i don't know if that's correct or not. it doesn't sound logical to me, but maybe when you look -- again, our study looked at passenger vehicle drivers, which wouldn't actually support your hypothesis because motorcyclists deaths have gone up among young bird drivers we didn't will get that, so i -- i don't know if that's the case or not. would be easy to check. i can check while you're asking other people questions. but i don't know. >> thank you. and a following question has to do with barriers in the use of cars, and volunteer programs, but in the type of program that some outside the traditional options with these be in shorter the become a training, cost of

gas, etc., so dr. dobbs and dr. rosenblum if he might address some of the barriers. >> the barriers that we've identified and alternate transportation service provision and just for clarification ultimate test provision as transportation outside of traditional modes such as public, ultimate transportation provided of the community level by community organizations, senior organizations, church groups. typically, the model is such that alternate transportation service providers for seniors rely primarily on volunteer drivers. some organizations use a blend of peat drivers and volunteer drivers. when you look at the service professional cross t's to come the paid driver, a volunteer driver model is a more

responsive model because it allows the service provider to provide transportation not only on weekdays but weeknights workweek days and evenings, daytime and evening, and we know that when we look at senior transportation that often what is called life enhancing transportation needs are met savitt to the doctors, the get to the grocery store. but they are life enhancing transportation needs are not met, so the ability to go to social events and attend religious evens, so using a blend of peat drivers and volunteer drivers is more of costly. we also know that funding streams there also are not dedicated funding streams so alternate transportation providers as i mentioned earlier spend a great deal of their time and their resources fund raising to provide what they perceive as

being affordable transportation for seniors. interestingly, that perception, that assumption that transportation should be provided and no cost or little cost is a barrier in that all of us pay for transportation until we are 65 years of age. for some reason there's just assumptions that as soon as we turn 65 we should have our transportation subsidized. when you talk to seniors themselves, most of them say i quite expect and i quite willing to pay and pay more than what my service provider is charging me. i recognize that there are segments of the older driver population that don't have the resources for transportation and we do need to supply is that population, but for the most part like and there's more capacity from the seniors themselves to assist with building better models of transportation.

>> thank you. >> i think it's a given there's not enough money because there is a huge demand in the there's not enough service. but some of the other issues are not as pressing -- it turns out insurance is not that big a problem. people talk about it a lot and some of the volunteers systems to provide additional insurance coverage. you can be covered under the national agency or the agency's service, and that sometimes i think makes drivers -- volunteer drivers feel better. but there's not a lot of the finance these people are running around getting into terrible crashes, so it's less of an issue than you might think. one of the problems that i see is when any of these services get to any side they've run quickly into diseconomies of scale. and i run earlier in my career the red cross was running a service in el paso, texas, and i went on their assuming -- rediker had a contract from the texas department of transportation -- i went down there assuming they would have

the cheapest cost of any big city in texas. and in fact they were somewhere in the middle and i couldn't understand that. the had volunteer drivers. well, they had to have a lot of people sitting around called coordinators' or social service providers or -- for the drivers who didn't show up when you have a large system of drivers and a lot of them are themselves seniors, then they don't feel well or it's raining and so you have to have paul fees paid back up drivers. so i think one of the problems is -- i don't want to do too much about this thousand points of light business but i do think that a lot little services, like thousands and thousands of little services might actually be a better way to do it. once you start to aggregate them up, then the drivers wages go up then you have to have dispatches and backup drivers. then you start to be a business, and i have looked at the in the beverley foundation has as well which looked at some of the costs of some of the well-known

volunteers systems and they are running 20 to $25 on one-way trips. so with volunteer drivers in their own cars. so i think the problem -- there is an issue of how big you can get before you start to be very expensive. >> the one area where there are opportunities, certainly the use of technology in terms of allowing the local service organizations to start using technology to the scheduling of rights and there is cost efficiency in that. >> thank you. our group has time for one more question. okay. sandy, you mentioned land use is a major issue, and as a city planner, could you talk more specifically about what some of the potential land use solutions might be? >> well i think it's very heartening the federal transit administration has taken on along with their promotion of transferree into development and understanding that you have to

