Licencing Issues for Seniors

One of the workshops I give is on Licencing Issues for Seniors. In BC when a person reaches 80, they have to go in for a medical assessment to see if they are still able to drive.  As one ages, specific functions related to driving skills may be impaired. These functions include vision, hearing, sensation, and cognitive and motor abilities. For example, a decline in peripheral vision may affect the ability to pass approaching vehicles safely, and the decreased range of motion in an older person's neck may impair the ability to look behind when backing up. In addition, reaction time decreases by almost 40 percent on average from age 35 to 65. 

The aging process may also affect cognitive skills. Short-term memory loss, for instance, can impair driving skills by interfering with a person's ability to process information efficiently when merging with traffic or changing lanes. Such difficulties are magnified when the older driver performs these driving skills under stressful conditions. The higher incidence of cognitive impairment, particularly dementia, among older adults produces an increased risk of accident involvement. 

As a group, persons age 65 and older are relatively safe drivers. Although they represent 14 percent of all licensed drivers, they are involved in only 8 percent of police-reported crashes and 11 percent of fatal crashes. This can be compared to drivers age 16 to 24, who are involved in 26 percent of police-reported crashes and 26 percent of fatal crashes, but represent only 14 percent of licensed drivers.

In fact, drivers age 65 and older have a lower rate of crash involvement per 1,000 licensed drivers than any other age group. They also drive fewer miles on average than any other age group.

When drivers over 65 are involved in crashes, the situations and reasons are generally different from those associated with crashes involving younger drivers. For older drivers, the situations in which crashes occur most frequently are when they are turning left, whereas for younger drivers, crashes occur most often while they are driving on a straight road or highway. The errors most often involved in older driver crashes are failing to yield right of way or not responding properly to stop signs and traffic lights. By comparison, the errors most frequently made by younger drivers are related to speed or to following too close.

Among all drivers age 65 and older, it is the oldest drivers who pose more risk to themselves and to public safety. For all adults age 25 to 64, and for adults age 65 to 69, the rate of crashes per miles driven is relatively constant. The rate begins to rise at age 70, and increases rapidly at age 80.

Older persons may also regulate their own driving behavior. They may stop driving or limit driving to accommodate their individual declining capabilities. On average, persons age 65 and older drive substantially fewer miles than drivers in any younger age group.

In addition, older drivers often adopt different travel patterns, driving shorter distances, driving less at night, and avoiding rush hours, major highways, and bad weather conditions.

Ode to Forgetfulness

This post is for my friend Larry. Larry is a little forgetful, and he worries about it. We keep telling him that people at all ages forget things. In this wonderful song by Mack Dryden, he references the "Threshold Syndrome" which affects all ages. More videos by Mack Dryden can be found here

Is it harder to hear as you age? Short answer yes

I have worn a hearing aid for about three years, and I have found it to be a wonderful tool. However, many of my friends do not even though I think they are having trouble hearing. The issue is that many of us as we age, suffer hearing loss.

Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs in most of us as we grow older. It is one of the most common conditions affecting older and elderly adults.

Approximately one in three people in the United States between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing. Having trouble hearing can make it hard to understand and follow a doctor’s advice, respond to warnings, and hear phones, doorbells, and smoke alarms. Hearing loss can also make it hard to enjoy talking with family and friends, leading to feelings of isolation.

Age-related hearing loss most often occurs in both ears, affecting them equally. Because the loss is gradual, if you have age-related hearing loss you may not realise that you’ve lost some of your ability to hear.

There are many causes of age-related hearing loss. Most commonly, it arises from changes in the inner ear as we age, but it can also result from changes in the middle ear, or from complex changes along the nerve pathways from the ear to the brain. Certain medical conditions and medications may also play a role.

Why do we lose our hearing as we get older?

Noise-induced hearing loss is caused by long-term exposure to sounds that are either too loud or last too long. This kind of noise exposure can damage the sensory hair cells in your ear that allow you to hear. Once these hair cells are damaged, they do not grow back and your ability to hear is diminished. Many factors can contribute to hearing loss as you get older. It can be difficult to distinguish age-related hearing loss from hearing loss that can occur for other reasons, such as long-term exposure to noise.

Conditions that are more common in older people, such as high blood pressure or diabetes, can contribute to hearing loss. Medications that are toxic to the sensory cells in your ears (for example, some chemotherapy drugs) can also cause hearing loss.

Rarely, age-related hearing loss can be caused by abnormalities of the outer ear or middle ear. Such abnormalities may include a reduced function of the tympanic membrane (the eardrum) or reduced function of the three tiny bones in the middle ear that carry sound waves from the tympanic membrane to the inner ear.

Most older people who experience hearing loss have a combination of both age-related hearing loss and noise-induced hearing loss.

