the momentum moving and build on success and how you keep people like billie who has sunk an incredible amount of sacrifice and to this movement, how you keep folks in the movements and working and sacrificing like that as we succeed? i think that really is going to be the big question in the next couple of years. [applause] >> i want to thank you, mike, and everyone at heritage for inviting me to speak. i hope i have a little bit to add after that. just before the election i gave a speech at the federalist society. the deal was for me to talk about some of the candidates i have met during covering the campaign. i talk about what i thought was are really high-quality level

of a number of republican candidates. it was a very good class. these were people who were successful in their private lives. they had never thought about running for office, many of them, until the spring and summer of 2009 when they watched barack obama and the democratic leadership in congress to enact one enormous government initiative after another. they each came around to the idea of running and they aspired to be citizen-legislators. they did not want to be professional politicians. it was a touching story that i told, except the three guys that i've focused on all lost. -- that i focused on all lost. rob steele who ran a good race against john dingell in michigan. the last was a man named john dennis who challenged nancy pelosi.

after i did the speech i went back out and did the final trip for the campaign and went to illinois, wisconsin, and ended up in nevada. i think the most impressive person i saw during that trip was a man named ron johnson, the senator elected from wisconsin. very happy in his life as ceo of a plastics manufacturing company. never thought of our running for anything. is appalled by what happens in the first months of 2009 and invited to speak at a tea party rally in oshkosh where he lives. after he speaks people come up to them and ask them why don't you run? he began to think about it. after a lot of thought he gets in the race and runs on an

admirably simple platform. everywhere he goes he says i only had two things in my platform, i want to repeal obama care and reduce the size and scope of the federal government. obviously he will have to do other things when he gets here, but was an admirably simple platform. he is a very serious guy and is going to do what he said he is going to do. i would expect that he will devote a lot of his energies to repealing obama care. the question would be what would be the tea party's role in policing ron johnson? the bigger question is a are all of the republican candidates going to be that way? the one thing we heard the most was we have learned our lesson.

we really have learned our lesson. we're so sorry we strayed from conservative ways, but if you elect us again, we probably will not do it again. -- we promised we will not do it again. i give them some credit for that. i think some of them have learned their lesson. it seems to me they have gone about their business in a pretty sober way. i think the question for the tea party is the future of the party is in the hands of the congress. what if republicans really have learned their lessons? what if they've performed admirably over the next -- they perform admirably over the next two years? try to bring federal stimulus

back to pre-tarp budgets? i think if that happens, a lot of the passion with saul and te saw in the tea party rallies will dissipate. i think their actions will be seriously constrained by an energetic house of representatives, if that is what the republican leadership of the house chooses to do. i suspect that if republicans perform well, we will see a dissipation of the energy that took place, which will be compounded by the beginnings of a 2012 presidential race. there is no clear, single person that every tea partier would get behind. i think it will disappoindissipe

of the energy as well. and there are born to be performance monitors. they will keep their eye on everyone. i suspect that will take place, but i think you may have a situation where the success of the tea party creates a little dissipation and their energy. thanks. [applause] >> now we can go to some questions. i thought i would start off by asking billie, in terms of expectations, how do you think the two-parea party support woud define congress and the next few years? where would they set the bar? >> we certainly want them to

look at the health care bill. we want to see that actually take place. we want to see limited government. we do not want them intruding into our lives. we want our taxes to be less than what they are and what they're going to be. we want to see them do the things they said they were going to do. and we want them to fix the mess we're in financially. we are in a pickle. there is an article that i wanted to read. we have passed a milestone that is negative beyond the pale. the u.s. now has exceeded this level. they have work to do. we are scared out there in america, and we want this congress to fix this mess. we will see if they are

successful if they can fix that. >> questions from the audience. yes, sir. everyone identified themselves. >> [inaudible] if you look at the last 100 years of government, it is hard to argue that congress alone can't solve the problem, because we have periods where conservatives may be in charge and where liberals are in charge. where is this tea party movement on the the idea of constitutional reform? this is a question for anybody. where do think the people are on the idea that we need a constitutional reform if we are going to permit -- permanently

limit the idea of fiscal responsibility? >> balance the budget is a big deal in the tea party movement. and we want to go back to our constitutional foundation. the big government is not working for us out there. we want to go back to where we used to be at some point in our history. you know more than we do. we're not exports. but we know it has to go back to wehrwhere it was. >> i do not necessarily think you have of a balanced budget amendment to have a balanced budget. the problem is congress. congress writes the budget. they are responsible for writing the budget. they are not going to balance the budget or lower debt just

because there is a constitutional amendment to balance it out. it will just keep raising taxes. it is more incumbent on american voters to send people to congress that will spend less. he raised some very good questions, because a lot of the spending right now is automatically triggered. a key part of this will have to be entitlement reform. we will have to fix or replace social security and medicare. until you do those things, i am not sure a balanced budget amendment is going to address the actual problem. you can balance the budget and still exploit it. >> i think if you did a poll of supporters, they would favor a balanced budget amendment. i think that they would be happy just to see significant progress in this area, because if you talk about some hazy, lovely

time in the past where things were better 2007 might be a place to start. in 2010 that total federal expenditures are 3.7 trillion dollars. prior to 2007 the glut may be 100 billion per year. -- they go up maybe 100 billion per year. if i could say one thing in semi-defense of republicans, if the economic conditions that pre-date tarp and stimulus of existed, i doubt many of them would have very passionate about being tea parties. -- tea partiers.

the federal deficit is $160 billion. things were not nearly as bad. that is why i think the republicans got all lot of mileage by saying if we can just go back to 2008 spending levels. balancing the budget is certainly of gold, but making it better is probably something that would really satisfy most two-parea party activists. to>> you both talk about success dissipating in the movement. i thought opposite. i think that tea party members usually look -- term. -- usually look long-term.

i was wondering if success would help create the long-term of more conservative-leaning of the republican party if they could do some of the stuff you just talked about. >> first of all, there are zillions of ways for republicans to fail, some of which we do not even know about. [laughter] i was actually serious. if they fail to reduce spending, in other words, if they keep to their ways, and like i said, their old ways are not nearly as bad, if they keep to those ways, i think the tea party -- there is a serious decision to make. there are other issues that the tea party is much less clear

about. obviously the president conducts foreign policy, but if there is an enormous foreign policy issue that arises in the next couple of years, what is the tea party's position? what is the tea party's position on afghanistan right now? they have been extremely focused on budget, and not as much on the entire spectrum of issues that face government leaders. >> i want to disagree a little bit with that. and people tend to think of the tea party as focus on fiscal issues. that is really what brought people together. but because of my background and leadership i always found out that there will be one thing -- how many of you are in relationships? right, and when you are in a fight with somebody in a relationship, it always starts

with a surface issue. what you have to do is dig deep to find out the real issue, the one we do not want to talk about. that is what happened with the tea party movement. we started with the monetary issue, but the more we work together, the more we found out it was a deeper issue in our country. the deeper issues we have in our country is one word, and it is corruption. that is it. we have been out there working, we have been out there doing our job and sending our money to washington, and the political class corrupted our money. that is the issue that is going on in this country. to>> the issues you're talking about, dustin, armonk-tee long-m issues. repealing obama care is not

something will happen in the next congress because it cannot happen. when she is talking about with corruption can also be talked about in terms of trust. the reason you had depth tea the tea party erupts because of trust. good start counting. i think that is something that we need to make sure we acknowledge. if you have republican congress that starts working on rolling back obama care, serious entitlement reform, serious structural changes to the budget, including the budget process, i think that is a good start and people will reward them for that. >> our country was founded on a good start. it started with a tax on tea,

but the reality was taking our freedom from us. that is the same exact thing that is happening in our country again. >> [unintelligible] my question is it is very easy to win an election -- >> really? [laughter] >> ross perot did this 15 or 20 years ago. newt gingrich did this 12 years ago. the point you are trying to make is many organizations in washington who are fighting for reform but did not happen. the people that are reflected in congress --[inaudible] i am from pakistan. we have like 50%. here it is very different.

you did not have that type of corruption. my question is, i am republican. one person said we should defeat a congressman because he is muslim. if this is the substance of the party -- >> it is not the substance of the party. at the start represent the tea party -- it does not represent the tea party movement in america. if somebody said that, shame on them. [applause] >> jeff fox were the, you know what you are a republican when you threaten the life of jim demint. i wanted to get the panel's call

on the conventional wisdom in the establishment circles that the two-parea party cost the republicans the majority in the senate. >> they would of had to completely run the table to win. it was theoretically possible. i do not think it was realistically possible. i think what you had was the tea party. a former senator explained this to me, and i think he is right. you had existing candidates and existing politicians who latched onto the tea party because they thought it could get them support that they cannot have. christine o'donnell had run to for office before. neither was a good candidates. ron johnson is a more pure tea

party candidates in the fact that he had never thought about running and that is because he saw the energy and concern that he began to think about it. to me, candidates quality mattered more than anything. there were a couple of races that republicans may be could have picked up that they did not, but if you look at nevada, for example, i was out there and i got the sense that angle was going to win by a tiny amount, and that was wrong. if you look at the three finalists, i do not think any of them would have been a great candidate, nor would they have been carriharry reid. >> the gop never offers poor- quality candidates.