have affordable housing at the same time. one of the problems is that land value goes up a lot of not like real and very good transit service, and you gentrify and there's neighborhoods in san francisco where they put in the service simply to hit populations of elderly people and forced them out because the rent went up and prices went up, so i think we have to be looking at a coordinated way to make sure that in the denser areas with more transportation choices, with more land use choices that you can walk to grocery stores and all those sorts of things, that they remain affordable. now there's plenty of older people with a lot of money, but i think we have to be watching to make sure that as we provide more desirable neighborhoods the people we are looking at naturally live there, afford to live there. >> i wanted to just follow up. i don't have the information to answer the question. it's a really good question and

i should know the answer, but i wanted to -- and it is possible when you look at the deaths come if the study looked older drivers but if you look a deaths and include children and pedestrians i don't know how the total package has changed. but it gives me an opportunity of reiterating the importance of exposure measures. the reason our study was interesting or important media is that this is not what we expected because we have more older people come more drivers, and the best indication we have is that older drivers are driving more. some deaths are always the ultimate measure. always try to reduce but especially when you're comparing age groups or different types of drivers it's critical that you have an exposure measure. so i just wanted to clarify. i think our study wasn't focusing on death it was focusing on a licensed driver

and if you look at the population week of the most traveled the same patterns. >> thank you. we will proceed to the next table. looks like the alliance of manufacturers is going to be designated to ask questions for the table. >> yes, and excellent presentations so far and questions by the other panel. this is for the whole group and it's kind of a two-part question. data is lacking on the effectiveness and validity of many screening methods, assessment programs and associated licensing policies. what, if any of the above, should have national priority for data collection? and also, the second part, how should priority areas be defined for large skillet and national epidemiological studies to address those issues?

>> could you repeat the first -- could you repeat the first part of your question, please? >> sorry -- it's a long question and i tried to rush through it. data is likely ineffectiveness and the validity of screening method assessments, and licensing policies. what, if any of the above, should have a national priority for data collection itself, the actual collection of data for the los -- >> well, i think there are a couple of efforts under way. i know california and maryland have both been progressive in looking at the development of screening tests that could produce reductions in crashes and i know california isn't just focusing on older drivers, i've done a series of studies

comparing the drivers of all ages and different screenings so i think the priority with a lot of countermeasures and older drivers' safety is relating them to crashes. so i think the priority would be, whether through random assignment or other very strong research methodologies, to try to -- to try to get to that goal, which is to identify specific screening instruments there would not only change driving behavior or self reported behavior's, test behavior is the national tv contract will test reduction and that won't be easy, believe me. >> i could talk about what's happening in canada. we have just developed a screening tool for the

identification of cognitively impaired drivers and one of our jurisdictions in canada, the province of british columbia, the new screening tool which is called the smart md has now become the new screening tool for cognitively impaired drivers and it's a requirement by their department of motor vehicles evidence based driving and evaluation and in alberta the screening tool was increasingly being used by the medical committee looking at our website the screening tools are also being used a lot or picked up a lot by the medical community, the occupational therapy community in the united states. i think it would be -- it is really important for us to start looking at the effectiveness, the efficacy of these tools when they are introduced, but love to see research done. we are doing research in canada, but it would be nice to see some

research, the state level in the united states as well. the screening tools, the smart m.d., focuses on akaka to flee impaired drivers, but we need some type of development and then a implementation and result of that implementation for motor conditions and visual conditions, so to me there would be a parody particularly when you look at the demographics that are coming out as said earlier that it's most often illness, not age, that in paris a person's ability to drive. so if we can start targeting the at risk population, then there should be reductions in collision as a way of written defining the appropriate drivers who are at risk. >> the next question is for dr. rosenblum. is there evidence of change in the pattern of drivers of older

drivers that may help explain their greater crash reductions compared with younger drivers? >> no i think that is what is ironic about it they are driving more, they are driving to different places, they appear to be driving in situations they didn't before peke period traffic has spread out so much you can't avoid it so they are driving more in congested times because they can't avoid it, so i think it's sort of interesting and i think that's the issue that's been raised the hour driving while the original these things why aren't they getting into more crashes, and i don't think we have good data on that. >> ethical so we don't know the relationship -- why are the driving more. maybe they are healthier. so i think all of these things are bound up together, and in terms of looking at the root cause, you know, it's hard to figure that out.

