When To Hang Up the Car Keys – The Elderly and Driving
Hanging Up the Car Keys for Good
Telling Mom she shouldn’t be driving anymore is not an easy task. No one wants to lose their independence, and driving is a major form of independence. So what can we do to keep our parents and grandparents safe?
Many seniors may notice changes in their own driving ability and as a result, they may “self-regulate” by driving only familiar routes, or in daylight hours only. But others may not see their own limitations, or may stubbornly hang on to whatever forms of independence they have left. The early stages of Alzheimer’s and dementia are the most common reasons an older driver will fail to recognize their own declining abilities. Family members are the most likely ones to notice the changes: incidents like minor fender-benders, or making maneuvers with their eyes closed against the sun.
When this happens, problems should be reported to the DMV. Seniors can report themselves, but often don’t. It takes a lot of courage to hang up the keys! Others who can help in this area are:
- Physicians and Optometrists – they can assess and counsel older drivers but they are not required to report problems. They may, if they are concerned, but they might not have a good sense for when a patient should hang up the keys.
- Occupational Therapists and Rehabilitation Specialists – they can evaluate an individual’s overall ability to operate a vehicle safely and, if needed, recommend ways to limit risks. Older drivers can be referred to these experts by their doctors.
- Family and Friends – they may be the key observers of the warning signs of risk factors. Advance planning is a good idea. When faced with loss of independence, emotions run high. So approaching the subject as early as possible, before it’s a crisis, has a much more positive effect. Begin a process of having periodic conversations about driving and suggest options, depending on the degree of impairment.
The physical problems associated with aging can have an impact on driving skills, such as having multiple minor health issues. No one specific issue in itself is a problem, but when several combine, the effect adds up. Deteriorating vision can be dangerous; acuity, visual field, depth perception, color recognition, eye movements. All are needed for safe driving. Visual processing can slow down, too. Noticing that a traffic light is about to turn red and at the same time, being aware of pedestrians crossing the road – no big deal for younger drivers, but sometimes impossible for seniors. Hearing loss can contribute to risk, as well as slower reaction times. And many times, medication can be a problem. Many medications have side effects (like dizziness or sleepiness) that can hamper any driver, not just seniors.
The diminished driving skills that most often signal risk are:
- becoming easily frustrated or confused
- poor scanning and having a decreased awareness of surroundings
- failing to observe signs, signals or other traffic
- needing help or instructions from passengers
- making slow or poor decisions
- frequently getting lost, even in familiar areas
- using inappropriate driving speeds
- confusing the pedals
- maintaining poor road position or making wide turns
- having multiple “near misses”
These signs are usually observed by family and friends. Doctors, therapists and other professionals who deal with seniors rarely, if ever, see them in their cars.
So what can we do to keep our loved ones safe? If they are willing to cooperate, and recognize that they have lost some of their safe driving ability, they can “self-regulate.” Some ways of doing this are to avoid night driving and to stick to familiar or pre-planned routes. Safety equipment can be installed in a car, such as extended mirrors or back-up alerts. Raised seating or extended pedals can help those who can no longer see over the steering wheel comfortably. Or seniors can take a driver improvement course. These are offered online or in person from the AARP Driver Safety Course or AAA Roadwise Review. The AMA also has a guide for older drivers.
If an older driver is unwilling to cooperate, a driving evaluation can be ordered by the doctor, which is linked to the DMV as needed. It includes a clinical evaluation of the senior’s medical records, driving history, vision perception, reaction time, range of movement, sensation, cognition and a behind-the-well evaluation. The information from this series of tests goes to the doctor who then decides if driving should be restricted or stopped. It doesn’t have to go to the DMV unless the senior will not self-regulate.
A few interesting facts about older drivers: Drivers over 80 have higher crash death rates per mile driven than all other age groups except teen drivers. Older drivers involved in accidents are much more likely to die of their injuries than younger drivers. But it’s not all bad news: Older drivers wear seatbelts more often than any other age group except infants and preschoolers. Older drivers tend to drive when conditions are safest and they drive fewer miles than younger drivers.
Some alternatives to driving are:
- walking, if possible – it’s healthy!
- riding a bike – that’s healthy too!
- public transit
- ride sharing through church, volunteers, organizations
- community shuttles or senior transit, like Access-A-Ride
- taxis or private drivers, although these are expensive, but the cost can be included as health care expense
- motorized wheelchairs
All these options are a compromise, there is no way around that. None are as easy and convenient as driving your own car. Some are inefficient or very inconvenient. But they are all much better than an unforeseen tragedy because of a senior who shouldn’t be driving.