E4
Aging Well
Scientists visit Montana man for secrets to a very long life
by Josh Tapper Guinness World Records calls
Walter Breuning the world’s oldest living man.
A resident of the Rainbow Re- tirement Community in Great Falls, Mont., for 30 years, Breuning swears by a simple regimen: exercise, eat (but only two meals per day, plus one baby aspirin), work, repeat. Of course, at 113, Breuning
doesn’t work much these days. He performs light, upper-body calisthenics for 10 minutes each morning, listens to radio news (his deteriorating eyesight pre- vents him from reading), enter- tains a continuous stream of visitors and retires by 8 p.m. De- spite some wear and tear, Breuning, who uses a walker, has a clean bill of health. “The way I feel, I’ll be here a long time yet,” he says.
Breuning maintains an un- equivocally rosy outlook on life. While many adults dread old age, Breuning thinks people ages 19 to 25 are the most trou- bled; after that, each year marks an improvement. He began his 50-year career with the Great Northern Rail-
JOSH TAPPER Walter Breuning, 113, feels fine.
way as a teenager, in 1913. He enlisted for military
service
during World War I but was never called for duty. By the time World War II flared, he was too old to serve. His wife of 35 years died in 1957. Last year, researchers from Boston University visited Breuning, extracting blood for a study on genetic markers of long life. Breuning told them they weren’t going to find any- thing revelatory. His own prescription for
healthy aging is following a dai- ly routine. And death doesn’t re- quire a second thought. “You’re born to die,” he says.
“Everybody should know that. There’s nothing to be afraid of.”
health-science@washpost.com
Tapper is a fellow of News21.
We were surprised when he aced the first part, which assessed cognitive function and mobility. By the time the driving exam rolled around several weeks later, in November 2006, the matter was moot. He had fallen and was in a nursing home where he died peacefully a few weeks later, nev- er having learned that his chil- dren had dropped a dime about his driving. My family’s dilemma — wheth- er and how to intervene when a potentially dangerous elderly driver, often a parent, refuses to hang up the keys — “is happening all across the United States in families up and down the streets every day,” said Elinor Ginzler, a senior vice president of AARP. “It’s a huge issue.”
Impairment, not age Ginzler and other geriatrics ex-
perts predict that the issue will explode in the next decade as the leading edge of the 78 million- member baby boom generation hits its 70s. In 2008, according to the Insurance Institute for High- way Safety, 78 percent of the 28 million Americans older than 70 had licenses, up from 73 percent in 1997, an upward trend that is expected to continue.
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Because more Americans are living longer with progressive, disabling diseases that make driv- ing iffy or downright dangerous —heart problems, stroke, Parkin- son’s, dementia and diabetes, to name a few — families are in- creasingly wrestling with ques- tions that defy easy answers. Al- though many seniors stop driving voluntarily or sharply limit their driving, others refuse. Some fear being marooned in their subur- ban homes, while others, like my father, cling tenaciously to the in- dependence a car represents, un- aware of how hazardous their driving has become. A survey by the MIT AgeLab and the Hartford insurance company found that age enhances confidence in driv- ing ability. Drivers 75 and older were twice as likely to say they planned to drive into their 90s as did those 65 to 74. Such confidence can belie real- ity. A 2007 report by the Govern-
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ment Accountability Office found that drivers 75 and older were more likely than drivers in all oth- er age groups, including adoles- cents, to be involved in a fatal crash. “In the old days, or even 20 years ago, people just did not live long enough for this to be a prob- lem,” said Elin Schold-Davis, head of the American Occupational Therapy Association’s Older Driv- er Initiative, who notes that some older drivers are taking potent medications that fog concentra- tion. “People are living with a lev- el of impairment that is unprec- edented. And these days driving is more complicated. There’s more congestion, more compli- cated signs and traffic patterns,” while cars no longer demand the physical strength required before power steering and power brakes. Drivers with dementia are of
particular concern. One study es- timated that 4 percent of drivers older than 75 have dementia, and many drive until the disease is ad- vanced. In April the American Academy of Neurology issued new guidelines stating that some people with mild dementia may be able to continue to drive. The recommendation is based on re- search that found that 76 percent could pass a road test.
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fatalities caused by elderly driv- ers, a growing number of states are tightening restrictions, re- quiring vision exams, in-person license renewals or a doctor’s ap- proval to retain a license. But ac- cording to the National Highway Traffic Safety Administration, there is no single test or screening tool that will reliably weed out unsafe older drivers. Often it falls to family mem- bers, who are most familiar with the driver’s condition, to take ac- tion. But the emotions such deci- sions unleash can be anguishing, igniting conflict among siblings and creating resentment in par- ents who feel their meddlesome children are bossing them around or, worse yet, ratting them out. Because such discussions invari- ably occur at a time when loss — of a spouse, close friends, health, independence — dominates, giv- ing up driving can be a terrible blow, particularly for men. “Driving is an issue of control,” Ginzler said. “It’s a mistake to say, ‘This isn’t a big deal.’ It’s a very big deal.” Even those who decide to stop driving on their own may mourn the loss. “Many’s the time I wish I hadn’t given it up,” said Emmett Miller, 89, of Arlington, who suf- fers from sight-robbing macular degeneration. Miller said he trad- ed his Virginia license for a DMV- issued ID card two years ago after an incident in a supermarket parking lot when his car “sudden- ly shot forward like a bullet” but caused no damage. “I thought to myself, ‘I’ve had it.’ ”
How old is too old?