and [laughter] got that stuck in my throat. sorry. billie knows that better than anybody. athe whole establishment got behind charlie crist. he was a terrible candidates. there will always be candidates to fall short. -- who fall short. just to give you a perspective on the actual idea what happened, in 1974 after watergate, when the republican party had to go to a midterm election three months after their president had to resign on national television and then gerald ford pardoned him after that, the democrats picked up 49 seats in the house and three seats in the senate. granted they were the majority. this was a fairly-monumental

win. you can go to any election and say that there were poor candidates in good candidates and that election cycle, and i think when you take a look at the totality of what happened on tuesday, you cannot walk away saying somehow the tea party costs as something. you can quibble about nevada or delaware, but with although tea out the tea party we would not be having this discussion. >> i would like to save the gop cost us some races. -- i would like to say the gop cost the summary says. [laughter] i had to go home and tell my dad that. i thought he would throw me out of the house. i supported republicans my

entire life, but i am a tea party person now. there were many states where we heard the stories. we talked. it there were some -- there were some goper's that would not get behind the party. you do not want to make hazmat and florida. when mama ain't happy, ain't no bodbdyody happy. they could have taken more seats had to work with the tea party and the local races. >> i think other countries are looking very rigid were very interested with what will happen

in congress. -- i think other countries are very interested with what will happen in congress. you give the long list of guidelines. had there been any discussions on the ground about the issue of dissipation, whether you can keep the momentum going? also, the relationship with the gop going forward. what about 2012, the presidential race -- have there been any discussions on the ground about this? to go where it after the election that everyone might go away. -- >> we were read after the election that everyone might go away. but we all have our individual sites and we are all reporting people are still joining. we're still steer. -- here. >> your relationship with the

gop going forward. >> we love the gop. it will be one of cooperation and working with them we are here. if they do not call us, we will call them. we have people better already starting to get out there in america. we have that all kinds ohad alld teams reaching out to us. we're waiting to see who the candidates are. we will be part of the 2012 election. >> there has been a lot of analysis and talk about the ability of the tea party candidates who are now in congress to govern, and a lot of analysts are saying we're just looking at gridlock. what is your take on this two-

ea party block in congress? >> i did many of them would be gridlock as progress. [laughter] a lot of the platform was negative. it was to repeal obama care and stop doing what the administration had been doing. they certainly believe if they can get a handle on spending, make sure tax cuts are extended that they can make a difference and bring around jobs. we will see what happens on that score. i sthink if they see

leadership working hard and passing things in keeping up with issues, if not all of them get through the senate, they will understand that. they understand the way the system works. the question is will house republicans be working hard on their issues? >> if you go to heritage.org you will find a checklist that will hopefully guide the next congress. it involves appealing -- repealing obama care, and reining in government, mostly on the regulatory side. you can go to heritage.org to see the details. >> all three of you have mentioned that in order to have a niche of reform, we need to cut back on entitlements. if they are the motivation, the

courage, and the desire to go into that fight to cut social security, medicare, and all of those programs? >> yes, and we have had discussions about that, because we know it is a problem. again, the american people are smart, and the tea party members are smart. we know we cannot do away with spending without looking at the entitlement programs. the word we do not like is to say that social security is entitlement. people are sick of that, and it want that changed. they paid into a system that was set up by this government, again, sort of like this health care. it was not entitlement. the problem is corruption happened and it did not do with the money what they were supposed to do with the money. we are willing to work on that issue, but we're not willing to give it all up because they screwed it up. does that make sense?

when it comes to entitlements for people that are not willing to work, absolutely we're willing to talk about that as well. there are a lot of good people that can get to work, but they are on the dole of the government, and we cannot have that. we're willing to negotiate. we're going to take care of the people that paid into the system. i have an 85-year-old mother in law that paid into the system and she will get out what she is entitled to. she is willing to the of a little, and not everything for people who are unwilling to work. -- she is willing to give up a little, but not everything for people who are unwilling to work. >> medicare is an utter disaster just waiting to happen. adding obama care to it made it even worse.

you cannot get around that. it will be a measure of the seriousness of the people we just sent to washington whether or not they will address that. people like paul ryan who are willing to address it in stark realistic terms. people were willing to talk about what you actually need to do to restructure the system, otherwise it will -- go to heritage.org for the list -- but otherwise it will eat up trillions and trillions of dollars. everyone knows that. that was not sort of wisdom i got off the internet. every single person in this town knows that precisely. whether they're willing to do something about it or not will be a function of people holding them accountable.

>> there was a debate as they drafted their pledge to americans about what to include about entitlement spending. it did not end up being in. my guess is you will not see any serious action on entitlement reform. >> we have time for one last question, and we will go to the very back. >> a question about 2012, the presidential candidates. will the gop and tea party candidates be behind the same candidates? >> i cannot speak to that. it depends on who the gop gives us. >> i agree. it depends on the candidates. i think there will be a number of interesting candidates, that we've seen before. i think you will see fresh faces come out.

>> [inaudible] [laughter] >> i will ask two questions, who do like in the 2012 field -- who do you like in the 2012 field? . . please join me and ron. >> warm round of applause for our panel. [applause] [captioning performed by national captioning institute]

[captions copyright national cable satellite corp. 2010] >> landmark supreme court course -- supreme court cases on c-span radio. >> there is nothing in the constant -- in the constitution concerning birth or conception. >> roe v wade is still considered one of the court's most controversial decisions. over the next two saturdays, listen to the arguments at 6:00 p.m. eastern on c-span radio, in washington d.c., a nationwide on ex-im channel 132, an online at c-span radio. >> the national transportation safety board, one in five licensed drivers will be age 65 or older. next, a portion of a forum on

aging drivers and efforts to make a road save with an aging population. this panel is to 0.5 hours. -- is 2.5 hours. >> i encourage you to interact with the board members during the break. welcome to the board room. we begin a public forum on safety, mobility, and aging drivers. many of you are familiar with the safety board's role in the transportation tax and determine the probable cause of accidents. the safety board also has the opportunity to bring leading experts together with the goal of understanding safety risks

and identify solutions. we are convening this public forum to explore the safety issues relating to 18 drivers and to discuss possible strategies to prevent and reduce accidents, injuries, and fatalities within this growing possible -- population. america is aging. baby boomers are into their middle years. people on average are living well into their 70's, compared with their 40's a century ago. more and more seniors are on the road than ever before. in fact, 30 million licensed drivers in the united states are 65 or over. the forecast is that in 15 years, in 2025, this age group will comprise more than 20% of the entire u.s. driving population. that is one in every five

drivers on the road. there is no precise way to define the term aging driver. justice note to 18-year-old have the same set of skills, neither do older drivers. driver performance varies widely in every age group, and age alone is not a good predictor of how well one would perform behind the wheel. factors like cognition, motor skills, medical conditions, and injury tolerance are also predicted. when we talk about the aging driver, the mean age in relation to one's capabilities, not age as an old or senior. older drivers tend to be conscientious and safety- oriented. they wear their seat belts. they make use of driving when it

is dark. they are not likely to drive intoxicated in the drive fewer miles than other age groups. the good news is that drivers age 70 and over involved in fatal crashes had decreased in the past decade by 20%. even though the number of licensed drivers in this age group and the miles logged has increased. despite these encouraging numbers, we know that when there is an accident, it is the older driver who is more likely to be killed or seriously injured. they simply do not there as well as younger drivers. this forum is an exciting opportunity to better reduced and highway safety trends and to discuss ways to minimize the safety risks for a growing segment of drivers. whether we are an older driver deciding whether to put the keys a cider not, or the older

drivers family or community, we are all responsible for making sure that no matter what your age your destination, every one of arrives safely. while many of these issues that we will discuss our topics that have been explored by other organizations in recent years, this is the first time that the ntsb is analyzing them in this format. we're very fortunate to have some of the leading experts in highway safety, academia, the medical community, and industries here with us today. i would like take him -- i like to take a moment to recognize some of the groups. aaa, the aaa foundation for traffic and safety, the alliance of automobile manufacturers, the insurance institute for highway safety, the american association of motor vehicle administrators, the american occupational therapy association, if the governor's highway safety

administration, the american optometric association, the international association of police chiefs, national institute on aging, federal highway administration, the national highway safety administration, and aarp. thank you to all the participants for sharing your time, your insight, and your expertise. and for our roadmap for the next two days, this morning we will begin with a discussion of safety metrics, accidents, injuries, and fatalities, and how we use this metrics to assess the risks associated with aging and mobility. as part of this discussion, we will also consider the travel characteristic and the travel needs of an aging population. we will then break for lunch and i am pleased to announce that during the lunch break, but today and tomorrow, we will be showing the documentary opened quake -- "old people driving."

it chronicles the stories of milton, age 96, and herbert, aged 99, as they confront the end of their driving years. i encourage you all to take the opportunity during the lunch period to view this documentary. this afternoon, we dedicate up panel for document protection for drivers and passengers. this is important because the core of our mission is to prevent death and injuries. we know that older drivers face an increased likelihood of injury, hospitalization, and debt as a result of the crash. if because older drivers have to create entry -- have increased entry tolerance, we will find how to protect them as well as the amount it -- the limitations of current systems and the potential benefits of new technology. we will then turn the highway and vehicle design and high

changes to those designs can affect the 18 drivers performance. -- 18 driver's performance. -- aging driver's performance. tomorrow morning we will focus on driver performance, driver capabilities such as self training and truckers assessment, and how we remediation performance once the detriments are identified. we will conclude the program with state programs including state licensing schemes and the role of medical review boards and state safety programs. this is a lot of ground to cover in two days. i hope the dialogue will be

honest and open prefer some our discussion maybe i opening. for others, it may be s opportunity to dispel misunderstandings about the aging driver. even more significantly, this forum likely represents a collaborative launching point toward improved highway safety for us all. now for a few housekeeping items. as a reminder, please silage or cellphones and familiarize yourself with the emergency exits that are available in the front of the room and behind you where you came in. we welcome the public to view the forum, but those in the audience as well as those viewing by web cast on the ntsb says website. copies of the agenda are in the board room, and descriptions of the parties is also posted on the safety board's website. we have invited 20 panelists and

over a dozen organizations to take part in this forum. notably there are more organizations participating as parties in this forum and is generally typical in an accident hearing. this stems from our desire to fully air their range of voices on this topic. for the invited parties, i urge you to work for your spokesperson and to rotate the responsibility of spokesperson as we move through the panel. you will find question cards on your table and you can pass your questions to the spokesperson on the question card. because we have a full agenda, we appreciate your cooperation in the cooperating with the schedule. we asked for time limits and keep the discussion focused on the subject at hand rather than flipping two topics covered by other panels. we recognize that all stakeholders are not represented in person at this forum. it was not possible to accommodate everyone who wanted

to protest pay. those individuals and organizations who wish to submit written comments made do so until november 30, 2010. finally, i like to take a moment to set -- think the ntsb staff for organizing in preparing this forum. undertakings of this do not simply happen. they're the result of many months of meticulous preparation and planning. thank you to the staff for your hard work and dedication. in particular, i like to recognize the technical staff to make this form possible. dr. robert malloy, dr. janet price, and others. dr. mitch garber, and dr. christian poland from the office of research and engineering. and stephanie davis, keep blackstone, and others from the

