain age? Why couldn’t some insurance agency — AAA comes to mind — get behind a state-mandated program of this sort, offering the lower rates for graduates that are commonly offered graduates of safe-driving programs? Why couldn’t safe-driving seniors be offered a small compensation for running such programs, in return for the savings in lives and ER costs?

My license expires on my 81st birthday. I’ll happily sign up for a seniors class. Meanwhile I will remain on the alert for texting juniors.

New idea: patient-centered healthcare

American health care, with or without the reform so desperately needed, seems headed in the direction of comprehensive care. For us patients — those of us fortunate enough to have coverage allowing us to be patients — part of this is having one doctor who really knows and follows your general condition. A century ago, before costs went through the roof and access to care went out the window, American health care worked that way.

At the California Wellness Foundation‘s Healthy Aging Conference in Los Angeles earlier this week the talk was all about “medical home“. Unwilling to risk a blatant display of ignorance I spent much of the morning frantically searching the speaker’s handouts for a clue about what a medical home might be. The speaker, it being early on in the event when my bewilderment arose, was keynoter John Rother, Executive Vice President of Policy and Strategy for AARP.

Though it was not in the handouts — the audience consisted largely of health professionals who presumably knew all this — I will clarify the medical home business here. With a little help from Wikipedia: “an approach to providing comprehensive primary care… that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”

Rother’s power-point presentation, billed as “Moving Past Talk: the Challenge of Wellness” reviewed the state of U.S. health, health care and endangered health reform before getting to the medical home issue. When he did, he characterized the medical home as “more personalized delivery of services,” adding that the concept envisions that “someone’s in charge.” It enables hospitals and doctors to work more closely together, Rother said, and provides extra payments for primary care doctors.

Kaiser has this. Many of us enjoy this. Could we please find a way for the healthcare homeless of America also to find a medical home?