Phil Christenson had worked his way through a litany of tests -- identifying objects, remembering names, reciting the months in backward order -- when exam coordinator Aida Weber asked if he ever had gotten lost on the way home. The 92-year-old Edina resident slowly shook his head and turned to his wife, Dorothy, for verification. "Not that I know of," she said with a soft, wary chuckle.

Shortly thereafter, the Christensons headed off for Phil's driving test, part of a three-hour exam the Courage Center administers to hundreds of elderly drivers every year.

The center's task -- assessing whether older folks belong behind the wheel -- is a tough one. It's about to get a lot tougher.

Over the next 20 years as the largest demographic ever, the baby boomers, ages, the number of U.S. drivers over 70 will triple. That almost certainly means more mishaps like earlier this month when a 74-year-old woman mistakenly put her car into reverse and plowed into the Finnish Bistro's outdoor patio in St. Paul, injuring two people.

It also means that more concerned families will face "the conversation," addressing how and whether an older relative should drive -- a discussion with implications far beyond control of the car keys.

"A lot of people equate their self-worth with being able to drive," said Connie Shaffer, a Courage Center occupational therapist and driver-rehab specialist. "You know, 'If I can't drive, I might as well die because life is over.' You're talking about taking that away when it's all that people know."

If and when a family holds the conversation (more on how to do that later), the result could be an evaluation at a place such as Courage Center, which then might refer the driver to the Department of Public Safety.

But the repercussions can reverberate broadly, into the whole realm of self-reliance. In a recent survey by the drug company Pfizer, 64 percent of Americans over age 65 said their biggest fear was losing independence.

John West of Minneapolis can relate. He said his mother was about 85 "when I started asking her about her driving. She said she was fine."

Not long after that, she was backing out of a parking space at her beauty parlor and somehow put the car into drive and rammed the wall with her Jeep.

"Then, one day soon after, I received a call from the Edina police saying they found her parked by Southdale not knowing how to get home," West said. "That's when I physically took her Jeep away from her."

Problem solved. And another created: "So that meant she was living in a house in Edina with no vehicle," West said. "We had to sell her house and move her into a senior building in Minnetonka. It starts with the driving but soon bumps into other areas of living."

States' testing varies

Aging affects our driving ability in myriad ways: vision and hearing problems, lessened depth perception and ability to focus, slower reaction time and more medical afflictions, which often bring with them medications that exacerbate the other issues.

That has prompted many states to ramp up testing of older drivers. In Iowa, license renewal moves from every five years to every two years beginning at age 70, and Illinois drivers must take a road test beginning at 75. Other states, including New York, allow seniors to renew by mail or e-mail.

Minnesota has stuck with a vision screening every four years for all ages, and no one contacted for this article had heard of any push to change that standard. The state can and does enact formal restrictions for certain drivers: no rush hour, no freeway, daytime only, staying within a mile of home.

Many Minnesotans don't let it come to that. "What we find is that individuals tend to be good about self-limiting," Shaffer said. "They don't go out in the dark, or at rush hour. They plan ahead."

The records also show that older drivers in general are not exactly public enemy No. 1. They tend to drive more slowly and wear seat belts more regularly. According to the American Automobile Association, drivers ages 65 to 69 are similar to those in their 30s in fatality stats, and even those over 80 have fewer accidents per mile driven than do teenagers.

Still, friends and family members can look for warning signs of diminished driving skills, from a few dents to basic observation, in or out of a vehicle. Shaffer cites two traits that tend to fade first -- the ability to divide attention and visual focus -- and added one caveat. "Those who have been bad drivers all their lives get worse sooner."

Doctors can help

Renee Roth of Bloomington has been down that road with her father. "Over the past couple of years with his age, we've noticed kind of a decline in his cognitive abilities," she said.

When he returned from wintering in San Diego, Roth noticed a bigger difference in his behavior. "I rode with Dad in late April and it was kind of scary. He was changing lanes without looking. I had to give him specific directions where to turn to places he's been going to for years."

In these situations, it's not a copout to have a doctor do some of the heavy lifting. Shaffer pointed out that the current seniors "grew up with physicians [and see their doctor] as the person who knows all."

Absent that, a family can write to the Department of Public Safety, which will interview the principals and might have the person retake the written test or the road test.

But first, the hard part: the conversation. Shaffer recommended making the focus "concerns for their safety as well as others' safety."

Colleen Colbeck, a therapist and former program director at the University/Fairview Mental Health geriatric services, called for "long, loving conversations."

"Finesse by loved ones is usually more effective, but not easy. Including the parent, there has to be problem-solving. This is not only related to driving. It represents various other issues," she said.

Roth knows that all too well. When she talked to her dad about moving into assisted living, and about seeing his physician, he "was pretty angry at the way things were going. He felt like so much was being taken away from him, like I was trying to lock him up and take away the keys.

"I made the appointment, but I ended up having one of the neighbors take him over there, so that it was one less time I was trying to take something away," she said.

Bill Ward • 612-673-7643