office of communication. we also have some excellent administrative, technical, and press support provided by davis clark, the key lock, rochelle hall, robert turner, and richard certification check. with all those housekeeping items taken care of, we're ready to begin. we will begin with our first panel. they will focus on safety that assessment and transportation risks in aging. we will begin with a discussion of safety metrics to help qualify what we know about the risk of aging drivers. past forecasts had predicted an increase in accidents and injuries associated with aging drivers and they have not materialized. we would like to understand why. this panel will examine the demographics of the u.s. population, at fault accident rates by age, the injury data

for drivers, passengers, and pedestrians. the discussion will factor into consideration of exposure measures such as the number of licensed drivers, active drivers, and trip or trip miles traveled by age groups. we will also discuss how crashes deferentially affect aging travelers. my colleagues here at the safety board have organized this panel. could you introduce the panelists? >> first i would like to introduce the four panelist and then we will return your opening comments. from the insurance institute for highway safety, a vice president. she recently co-authored a study on crash trends for older drivers released by iihs in june. we will ask her to talk about some of those findings today. she received her ba from duke

university and her doctorate from rockefeller college of public affairs and policies at the state university of new york-albany. our second panelists is a professor of planning natural and renewable resources, a gerontologist, and women's studies at the university of arizona. she directed the institute for land and regional development studies at the university from 1990-2004. dr. rosenblum has a master's in public policies and a ph.d. in political science from the university of california-los angeles. our next panelist directs programs within a division of care for the elderly on the faculty of medicine and dentistry at the university of alberta. she is a professor in the faculty of medicine and dentistry. dr. dobbs participated in the

safety board forum on medical issues of non-commercial drivers in 2004. dr. dobbs has a b.a. in psychology and a ph.d. in gerontology with special license in psychology and medicine from the university of alberta. an epidemiologist and team leader for the motor vehicle injury prevention team at the centers for disease control and prevention. the center she is affiliated with is the national center for injury prevention and control. she conducts research in motor vehicle safety, focusing on older drivers, occupant protection, and pedestrian injury. global road safety an injury risk behavior. she received her b.s. in biology from the university of san diego, her master's degree in graduate school -- from the grandeur of school of public health at san diego university, and her doctorate in epidemiology from the university of california-los angeles.

we have asked each if you did part us with summary remarks in your area of expertise. we would like to take 20 minutes to cover that. i will help us do that by stepping in and introducing the next topic as we go along. dr. mccartt, could you start about the limitations of safety data and tell us what we know about the safety of drivers 70, 80, in 90 years old? anne, there is a light. thank you. >> the crash rate for mile travel begins to increase at about age 70. this is true for fatal crashes and for crashes of all severity. as we've heard and we know, the population of people 70 and over is increasing and is supposed to

increase dramatically so that by 2014, it will have doubled. -- 2040, it will have doubled. we can see for the last decade, the percentage has been pretty stable. when we look at older drivers, 70, 79, 74 -- you can see very dramatic increases in the percentage of people holding on to their licenses, especially the oldest drivers 80 and over. when you put these things together, what we expected to see when we look at the crash deaths of older people was an increase. in fact we have seen just the opposite. if you go back to 1975 and lookit crash deaths of older people, there is a steady upward trend. what we've found is that they peaked in 1997 and they have been coming down very strongly.

two. someone and make about crash deaths of older drivers -- most involved are in passenger vehicles as opposed to young people driving a motorcycle, for example. in the fatal crash involving older drivers, people who die are i did the older driver or the older drivers passengers who also tend to be older. we wanted to take a closer look at these trends. we did so by looking at the fatal crash rate first, and we looked at this middle-aged group for comparison. you can see for this group, over the last couple of years, their fatal crash rate has come down. when you look at the older driver trend, if you can see again especially for the oldest driver, the very dramatic decline. for drivers 80 and over, their fatal crash rate has come down

by half. we had questions after this initial study. two things could explain this. one is that older drivers might be getting into fewer crashes. the second thing that might explain it is that maybe they are also doing better at surviving crashes when they are in one. so we turn to the best data that we could find to look at non fatal crashes. we were not able to use a national data base, so we went the 13 states and we did a similar analysis where we looked at middle-aged licensed driver crash rates, these third non fatal, and we did see a decline. and when we look at the older drivers, their decline was larger. when we look at property manage -- damage-only grasses, the

crash weight went up a little. -- the crash rate went up a little. so guess, the overall crash rate has come down. to look at the second question, the survivability, when you look at the 13 states and measure survivability as a percentage of older drivers who died in a crash, and compare them to middle-age drivers, middle-aged drivers a slight increase of those who die in the crash. looking at older drivers, down. the answer to the second question is, gas, the crash risk has gone down and when they are in a crash, older drivers are less likely to die. in a stronger way as compared to middle-aged drivers. i think in the questions we will talk more about this. we do not have the explanations yet for this. these are some of the hypotheses

we have. it may be -- older drivers are healthier and better physical condition. emergency medical services and medical treatment they have proved better for older drivers. we think there are probably some answers in their travel patterns. taking a preliminary look at the national travel survey, older drivers are driving more in the aggregate and also on the average. drivers of any age, drivers who do not drive a lot of miles have higher crash rates. we're thinking that the quality or the patterns of driving may help us explain some of this. and finally it may be that older drivers tend to stop regularly. if they are doing this, it's an increase in the self regulation that might give us some answers.

and finally, the last point, i think we will focus on this and the question, there are important limitations in try to take a look to the understanding why older drivers crashes are down. we do not have a good national sample of non-fatal crashes that will allow us to look in detail at the crashes of older drivers. we do know that have perfect licensure data. -- we do not have perfect licensure day. if a state has a long renewal period, it may be that they may overestimate how many older drivers are there. and finally, as i indicated, we do have a national travel survey.

the sample is being wasted. we only have the surveys every two years and they could be more detail. i would like to make the point of important exposure measure for any age group, especially older drivers, is there travel patterns. thank you. >> our next panelist, dr. rosenblum, what do we know about where people live and how that affects their travel patterns? >> now i have to microphones. and soon i will electrocute myself. about 75% of older people either lived in suburban or rural areas nationally. they are over represented, for example, in rural areas where you could have one in five

drivers over 65 nationally. but it may well be 40% or 50% in some rural areas. people 80, 90, they will be driving because that is their only option. if folks are living in low density areas, but their alternative to driving is less. and as in so many things, there are significant differences between women and men. women are substantially more likely when over 65 to live alone, with no other driver in the house and they start to have problems. they are significantly less likely to have financial resources to allow them to purchase services for alternatives and goods delivered to them when they no longer feel safe in driving. we know that older women generally ceased driving before men because they do not feel

comfortable if there is not some kind of sharp medical reason or a crass, but because they do not feel confident. but at the same time, we know that over the last four decades, people have been driving longer. they take longer trips, they make more trips. the folks who have driven their old high -- their whole lives have not made the kind of life decisions about where to live based on the convenience, and it is hard to see how we can substitute for that. there is a tremendous tension between mobility and safety. i know that we will focus largely on safety but i think that we have to deal with a lot of people driving when they no longer want to or when they are no longer safe because they think they have their -- they think they have no other alternative. it is very common that someone will get up in the audience and

say, my mother will not have any problems when she stops driving. she would use resources available to her. later on a discussion, i have some slides that show how unlikely it is that there are enough community resources today to deal with the vast number of older people who might want to seize or just reduce driving. if we want to talk about safety, one of the things that we have to talk about is how to provide mobility for people they want to stop driving or should stop driving. in addition, there are important issues about self regulation, but we have tremendous evidence that older drivers, particularly women, self regulate. that can seriously impacting quality of life in your mobility. it is one thing to make three

right turns instead of a left turn. that does not have a lot of impact in your life. it is quite another to avoid all congested areas, to abide driving in the peaks, and another to avoid certain groups and so forth. we know that older drivers do that. they stay off the freeways and highways and tend to stay on smaller roads. these things actually to impact people's mobility in lifestyle and we have to take about that. -- talk about that. and wanting to keep people safe but also to keep the mobile, that is something we have to consider as we consider safety issues. and land use is a good-natured issue. i am a city planner and that is something that we look at a lot. 18 people are aging in low density places and that is a reason. one of the things that we know about the travel patterns of

older people is that once they retire, they tend to make it longer trips the young people. because you remove the constraints of having to shop or take care of activities near your work location, once you are freed from those constraints, older people seem to be more interested in going to different places to shop and different locations for socializing. they think all of these patterns interact with safety issues in a profound way. i like to leave the panel with this -- you cannot address safety issues independent from how people live their lives and where they are leaving and we have to deal with them both.