>> i was just asked to pay in. we can't really explain fully the huge drops we've seen in the last couple of years overall,y and so for the first time in decades we have only 34,000 deaths a year in 2009, almost 34,000 deaths. on the one hand, it's amazing that it's gone down that far. on the other hand, i'm not willing to say that 34,000 deaths is anywhere near good news. part of the good news mabey is older driver safety seems to improve more than anybody else and we have the shocking safety gains over the last couple of years. but we can't fully explain it. people talk about the economy and differences in discretionary driving and that might affect

older folks and teams more than it affects people that are working everyday. but a lot of it is guessing. even when you put together a the economy and safer vehicles and on the other hand driving more we can't explain it. it's interesting, but we can't explain it. >> i think also that, you know, i seem to be the bearer of bad times of a today that, but the survey, the last was conducted during the gas crisis and during the downturn in the economy and that will make it -- now the last one was also during the recession but not as bad a recession. so if we didn't have to have a national trouble -- if it were not only every seven or eight years we do a survey we would be these things, but i think it's7% going to be effective life the latest travel data we have were collected during a very unusual

period think flecha hopefully unusual. but that will make it challenging, especially when you're trying to look at how one age group differs from another that will make it very challenging to draw conclusions on how things have changed since 2001, 2002. >> okay. another one for the whole panel. we know the boomers are coping with how to deal with aging parents and their driving skills and safety that is their research that looks of the influence adult children have on their parents driving decisions and cessation? >> i think that question goes back to the accuracy of self assessment or the accuracy of assessments. we know that self assessment of driving competency is pretty inaccurate and not risk populations. we know that most older people overestimate their driving

competency. everybody's better than average. research that we've looked at in terms of family members, caregivers making assessments of driving competency and these assessments are compared to actual on road driving assessments where the individual was determined to be safer on the road test is that family members are not free accurate either. caregivers, spousal caregivers tend to be less accurate than sons and daughters who live nearby. and i think that there's some good reasons for that. if you have an older couple, if it's the gentleman who's driving, competencies' been questioned, she doesn't drive, the wife doesn't drive. she is going to be less reluctant to admit or to disclose that his driving has declined to an unsafe level because if his driving

privileges are revoked their with obliged. that may change with the baby boomers because there are more females licensed to drive in my cohort fannin my mother's colewort. having said that, so the next group would be sons or daughters and if they are living close to their parents, they may be a little bit more accurate, certainly asking sons and daughters the of no greater insight than you or. might take of the situation is if you have someone come a family member or a neighbor that you are concerned about their driving, the most evidence based assessment is to have them have a road test. >> they're actually is a lot of -- leaving aside whether the kids are right or not which is not trivial -- the is a lot of evidence about parents and kids, and a lot of it shows that olde

parents don't want to listen to their children or their family] members. they just don't. or as i said earlier that women are more likely to listen to criticism than men are. what i found some funny things. i did a major study for the british government rarely interviewed a lot of battle to children of older drivers in britain compared to the united states command while they both expressed both sets of kidsró express concerns either about their parents' current drivingmñ or what would happen in the future, i found that americans were much more worried about what it would mean for them if their parents stopped driving. and i liken it to white parents that teenagers who are, you know, much more dangerous, why[o would you let your teenager's drive all the time? and it's because it makes your life easier. once those kids get a license and you don't have to cart them

around your life gets easier. what i am seeing a non-adult children in the united states is that yes, the are worried thatew they are equally worried about what is it going to mean to me when my mother stops driving. and it's not just the driving7 committed this will she come live with us, will we have to move her to a care facility. and it's hard to interpret what people say sometimes, but i see a sort of willful ignoring of some bad science about their adult -- about their parentswo because they see this crushing weight of responsibility hitting them, which i think gives us a window for policy because if we can be talking to be boomers -- beebee boomers experiencing problems with their parents and a vacancy the burden they are going to carry because there are not enough transportation and all but the options that maybe

you never saw what was going to do for you because they never want to see themselves in that position -- but if we can say okay, here is all the burden you're going to carry for your parents don't you think you want to find some more public transit and alternative services so those burdens don't hit you? >> dr. rosenblum's white is a good one. the longer afford in this area, the longer i'm starting to realize that for particularly for illnesses the driving is a canary in the coal mine and particularly for the cognitive disappear met. so if mom or dad have problems or memory problems, the families can usually explain that away. but when driving becomes affected, then they can no longer explain it away and that is when actions start occurring.

