Staying healthy in your car: Equipment and precautions

Content provided by the Faculty of the Harvard Medical School

Staying healthy in your car: Equipment and precautions

A kid and his wagon, a boy and his bike, a man and his car. At every stage of life, there seems to be a special romance between a male and his wheels. Perhaps scientists should investigate the Y chromosome, which separates men from women, for a vehicular gene. Even without a gene, though, it’s easy to see how a set of wheels provides the independence, mobility, and self-esteem that most American men prize.

While driving has a special meaning at each stage of life, it also has special hazards. The risk is greatest for young men just learning to drive and control their impulses and for older men coping with slowed reflexes or medical problems. Few people think of driving as a medical issue, but they should: Car crashes are a major cause of injury and death, and many can be prevented.

The toll

An American man is nearly two and a half times more likely to die in an accident than a female. In all, accidents are the third leading cause of death in men — and motor vehicle accidents account for about 43,000 deaths in the United States each year. Add the countless injuries, and you’ll see that motor vehicle safety is a medical concern.

Accidents or crashes?

Doctors know that prevention is the best medicine. They ask people to eat well and exercise regularly to reduce their risk of heart disease and stroke, to avoid tobacco to protect their lungs and hearts, and to wear sunscreen to help prevent melanomas. The list goes on and on. Prevention works because many illnesses can be detected and corrected before harm develops.

Accidents seem random and unpredictable, but they’re not. In most cases, they begin with risky or careless behavior, which is why the prestigious British Medical Journal banned the word “accident” from its pages in 2001, except for “acts of God” and other truly uncontrollable events. By any name, accidents are events that are just waiting to happen — if we let them.

Who is at risk?

Every driver and passenger is at risk, and every pedestrian as well. But especially in the case of men, the hazard is greatest under age 25 and above age 65. Young men are at greatest risk. Many seem to fill their tanks with testosterone, not gas. They drive aggressively and too fast, sometimes under the influence of alcohol or drugs. They drive late at night and in extreme weather conditions. They are less likely to wear seat belts than any other group. They endanger themselves, but they also imperil their passengers, to say nothing of responsible drivers and pedestrians. It’s a complex problem with no easy solution. But fathers and grandfathers can help by setting good examples. A study of accidents in North Carolina found that children of parents who had been involved in three or more crashes were 22% more likely to have an accident themselves than children of parents who had never crashed. Perhaps there is a gene, after all.

Alcohol and aggression can cause problems at any age, but as drivers mature, they mellow. Older drivers, though, face special problems brought on by age, illness, and medication. That’s why drivers above 70 have a higher rate of motor vehicle crashes and more fatalities per mile driven than any other age group.

Better safe

Many crashes can be prevented, and even if they can’t, many victims can be protected from injury. Much of the advice seems self-evident, but it is worth repeating. And some of the issues, particularly those most relevant to older drivers, may not be so obvious. Obvious or not, here’s a review of some ways to be a responsible driver:

Be sure your car is safe. That’s a job for your mechanic, but he can’t help if you don’t ask him — and unlike most doctor’s offices, service centers don’t send out annual reminders.

Get car options that can help. Power steering, power brakes, and an automatic transmission are obvious assets for older drivers and for people with arthritis and other musculoskeletal infirmities. Because many people grow shorter as they grow older, seniors may get a boost from a cushion to help them see better; similarly, pedal extenders can compensate for short legs. Wide-view mirrors can make up for some visual limitations, but they take getting used to.

Wear seat belts, even if you have air bags; they really add a great deal of protection. And if you do have an airbag, don’t sit closer than 10 inches from the wheel; very short drivers may have to inactivate the device to avoid excessive impact that can do more harm than good.

Drive defensively. An obvious suggestion, to be sure, but it’s even more important in the era of road rage. Always suspect the other guy, and don’t try to get even if he does something dumb. Older drivers need to take special care to compensate for slower reflexes. That means leaving extra room behind the car in front of you, maintaining a conservative speed, and so forth.

Don’t drink before you drive. Private citizens can often do things better than the government. When it comes to blood alcohol levels, the legal limit may be too high, especially for older drivers. Low doses of alcohol can be good for your health, but even one drink can slow your reflexes and cloud your judgment. Perhaps that’s why motor vehicle injuries and deaths are about 40% higher on Super Bowl Sunday than on the Sundays flanking the big game.

Avoid medications with sedating effects. As people age, they often take quite a list of prescription drugs, many of which can cause mental slowing. Tranquilizers, antidepressants, and powerful painkillers lead the list. Be careful, too, with over-the-counter medications. An Iowa study of 40 drivers found that diphenhydramine (Benadryl), a popular nonprescription antihistamine, had a greater negative impact on driving than alcohol. Check your medications’ labels for a “may cause drowsiness” warning, then discuss alternatives with your doctors and pharmacists.

Stay awake. Sleepiness and fatigue are as dangerous as alcohol and drugs. Men are particularly vulnerable because they have a greater risk of sleep deprivation due to sleep apnea and because they often tend to stay behind the wheel for longer stretches than women. Don’t count on a quick cup of coffee to compensate. A New Zealand study found that sleepiness was responsible for 19% of crashes serious enough to produce injuries and that such accidents were five times more likely between 2 a.m. and 5 a.m.

Avoid distractions. A cell phone conversation may keep you awake, but it will increase your risk of crashing. In 2001, New York became the first state to ban the use of handheld phones while driving, but mental distraction is even more important than manual dexterity. A 14-month study that evaluated 26,798 cell phone calls found that a driver’s risk of accident was four times higher during a call than at other times. The best advice is to pull over before you place a call or answer one, particularly if you are a senior or have medical problems that might affect your driving.

Respond to road conditions. A pilot won’t take off if the visibility is poor or the runway is icy; you should be just as responsible. Here, too, age is a factor. Younger drivers may be able to compensate for snow, but older ones might be better off grounding themselves in a hard rain. Similar cautions apply to high-speed highways, hectic traffic, or driving after dark. Know your abilities (and those of your car), and adjust your travel plans accordingly.

All drivers should obey the rules of the road, but some need extra care. In particular, illness and aging merit special considerations, which will be discussed next month.

Last updated:	August 21, 2006