mobility considerations for an aging population? >> i would like to spend the next five minutes describing an integrated approach to what i see is the most at risk population. the free-market i am presenting has relevance to the topics i have been asked to address today. that involves the impact of medical of conditions and premature [unintelligible] the free market that is the overhead is the focus, -- the

framework that is the overhead involves how do we identify older people, how do we identify drivers in general who are out risk because of medical conditions? once we have identified them, how do we assess that driver for determination of driving competency it? finally, for those that we have determined are no longer safe to drive, how do wevis? we know that the role of elvis plays a critical because of age as the -- role of illness plays

a critical role. because of the prevalence of medical conditions, it seems to me that we need broad involvement. that includes the medical community, the law enforcement community, the individual families and friends, the community at large, and other authorities. to assist each of these communities, we need evidence- based screening tools. we also need a coordinated system. we need the medical community talking more working collaborative lay with the licensing community. we need individual families court -- we need individual families coordinating with the medical community. we need a more coordinated system. as i mentioned, it is one thing to screen or identify someone who may be at risk, but because of the importance of driving for mobility and independence, we want to be sure that when a

license is revoked, the person really is at risk. for that, we need evidence based standardized protocol. those particles are important, because what they do is prepare -- those protocols are important, because what they do is protect those who are still safe to drive. we are also protecting not only the individual, but other road users from those who are unsafe to drive. it is politically unpopular to talk about revocation of driving privileges, but my perspective is that if someone is no longer safe to drive, we shut remove their license but support them. and we should talk about the third pillar in terms of support. when i think about support for the medically * driver, or for any driver, it is in -- and medically that risked driver --

medically at-risk driver, or for any driver, it is a psycho- sociological approach. we know that the transition from driver to passenger is a difficult one. we have developed support networks to help people make that transition. we also know that mobility is critical, and often, if you look at mobility in the community, we tend to think of mobility in terms of public transportation. unfortunately for the medically impaired driver, those forms of transportation are simply unacceptable. our focus has been on developing more responsive, alternate

models of transportation to keep people mobile and independent. >> thank you. >> one of a the findings from the reporting of the increased fatality risk from the very old driver. what can you tell us about crash involvement? >> it is a pleasure to be here today and to be able to speak to you about this. i am going to give you my bottom line message up front, and then i will explain. i think that the issue of crash involvement and fragility or frailty is trying to answer the question of responsibility. the main question around the issue of crash involvement and frailty or fragility is that older drivers tend to have higher crash rates when you take into consideration how much they drive. is this because they truly have more crashes, or is this

because they are more likely to be hurt or killed in a crash? they will end up in our databases and either it will appear that they are more of the problem then they are, or it will appear that they are a problem when they are not. that is the issue that we are trying to get that. the answer is critical, because if you are causing more than your share of crashes, maybe the safety measure that we need is to take you off the road. in short, you are responsible. if the answer is just that you're more likely to be hurt, the answer may be to improve vehicle safety features or roadway safety features. in short, you are physically frail, not responsible. research has investigated many of the factors involved in crash involvement. i'm going to mention just a few that i have put up on this slide

here. how much do you drive? the low mileage bias that was mentioned. drivers to drive a lot tend to have your crashes. drivers to drive fewer miles than to have more crashes. is this because they are restricted to slower speed urban roads where there are more likely to have potential conflicts and crashes, or is it because of a reduced driving ability so that they are driving the minimum they need to get by? crash involvement may not differentiate between a causal action that you have done -- u.s. caused the crash, so you are responsible, and crashes that someone else caused so you could not avoid it. factors affecting whether your physical frailty will lead to injury or death in a crash include whether you were buckled up, how save your vehicle was -- how safe is your vehicle was,

and what kind of medical care you received. that is a mix of factors that you have control over and factors that you have no control over. part of crash involvement is whether you are a risk to yourself or others on the road, or both. researchers have quantified this risk in addition to quantifying the proportion of excess crash involvement that can be explained by fragility or frailty. i keep using fragility and frailty of the same time. people typically use them interchangeably. it is interesting that the medical people tend to say frailty and the traffic people tend to say fragility. in the literature, they are normally used interchangeably. in general, when you look at the literature, there is some accessorized to other road users, typically to passengers of older drivers who are themselves frail or in fragile

health, although the excess risk is small when you compare it to teenage drivers or young adult drivers. high-pitchthe contribution of ro excess crash involvement is in -- of frailty to access crash involvement is interesting to quantify. several studies have estimated that it is about half of the ss crash involvement. it is hard -- half of the excess crash involvement. it is hard to quantify. when you take into consideration frailty and fragility, a low mileage bias, and maybe the types of roads that older drivers are driving on, it makes a difference in our consideration of how much of the excess crash involvement is the

responsibility of drivers themselves or not. i think i will stop there. thank you. >> thank you. the way we have structured the format for the panel this morning, we are going to not take an opportunity to ask you questions. i have targeted these questions to individual panelists, but i want to take this opportunity to encourage all of you to step in. this is meant to be an interactive discussion at this point. by way of foreshadowing, we are going to do the questions and answers from the technical panel to the panelists until about 10:20 a.m., which gives us about half an hour. thank you is so much for the timing on your opening remarks. we really appreciate your respective clock.

just to reiterate, we have asked that one person from the table be a spokesperson for that table, and that the questions you want to ask you are riding on the question cards, which will help to make it -- riding on the question cards, which will help to make the -- writing and the question cards which will help to make the questions the sink when they come around. -- succinctl when they come around. your report seems to tell us the drivers are not the problems we might have anticipated. what might have changed from earlier studies to today? >> safer vehicles, for example, we know through research that we

have done and others have done. we are all driving much safer vehicles than we used to. the key to our study is the weber explains our findings has to be a factor that has -- whatever explains our findings as to be a factor that has affected older drivers more so than middle-aged drivers. older drivers tend to drive older vehicles. we know that more people are buckled up, but the key to answering the questions that derived from our study are, these factors have to be something that have affected older drivers much more strongly than middle-aged drivers. i talked about a couple of the possibilities. certainly, improved health, and basically, better physical conditioning stands out. how we do the studies to see

whether that part of the answer -- we're not sure how to do that. again, i think travel patterns are important. when we get the data from our latest travel survey, again, the preliminary findings show that older drivers are driving a lot more overall and on average, but we need to look at, beyond just the quantity of driving, it has been suggested, for example, we know that older drivers tended to have certain types of crashes. there crashes at intersections are particularly high because they tended to drive in more urban areas. has this changed? are they driving on high-speed roads which have a lower crash risk and are safer if you crash ta?

and these in the things we want to take a look at, but again, it is very challenging to figure out how to do the study in a way that will come up with the answers. basically, we are not sure. >> thank you. you alluded to this in your opening comments, but i wanted to get a quick answer to assisting question. people worry about older drivers posing a risk of injury to the other drivers. how do older drivers compare with teenage drivers and those in middle age? >> older drivers do less harm when compared especially to teenagers and people in their 20s. >> thank you. they are mostly a danger to themselves and to their passengers, who also tend to be older. >> the last of my three questions to you is, self restrictions such as limitation

of time of day for travel or avoiding and noun routes appear to be, a common in older drivers. does this solve the risks that they might pros -- that they might pose to themselves? what i do not think we have the answer to that question. >> do the right people self- respect? we are doing a study now that is falling older drivers over a five-year time period. we're asking them about physical mobility, diseases, and their travel patterns. we had a couple of questions, but one is, doesn't look like the right people are self --

does it look like the right people are self restricting? with an increase in an impairment overtime, does that translate to an increase in self restricted driving? i do not think we know the answer to that question. another thing i would point out, and there may be people talking about this later, is that there are state programs, and we looked at one in iowa, that have -- that attempt to identify drivers of any age, but especially older drivers, who may be should be restricting their driving. they are given a road test. they can renew the license without restrictions, but for some drivers, they place restrictions. we interviewed drivers in these categories, and we found that the drivers to report said --

reported the greater impairment surety drivers that iowa was identifying for a road test and then giving restrictions. the other thing we found was that they tend to comply with the restrictions, but they also, in general, a firm or strengthened if the restrictions these older drivers -- confirmed or strengthened the restrictions these older drivers were making. i think in the long run this would not totally eliminate the higher crash risk. >> thank you. >> doctor, you have been showing a very dramatic decrease among drivers who are 80 or older.

you said that these drivers are driving more than in the past, but i am also wondering whether this age group might contain a lot of people who are holding on to their licenses because we use licenses for all sorts of purposes, at the bank, the airport and so forth, whether you might have a large proportion of people in their eighties who hold on to the license but in fact are not active drivers. is that one possible explanation for the very dramatic decline? >> i keep pointing to the national house will travel survey. there may be other surveys -- household travel survey. there may be other surveys that are not national, but that is one of the questions that i think we can answer when we have travel patterns. although, the survey did not specifically asked if someone is

a licensed driver. they asked if they drive. again, without a good survey with detailed travel data, i do not think we can answer that. >> do you expect the national health and travel survey, when it becomes available, to provide adequate data on the amount of driving and type of driving performed by older drivers? >> i am a researcher, so probably i would never say that anything is adequate, but i think it would go a long way. for example, it would talk about the number of trips, the length of trips, to some extent the types of roadways circumstances for older drivers, so i think it

would go a long way. it has information on the vehicle being driven, for example. it is a sample, a fairly large sample, but still, whether for the very oldest drivers there will be adequate data to look at everything we want to look at, in our models that included the 13 states, we controlled forestay but we did find some differences among the 13 state -- controlled for state, but we did find some differences among the 13 states. we would like to look at the geographic component of what we are seeing in crashed trends. a national sample, even a very big national sample, quickly becomes problematic when you get to a state level or a city level, for example.

i wanted to 0.1 more thing out because a couple of people have that -- i wanted to point one more thing out because a couple of people have asked about gender in our studies. we have done a couple of gender studies, but we did not specifically looked at the differences between men and women in some of these trends that we saw, so we took a look at that, and we found that the declines for women were somewhat stronger but not significantly so. so, what ever is explaining these differences, the answer does not seem to lie and differences among the genders. >> thank you very much. that is very interesting. i am now going to turn this over. >> hello. i cannot do this without my

glasses. what is that telling us? where people live dictate their travel patterns. the first question is, what do we know about where seniors live? you alluded to it in your opening remarks. i am curious about the types of knowledge we have about the types of traps they take and where that information comes from -- types of trips they take and where that information comes from? >> as i suggested, at older people live in low density places. these numbers are from the census. one of the problems with the senses is determining what is suburban. you can live 30 miles from downtown houston, downtown tampa, downtown phoenix and be considered in a central city. these numbers actually under- estimated the number of people

living at fairly low densities. that trend is strengthening. i invite you to read this chart from left to right, because the younger cohorts are very suburban, and they are bumoving through, and the cohorts' behind them are even more suburban. what we are seeing is that as people age and place, the largest percentage of older people are going to live in very low density areas, and somewhere around a little less than one- fourth are going to live in rural areas. what this means is that the car is the only feasible mobility option in many of these areas. and people talk about, well, what of older people moved back to the central city, but that is not what they are doing. let me see chart four please.