The most infamous crash of an elderly driver involved 86-year-
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It’s hard to curb unsafe drivers driving continued from E1
ican Medical Association.) There is some indication that
state laws requiring stronger oversight of license renewals may be having some effect. In June, the Insurance Institute reported that the rate of fatal crashes among drivers older than 70 de- clined by 37 percent from 1997 to 2008, a sharper decrease than among drivers 35 to 54, whose fa- tal crash rate dropped 23 percent. Officials say the finding was un- expected and are planning more research. One theory is that the decline also reflects better self- policing by seniors, the improved crashworthiness of cars and re- duced driving because of the fal- tering economy.
Early discussion about driving may avert clash
Talking about the decline of driving skills long before problems are evident may help minimize conflict, experts say. Asking “Have you thought about what you’d do if you could no longer drive?” is one way to start a discussion.
The Hartford insurance company offers a brochure, “We Need to Talk,” which includes an advance directive similar to a living will in the event that a person can no longer drive safely and tips about how to have such conversations. To see the brochure, go to www.
thehartford.com/ talkwitholderdrivers/ brochure/
brochure.htm.
One way to deflect a confrontation may be to focus on powerful medications a person is taking, or a medical problem that’s less stigmatizing than dementia, such as poorly controlled diabetes.
In other cases, emphasizing the possible legal and financial consequences that could result from an accident might be
persuasive. Maryland driving instructor Carol Wheatley recalls one woman whose reluctant husband agreed to stop driving after she told him, “Honey, I don’t want to lose our house.”
Families should be prepared to take action by calling a physician or filing a report with motor vehicle officials if a driver denies having a problem. Sometimes it is necessary to confiscate the keys or to disable, remove or even sell a car. If you’re unsure about intervening, consider whether you’d let your children ride with the driver.
— Sandra G. Boodman
Although aging causes declines in vision, flexibility, response time and memory, many older drivers can and do compensate by taking refresher courses or using adaptive equipment such as ped- al extensions. “We do things on a case-by-case basis,” Maryland’s Soderstrom said. “Our job is to keep the roads safe, not to take people’s licenses away.” Some- times the board recommends a restricted license that allows driv- ing within a three- to five-mile ra- dius of a person’s home. “If you live right off Connecticut Avenue, you’re not going to be a candidate for this,” he said, because of the volume of traffic. One mistake families make,
AARP’s Ginzler said, is to tell an elderly relative to stop driving without “figuring out how they’re going to get where they need to go. You can’t say, ‘Oh, you can just take [public transportation] from now on’ ” if the person has never taken the bus. Specificity is important, Gin- zler noted. “You need to know the warning signs and have observed them, and to be as concrete as possible. That may mean saying, ‘Dad, I noticed you really didn’t come to a complete stop at that intersection.’ A big mistake is to say, ‘I know better than you.’ ” Washington internist Alan Po- cinki said he raises the matter with patients who he suspects may be having problems or whose relatives contact him. “There are definitely times you have to be the bad guy,” he said. “They’re going to take it better from me than from their [children].” Families should also pick the right person to deliver the mes- sage, typically the one with the most influence. “It might be the firstborn son who lives in Califor- nia and sees Dad three times a year,” Ginzler said. Often siblings disagree about what should be done, sometimes for financial reasons or because they fear they will be forced to shoulder a dis- proportionate share of the bur- den.
“One of my sisters was a hold-
out,” said a 43-year-old Washing- ton area auto club employee who took the lead in confronting his elderly parents after several mi- nor accidents. She “probably fought it more than my father did. But the rest of us decided, ‘We’re doing it,’ and she stepped up.” The siblings take turns driving their parents, who live in their own home. “They can’t walk to any- thing and are very dependent on us,” he said. “It’s definitely been more work for us kids.” Many physicians are unaware
old George Weller, who in July 2003 plowed his 1992 Buick Le- Sabre through a crowded farmers market in Santa Monica, Calif., killing 10 people and injuring 63. Weller, who was convicted of 10 counts of vehicular manslaughter and gross negligence, apparently confused the brake and the gas pedal. Two weeks earlier, he had hit a gardener’s truck; previously, he had backed over a retaining wall and repeatedly struck a car in a parking lot. Experts emphasize that Wel-
ler’s age was not the problem; some people can still drive safely at 100, while others are too im- paired at 60. “The bottom line is that it is really about function, not age or even diagnosis,” said Carl Soder- strom, a former trauma surgeon who heads the Medical Review Board of the Maryland Motor Ve- hicle Administration. The board, the nation’s oldest and one of the most respected, evaluates the fit- ness of about 8,000 drivers an- nually, many of them older than 65 and some of whom have been flagged by police, families or spe- cialized driving instructors who conduct evaluations. (Maryland, Virginia and the District grant confidentiality to doctors and relatives who report problem drivers, according to the Amer-
that they can refer a patient for an evaluation with a driving rehabil- itation specialist, Soderstrom said. In Maryland, the two-part evaluation usually costs the driv- er about $200 per segment. The first part consists of a 90-minute assessment of vision, cognitive ability and physical mobility, said Carol Wheatley, a driving special- ist employed by Baltimore’s Good Samaritan Hospital. Those who pass proceed to a road test. Not infrequently, drivers who
are referred for evaluation by their doctors or the police are weeded out along the way. Some are unable to make or keep an ap- pointment, Wheatley said, while others decide to stop driving on their own rather than risk failing the test. Wheatley has witnessed the fallout firsthand. Her father-in- law, who suffered from cancer and dementia, had no problems driving when his dementia was in its early stages. After he got lost driving home from a familiar bowling alley, his Virginia doctor wrote him a prescription that said: “No driving.” The family took his car so it was not a con- stant reminder, and initially things went smoothly — until he insisted on getting his keys back. “He went through a period where he was very angry, and my mother-in-law had to endure that for a month until he forgot about it,” Wheatley said. “It really made me appreciate the day-to-day dif- ficulties of families dealing with this.”
boodmans@washpost.com
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