DALLAS -- As his 90-year-old neighbor struggled last May to set out on a morning drive to the store, David Prager began to worry.

Elizabeth Grimes, a widow who had lived on Meaders Lane for 50 years, had backed out of her driveway, across her lawn and off the curb. Her 1994 Mercury Grand Marquis then hit the curb across the street, Prager recalls, before Grimes mistook the gas pedal for the brake and "took off with a jackrabbit start."

Six blocks away, Grimes drove through a red light. The car slammed into Katie Bolka, a 17-year-old high school junior who was driving to school to take an algebra test. Five days later, Bolka died.

The crash was emblematic of what health and safety analysts say is likely to be an increasing problem as the elderly population booms: aging drivers, clinging to the independence that cars give them but losing their ability to operate the vehicles, causing more accidents.

Fatality rates for drivers begin to climb after age 65, according to a recent study by Carnegie Mellon University in Pittsburgh and the AAA Foundation for Traffic Safety, based on data from 1999-2004. From ages 75 to 84, the rate of about three deaths per 100 million miles driven is equal to the death rate of teenage drivers. For drivers 85 and older, the fatality rate skyrockets to nearly four times higher than that for teens.

The numbers are particularly daunting at a time when the U.S. Census Bureau projects there will be 9.6 million people 85 and older by 2030, up 73% from today. Road safety analysts predict that by 2030, when all baby boomers are at least 65, they will be responsible for 25% of all fatal crashes. In 2005, 11% of fatal crashes involved drivers that old.

Debates over how to prepare for a boom in elderly drivers are resonating in statehouses across the nation -- including Texas, where Bolka's death has inspired the Legislature to pass a measure that could lead to more frequent vision tests and behind-the-wheel exams for drivers 79 and older.

The only measure scientifically proven to lower the rate of fatal crashes involving elderly drivers is forcing the seniors to appear at motor vehicle departments in person to renew their licenses, says the Insurance Institute for Highway Safety (IIHS), citing a 1995 study in the Journal of the American Medical Association.

But most states do not require older drivers to renew licenses in person, and only two -- Illinois and New Hampshire -- require them to pass road tests, which can be crucial in identifying drivers whose physical ability or mental awareness has diminished.

States have tried a range of approaches, but for the most part they have struggled to establish precise standards for determining when seniors should be kept off the road while being fair to older drivers who remain capable.

State laws are inconsistent on the issue, according to the IIHS, which researches factors that cause crashes. Most state driver's license laws require basic eye exams but typically cannot detect a driver's diminished physical capacity and cognitive awareness.No state has an age limit on drivers.

"It's a huge problem, and we really don't have any solutions to it yet," says Barbara Harsha, executive director of the Governors Highway Safety Association. "We need to keep moving on it and try to find solutions as quickly as possible."

Safety and health specialists are especially concerned about drivers 85 and older, who, federal crash statistics show, are involved in three fatal accidents a day.

"You always hear about teenage (driver) risks being so incredibly high, but to me the amazing thing is there are two clusters you really have to focus on": teens and elderly drivers, says Paul Fischbeck of the Center for the Study and Improvement of Regulation at Carnegie Mellon.

Normal aging causes medical problems that affect driving. Reflexes, flexibility, visual acuity, memory and the ability to focus all decline with age. Medicines that treat various ailments also make it more difficult to focus and make snap decisions.

Elderly drivers are less likely than other drivers to be in crashes involving high speeds or alcohol, but they are more likely to crash at intersections where they miss a stop sign or turn left in front of oncoming traffic.

"Where single-vehicle rollovers can be described as a young person's crash, side impact appears to be an old person's crash," National Highway Traffic Safety Administration researchers Rory Austin and Barbara Faigin wrote in a 2003 study of crash occupants published in the Journal of Safety Research.

Crashes shine a spotlight

Even so, a series of incidents involving elderly drivers in the past few years has fueled the debate over how to deal with the risks they can pose. Among them:

· George Russell Weller, then 86, killed 10 people and injured more than 70 when he drove his Buick Le Sabre into a crowded farmers market in Santa Monica, Calif., on July 16, 2003.

His attorneys explained that Weller had confused his car's accelerator for the brake. He was convicted of vehicular manslaughter with gross negligence.

A judge ruled that Weller was too ill to be imprisoned and sentenced him to probation and $101,700 in penalties. The case fueled a nationwide debate over how elderly drivers should be screened.

· Brian Fay, 19, was making change for a customer at a Sears store in Orlando on Oct. 9 when he heard what he thought was a bomb. Fay looked toward the store entrance and saw a pane of glass shatter and fall to the floor. Then he "looked down and saw (a) car barreling" toward him.

Elizabeth Jane Baldick, 84, drove her car into the cash register counter Fay was using, knocking him over. Bleeding, he rushed to check on Baldick, whose car had come to rest against a concrete pillar. Her foot was still pressed firmly against the accelerator, the tires screeching against the tiles on the floor.

Florida revoked Baldick's driving privileges in December, citing medical reasons, says Kim Miller of the Florida Highway Patrol.

The Grimes accident in Dallas is typical of many crashes involving elderly drivers, health and safety specialists say: It involved someone who was reluctant to give up her car keys, and who drove mostly on familiar roads near her home.

Elinor Ginzler, AARP's director of livable communities, says the elderly can "suffer because they are stuck at home" after giving up their keys. So they drive for as long as they can by going only where they must as their skills diminish.

"Many elderly drivers do what we call 'self-regulate,' " says Ginzler, whose association for seniors encourages its members to assess when they should give up driving. "They only drive the places that they know, on familiar roads, at certain times of the day."