this is brookings institute data. the census does not every year figure out a one-year move freight. these are people the move tom. this is not a percentage -- people that moved home. these are in the thousands. this is not a percentage. there's substantially less likely to move than younger people. there is substantially less likely to move states, so they're not moving very far. most of the movement is in to care facilities. the idea that older folks move from chicago or detroit to tucson or tampa or houston, actually, they are less likely to do that then they were 20 years ago. it is just that there are many more older people, so those of us that live in the sunbelt see a lot of older folks coming in, but they are actually a smaller and smaller share of the total

population. most people stay in the house where they were when they were still in the labor force. what we need to be talking about then is talking about mobility and accessibility in those types of communities, because as older people encounter difficulties with driving or just do not feel like driving, there are very few options in those communities. well we are seeing is people staying in low density communities. there it is. remember, not many older people are moving, but for every alderperson him moves from suburbs to central city, -- for every alderperson -- older

person who moves from suburbs to central cities, those are what we call man bites dog stories. they are reported on because they are unusual. let me show you something else. could i see number eight? it is a map of tucson. there we go. that is it. this is a really terrible picture, and i am not sure the colors are going to show up. in the left is tucson, arizona. the shaded areas are in the city of tucson, the incorporated area. the little map that you cannot see on the top is north of tucson. those red dots that are hard to see our active adult retirement

communities. they are also informal groupings of people who moved out, someme dots, you will see that almost all of these are on the edge of the metropolitan area. these are people, causlargely, o moved in from the snow belt to the sun belt. we did this in phoenix. other people have done it in other areas like tampa. where they move is to the edge. most older people do not move. they are aging in place in low density areas. but those who do move to other states are moving out to the boondocks. many of these communities have no resources, transportation resources whatsoever.

there are no bus resources. these are people who move when they have a car engine not have in their mind that they will not have a car in the future. >> can you give us some urban planning results that would be of benefit to seniors? i know you have worked in other countries. is there anything you know of in other countries that would serve as an example? >>-agree with my fellow panelists that public transit is not generally the answer because traditional public services are not meant for older people, they are meant for commuters. they do not serve the destinations that older people want to go to. they report frequently that they do not like the vehicle starting before they get to their seats

and all of the other kinds of inconveniences that the rest of us put up with when we use public transportation. but there are some services that have been tried abroad, particularly in scandinavia, where they have community buses or service routes. they are public transit in smaller vehicles. older folks report liking being in smaller vehicles so that if they have a problem a driver can see that they have not made it to their seat and so forth. and they serve the origins and destinations that seniors are more interested in. they are public transportation. anybody can get on board and pay the fare. but these have been successful in europe. they're more expensive than traditional transportation services, but they are not more expensive than door-to-door services. i wonder if you could show me slide 20 please? this is, when it comes up, i just took some public transit systems at random. you may know that the americans

with disabilities act requires public transit operators to provide at least curb to curb and services. some provide door-to-door, even door through a door. i did not cherry pick these. i wanted to get some sun belt and rust belt cities in a random selection. the first column is the annual number of trips that these services -- that are provided by the transit operator in their community. if you look, the next column is what percentage of the total system writer shed -- ridership are these ada trips. you will see it is very small. the highest is miami. in the next column you will see what a one-way trip costs. if you take mrs. jones, just take her to the doctor in

boston, that costs you $33.21. if you take her to the doctor and bring her palm, it is $66.40 two since. -- bring her home, it is $66.42. look at some of those systems. miami is spending almost one out of every four transit dollars to provide these aba services to a very small percentage of its total writer ship. what this means is that these systems -- ridership. what this means is that these systems are not very likely to expand. crises like 22 please? -- could i see slide 22 please?

these are all people the reported to the senses that they had a serious disability, not just older people. all i did was divide the number of trips by the number of people who might be eligible for those services. in chicago, for example, the average person of any age with this serious, self reported disability, got less than one- fifth of a trip per year. in fact, what happens is that the overwhelming number of people who are eligible for these services never use them at all and a small number use them frequently. but the last column calculate, for each system, given their 2004 costs, which you just saw on that previous chart, and i

just said, well, what of the transit operator provided for every person with the serious disability of any age, what if they just provided them with one round trip a year? so, you're talking about in atlanta, for example, to hundred $90 million more per year just to provide people with serious disabilities with one trip per month. so these options are not realistic options for the very large number of older people who are not going to be able to drive. i do think that there are public transit options that are more geared toward older people, but i think the answer really is to use the underutilized capacity in cars, all those empty seats in cars, and i am a very big advocate of volunteer driver programs which are much less expensive and are a way to provide services in the low density areas where public

transit and these kinds of services are not going to make sense. >> thank you very much. this is very interesting. i really appreciate that you have covered a lot of the questions that we were going to ask. i am now going to move on to ask some questions of bonnie. i know that you have an expertise with the whole area of premature driving cessation. i would like to ask you a couple of questions about it. what evidence is there that save drivers are misjudging their own skills? >> a the issue of self- determination driving competency

is an interesting area. when i think about the senior population, people often think about the population as being a homogenous population. when i think about whether people can accurately assess their ability to drive, i think about a framework, if you think about the person's real competency, and then their perceptions of competency. if we look at the combination between real competency and perceptions of competency in the first upper left sell, you can see that there are a group of people that are competent to drive and perceive themselves as competent to drive. the likely outcome of that

combination is that those individuals will continue to drive. at the next cell, in the upper right corner, is when individuals do not perceive themselves as being competent to drive -- sorry, thank you. the individual is no longer competent to drive, but they perceive themselves as competent. in this case, the individual will likely continue to drive, but that will be an inappropriate continuation. in the lower left sell is where the person is competent to drive but they perceive themselves as incompetent to drive. the likely outcome would be inappropriate driving at cessation. the fourth cell is where the

person is no longer competent. they recognize that they are no longer competent to drive, and there is appropriate driving at cessation. how does that have relevance to self perceptions of competency? if you look at the first cell, that likely represents the majority of healthy, older drivers. the upper right selcell represes individuals with dementia. they perceive themselves as competent when they are not, and they continue driving. interestingly, research we have done indicates that if you ask them to rate their driving competency, most often they overestimate their driving competency, such that they perceive themselves even better to drive than their age matched

individual. using screening tools and this population, cell screening tools, is not going to be helpful at all. they perceive themselves as competent to drive and will continue to drive. interestingly, the lower left cell, where the person is competent to drive but they perceive themselves as not competent, that is likely representative of older females. we know when we look at the data that older females often engage in premature driving sensation. i think this selig is interesting in that we could likely -- i think this selcell s interesting in that we could likely to some intervention to keep them driving. the ones you are not competent and perceive themselves as not competent are once we need to provide transportation for. >> how much longer can we expect

to live than we drive? >> this is research that men outlive their driving careers by six years and females outlive their driving careers by 10 years. >> thank you. most of us should prepare for the day when we no longer drive. there is news in that. doctor, you have been the cleanup analyst for two rounds in a row. thank you for your remarks. they were right on. a recent study from cdc shows that the annual cost of traffic accidents are about $500 per licensed driver. older drivers have an average annual cost of $118 per driver. that is such a difference. why are the costs so much less

for licensed, older drivers? >> if i could explain to the audience a little bit about what we did in that study, i think it will make sense. i'm from the injury center at cdc, said you will understand when i tell you that when we do cost studies, we consider medical costs and productivity costs. we're less concerned with damage or travel delays. we are more about injury prevention. it is a very conservative cost estimate of motor vehicles in the united states. to study the first. we estimated $99 billion for a year. to cover that cost, because it is a great way to get people's attention, that would mean $500

that every licensed driver has to pay to coverage the medical and lost productivity of all drivers and a crash. it would be fatalities, hospitalizations and visits to an emergency department. plus of lost productivity. this human capital approach, one thing and does -- it does is it undervalues children, women and the elderly. why why? because we either do not make any money as children or, as women, we make less money than the men. so the cost for men will be higher. the $118 per capita for older male drivers was an average, and for older women it was $67. so the differences here are largely due to our methodology,

at which takes the medical spending plus they productivity losses, and the productivity losses are a bit skewed, i guess, is the way to put that. does that make sense? also, as an aside, the death does not usually cost as much as hospitalization, so if you die, you're accumulating less cost than someone who has an extended hospital stay, for example, which might do if you are older and have underlying medical conditions and then you get injured in a crash. >> thank you very much. we are running a little bit low on time here. i would like to ask the entire panel to make some great grit -- brief remarks about their recommendations for future research. bear in mind we want the party

still have time for questions. since you keep starting last, why do not start first, doctor? >> one question that might have come up that i think we discussed, at what risk to other road users and what kind of research in that category do we need? my point there is, there have been several studies on risk to other road users by older drivers and teenage drivers. i am not actually sure we need to do that again. the results are fairly consistent. my answer to that is that we probably do not need another study that shows the risk of older drivers to other road users. i think we have that covered. >> thank you. >> i guess i think about the older driver population, an area

of research that is sorely needed is in terms of providing alternate transportation. we know that there are challenges in providing transportation to seniors, and that is only going to escalate in the next two-three decades. when i look up the research that has been done, regarding transportation outside of the traditional public system, we know that there are a number of organizations in the communities that are not providing transportation for seniors, but there are more gaps in that transportation provision then there are strengths. research that we have done indicates that in order to build a responsive model that will meet the demands today and in the next two-three decades, we

need leadership that both the local, state and federal levels. we have a need for more collaboration. there is the need for the identification of new funding streams to start building the transportation models needed, and we need implementation of innovative and sustainable models. it is interesting, when you look alternate transportation for seniors, most of the organizations are working tirelessly. they do a lot of work in terms of fund-raising so that they can provide the transportation for seniors at a cost that is acceptable. however, that approach often ends up being a barrier in that they spend most of their time fundraising so that they cannot afford to provide the transportation. i think that, when i look at transportation for seniors now,

there is a lack of capacity building and there is a lack of sustainability, and research is needed, and implementation in order to address those needs. >> thank you. your thoughts, doctor, on directions for future research? >> i would mention three. the first is, as i said, to try to dig down deeper and look at the geographic differences, to try to understand better why we're seeing this very positive change. the sec would aid -- and i know you have a panel on this -- -- the second would be, and i know you have the palin desk, -- have a panel on this, the safety of

vehicles. i think all we can do is look at crash-readiness. there are new crash-avoidance technologies that people are looking at as being very promising to preventing crashes from happening at all, and there is a lot of discussion with regard to research on this about how older drivers either find them confusing or how will they benefit compared to younger drivers. i think that is a promising area. finally, i think we still need to look at restrictions by state. when there are bad crashes involving an older driver there is always a move to impose restrictions. i think there is still a lot we do not know about the effects of visual requirements or other

special restrictions better placed on older drivers which, in the end, affect their mobility. so, that would be the third area i would suggest. >> thank you. dr. rosenblum, your brief thoughts on directions for future research. >> i am very interested in the whole issue of premature driving sensation. i do a lot of work he -- driving a cessation. i do a lot of work on that here and abroad. it tends to be women who give that a more than they need to, and increasingly they are spending their senior years living alone and with no family members. i am very interested in that. i am very interested indeed all issue of whether men and women receive safety issues differently. there appeared to be some messages about that.

