By Jane Noble
June 10, 2013
As we age, our driving skills tend to deteriorate. Reaction time becomes slower, vision may be impaired (particularly for night driving), and decreased flexibility and hearing loss may occur. These are all factors that contribute to a general retrogression in skills – to the point where a driver is no longer safe on the road. The dilemma faced by many families is how and when to branch into this sensitive subject with an elderly loved one. What do you do if a strong-minded individual insists on continuing to drive when you feel that he or she is a danger behind the wheel?
Amada Operations Manager Dawnette Ayres comes across this problem all the time with our clients and their families. “Very rarely will a person admit voluntarily that they should stop driving,” she says. “Some drivers do monitor themselves, but the usual reaction is total denial – there is absolutely nothing wrong with my driving!” It appears that even when a discussion revolves around the possibility of a serious accident occurring, there is a stubborn refusal to face this reality. “You have to remember,” says Dawnette, “that for so many seniors, their car is their lifeline to the outside world. Once that goes, they feel they have lost their last vestige of independence.”
Put yourself in their shoes when suggesting a discussion. Be honest and empathetic about the changes involved in giving up driving. Acknowledge that some spontaneity will be lost without a car and that more forward planning will be required. Use phrases like “we care” or “ we’re concerned,” and don’t be accusatory. You will also have to have a plan in place for alternative transportation. This is a lot easier for seniors who have a good support system in place and who live in an area with reliable public transportation. As a family member, you may need to be willing to take on certain driving responsibilities. Amada caregivers can also help transport clients to appointments and activities and can take them shopping.
So when is the right time for this discussion? You may instinctively feel concerned about a parent’s driving, but are there any particular warning signs to look out for? First of all, take a good look at the car. Are there lots of little scrapes and dents? Many minor accidents can occur while parking. If your loved one suffers from any of the following, it may be time to start discreetly assessing their driving skills.
- Poor vision: Good vision is key to safe driving. When there is visual decline, depth perception deteriorates, peripheral vision narrows and judgment of speed is impaired. Many older drivers become sensitive to the glare of headlights and have difficulty driving at night.
- Hearing loss: It is essential to be able to hear important warning sounds while driving.
- Limited mobility and decreased flexibility: These can affect a driver’s response time, pedal selection and steering control and can also limit their ability to look over their shoulder or turn their head to look for hazards and dangers.
- Chronic conditions: Many chronic conditions can impair driving skills and can cause sudden deterioration in ability: conditions such as Parkinson’s disease, sleep disorders like sleep apnea or narcolepsy, brain tumors, seizures, heart disease, rheumatoid arthritis, diabetes, vertigo or stroke.
- Medications: Many seniors take medications, which can cause drowsiness and side effects. These can be particularly dangerous in combination with alcohol.
- Dementia or Alzheimer’s: Most cognitive impairments are progressive. Early diagnosis and treatment are vital to ensure that an individual will be able to drive safely for as long as the condition remains mild. Once the condition reaches the moderate or severe stages, however, it is too dangerous for the person to continue driving. Any cognitive impairment will negatively affect the ability to drive safely. Driving uses perception, reasoning, judgment, intuition and memory.
In California, the Department of Motor Vehicles has produced a comprehensive booklet called Senior Guide for Safe Driving that could be used as the basis for a discussion. One of the first sentences states that the DMV would like all drivers to maintain their driving independence for as long as they can safely do so – “safely” being the key word. The guide takes a positive approach and includes everything from tips on nutrition, physical and mental fitness, safe driving and self-assessment to the driver’s license renewal and reexamination process.
If your loved one is receptive to your concerns and willing to acknowledge any limitations, there are a number of steps that can be taken to ensure continued safe driving. First of all, make sure that the car itself is a good fit.
- Can seats be easily adjusted so the driver can see clearly over the steering wheel?
- Are the seat belts comfortable?
- Is the car an automatic?
- Can all the mirrors be easily adjusted?
- Is the vehicle mechanically sound with properly inflated tires?
- Are the brakes, windshield wipers and lights all working properly?
- Can your loved one get in and out of the vehicle with ease?
In California, the DMV offers a Mature Driver Improvement Course. In addition to teaching defensive driving and California motor vehicles laws, the course also provides information on the effects that medication, fatigue, alcohol, visual and auditory limitations can have on a person’s ability to drive safely. Drivers who successfully complete the course may be eligible for a reduction in their vehicle insurance premium. If a mature driver improvement course is offered in your state, you may want to reach a compromise that if your loved one is willing to take it, or take and pass the DMV written and behind the wheel test – you will wait a year before readdressing the issue of their driving ability (unless of course there is a dramatic change in their circumstances).
But what do you do if you feel that a loved one is at risk but flatly refuses to stop driving? An intervention may be necessary. Although it is up to the family to make a decision about whether or not to actually take the car keys away, an Amada advisor can provide valuable support and reassurance. It is also sometimes easier for the family to put the blame on a third party. For example, Amada has a client who suffers from cataplexy, a condition that can cause a sudden weakness of the body especially in the legs, face and neck. Following a discussion with the family, Amada made sure that each episode that the client suffered was carefully documented with dates and times. This information was passed on to the client’s neurologist who then sent the appropriate paperwork to the DMV so that a driver safety reexamination could be scheduled. A DMV hearing officer can then make an assessment and determine appropriate action. This may involve putting a driver on medical probation, giving a limited term license, deciding that the driver should be reexamined at regular intervals, placing restrictions on when a person is allowed to drive, or possibly suspending or revoking their license.
In California, drivers who are 70 and older at the time their driver’s license expires must appear in person to renew their license, and must take a vision and written test. Different countries deal with this predicament in different ways. Elizabeth Dugan, professor of gerontology at the University of Massachusetts, Boston wrote a book called “The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families” that is meant to address this subject. In the book, Dugan explains that in Canada, doctors in seven out of ten provinces are required to report concerns about a patient’s ability to drive. In many regions of China they take a radical approach and have a blanket prohibition against driving after the age of 70. Though there would no doubt be an outrage if a similar restriction were suggested in the US, the main point to remember is that the responsibility of being behind the wheel of a vehicle should never be taken lightly. Medical, physical and emotional conditions can affect safe driving abilities at any age, not just in the later years of one’s life.