By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) - Families may have to watch for dings in the car and plead with an older driver to give up the keys _ but there's new evidence that doctors could have more of an influence on one of the most wrenching decisions facing a rapidly aging population.
A large study from Canada found that when doctors warn patients, and tell driving authorities, that the older folks may be medically unfit to be on the road, there's a drop in serious crash injuries among those drivers.
The study, in Thursday's New England Journal of Medicine, couldn't tell if the improvement was because those patients drove less, or drove more carefully once the doctors pointed out the risk.
But as the number of older drivers surges, it raises the question of how families and doctors could be working together to determine if and when age-related health problems _ from arthritis to frailty to Alzheimer's disease _ are bad enough to impair driving.
Often, families are making that tough choice between safety and independence on their own.
"It's very scary," said Pat Sneller of Flower Mound, Texas, who talked her husband, Lee, into quitting about a year after he was diagnosed with early-stage Alzheimer's disease.
The couple had recently moved from California, one of the few U.S. states that require doctors to report drivers with worrisome health conditions to licensing authorities. Pat Sneller was stunned to learn Texas doesn't require that doctor involvement, and health workers advised her to ride with her husband and judge his abilities for herself.
Eventually her husband called home in a panic, lost while driving in unfamiliar Dallas for volunteer work. A long scrape on the car that he couldn't explain was the final straw. In 2010, she persuaded him to quit driving, although the now-72-year-old's license remains good until 2014.
"He still says occasionally, `I can still drive, you know,'" Pat Sneller said.
By one U.S. estimate, about 600,000 older drivers a year quit because of health conditions. The problem: There are no clear-cut guidelines to tell who really needs to _ and given the lack of transportation options in much of the country, quitting too soon can be detrimental for someone who might have functioned well for several more years.
It's never an easy discussion.
"It did not go over so well," Benjamin Benson recalls of the time when his sons told the 87-year-old they feared his reflexes had slowed too much for safe driving.
"I've never had an accident," the Peabody, Mass., man said. His family's response: "Well, do you want to wait for the first one?"
The retired accountant wasn't ready to quit then, but he quietly began to analyze what would happen to him and his wife, who doesn't drive, if he did.
His longtime doctor wouldn't advise one way or the other. So over a few months, the couple tried online grocery shopping. They took a taxi to the dentist, not cheap at $38 round-trip. But Benson calculated that maintaining and insuring the car was expensive, too, when he drove only 3,000 miles a year.
A few weeks ago, Benson surprised his family by giving away the car, and he says he's faring fine so far.
"Most people in our age group know that it's inevitable and play around with the idea that it's going to come and the only question is when," Benson said. "I didn't want to be pushed into it."
Unlike in most of the U.S., doctors in much of Canada are supposed to report to licensing authorities patients with certain health conditions that may impair driving. Ontario in 2006 began paying doctors a small fee to further encourage that step _ and researchers used the payments to track 100,075 patients who received those warnings between April of that year and December 2009 (out of the province's more than 9 million licensed drivers).
They compared the group's overall rate of crashes severe enough to send the driver to the emergency room, before the warnings began and afterward, and found a 45 percent drop, reported lead researcher Dr. Donald Redelmeier, a University of Toronto professor. While the study included adult drivers of all ages _ for conditions ranging from epilepsy to sleep disorders, alcoholism to dementia _ most were over age 60. A small percentage of the province's licensed drivers have received warnings, Redelmeier stressed, and licenses are suspended by authorities between 10 percent and 30 percent of the time.
His study highlighted one reason physicians don't like to get involved: About 1 in 5 of the patients who were warned changed doctors. There also was an uptick in reports of depression.