i think we need to look of the range of women, for example, being more willing to ask for rides from friends, family and neighbors -- family members and people in the neighborhood. i think there is a lot we could look at that will be very gender based because women are willing to look at options that men are not. i want to disagree a little bit with dr. dobbs. i am not sure that we'll lot of research about why things are so expensive. i think what we ought to be looking at is how we can develop a package of options that could include people moving to facilities that meet their needs better. i do not necessarily mean

nursing homes, but whether there is a way to get people to a better place within their own neighborhood. >> thank you very much. this has ben a very interesting set of presentations and questions. i am now going to turn this over to the chairman to work with the parties. >> this is great. you have certainly helped me understand my parents a lot better by explaining who decides what to give up when. how are the panels doing? would you like a short break? we will move to the parties, and we are going to go in a round robin and allowed each of the tables to do questions. we will begin with n.h.t.s.a.

>> good morning and thank you for the presentations, all very interesting. we have a couple of questions here. you mentioned that you thoughts our national database as -- you mentioned that you thought our national database was not sufficient for answering these questions. are there other databases and other countries the would be useful to look to for comparisons? >> i am not as familiar with databases in other countries. we do have a sister agency that gives us claims data for the insurers the limitations to our

data is that it is a huge database, huge sample size, but not a lot is known about the circumstances of the crashes. it is a database that we use. >> do we continue with our table? this is a question from jonathan at the national institute on aging. pardon me, my throat is sore. what would be the best estimate of the cost of premature driving cessation in older drivers, just considering the cost of paratransit and other taxing services? >> i've no idea with the dollar

cost would be, but if someone prematurely stops driving, they probably do not qualify for the community-based services. you have to be significantly disable to qualify for ada services. i think it is hard to quantify the social isolation and the lack of interaction. i think there is a lot of evidence that those kind of symptoms lead to earlier morbidity, and i think it is tragic. i do not know that anybody can put a dollar figure on it. >> have a demographic changes related to people staying in the labor force longer affect older driver issues?

>> actually, it is women who are staying in the work force longer. presumably, they will keep their drivers' licenses. i think that is an interesting question but i do not know that anyone has done any research on it. >> we have one last question. someone mentioned that seat belt usage rates for over drivers -- older drivers is different. how does it compare to the average age driver and does it change for drivers you're under restrictions, restricted drivers? >> i do not think that the belt use is problematic compared to

younger drivers. i do not know how bellevue's relates to restricted drivers. -- belt use it relates to restricted drivers. when we did our study, we did talk about, when you look at trends in the insurer claim database, they are not seeing the decline in claims rates for older drivers compared to younger drivers. there are some differences. their data related to newer vehicles. these are crashes reported to insurers, not police-reported crashes, so those are two different reporting systems. it is different, and again, we tried to figure out why that might be, but i should mention

that it does present, not a positive finding, as you might say, for older drivers relative to younger drivers. these are crashes of all severities, and the data are dominated by a low injury non- severity crashes. >> some of this is predicated on the recognition that mobility is so central to our independence. restrictions in driving are appropriate, i would argue, for some segments of the older driver population, for individuals with visual impairments, restricting their driving to daytime only make sense. but often, those restrictions are generalized or extended to individuals with cognitive impairment.

in those instances, it is inappropriate. my analogy would be that, we would not think about letting an alcohol-impaired driver drive within a 5 kilometer radius of a palm. we would not -- of home. we would not allow the driver to drive between 10-2 in the afternoon. that is essentially what we are doing with an individual with a cognitive impairment to is no longer safe to drive. . .

the women rated themselves worse before and better after. what seems to be occurring is

that women are saying, this is what good driving is and i am doing it. i feel better now. i think we need to be looking in terms of immature driving, get some evidence-based things about telling safe drivers that they are a safe driver, here's something i can say to my husband are just to myself to feel good about driving. >> our next question is for an mccartt. despite decreasing numbers of fatal crashes for aging persons, the share of all fatalities is increasing? this is from a recent white paper that was held this past summer -- for a conference held this past summer. >> i am not sure i follow your question. you're saying that even though fatal crashes are

going down at a faster rate that middle-age driver, they are an increasing percentage of all the deaths? >> that is correct. >> i do not know what that is the case for not. i know that we have seen strong declines in team crashes teamteen -- teen crashes. our study looked at the vehicle drivers. it would not actually support your hypothesis because motorcyclist deaths have gone up and foreign drivers, we did not like that. -- we did not like that. we would need to check and i can check why you're asking people other questions. but i do not know.

>> the following question with barriers and the use of car programs, any type of program outside the traditional options, whether in shirt ability, training, education, etc. dr. dobson dr. rosenbloom if you my address those -- dr. dobbs, dr. rosenbloom, if you might address those? >> in alternate transportation service provision, just for clarification, transportation outside traditional modes such as public transit. it is often provided at community levels by community organizations, seniors' organizations, church groups. typically the model is such

that alternate transportation service providers for seniors rely primarily on volunteer drivers. some organizations in new -- use a belinda pay drivers and volunteer drivers. when you look at service provision comparable to the paid driver and volunteered drive robot, it is more responsive because it allows the service provider to provide transportation not only on weekdays but weeknights and weekends. we know that when we look at senior transportation, often there what is called like enhancing transportation, to get to the doctor, to get to the grocery store. but they are life enhancing transportation needs are not met. to attend religious events, so

to use a blend of drivers is more responsive and costly. alternate transportation service providers spend a great deal of their time and their resources fund raising to provide what they perceive it as the affordable transportation for senior. interestingly, that perception, that assumption, that transportation should be provided at no cost or little cost is a barrier in that all of us pay for transportation until we're 65 years of age. for some reason, there is an assumption 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 am quite willing to pay and pay more than

what my service provider is charging me. i recognize that there are attempts to deal that do not have resources and we to name the subsidized. but for the most part, there's more capacity from the singers themselves to assist with building other models of transportation. given that there is not enough money. there is a huge demand and there is not enough service. some of the other issues are not as pressing. it turns out that insurance is not that big a problem. people talk about it a lot and some volunteers systems to provide insurance coverage. you can be covered under the national agency service. that sometimes make volunteer drivers feel better. there's not a lot of evidence that people are running around getting into terrible crashes. it is less of initiative you

might think. one of the problems i see is that when any of the services get to any size, they run into economies of scale. early in my career, the red cross was running a service and el paso, texas. i went down there -- i think i have that contract -- assuming they would have the cheeping -- chip is cost of any big city in texas. in fact they were somewhere in the middle. i cannot understand it. they had volunteer drivers. they had have people sitting around, coordinators' or social service providers, for the drivers that did not show up. a lot them, they do not feel well or it is raining. you have these paid back of drivers. the problem is, i do not want to talk about the thousand points of light business, but a lot of little services, like

thousands of little services, might be a better way to do it. once you aggregate them up, then you have to have that back up drivers and the new start to be a business. i have looked in the beverly foundation has as well, looking at some of the well known volunteers systems, and they are running $25 for a one-way trip. with a volunteer drivers in their own cars. there is an issue there, 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 do the scheduling, and the cost efficiencies. >> our group has time for one

more question. sandy, you mentioned that this is a major issue. as a city planner, could you talk about what some of the potential land use solutions might be? >> it is very heartening that the federal transportation administration has taken on along with their promotion or 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 around light rail and transit services. you gentrified, some neighbors in it -- and sent to cisco where they put in transportation to force elderly citizens of because the rents go up. we have to make sure that denser areas with more transportation choices and land use choices, to walt to places, that it remains affordable.

they're plenty of older people with a lot of money. others do not and we have to be watching to make sure that as we provide more desirable options, that the people who live there can afford to live there. >> i wanted to follow. i do not have the information to answer the question. it is a good question and i should know the answer. in this possible, when you look at the data, and we looked it over drivers, if elected death in children and pedestrians, i do not know how the total package has changed. but it gives me an opportunity to reiterate the composure. the reason that our study was interesting or important, maybe, is that this is not what we expected. we have more older people, more drivers, and the best indication is that older drivers are driving more. that is always the ultimate

measure and we are always trying to reduce, especially when you're comparing age groups and different comparisons of drivers, it is critical that you have this exposure measure. i just wanted to clarify our study, not focusing on deaths, but deaths per licensed drivers. you tend to see the same pattern. >> we will proceed to the next table. >> an excellent presentation so far. this is for the whole group. it is kind of a two-part question. that is lacking on the effectiveness and the lives sea of many screening methods of programs and associated licensing process was seized. what should have national priority for data prior to?

i should priority areas be defined for large-scale national epidemiological studies to address those issues? >> could you repeat the first of your question? >> is a long question. that is lacking on the effectiveness and quality of many screening methods and assessments and licensing policies. what if any of the above should have a national priority for data collection -- the actual collection of data? >> i think that there are a couple efforts under way.