At this time, scientists don’t know how to prevent age-related hearing loss. However, you can protect yourself from noise-induced hearing loss by protecting your ears from sounds that are too loud and last too long. 

It’s important to be aware of potential sources of damaging noises, such as loud music, firearms, snowmobiles, lawn mowers, and leaf blowers. Avoiding loud noises, reducing the amount of time you’re exposed to loud noise, and protecting your ears with ear plugs or ear muffs are easy things you can do to protect your hearing and limit the amount of hearing you might lose as you get older.

The most important thing you can do if you think you have a hearing problem is to seek advice from a health care provider. There are several types of professionals who can help you. You might want to start with your primary care physician, an otolaryngologist, an audiologist, or a hearing aid specialist. Each has a different type of training and expertise.

Source:  U.S. Department of Health & Human Services

A single person is missing for you

“A single person is missing for you and the whole world is empty. But one no longer has the right to say so aloud.” Phillipe Aries, (French medievalist and historian), Western Attitudes toward Death: From the Middle Ages to the Present, published in 1975

As I age I probably think about death more than my younger friends. I am nearer the end of my life than the beginning and I know this. It is interesting how over the years our society has changed in our attitudes toward death. In North America, death like sex is a taboo subject. We do not talk about death in polite society, just as we don’t talk about sex in polite society. We couch our talk of death by talking about longevity. Today my friends and I talked about how a 70-year-old today is as healthy as a 56 year off in the 1950’s. We also talked of all those Canadians who were reaching 100. We focused on longevity in our conversation. 

We talked about average life span and wondered at the fact that as a society people are living longer today than fifty years ago. Fifty years ago, a Canadian who lived to 100 was a news item and the recipient of a letter from the Queen. Today Canada has about 6,000 centenarians and their number increases by roughly 1,000 a year. They still get the letter from the Queen, but someone has to let the Queen know, so a form letter can be sent.

Our conversation touched on death, as some friends had died, and we thought about the fact that when an older person dies, it is part of life, but when a child dies it is a tragedy. How times change. A century ago, the death of a child was an expected part of family life; today we are appalled and outraged when it happens. Fifty years ago, suicide was universally abhorred and treated as a crime, if not a sin. Today the right to die, which means suicide for a good reason, is legal in several countries and some American states; it is now a part of Canadian life.

My friends and I say we don’t fear death.  But I am not sure that is true for me. To quote Robert Frost, “But I have promises to keep, and miles to go before I sleep” and I hope that when my time comes, I will still be looking for the next promise to keep. Our time in history is worldly, which means that it’s relatively easy to consider dying simply as the last page in our life story. Ideally, we would like death to visit us while we sleep, or when we are in a relaxed mood.

But dying can be horrible. My mother took a year to die and I watched her fade away. I don’t fear death but I want it to stay away for a long time. I’m however terrified of painful and boring months (or even years) in palliative care and watching those who love me watch me fade. I wonder will joy and wonder disappear, as another version of my life endures. My mother lost her ability to talk. I wonder what I would do if I could not exchange words with anyone? What if I can’t read? What if I can’t write? What if I can’t watch my grandson grow, and laugh with him? Will I truly be alive? But even then, I would not hasten death to my door although there are some who would do this. As the old joke goes, I don't want to die screaming as my aunt did, I want to die in my sleep as my uncle did when he was driving down them down the highway.

However, in our society where we don’t talk about death, jokes about dying are seen as offensive by some, dying people are often abandoned psychologically by family, friends and doctors. Compassion, honesty and reassurance can help the seriously ill adapt to the approach of death. Research shows that psychological distress diminishes if the person who is dying is not alone and is able to express feelings and concerns to those who care, and who will listen. Our society takes great stock, in putting a person who is dying into care, Palliative Care or hospital care. This allows those who are friends of the person dying to prepare for Bereavement but does little to help the dying face their own death. Bereavement is now perceived as a normal psychological and physiological reaction to death. 

We grieve for those who die. Grief is characterised as somatic distress, guilt, hostility, change in patterns of conduct. In our society individuals, after the initial shock, are typically left to grieve alone.  There are five stages of grief that a person might go through, Denial, Anger, Bargaining, Depression and Acceptance.

When a person dies, they are mourned by those who love them, but when they are dying there is no time them and their dying.  Our fear of death and the hope that we will live and enjoy our lives with interest and joy make it hard for some to be around those who are dying.

When a person dies, their passing becomes a community event, a celebration of life. Family members friends, and acquaintances band together with each other to share the moments of sorrow. This helps all, as we can share our emotions and be there for each other at a stressful time. A celebration of life is a good reason for being together and for an afternoon or a day we share our sorrow. 

However, in the days after the celebration of life, the closest to the deceased, still face the fact that for them, a single person is missing and their whole world appears to be empty. Take time with those who grieve, so that they know they don't need permission but have the right to say they miss their loved one aloud.