so driving can become the early or not so early indicator of cognitive decline coming and we know that in the primary care setting, two-thirds of all dementia are missed and mild cognitive impairment, so the driving issue really does need to be on the radar screen. the other point a finger is really important is that austin, when trifling privileges are revoked because of illness, the blame is put on the driving that mom or dad, there now has to be all of these lifestyle changes because they can no longer drive. well, in fact it's because there is an illness and lifestyle changes are going to occur. the loss of driving privileges means the family has to step in or somebody has to step in and

make the arrangement, so those arrangements are going to have to be made anyway. it just becomes the red flag >> thank you. thank you all for your honesty in answering the questions. it's very refreshing. moving to the last table, gssa will ask the questions for the last table. >> first question is for anne mccartt and it has to do with subgroups within the aging population -- >> if you could pull the microphone close, there you go. >> do you see -- thank you. are there differences within the aging population -- in other words, are there differences in crash risks between those drivers who are say 65-75 and those who are maybe older than

research? >> yes, in our study we had @ three older groups. we had 70, 74, 75, 79, and older and consistently what you saw was the beneficial with the improvements we were seeing were the strongest for the very oldest drivers and i believe in a were initial study we did take a look at 65-69, and i believe" we found that they were not that different actually, in our study, they may be in other ways but in our study using thata method they were not that different from the middle age group we were looking at. >> another -- to have you make some projections if you can. crash risk and older drivers to continue in the future?

>> do i expect our were studied, the improvements that we have sought to continue? >> [inaudible] >> i would say yes. but i'm intrigued by the question and i couldn't answer it very well because whenever you're looking at a group and you're looking at other groups there are other great things going on and we were partly looking at not just are they doing better but are they doing better than other groups and children, for example. the gains to be made for children in crashes is phenomenal. but yes. and i don't have a scientific reason for tabhat, but i think that what really stood out for me in our study was the consistency of what we were saying. so it was almost every year there was a decline in deaths. we looked at all these different severities of crashes in the states and was very consistent, and i didn't talk about it today but we look not only at whether

older drivers are less likely to die. we look at whether they were less likely to die or be seriously injured. so i think that what was compelling to me was the strength and consistency of what we were seeing, and while we can't explain that, what that says to me is that part of something that may be long lasting. the big question, which one of the other panels mentioned is what happened in the last couple of years, and i agree we don't really understand. we don't really understand it, and -- but putting that aside, yes. i think whatever is happening will continue to happen, but could be wrong.

and people who will be older in the future? >> is this for me? >> yes. >> well, it's hard to be object of about this because i'm going to be older pretty soon. i'm going to be 70 and older. but yes, this is purely speculative on my part. there's an expression i never get right, but the new 70 is the 60 or whatever.

i think older -- i think people who are older are really different than they were certainly 20 years ago, maybe 1d years ago. and i think it has to do with house, but also just lifestyle and so, you know but again i'm looking at myself here and my colleagues. are different than their parents and i think i'll be different from my parents. my travel patterns will be different. i hope will be better i'm not representative of the population as a whole. there are lots of people who won't be healthier than there. i think old age is not what will

they choose to be. >> sandy, that same question is for you. do you think that they will be a difference in terms of lifestyle and demographics and geography? >> one of the things that anne said that while women increased safety faster there were an assist statistically different. if she hadn't said that, what i would guess is there more women having their 65th birthday with a lot of experience under though about. they're coming into their senior years of better drivers with higher exposure over the outcome you know, 3000 low mileage prius. and not what i would guess, that women are coming in with 30 and 40 years of driving is so hectic situations, with screaming kids in the car and all of that. so even if she can't see a statistically, i still suspect that some of it, that women are

just more experienced drivers now. and also, i think people do have a healthier attitude towards these things. it's hard. you see up going into people's behavior. >> i don't know what the data looks like in the united states, but paul bowles from transport canada, he and i a data last year in terms of the baby boomers. and we looked at the female and male crash rates. and historically in terms of the older driver population that male crash rates are higher than female crash rates. and what we found in or transfer data that the baby boomer females are looking more like the male baby boomers, both in terms of amount driven, but also in terms of crashes. based on those projections, we

can expect our cohort, the baby boomer cohort, the females to look more like the males. in the second consideration is while there is a stigma of the baby boomer population that is going to be healthier than their parents. there also are going to be segments of the baby boomer population that are in poorer health. if you look right now and -- i'm sure the statistics in the united states are similar to the canada, diabetes is up epidemic proportions, cardiovascular disease fat epidemic proportions. right on the united states, one in seven has dementia. and that's project lead to increased sevenfold with the aging of the baby boomer population. so there may be segments of the baby boomer population that will