i know that california and maryland had been very progressive in looking at the development of screening tests supposing to the -- that could produce reductions in crassus. i know that california is not just focusing on older drivers. there's a study of drivers of all ages and different screeniet of countermeasures is older to -- older driver safety, relating them to crashes. i think the priority would be whether to random assignment or other strong research methodologies to try to get to that goal, which is to identify

specific screening instruments that would not only change driving behavior or self- recorded behaviorist, but track behavior's for actual crash reduction. and that will not be easy, believe me. >> i will talk about what is happening in canada. we've just developed a new screening tool for the identification of cognitively impaired drivers. one of our jurisdictions in canada, british columbia, the new screening tool called a smart md has become the screening tool for positively -- cognitively impaired drivers. it is a requirement by their department of motor vehicles. it isn't evidence-based driving about tuition. -- it is a evidence-based driving evaluation. in alberta, it can be used by the medical community. looking at our website, screening tools are being picked

up a lot by the medical community, the occupational therapy community in the united states. i think that it is really important for us to start looking at the effectiveness, the efficacy of these tools when they are introduced. i'd love to see research done -- we're doing research in canada to see research done at the state level in the united states as well. the screening tool, the smart indeed, focuses on cognitively impaired drivers, but we need the same type of development and then and implementation in results of that implementation for motor conditions and visual conditions. to me, that would be a priority, particularly when you look at the demographics that are coming out it is most often illness, not age, that affects a person's ability to drive.

if we can start targeting that at risk population, then there should be reductions in collisions as a result of identifying the appropriate drivers who are at risk. >> the next question is for dr. rosenbloom. is there evidence of changes in patterns of older based drivers that may help explain their production in crashes? >> what is ironic is that they are driving more, driving to different places, they appear to be driving in situations they did not before. peak periods traffic is spread out so much that you cannot avoid it, so they are driving more in congested times because they cannot avoid it. it is interesting and i think that is the issue, they are doing all these things more. why aren't they getting in the more crashes? i don't think we have good data

on that. >> i think also, we do not know the relationship why they are driving more. i think all these things are bound up together in terms of looking as the root cause, it is hard to ferret that out. >> i was just asked to pipe again. we cannot really explain fully the huge drops that we have seen in the last couple of years overall. and 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 is amazing that it has gone down that far. on the other hand, i am not willing to say that 34,000 deaths is anywhere near good news.

it is part of the good news, maybe, that older driver safety seems to have improved more than anybody else, and we have the shocking safety gains of the last couple of years. but we cannot fully explain that. people who talk about the economy, and differences in discretionary driving -- that might update others besides those that are working every day, but a lot of it is guessing. even when you put together the economy and safer vehicles, and then they are driving more -- we cannot explain it. it is interesting. >> i think also -- i seem to be bearing the bad tidings of data -- but alas travel survey conducted during the gas crisis and during the downturn in the economy. the last one was also during a

recession but not as bad. if we did not happen happened national travel -- if it were not only other seven -- every seven or eight years that we do a survey, we would be able to understand a lot of this. it will be just the fact of life that the way -- that travel data that we have was collected during an usual periods. hopefully unusual. that will make it challenging, especially when you are 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 from 2001 and 2002. >> another one for the whole panel. we know that boomers are struggling with houses and aging parents. as we look at the influence of adult children on their parents driving decisions --

>> i think that question goes back to the accuracy of self assessment. we know that self assessment of driving competency is pretty inaccurate in populations. we know that older possible -- older people overestimate their competency. the research that we have looked at in terms of family members, caregivers, making assessment of driving competency, these assessments compared to actual on road driving assessments or the individual was determined to be driving safely based on a road test, is that family members are not very accurate, either. caregivers tend to be less accurate than sons and daughters who live nearby. i think that there is some good

reason for that. if you have an older couple, it is the gentleman driving and his competency is being questioned, the wife does not dry. she is going to be less reluctant disclose that his writing has declined to wait on safe level. that may change with the baby boomers because there are more more license to drive in my cohorts in in my mother's cohorts. the next groups would be sons or daughters. if they are living close to their parents, they beat me -- they may be more accurate than those who live at a distance away. they have no greater in science thing you are right. i take on the situation is that if you have someone, a family

member or a neighbor, the most evidence-based assessment is to have them have a road test. >> there actually is a lot -- leaving aside whether the kids are writer not -- there is a lot of evidence about kids and a lot of it shows that older parents do not want to listen to their children or their family members. they just do not. whereas i said earlier, women are more likely to listen to criticism than men. i have found some funny things. i lifted the study for the british government, and while both sets of kids expressed concerns either about their parents' current driving or what was happening in the future, i found that americans were much

more worried about what it would mean for them if their parents stopped driving. i liken it to white parents let teenagers, much more dangerous, why would you let your teenager's drive all the time? it is because a major life easier. once the kids get a licensing you do not have to cart them around, you're like gets easier. what i am seeing among adult children of older drivers in the united states is that yes, they are worried, but their equally worried about what it will mean to me when my mother stopped driving. it is not just the driving. will she come live with us? will we have to move her to a care facility? it is hard to interpret what people say, sometimes, but i see some willful ignoring of some bad signs about their adult -- their parents, because they see

this crushing weight of responsibility hitting them. i think that gives us a window for policy. if we can be talking to baby boomers who are now experiencing problems with their parents, and they can see the burdens that they are going to carry because there's not enough transportation and mobility options, maybe we can get the baby boomers -- not for themselves, you can never sell people on what it will do for you, they do not want to see themselves in that position -- but if it and say, ok, here are the burdens you will carry for your parents, don't you want to fund some more alternative services of those burdens to not hit you? -- so those burdens do not hit you? >> point is a good one. people are starting to realize that for illnesses, the driving

is a canary in the coal mine. particularly for cognitive impairment. people have memory problems, the family can explain it away. but it driving becomes effective, then they can no longer explain it away. that is when action start occurring. driving can become the early or not so early sign of decline. in the primary care setting, 67% and 90% of mild, the defense. then, so driving needs to be on the radar screen. often when driving privileges are revoked because of illness, the blame is put on the driving

mom or dad. there has to be all of these lifestyle changes because they can no longer drive. in fact, it is because there is an illness. the lifestyle changes are going to occur. the loss of driving privileges means the family has to step in and someone has to step in and make the arrangements. those arrangements were going to have to be made anyway. it becomes the red flag for it. >> thank you. thank you all for your honesty in answering the questions. it is very refreshing. the woman to the left table. geithner s.a. read -- ghsa. >> first question is for anne mccartt. it has to do with seven groups.

>> if you could pull the microphone closer? >> are there differences within the aging population, in crash risks between those drivers who are 75-65, and those that are older than 75? did you find that in our we had three groups. consistently, what you saw was that the beneficial or improvements we were seeing with the strongest for the very oldest drivers. i believe in our initial study, we took a look at 55-69, and i believe we found they were not that different, actually. in our study. there may be other ways, but in

our methods, they were not that different from the middle-aged group we were looking at. >> i wonder how you make some projections if you can. do you expect the decreasing crash risk in older drivers to continue in the future? >> do expect the improvements to continue? >> we would have to know what causes them. >> i would say that. i'm intrigued by that question. whenever you are looking at a group and other groups, there are other things going on. we were partly looking not at better but are they doing better than other groups? children's, the gains that we have made for children in crashes, it is phenomenal. but, yes.

i do not have a scientific reason for that, but i think that what really stood out for me was the consistency of what we were seeing. it was almost every year, a decline in deaths. we elected all of these different severities of crashes and it was very consistent. i did not talk about it today, but we not only looked at whether older drivers were less likely to die, we looked at whether there were likely -- less likely to die or be seriously injured. i think that what was compelling to me was the strength and consistency of what we were seeing, and while we cannot explain it, what that says to me is that it is part of something that may be long lasting. the big question which one of the other panels mentioned is what has happened in the last couple of years.

i agree, we do not understand it. putting that aside, i guess, i think what is it ever happening will continue to happen. >> we have to think about older drivers, not just the current older driver population, but those who will become older drivers in the future, our cohorts, people our age. so when you think about the future older driver population, do you think that -- can you project whether they will continue to have a reduced crash risk, or are there any differences that you think might occur between people who are older now and people who will be older in the future? >> is this for me?

it is hard to be objective about this. because i will be older present. i am already older, but i will be 70 and older. again, this is purely speculative on my part. there's an expression which i never get right, but the new 70 is a 60 -- whatever. i think people who are older are really different than they were certainly 20 years ago, maybe 10 years ago. and i think it has to do with health, but also just lifestyle. but again, i am looking at myself here and my colleagues, and i think, gas, i looked at my parents' being different than their grandparents.

i think my travel patterns will be different. my health will be better. i am not representative of the population as a whole. and there are lots of people who will not be healthier than their parents. but, yes, old age is not what old age used to be. >> sandy, the same question for you. do you think that there will be differences in terms of lifestyle at demographics? >> one of the things that anne said that surprised me, while women increased safety faster, there were no statistically significant differences. if she had not said that, what i would guess is that more women in the 60's with a lot of experience under their belt becoming better drivers with

higher exposure over low mileage bayh's. that is what we would get, women coming in with 30 and 40 years of driving, interesting situation with screening kits in the car and all of that. even if she cannot see is statistically, i still suspect that women are just more experienced drivers now. and people to have a healthier attitude toward these things. safety is a hard sell, but i think it is slowly coming into people's behavior. >> i do not know what that data looks like in the united states, but we looked at data last year in terms of the baby boomers. we look at the mail and mail --

male crash rates are higher than a female crash rates. what we found in our transport canada data is that the baby boomer females are looking more like the male baby boomers, both in the terms of amount driven and the number of crashes. based on those projections, we expect our baby boomer cohort, the females, to look more like the males. the second consideration is that while there is a segment of the baby boomer population that is going to be healthier than parents, there will also be segments of baby boomer population that are in poorer health. if you look right now, and i am sure that the statistics in the united states compared to canada, diabetes is an epidemic proportions. right now in the united states,

one in seven americans have dementia. 3.4 million americans 71 at or over have dementia. that is expected to increase sevenfold with the aging baby boom population. there may be segments of the baby boomer population that will be safer to drive as we move into senior years, but there will be population at risk. >> do you have any more questions? thank you very much. >> just one quick question. would any of you care to comment on the current or future role of doing things like shopping for my drugs on line or by telephone or my groceries in that way? things that can actually meet daily needs without causing the driver to get out on the

roadway. >> i just saw a study that said that online shopping encourages store shopping. it was not a substitute, it was a complement to that. you can troll online and the various things and then you go out to the store and look at them. it's an interesting question that a lot of people are addressing, the extent to which online's shopping will substitute for travel or almost all improvement in in communication technology and travel technology has led to more trips because you can easily cause someone in your -- call someone in europe, and you are more likely to go and see them. these things do not impact substitute. i do not think that we fully know that. >> other areas are social

