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Common Tread

Ask the doc: How do I know when I should give up riding motorcycles?

Nov 29, 2017

In his usual subtle way, Lance casually passed along one of Lemmy’s ideas for an "Ask the doc" topic. (Excellent!) How do you know when you should give up riding motorcycles? (Not so excellent.)

I do not think I could find a more controversial and polarizing topic than suggesting when die-hard gearheads should hang it up and park their bikes in their final resting spots. It’s a difficult subject, but important. And, it’s a topic that is usually ignored by everyone except the rider’s family and talked about only when the rider is not there, or in very hushed tones.

Is there a way to cut through the emotion and rationally decide when that hushed conversation is totally wrong and when it is spot on? Sure there is. Well, maybe.

Hard Stops: Definite reasons to stop riding

This is the easy part and why I started here. There are a variety of medical conditions and physical limitations that should end your riding career. In general, they are the same ones that should stop you from operating any vehicle.

Chief among them are active seizures, an untreatable brain tumor, lack of balance (dizziness), legal blindness, syncope (passing out), unstable diabetes mellitus (high blood sugar), poorly controlled heart rhythms that require cardioversion (electrical shocks to regain a normal rhythm), loss of essential limbs for control of the vehicle, certain musculoskeletal, vascular, or neuromuscular conditions, as well as certain psychologic or psychiatric conditions that lead to inattentiveness, or aggressive behavior that creates a clear and present danger to self or others (including suicidal ideation). State laws generally spell out conditions that disqualify you from operating a motor vehicle on the public roads.

Of course, if your physical condition prevents you from safely getting onto or off of the bike, or breathing normally while riding (dyspnea or shortness of breath on exertion), stopping riding just makes sense and is not a surprise to you, either.

What about limb loss? Yes, there are ample images and stories of bilateral leg amputees who pilot motorcycles using both manual and automatic transmissions; no problem there. Upper extremity amputees have prostheses that are not as well developed and generally do not have the necessary fine control required for safety. Many states preclude a motorcycle license if any limb is lost.

Then there are many kinds of conditions or therapies that might temporarily make motorcycling or driving unsafe, such as new opioid pain medication use, active chemotherapy that makes you very weak, recent abdominal or chest surgery from which you have not yet healed, or a recent traumatic brain injury, for example.

Those are not the difficult cases we are talking about. Such conditions above do not require making a value judgment — they are limitations that are encoded in law, or are so obvious even to the rider that stopping just makes sense. The hard stuff is instead related to aging, and it is often not one thing but a series of lots of small changes that, when taken together, drive that hard decision.

Harder stops: Aging and frailty

When people are really sick, you can immediately tell from the doorway to the room. No medical training is needed to recognize that a person is failing the look test. Now think about the last 80-something person you saw slowly crawl out of the driver’s side of a car. Did you think, “It is so wonderful that he continues to drive,” or was it more along the lines of “Really? He’s still driving?” I will bet it is the latter.

It is generally not one thing that crafted that impression. Instead, it was a lot of things. Bent posture, painfully slow movement, perhaps a shuffling gait, oversized sunglasses, and a frail-looking body are all common descriptors of people who have difficulty having their entire body work well as a whole.

There is a syndrome called, appropriately, frailty, and there are many scoring systems to identify those who are at risk of frailty (pre-frail) and those who have it, as well as how severely. We don't really have a robust guide for motorcyclists to use to create a score to tell them when to stop riding. We do have a list of events that occur while driving or are noted after driving that suggest there is a problem. The list in the table below is adapted (with my comments in italics) from a list by the Pennsylvania Department of Transportation.