be safer to drive as we move through senior years, but there's increasingly going to be segments of population that would be at risk. >> do you have anymore questions? >> no, we don't. thank you very much. >> excuse me, just one quick question. would any of you care to comment on the current or future way of doing things like shopping for my drugs online or by telephone or my groceries in that way? things that can actually meet your daily needs without causing the driver to get out on the roadway? >> i just saw a study that said that online shopping encourages in-store shopping. that is not a substitute. it was a compliment for that that you troll online and look at various things and you've got

to go out to a story and look at them, too. it's a really interesting question that a lot of people are addressing, the extent to which online shopping and those sorts of things will substitute for travel or almost all improvements in communications, technology and travel technology have led to more trips. now because we can easily cost them in europe, were more likely to go see them. so it may well be that all of these online kinds of things don't in fact substitute. but i don't think we fully know that. >> the one area i think is interesting is the social networking. and particularly when you look at life enhancing needs for social interaction, increasingly people can have those needs met, so i don't know of any research that's going to be done in that area, but it's an interesting

area that people will be about to meet more of their social needs without having to get into the car appeared >> thanks. that's a great question. i think that goes back to what ms. mccartt said that we will be the same seniors, but i think things are changing. i have a question for all of you. is there any agreed-upon age at which we would say someone is an older driver? i guess this also goes back to a 70 the new 64 is a new 70? what is an older driver and do we have a definition, maybe not there dellinger i'll go to you. >> the short answer is no. i think we've used 65 and 70 as the most common ages to talk about older drivers. i think 65 because that's when traditionally social security started. i don't think there's any

biologic or physiologic reason that we decided to use 65 and above. we can use 70 and above. i think that those u-shaped curves for crash involvement you can make a case for 70 above. you could probably also make a case for 75 and above. but there is no right answer to that. >> i have a number of questions and so if you want to jump in. doc dürer rosenbloom and dobbs, i was interested in a segment to all raised. i was intrigued by your chart that showed how people felt selected, who self-select and that women tend to stop driving before they really should work. , but also by this statistic if you use that women outlived

their driving ability by tenures and men by six. how does all of this can work together to demonstrate how people are making the right choices and self-regulating or not. how do you reconcile all of that and outlive men can't but they'll self-select earlier. what does that mean for us as society? i'll take a go at it and then dr. rosenbloom can take a go at it. in terms of self-selection -- well, first in terms of 9/11 are driving careers six years women, 10 years, that is due in part because women live longer. it's going to be interesting whether that trend halt for the

baby boomer population. the other is what is the trend in terms of premature driving cessation will halt for the baby boomer population. my sense is that likely it will not. i agree we're not going going to look like our mothers that are driving habits and our driving habits when they were our age. and so, i think you're basically going into the unknown. if i was going to project at all or predicted all, i suspect that there will be a certain segment of the female population that will look like the current population and they may stop too soon. but overall i think that female boomers are going to look more like male boomers and that we won't be prematurely stopping

our driving. >> i think there's two conflicting things going on here. i do agree that probably the baby boomer women will look more like baby boomer men. on the other hand, women are so much more likely when their drivers to sit in the passenger seat. and i think they're going to show a slide in a minute. if you look at older women drivers, they're hardly ever driving -- if they're in a car with another driver, usually male driver, they're not driving. okay, so this is already women over 65, so you can see if they get older, these are women drivers now, not just women. these are women drivers and how often they're actually driving the vehicle that they're in. and it's never more than 43%. and it gets less and less and less. so even though we know -- even

though women are coming into their senior years as drivers with all pics experience, are still sitting in the passenger seat, which put them at risk for the low mileage bias. and i looked -- i didn't bring it with me, but i look all the way back, all the way through 417-year-olds, if a women is in the car with a man, she's not driving most of the time. so i see two conflicting things. i see women with see women with all the driving experience that looked more like men. and then i see all these women sitting in the passenger seat and some well-known swedish researchers, lisa huckabee's bloom quest has looked at it inside if women drive as much as men, they have the same driving patterns, it better. her solution is women should insist on driving when they're in a car with the male driver. and it's very clear that men often have a different psychological investment in