networking that is occurring. particularly when you look get needs for social interaction. increasingly people can have those needs met for the internet. i do not know of any research being done in that area, but it is an interesting area that people may need more of their social needs without having to get into the car. >> that is a great question. that goes back to what ms. mccartt said about we're not going to be the same seniors that our parents were, and things are changing. is there any agreed upon age at which we would say someone is an older driver? this goes back to 70 for the new 60, what is an older driver and

do we have the definition? dr. del enter, old buddy. >> the short answer is no. 60 and 70 are the most common ages. i think 65 because that is when traditionally social security started. i don't think there is any biological or physiological reason we decided to use 65 and above. we can use 70 and above. i think that the view-shaped curve for crash involvement, you can make a case for 70 and above. you can also make a case for 75 and above. but there is no right answer to that. >> i have a number of questions. if you want to jump then -- rosenblum, an

intersection of some issues that you raise. i was intrigued by your chart that showed how people self select and that women tend to stop driving before they really should or could. also by the statistic that you used that women outlive their driving ability by 10 years and then by six. how does all of this work together to demonstrate how people are making the right choices and self regulating or not? how you reconcile all of that dissonant information, as people live longer and women outlive men, but they also saw select earlier -- what does that mean for us in society? thenll take a go at it and

dr. rosenbloom can take a go at it. in terms of self selection -- first in terms of men now living there driving by six years and women by 10 years, that is because women live longer. it is going to be interesting to see whether that trend holds for the baby boomer population. the other is whether the trend in terms of the premature to jiving cessation will hold for the baby boomer population -- the premature driving sensation will hold for the baby boomer population. i think not. i do not think that we will look like our mothers and that are driving habits are clearly very different. our mothers driving habits, when they were our age. i think that we're basically going into the unknown. if i was going to project that

all, i suspect that there will be a certain segment of the female population that will look like the current population, in that they may stop to soon, but overall the female boomers are going to look more like male boomers and we will not be prematurely stopping our driving. >> i agree. i think there are two conflicting things going on. i do agree that baby boomer women are going to look more like the men. on the other hand, women are so much more likely when they are drivers, to sit in the passenger seat. i thing you're going to slow ash -- show a slight in a minute. if you look at older women drivers, they are hardly ever driving -- if they are in the car with another driver, usually male, they are not driving. ok, so this is women over 65.

so you can see, as they get older, you get women drivers now, not just women, these are women drivers and how often they are actually driving the vehicle that they are in. it is never more than 43%. and it gets less and less and less. even though we know, even though women are coming in with all of this experience, they are still sitting in the passenger seat, which puts them at risk for that low mileage by as. -- bayh's. i looked all the way back, all the way through to 17-year-old, if a woman is in a car with a man, she is not driving most of the time. i see conflicting things. i see women with driving experience that look more like men, and then i see all these women sitting in the passenger seat. some well-known swedish researchers have looked at it

and said, if women drive as much as men, they have the same driving patterns, etc., and her solution is that women should insist on driving when they are in the car with the male driver. it is very clear that men often have a very different psychological investment in driving. i can see all of these fights across america, no, let me drive today. five years now from -- when you were too decrepit to drive, i will be able to. i do not see this happening so i see a dangerous situation even among the very young as women. they are only driving 8 miles for every 10 miles driven by men. the older women are driving three -- women drivers are driving three or 4 miles for every mile driven by koppel -- 10 miles driven by comparable guy. i am compared that women baby

boomer women -- that maybe bigger women will not look like a baby boomer men. >> for research priorities, perhaps we need to look more at the 55-64 year-old age group, because that is what we're going to be dealing with over the next 20-30 years. >> this is all of a little bit frightening. i think you're holding up a mirror on my life. i am questioning some of the decisions that i make in my family. i always tell myself that my husband is a really bad passenger and so i would rather him try. regardless, one of the questions that i was troubled with is how do you and to 40 years of conditioning for women -- undo 40 years of conditioning for

women who were told that they're not a good driver? they are not comfortable. how appropriate is us most of -- is it for us to say that you should be driving, when they do not have the comfort behind the wheel? is that an appropriate thing for society to be doing? >> i think you are right on. if people do not feel like they are confident to drive, and they do not wish to drive and they can meet their mobility needs in other ways, who are we to question them being behind the wheel? it is an individual choice. we can as a society empower them and give them driver training, attempt to increase their confidence, but that they do not feel confident to drive, i do not think we have the right to say you have to be behind the wheel. >> i have this vision of the police come into your house and asking how many miles you have

driven. if that is not enough, they give you a ticket. what we see in the data and we cannot price is an uptick of women driving between 80-85. we see this in lots of data, the british and australian data, and what is happening is that the age when their husbands die and become incapacitated and they start driving. no, of course we should not force anyone, but it people are confident driving and we are not offering them meaningful alternatives, then we have to provide ways for women to judge whether they are in fact safe and to encourage them to keep driving it they are, because we're not giving them anything else until -- we're not giving them anything else. until we do, that is a question for society at large. until we have mobility options for people, i think we have to

help women see if they are confident to dry. it is a vicious cycle. you do not drive, so you do not drive, so you do not drive. you're running into the same issues, you're more likely to have a crash. i think we have to offer women of way to assess whether they are content -- competent. >> mobility sounds like it is a big piece of wellness. i wonder if you all condition or if you are familiar with any scenarios in other countries with the state or the health care and medical services might pay for driver assessments or evaluation to keep people driving? >> in canada, in all provinces with the exception of one, having a driver assessment is

usually paid. the province of british columbia is paying for driver assessment for medical reasons. -setting, anddent it will be interesting to see if it is resulting in policy change. my argument would be that when a physician, often charged with the determination of driving competency, if they are being charged with the responsibility, they have to make that assessment, and they refer out for blood tests and those are paid for by the health care system. if they are referring driver assessments for medical conditions, then it should be paid by the health care system. >> great. a couple of data questions. are any of you familiar with any statistics -- we're talking about passenger vehicles --

about older commercial drivers? the safety board investigates accidents primarily involving commercial vehicles, and we do see many cohorts, whether truck drivers are school bus drivers, these many things that people elected to in their retirement. they certainly have high mileage components, but some other challenges. can you speak to that? shouldn't there was a study released by one of the cooperative research programs of the transportation research board on older commercial drivers. i recommended to you because there's not a lot of research. it is very good, a review of all the research on older drivers,. . they concluded that older commercial drivers are doing

that all older drivers are. if the self regulate and stay out of danger situation and their greater experience makes up for any physical deficiencies. they are not having higher crash rates as commercial drivers. i recommended that report to you. to get the report has been submitted to our pocket. i think you for summarizing it for our audience. but. one other question about data, how does the composition of the population potentially affect a data? and i drive in an urban, highly- congested area. my parents live in a very rural area. the way that people drive is very difficult -- different. i'd experience going to florida where there are different driving patterns on the road. what is experience -- what is potentially more risk?

a higher number of drivers on the road and maybe older drivers with performance issues, or a mix of population of drivers where you have young fast drivers and older drivers who may be self selecting or going slower, because that is how they feel comfortable. in the understanding that as we get the 20-25, and one in every five drivers will be an older driver, will that change the statistical information we are looking at? >> that is a tough question. if you look at what i think is the best exposure miracle -- the best exposure, vehicle miles traveled, it does show that when you get old enough, that the crash rate, with the overall crash rate for the fatal crash rate, goes up.

i think the issue of the severity of the crash is complicated, because when you're looking at fatal crashes and probably serious injury crashes, what is going on is not so much that the older drivers are riskier but they are more likely to be injured or killed as are their passengers. so i am not sure what the answer to your question is. again, if part of what is changing about older drivers it that they're beginning to drive more than they used to on safer highways, that is a factor that has to be considered. >> i would just pipe in. today i think we heard a lot of good news about older drivers.

and their risk on the road and their risk to others, for example. i think we're having this conversation because we thought a few years ago that this burgeoning baby boomer population, when one in five drivers is going to be over 65 a in a couple of decades, will be this horrible thing. i think the question is complicated because even now, we do not see that. what we were hoping would not happen doesn't look like it is going to happen. now we have to change our whole view. about what it means to have one in five or one in four drivers on the road that are older, when they are not even looking now like we thought they were going to look. it is one way of saying we do not know. we do not know. but i think we are confident

enough to stay -- to say -- it will not be as bad as we thought it might. we do not all why it is going to be as bad as we thought it might be. but is not going to be as bad. >> and maybe it might even be better for all of us than that. my last question, i think, dr. dobbs, we will have panels to talk about the medical issues with respect to screening and things like that. i wanted to assess for new, and i'm not talking about older drivers but all drivers, is there a particular medical condition that we really ought to be paying attention to? >> that is easy to answer. yes, to mention. demint to clearly is -- dem entia is clearly needing to be on the radar screen. people with alzheimer's disease,

it is certainly the most common form of dementia, but there are many other illnesses that can cause cognitive impairment with or without dementia. in terms of the medical conditions those of the ones to be most concerned about. when you look at the traffic data, individuals with dementia had crashed data more than two times higher than those without. we know that they are a very high risk group. with the progressive dementia, the question is not will they're driving become unsafe, but will will it 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 screen school -- tools. we have those tools to identify when their patient may be a risk. we need to, in addition to the screening tools, we need to embed particularly in primary care practices and family medicine practices -- because they are the doctors going to be seeing the people will d -- with dementia. we need to have the medical community's working with the driver fitness communities and the dmv's in order to streamline the reporting system, and we need to have reimbursement for doctors, for engaging in the medical at risk driver issue. we need reimbursement for driving assessments, so that the cost of driving assessment does

not fall on the user. we need to work really hard over the next four years to get as scientifically based an integrated system in place to address this issue. >> fantastic -- and then we need >> thank you very much, and thank you to everyone on the panel. you did a great job of setting the table for us. we know that what you have built is the foundation for the next few panels. thank you for your participation. before we break, i want to remind everyone that noone is showtime. we got special agreement to eat and drink and the board room. and of the staff is about to fall on the floor. bring your lunch back. please come back to watch