The recent tragedy in Santa Monica, California, caused by an elderly driver crashing into a crowded street market, killing 10 and injuring dozens of others, highlights an uncomfortable reality that is increasingly all too familiar for millions of Americans who know of elderly family and friends who continue to drive.

With a similar accident occurring in Florida only nine days later, we have a situation that warrants immediate attention before more lives are destroyed. When should the elderly stop driving? How we determine their competency and the diverse responsibilities of family, friends, health care providers and especially legislators are issues that must be addressed sooner rather then later if we are to avoid similar tragedies.

Both accidents confirmed my worst fears for the safety of my own elderly aunt and uncle, both in their 80's, who continue to drive. After spending a weeklong visit with them about six months ago, it was fairly obvious that my uncle's driving skills were questionable at best.

Worst yet, he insisted on driving everywhere we went, leaving me a nerve-wracked passenger relegated to the back seat. Though at the time I had kept my mouth shut out of some misguided sense of deference and my eyes frequently closed out of fear, I promised myself that if I survived my next visit would include a rental car.

But before returning home I felt at the very least I had a responsibility to share my concerns with their son, who informed me that he had in fact suggested they curtail their driving - not too strongly from my impression of things - but that they just wouldn't listen. Curtail? I wondered if he was being serious or not serious enough. While many may find broaching the subject of an elderly parent's competency to drive the menacing third rail of family dynamics, that does not in any way excuse misjudging the gravity of the situation. It is the avoidance of such responsibility that accounts for the thousands of elderly drivers risking not only their own safety and that of their passengers but also every person who shares the road with them. There are no two people who I love, respect, and admire more than my aunt and uncle and I realize now that in my silence I did them a disservice.

It should not be difficult to understand and in fact empathize with an elderly driver's reluctance to voluntarily give up their driving privileges. And that's precisely what's important to remember, driving is a privilege afforded to those sufficiently competent to do so safely and not an inalienable right as some senior citizen advocacy groups seem to suggest.

For many, the ability to drive represents much more than the mere utility of transportation. Acquiring a driver's license marks a momentous rite of passage from dependence on others to the greater independence of adulthood. Driving is so much a visceral part of adult identity, elderly drivers are the least qualified to objectively judge their own driving competency. Consequently, family members and friends must be the first to sensitively and respectfully suggest and accommodate safer alternatives.

In addition to and especially in the absence of caring family members and friends, health care providers must become more proactive in identifying the physical and neurological indicators associated with aging that may suggest a possible impairment to safe driving. Since elderly citizens are among the most highly medicated segment of the population, the issue of poly-pharmacology, the interaction of medications, is of particular importance.

As is too often the case, with numerous doctors prescribing numerous medications for an elderly patient, more often than not little or no consideration is given to the possible side effects produced by the various drug interactions. While we should take care not to add to the burdens of already overworked health care providers, effective protocols should be employed during examinations to ensure, as best as possible, the competency of an elderly driver.

The Department of Motor Vehicles (DMV) must offer the final safety net to catch elderly citizens no longer competent to drive. Unfortunately, to do so more effectively will require our legislators to act with uncharacteristic responsibility and courage to pass legislation that will reconcile the needs of an increasingly older driving population with greater road safety for all. Remarkably, a move is under way in New Jersey that will allow a senior citizen to renew a driver's license without a visit to the DMV. Though ostensibly being done as a courtesy for senior drivers who find visiting the DMV too stressful, some may suspect a more likely explanation to be that this is simply another shameful and irresponsible political ploy to secure senior votes, votes that may ultimately be paid in blood. At the very least, it does beg the question, "Should a driver who can't handle the DMV really be on the road?"

It has been reported that the 86-year-old driver in California had renewed his license two years ago without being required to pass a road test. Considering his age, two years is too much time to elapse between testing for a new license. In fact, research has shown that current road tests have serious limitations in how well they measure the multiple skills required of an older person to drive safely. One promising alternative is the "useful field of view" test, which measures how drivers process visual information and predict the risks of future accidents.

In a study funded by the National Institute on Aging, researchers found that drivers who measured a 40 percent or greater impairment in their useful field of view were twice as likely to have an accident in the next three years. But until such testing becomes widely available, new legislation should require citizens over 75 to renew their license annually. Over 80, the requirement should be every six months. While the aging process certainly differs for each individual, the accelerated pace of diminishing capacity associated with most senior citizens over 80 justifies such frequent renewals.

Yet, elderly drivers should not construe such legislation as being ageist. The issue is not the driver's age but the driver's competency. Effective legislation should be possible if framed in the proper context, namely that its intent is to ensure the safety of all, including elderly drivers, their children and grandchildren. The Greatest Generation, which sacrificed so much for our freedom, may now have to sacrifice a little of their freedom for our greater safety.