driving. so i can see all the sites across america, no, let me drive today so five years from now but you're too decrepit to drive i'll be able to. and i don't see that happening. so i see this dangerous situation, even among the very youngest women, they're still driving only eight miles for every 10 miles driven by men. and this older women are driving three -- women drivers are driving three and four miles for every mile driven by a comparable guy. and so, until this balance changes, i'm still worried that baby boomer women actually wants to look like baby boomer men. >> your question is a good one because it speaks to the need for research priorities. and perhaps what we need to do is we need to start looking more at the 55 to 64-year-old age group because that's over going to be dealing with an large part part over the next 20 to 30

years. >> well, i have to say this is all a little bit frightening because you're holding up a mirror on my life. and so, i'm questioning some of the decisions that i make in my family. i always tell myself that my husband is a bad passenger and so i'd just rather him drive. but you know, regardless, i think one of the questions i was a little bit troubled with is how do you undo 40 years of conditioning for women who might have been told you're not a good driver? and so, if they're prematurely stopping driving, they're not confident or they're not comfortable. and how appropriate is it for us to say you should drive when in fact the individual doesn't have confidence or comfort behind the wheel and is that an appropriate thing for society to be doing? >> i think you're right on.

if people do not feel like they're competent to drive and they don't wish to drive and they could meet their mobility needs in other ways, who are we to push them to be behind the wheel? it has to be an individual choice. we can as a society empower them, give them driver training, it tends to increase their confidence. but if they don't feel confident to drive, i don't think they have the right to say you have to be behind the wheel. >> i had this vision of police coming to your ask to your ask and ask him how many miles you've driven. and if it's not enough, they give you a ticket. what we see in the data that we can't quite -- there is a little uptick and the number of women driving between 80 and 85. and you see it in lots of data sets in the british in australia's davis said that i work with, too. i think what is happening is that is the reason when the

husbands die or become capacitive and start driving. no, of course we shouldn't force anyone. i think if people are competent drivers were not offered in a meaningful alternative, we do have to provide ways for women to judge whether they are in fact safe and to encourage them to keep driving as they are. because were not given them anything else. until we give them something else, that is the question for society at large. there are environmental issues of course. but until we have mobility options for people, then i think we have to help women see if they are competent to drive. it's a vicious cycle. you don't drive coming so don't drive, so you don't drive. producing are below 3000 miles a year and you're running the same issues that when you're out are more likely to have a crash. i think we have to offer women a way to assess whether they are competent drivers. in most cases i suspect that

will mean they see they are more competent they thought they were and will drive more. >> mobility sounds like it's a big piece of baldness. i'm so, i wonder if you own vision or are familiar with any scenarios in other countries, where the state or health care, medical services might pay for driver assessments or valuations to driving. >> in canada and all provinces with the exception of one, having a driver assessment is user paid. the province of british columbia now is paying for a driver assessment for medical reasons. and that's precedent-setting and it will be interesting to see if it results in policy change across the other provinces or territories. my argument would be that when a

physician, because it's often the position that is charged with determination not competency and reporting into motor vehicles, if there be in charge of that responsibility, they're having to make that assessment. they refer for catskill blood test. those are paid for by the health care system. if the referring to driver assessment for medical conditions, it should be paid for by the health care system. >> great. a couple of data questions. are any of you are familiar than a statistics. were talking about passenger schools. are you familiar with any statistics about older commercial drivers? the safety board investigates accidents primarily in commercial vehicles. and we do see there at many cohorts, whether its truck drivers or school bus drivers. these are things many people may elect to do in their retirement. and so they certainly have a

high mileage component, but they also have maybe some other challenges. can you all speak to that? >> there was just a study released by one of the cooperative research programs of the research board on the older commercial drivers. and i recommend it to you because there's not a lot of research about older commercial drivers, so they reviewed -- it's a very good review of all the research on older drivers. and what they concluded was older commercial drivers are doing the same thing that all older drivers are. they're self-regulating, staying out of dangerous situations and their greater experience makes for any physical deficiencies. they're not having higher crash rates as commercial drivers. i recommend that report to you. >> and that report has been submitted to our docket.

