A Clinical Case Study in Systemic Ageism
By Larry Lawhorne, MD, professor emeritus, division of geriatrics department of medicine, Wright State University Boonshoft School of Medicine
When my wife and I moved from Dayton to a retirement community in Illinois to be closer to our daughter—a migration pattern so common it deserves its own ICD‑10 code—we expected the usual hassles: forwarding mail, finding a dry cleaner, looking for a DLM equivalent, etc. We did not expect that because I was 79, Illinois required a behind‑the‑wheel road test before transferring my driver’s license. My wife, who had not yet crossed the mystical threshold of 79, breezed through the process untouched. She floated out of the Secretary of State’s office triumphant while I was left behind to demonstrate that I was road‑worthy.
Some context: I spent decades as a geriatrician evaluating older adults’ driving safety based on functional status—vision, cognition, reaction time, medical conditions, medication effects. You know… clinical evidence. Not the number of candles on a birthday cake.
But Illinois had long been the only state in the nation to require a road test solely because someone turns 79. Not because of a stroke. Not because of dementia. Not because they attempted to parallel park using only the Force. Just… 79.
There I was—a retired medical director who had written policies, taught courses, and lectured on ageism, suddenly starring in my own ironic sitcom.
The examiner instructed me to “drive like you normally would.” I briefly considered narrating my internal monologue (“Checking blind spot… adjusting mirrors… resisting the urge to fix your twisted seatbelt…”), but decided to keep things simple. We drove around a few blocks. I did not hit anything. I did not terrify pedestrians. I did not confuse the gas pedal with the brake, which according to popular myth is the only thing people my age do behind the wheel.
I passed. The examiner seemed relieved. So was I.
But here’s the part worth examining. This wasn’t about my driving. It wasn’t about safety. It wasn’t about function. It was about chronological age as a proxy for ability, baked into state policy. That is systemic ageism—when institutions, laws, and procedures treat older adults as a homogeneous, declining group rather than individuals with diverse abilities.
In this case:
- Policy level: A law requiring road tests based solely on age.
- Institutional level: Procedures that operationalize the law without clinical nuance.
- Cultural level: The assumption that turning 79 transforms a safe driver into a hazard.
- Interpersonal level: Expectations shaped by stereotypes, not evidence.
Clinical reality: Older adults are among the safest drivers—fewer crashes per mile, less risky behavior, more self‑regulation.
Policy reality: Illinois is only now raising the mandatory test age to 87—still age‑based, still not evidence‑based, but inching toward sanity.
Why This Matters
Older patients will encounter biased policies, biased systems, biased assumptions about competence, biased interpretations of symptoms (“just aging”), and biased thresholds for intervention (“too old to benefit”). And they will feel it.
When an older patient says they feel singled out or underestimated, believe them. They’re navigating systems built on age‑based shortcuts rather than individualized assessment.
I spent a career fighting ageism. And yet, at 79, I was told to prove I could drive around the block without catastrophe. I did. And when I turn 87 and must take the test again, I plan to request a more scenic route, perhaps a quick detour onto the iconic Route 66.
Teaching point: Systemic ageism occurs when institutions use chronological age as a stand‑in for function, embedding bias into policy, workflow, and expectations.
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