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Proactive and Personalised Primary Care of the Elderly
When To Stop Driving
If your aging parent or other family member is like most people, the decision to stop driving is likely to be a wrenching one.
It raises daunting practical problems (How am I going to get to the doctor? What about my weekly outings for dinner and a movie?).
It also represents another loss at a time of life already buffeted by major losses of independence, health, and lifelong friends and loved ones.
For practical and emotional reasons, then, giving up driving is a transition that everyone involved wishes to put off as long as possible.
It's no wonder that many adult children and spouses say that taking away the car keys was among the hardest things they ever had to do.
Still, if you have concerns about a family member's driving ability, it's vital not to ignore them. Many seniors are able to drive safely well into their 80s and even early 90s, but it's also common for elderly people to have vision and hearing problems, slowed reaction times, and illnesses that can jeopardize their ability to drive safely.
The rate of accidents per mile of driving increases steadily for drivers 65 and older. More worrisome still, drivers 80 and older have higher crash death rates than any other group except teenage drivers. (One reason: Older drivers are physically more frail than other drivers and thus more likely to die in a crash.)
But it's important not to urge a family member to stop driving until you're convinced he's dangerous behind the wheel.
Experts agree that age alone is not a predictor for poor driving skills. And older drivers actually cause fewer motorist and pedestrian deaths than drivers of any other age group. Seniors are more likely than other drivers to wear seat belts, for example, and less likely to drink and drive. In addition, seniors drive much less than younger drivers, so the total number of accidents is lower.
How can you tell when the time has come for someone to stop driving? We've developed guidelines that will help you avoid being an alarmist yet also realize when the time has arrived that driving is no longer a safe activity for the person in your care.
5 Risk Factors for Older Drivers
The following factors should not rule out driving, but they can elevate risk and warrant monitoring:
1. Health Conditions
Physical and mental impairments that accompany aging, from Parkinson's disease to dementia, can compromise driving agility and judgment.
If you have questions about someone's ability to drive given his health problems, consult with his physicians, if possible, and raise the issue of driving safety. (Keep in mind that his physician can't talk to you without his permission, unless you have power of attorney.)
2. Vision Impairment
Vision is obviously a key component of driving ability. In fact, 90 percent of the information needed to drive safely relates to the ability to see clearly.
From accurately reading the speedometer to detecting pedestrians on the side of the road, good driving requires good eyesight.
But deterioration in vision is an inevitable effect of aging; in people 75 and older, vision impairment rates increase significantly. As the eye ages, far less light reaches the retina, for one thing. Older eyes are also more susceptible to cataracts, glaucoma, and other problems that impair vision.
Encourage your family member to have regular eye exams, and check in with his eye doctor if you have concerns.
3. Hearing Impairment
Few people age without some deterioration in their hearing. In fact, one-third of those over 65 have hearing problems.
Hearing loss can happen gradually, without the person realizing it, and undermine the ability to hear horns, screeching tires, sirens, and other sounds that would normally put someone on high alert.
Make sure the person in your care has regular hearing tests.
4. Prescription Drug Use and Drug Interactions
Many drugs can compromise driving ability by causing drowsiness, blurred vision, confusion, tremors, or other side effects.
Certain drugs taken in combination can also interact and cause serious problems.
If your family member takes a lot of pills each day, as many elderly people do, educate yourself about the drugs and their possible side effects.
Even herbal remedies and over-the-counter medications can affect driving ability.
Talk to your family member's physicians and pharmacist, and be sure to ask about possible drug interactions.
5. Alcohol Abuse
Drinking and driving is always a dangerous combination; add old age to the mix and you have a disaster waiting to happen.
As people age, alcohol remains in the system longer and tolerance declines.
Also, elderly folks are likely to be on medication, which can exacerbate the effects of alcohol. Given these risks, and the difficulty of gauging exactly how much alcohol will impair an individual's driving, so the best advice is simple: "If you drink, don't drive. Period."
If you suspect that your family member is drinking and driving, don't wait to take action.
5 Warning Signs of an Unsafe Elderly Driver
Watch for these signs of a dangerous driver:
1. Auto Insurance Changes or Traffic Tickets
Find out if his auto insurance rates have increased recently or if he's received traffic tickets or warnings.
2. Damage to the Car
Check to see if his car has new dents or nicks.
3. Reluctance to Drive at Night
Pay attention if he's reluctant to drive at night, seems tense or exhausted after driving, or complains of getting lost.
4. Friends' Observations
Discreetly check in with his friends and neighbors and ask if they've noticed any driving problems.
5. Driving Behavior Changes
When you accompany your family member on an errand or an outing, encourage him to take the wheel and look for these signs of driving problems:
Does he fasten his seat belt?
Does he sit comfortably at the wheel, or does he crane forward or show signs of discomfort?
Does he seem tense and preoccupied, or easily distracted?
Is he aware of traffic lights, road signs, pedestrians, and the reactions of other motorists?
Does he often tailgate or drift toward the oncoming lane or into other lanes?
Does he react slowly or with confusion in unexpected situations?
If you drive with him a few times and notice problems, it's time to initiate a discussion about your concerns and whether it might be time for him to stop driving.
This article was written by Connie Matthiessen, (Matthiesen C, 2013).
Downloaded and edited by Dr Angelo Grazioli, Jan 2014.
This is one of several topics presented in the Thorny Issues sector of this toolkit
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