thank you for summarizing it for the audience. one other question i have about data and i don't know if ms. mccartt or others who have looked at this, but how is the composition of the population potentially affect the data? i say this -- i drive in an urban highly congested area. my parents live in a very rural area. the way people drive is very different and i've also experienced to florida during the wintertime in a few see there's very different training patterns on the road. and so what is potentially more of a risk? has the more they risk as we have a higher number of drivers on the road that may be older drivers, they may have some performance issues? or is it more of a risk to have a mix of population of drivers that she got some very jong fast drivers and you've got older drivers who may be self-selecting are going our because that may be how they feel comfortable? do we have any understanding as

we get to 2025 and one in every five drivers on the road will be an older driver? for that change the statistical information were looking not? >> that's a tough question. well, the last -- if you look at what i think is the best exposure measure of vehicle miles traveled, the latest data we have 2001, 2002, it does show when you get old enough, that the crash rate, whether it's the overall crash rate or the fatal crash rate goes up. i think the issue of the severity of the crash gets complicated because as we've heard, when you're looking at fatal crashes and probably three century parishes, what's going on is not so much that the older drivers are riskier or they're more likely to be killed as are their passengers.

i'm not sure what the answer to your question is. and again, is part of what is changing about older drivers as they are beginning to drive more than they used to unsafe for highways, that is the factor that has to be considered, too. >> i'll just pay pin. so today, i think we've heard a lot of good news about older drivers and their risk on the road and the risks to others, for example. and i think we're having this conversation because we thought a few years ago that this burgeoning baby boom population when one in five drivers is going to be over 65 and a couple of decades was going to be this

horrible thing. so i think the question is complicated as even now we don't see that. so what we were hoping would not have been doesn't look like it's going to happen. so now we have to change our whole viewpoint about what it means to have one in 541 in four drivers on the road that are older when they're not even looking now like we thought they were going to look. so i guess that the long way of saying we don't know. i think you're saying we don't know. but i think were confident enough to say it's not as -- it won't be as bad as we thought it might. we don't know why. it's not going to be as bad as we thought it might be, but it's not going to be as bad. >> well, maybe it might even be better for all of us. my last question -- i think

dr. dobbs, we'll have some panelist to talk about medical issues with respect to screening and things like that later. i'll get a sense from you i'm not talking about older drivers. i'm talking about all drivers. is there a particular medical condition that you think we really ought to be paying attention to? >> that's easy to answer. a guess, dementia. dementia clearly is a medical condition that needs to be on the radar screen. and it's interesting that when you mention the word dementia, people often thing about alzheimer's disease and certainly it's the most common form of dementia. but there're many illnesses other than alzheimer's disease that can result in a cognitive impairment with or without dementia. so in terms of the medical conditions, that is the condition that, from my perspective, we have to be most concerned about. when you look at the traffic

data, individuals with dementia have crash rates that are two to eight times higher without individuals with dementia. we know they are very much a high risk group. >> and what do you recommend as the best way to address any driver that has dementia? >> for individuals with a progressive dementia, the question is not, will their driving become unsafe? the question is, when will there driving become unsafe? for that reason, we absolutely need the medical community to be engaged. for the medical community, we need to give them evidence-based grading tools. we now have that screening tool that they can use to identify when their patient may be at risk. we need to, in addition to the screening tool, we need to embed particularly in primary care

practices or her family medicine practices because they're the positions that are going to be seen people with dementia appeared ready to embed embed the evidence-based protocol. we need to have the medical community is working with the driver fitness communities, the dmv is in order to streamline the reporting system. and then we need to have several reimbursements for physicians, for engaging and the medically at risk driver issue. we need reimbursement for driving assessment so that the cost of the driving assessment doesn't fall on the user. so we need to work really hard, i think, over the next two, three, four years to get a scientifically-based integrated system in place to address the issue. >> fantastic. >> anemone to get the alternate transportation systems in order. >> fantastic. succinct answer.

thank you very much. and thank you to everyone on the panel. you've done a great job of setting everything in the table for us. it's almost lunchtime. we know what she built as the next several panels will help us in our conversations. sit thank you for your participation. before we break, i want to remind everyone at noon it's show time and we've actually got special dispensation to be able to even treat in the boardroom while you watch. i know our staff are all about to fall on the floor. so bring our lunch back and this was originally a movie theater. and so, please come back to watch elise haas's work and you won't want to miss this. it's a really poignant portrayal of milton and herbert and the decision that all of us are going to face one day. so we are adjourned. the movie starts at 12:00 and will reconvene at 12:12:30. [inaudible conversations]

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>> also standing in for ed, is deputy leader harriet harman. this is live coverage on c-span2. >> officials it's a devolved matter. >> eu legislation administration -- eu legislation has within the eu a fundamental right to work. could the minister take what steps he's taken and what europeans ensure that the fishermen who have their respected that their right to work is enshrined.