Warning signs it might be time for an older driver to limit or stop driving
Feeling uncomfortable, nervous or fearful when driving or getting ready to drive
Unexplained dents and scrapes on the vehicle, property, garage doors, etc.
Frequent and/or unexpected "close calls" that did not happen before
Slowed response to unexpected situations leading to close calls
Unintentionally getting lost while going to a place you know well
Difficulty concentrating while driving
Difficulty staying in the lane of traffic or maintaining a line
Trouble paying attention to signals, road signs, and pavement markings
Trouble judging gaps in traffic at intersections or highway entrance/exit ramps
Frequent traffic tickets or "warnings" by traffic or law enforcement officers in the last two years (assume that you are not misbehaving on your favorite stretch of road for this one)
Feeling increasingly weak and tired despite getting enough sleep

Clearly, one of those events should not stop you from riding, but how about two, three, or more? This is that part of the map where the territory is uncharted and the only entry is “Here There Be Monsters.” Some states have tried to address this by having voluntary evaluation programs for older (a.k.a. mature) drivers while others have mandatory investigations that assess vision, sometimes knowledge, but vanishingly few (Illinois, for example, at age 75) require a practical driving examination. Moreover, the age at which any testing is required varies from 64 to 80. Renewal periods generally shorten with increased age and many states require renewal in person as opposed to on-line. Some states require certification from a medical professional with regard to visual acuity while most do their own vision testing. Overall, 33 states have some unique requirements for older drivers, spanning vision or road-testing, more frequent renewal, and renewal in person. Additional information may be found here as compiled by the Insurance Institute for Highway Safety. Clearly, there are highly varied practices with regard to motor vehicle licensing and reassessment in the United States, providing no easy way out for me to suggest when you should turn in your key.

motorcycle with sidecar
Some riders switch to three wheels to extend their riding careers. Photo by Justin W. Coffey.

What about a third wheel?

No, this does not mean what it does in dating. It is the recognition that some trade in their two-wheeled bike for a three-wheeler when they have issues with strength or with leaning (i.e. balance). Importantly, most of what should stop you from driving is about things that get in the way of integrating the skills needed to drive. Strength, vision, reflexes, clear thinking, judgment, memory, and yes, balance are all required. Moving to a third wheel up front or in back will not address the majority of the things that might make you a less capable pilot.

Some “crowd-sourced wisdom”

Given that there are no firm data on which to base a concrete recommendation, I interviewed a host of riders from young to really old, and from truly unknown to fairly famous. I asked them when they thought it would be time to stop riding and how they would know when they got there. Here is a distillation of their thoughts.

I will know it is time to stop riding when:

  1. I can't pick up my bike anymore (and I have started dropping it)
  2. I lose sight of the road at night, even with yellow lenses
  3. I can't get my leg over the seat
  4. I fall getting off of my bike on level ground
  5. My buddies won't ride with me anymore; my driving scares them
  6. I can't even go the speed limit without being scared I won’t react in time to an emergency
  7. I can't remember how to go places I know
  8. I can't afford my motorcycle insurance
  9. I can’t read the street signs at the speed limit — even with my glasses
  10. I scare myself because I can't keep it in my lane or on my line
  11. All of my riding buddies tell me to stop, not just my family
  12. The DMV won't renew my license (probably not good to wait that long)
  13. You pry the grips out of my cold, dead fingers (likely a little too long as well — though some may consider it perfect timing, depending on their perspective)

I would suggest that any of the above — except 12 and 13 — should prompt a visit to a doctor to inquire about the advisability of operating any motor vehicle on the road. Sometimes, there are conditions to identify and treat that will make riding safe again. Sometimes, we will tell you the same things as your family. And sometimes we have to report those conditions to the state (depends on the state) for your safety, as well as the safety of others on the road. I have combined those thoughts and the events into groupings of things that should drive you to evaluate whether you should continue to ride (see graphic below). And perhaps discuss it with your family, your riding pals, and maybe even your doctor.

should I keep riding?
Graphic by Dr. Lewis Kaplan.

A few final comments: A recent study noted that older motorcyclists were more likely to crash on high-speed highways and rural roads, more likely to need intensive care, more likely to be operating large-displacement motorcycles and perhaps most importantly, to be returning riders. While not conclusive, it raises thoughts about ongoing rider training beyond initial licensing and its impact on safety.