David Hosford is worried about a big test in December. That’s when the 87-year-old retired high school teacher will receive the title driving skills evaluated To see if it was still safe for him to get behind the wheel.

Hosford was diagnosed mild cognitive impairment about four years ago but appeared fit to drive. But recently his neurologist became concerned about some impairments and recommended that Hosford undergo a safety test and stop driving until that evaluation was completed.

For now, Hosford and his wife, Diana, who doesn’t drive, rely on neighbors and friends to take them to appointments, shopping and wherever they need to go. The waiting period for retroactive safe driving evaluations can be several months in Massachusetts.

“We live in rural Plymouth. “The nearest loaf of bread is seven miles down the road,” Hosford said. “There’s nowhere to walk.”

One old person Staying safe to drive has become a third way to age, with many people keeping their driver’s licenses much longer than they did a generation ago. At the same time rate of fatal accidents Nationwide, older driver participation has increased 73 percent since 2001, according to federal data. Now, two new studies by local researchers underscore the challenges ahead.

Dr., director of the Center for Brain/Mind Medicine at Brigham and Women’s Hospital. “Most healthcare professionals do not have the knowledge and training necessary to evaluate driving proficiency,” said Kirk Daffner. October article In JAMA Neurology.

Daffner sees many patients with cognitive impairment who may eventually need a comprehensive driving evaluation by a specialized program; This evaluation usually includes a road test. But many people like Hosford struggle to pay the hefty price tag, which can run as high as $800 in Massachusetts.

Medicare doesn’t cover the cost, meaning millions of older adults, many on fixed incomes, must come up with the money. This policy needs to change, Daffner wrote in JAMA.

“Disabled drivers,” he wrote, “pose safety risks not only to themselves but also to society at large.”

But Daffner said revoking old driver’s licenses shouldn’t happen in a vacuum because it often leads to isolation.

“If we take away people’s keys or their ability to drive, we need to do a better job as a society of providing them with alternative means of transportation,” he said. “It’s very cruel to say that; ‘You can’t drive anymore, good luck.’”

While the number of fatal accidents involving elderly drivers has increased in recent years, the number of these accidents has decreased due to the decreasing share of the elderly population.

Still, Daffner and other health experts said they see problems ahead.

More drivers than ever are retaining their licenses into old age. Federal data show According to the most recent data available, 59 percent of people 85 and older still had a driver’s license in 2020; this rate was roughly half that in 2000. And about 17 percent of Americans over age 65 (about 8.2 million people nationwide) experience mild cognitive impairment and are currently at the stage of increased crash risk.

Age alone does not determine driving performance. However, as we get older, so does the potential for health problems that can negatively impact your ability behind the wheel, such as decreased vision or hearing, slower reaction times, seizures, or heart conditions that can cause dizziness.

Andrew Zullo, an associate professor of public health at Brown University, recently examined medications commonly used by older adults that can impair driving ability, such as drugs to treat anxiety, insomnia, pain, depression and even high blood pressure, and found that many of them are more common in car accident victims. then proceeded to take them.

Zullo’s study published this month JAMA Network Open found that nearly 20 percent of drivers age 65 and older There will also be someone else involved in an accident. He said this sobering statistic makes it vital that healthcare leaders identify ways to prevent these accidents.

One obvious hurdle, he said, is that doctors often don’t know their patients have been involved in an accident unless they are seriously injured.

“We don’t have robust systems in the U.S. to inform doctors,” he said. If doctors had such a system, or if their patients felt comfortable giving the information, their doctors could review their medications and perhaps lower the dosage or switch to another drug with less potential to impair driving.

“I think many older adults are concerned that if they are involved in a motor vehicle accident, their family or other people in their lives may express concerns about their driving and put pressure on them to stop driving,” Zullo said. “This is a concern for older adults because it takes away their autonomy.”

massachusetts law needs people 75 and older must renew their license in person and pass a vision test. However After passing the road test required to obtain a driver’s license, often decades ago, the state relies on drivers themselves to determine whether they can still drive safely. IT does not require It provides a system for reporting concerns to the Registry of Motor Vehicles, which has a medical affairs unit to review reports, although health care providers are allowed to report patients they believe are physically or medically incapable of operating motor vehicles safely.

UMass Memorial Health clinical chief of geriatric medicine, Dr. Sarah McGee said she only resorted to reporting one or two patients to the state in her 34 years at UMass. But he said he strongly recommends that patients who may be disabled have their rides evaluated by an assessment program, explaining where the programs are located and how much they cost.

Sometimes driving assessments find that a patient may just need a refresher course, and they arrange a lesson.

“Some patients say, ‘I’m driving a lot less at night,’ or ‘I don’t like driving in storms,’ or they don’t like going on the highway,” McGee said. “It’s very meaningful in terms of what people share with you. Often people will restrict their driving themselves.

Often the children of middle-aged people are left in the middle; They watch with concern as a parent declines but are unsure how to broach this thorny subject.

That describes 45-year-old social worker Anna Stern, who noticed her then-76-year-old mother was driving well below the speed limit in Somerville, changing lanes without signaling and appearing uncertain behind the wheel. Stern contacted his mother’s doctor privately and asked him to bring up the issue.

His mother, who thought his driving was fine, failed the initial in-office evaluation at Spaulding Rehabilitation. driving in a handful of hospitals Assessment programs in Massachusetts. So he chose not to continue with the road test and gave up his car.

“I was shocked,” Stern’s mother said. Tam Neville is now 80 years old. “I studied the AAA book and thought it would be easier than before. “My sense is they don’t want older people on the roads, probably for good reason.”

Neville is among the lucky ones. She can easily afford $300 for an initial appraisal and lives within a 10-minute walk of many shops and restaurants in Somerville. They also have a home health aide to help run errands.

But Hosford, 87, who is awaiting his driving assessment in Plymouth, is not so lucky. On a fixed income, the $300 tab on his credit card feels heavy as he stares longingly at his idle Ford pickup.

“I feel like a beggar when I have to have my friends and neighbors show me around,” he said.

His wife, Diana, said losing the ability to drive was like breathing. “You don’t think about it until you can’t do it.”

You can reach Kay Lazar at [email protected]. @GlobeKayLazar.