As long as a driver can navigate such trips safely, "those are very, very good decisions to be making," she says. "Making a decision (not to) drive at night anymore is terrific. It means you recognize this isn't safe anymore."

AARP offers a Driver Safety Program at sites around the country and online.

The program is an eight-hour class for drivers 50 and older that deals with the effects of aging on driving. The organization's website, aarp.org, also offers advice for seniors and their adult children on how to stay safe.

Most elderly drivers decide to stop driving themselves. More than 600,000 drivers age 70 and older decide to give up driving each year, according to a 2002 study published in the American Journal of Public Health.

That's partly why insurance rates usually are only slightly higher for drivers 75 or older -- and far lower than such rates for teenage drivers. Insurance analysts say the car insurance industry does not see a big liability threat from the rising number of elderly drivers because such drivers hurt themselves more than others and tend to stop driving on their own.

"When they realize they are driving in dangerous conditions they generally stop doing it," says Carolyn Gorman, vice president of the Insurance Information Institute, based in New York City.

"The industry views them as pretty much a self-policing group. Many elderly drivers do not drive at night. Many will make three right-hand turns instead of one left-hand turn."

Grimes, who died Jan. 15 from what Dallas County medical examiner Richard Baer says were complications from a stroke and old age, had cooked her own meals, cleaned her house and mowed her lawn -- which she called her therapy.

Through their attorney, her family members declined to discuss her driving. But Grimes said after the crash that she frequently had made short trips around her neighborhood.

"I'm not going at any high rate of speed because I'm here, there and yonder along the way," she said about three months after the crash in a videotaped deposition for a lawsuit filed by Bolka's family. "This is my area."

Grimes' family members say they suspect she had a mild stroke the night before the crash that fatally injured Bolka, and the stroke caused a sudden decline in Grimes' ability to drive safely.

The lawsuit filed by the Bolkas was settled on Sept. 14 for an undisclosed amount.

Harsha says no state has a good "early warning system" when it comes to identifying elderly drivers in declining health.

The burden rests on spouses, family members, doctors and police to request that a license be revoked. Appealing for a state to revoke someone's driver's license on medical grounds is a cumbersome process, and such requests are rare.

What states are doing

Twenty-three states require licensed drivers of a certain age to appear periodically at a department of motor vehicles office to renew their license. In 16 states, older drivers must prove that they can see well enough to drive. Some states have tried other ways to identify drivers who, because of age-related health problems, put themselves or others at risk.

But the IIHS says such efforts have failed to accurately predict the risk an elderly driver may pose.

Without precise measures, analysts estimate that 500 good drivers would have to be taken off the road to prevent a single crash. Among states' efforts to restrict elderly drivers:

· California tested a three-tiered pilot plan for assessing drivers of all ages that included a driving knowledge test, cognitive screening and vision tests. People who failed the first tiers had to pass a road test. The 2003 study of 152 drivers did not predict who would go on to have a crash.

· Maryland conducted a study that found drivers who performed poorly on certain cognitive tests -- such as following basic commands and repeating simple movements -- were about 25% more likely than others to go on to cause a crash. Results of the study of 1,910 drivers ages 55 to 96 were published in January 2006 in the Journal of the American Geriatrics Society.

Maryland now uses such screening on a regular basis with drivers whose actions raise concerns about their cognitive abilities.

· Florida's requirement that drivers 80 and older pass a vision test resulted in the loss of a license for about 7% of elderly drivers seeking renewal, according to a study by the IIHS.

But nearly 20% of those 80 and older who needed to renew their license told researchers they decided to give up driving because they did not think they could pass the vision test.

"We don't know for sure if any of these (efforts) will prevent fatal crashes," says Russ Rader of the IIHS.

"But having drivers go in person for renewal allows the examiner to see the person and spot impairments. That can be effective."

'I did it. I'm terribly sorry'

David Prager, Grimes' former neighbor in Dallas, says there was little he could do to keep her off the road. "There was no way Mrs. Grimes was going to stop driving," Prager says.

Grimes said in her deposition -- taken in the nursing home where she went after suffering two broken ankles in the accident that killed Bolka -- that she "never had a reason until now" to discuss giving up her car.

Just before the fatal crash, Grimes' car had suffered front-end damage after an accident in a parking lot at the same intersection where Grimes struck Bolka.

"I had it repaired," she said in her deposition. "Everything was happy."

Bolka's family members say they pushed the Texas Legislature to pass the bill toughening the state's laws on bad elderly drivers because they believe states should be more aggressive in keeping such drivers off the road.

Right now, "the first level of defense is the driver," says Rick Bolka, Katie's father. "The second level of defense is the (driver's) family. The third level of defense is the (driver's) physician. We would like to see the state become the first level of defense. The government has a responsibility to protect its citizens."

Texas Sen. John Corona, R-Dallas, the Bolkas' state senator, said during a recent hearing that his mother "is blind, and they just renewed her license by mail."

The bill, which is scheduled to be signed soon by Texas Gov. Rick Perry, would require drivers 79 and older to appear in person for renewals and subject them to mandatory vision tests and behind-the-wheel exams if officials have any question about their driving ability. Drivers 85 and older would be required to renew every two years.

During his deposition of Grimes, the Bolka family's attorney, Peter Malouf, asked Grimes whether she understood that she had crashed into a young girl's car and killed her.

"I'm aware of that very sad story, yes," Grimes said. "Sure I did it. I'm terribly sorry. But I did it."

Malouf asked whether there was anything she would like to say to the family.

"What is there to say to people who have been hurt?" Grimes said. "That's best left alone, I think."

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