For older adults, driving can symbolize independence and freedom by preventing isolation and allowing them to take care of themselves. While many older adults drive responsibly by recognizing limitations and avoiding problem times, such as night driving, studies show that with aging, driving may become unsafe. This is due in part to chronic disease, physical limitations, and cognitive limitations.
Many older adults face the emotional decision of giving up the car keys and accepting alternative methods of transportation. Consider the following:
Mr. Brown's 83-year old mother recently confused the brake and the accelerator while trying to park the car. His mother ran the car into the side of the house, totaling it and causing significant damage to the home. She explained, "A slip like that can happen to anyone."
Mr. Brown now wonders if it is safe for his mother to still be driving. Lately he's also noticed his mother becomes easily confused and it is difficult for her to maneuver the car quickly. When he brings up giving up the car keys with his mother, she becomes very defensive and refuses to discuss the issue. Mr. Brown doesn't know if he is being "overly cautious" or if something needs to be done.
For the safety of Mr. Brown's mother and others on the road, Mr. Brown needs to talk with his mother about giving up the car keys. In this article you will learn how to address this difficult discussion as well as find out how to help the situation and support the elder.
How Does Age Affect Driving? According to the Federal Highway Administration (FHA), older drivers are more likely to be involved in a crash while driving, and more likely to die in that crash. Older drivers have a higher rate of fatal crashes than all but the youngest driving population. Why?
The FHA states that older drivers do not deal as well as younger ones with complex traffic situations, and multiple-vehicle crashes at intersections increase markedly with age. Furthermore, older drivers are more susceptible to medical complications following motor vehicle crash injuries. This means they are more likely to die from their injuries than younger crash victims.
Some of the age-associated problems that contribute to increased motor vehicle fatality include:
- Vision decline - As the eye ages, the lens of the eye changes, requiring more light and a broader viewing field. Due to this vision decline, older drivers have a greater risk for accidents at night or in poor weather conditions. Furthermore, older drivers struggle with congested or fast moving traffic when peripheral vision is needed to negotiate traffic. Older drivers may also experience the following vision related problems:
- Cataracts - The lens of the eye becomes cloudy, and seeing becomes difficult. Surgery can correct vision loss caused by cataracts and improve road safety in older adults.
- Macular Degeneration - This condition leads to the break down of tissue inside the eye and, in many cases leads to complete vision loss. Even in the beginning stages of this condition, there is a decrease in road safety.
- Glaucoma - A relatively common condition in older adults, glaucoma is a condition in which pressure develops inside the eye and restricts sight area and vision. For older drivers the risk of a crash is 5 times higher when glaucoma is present. Glaucoma is treatable and individuals with glaucoma should see a doctor for appropriate treatments.
Those experiencing these types of vision related problems should receive regular check-ups and have a physician's approval before attempting to drive.
- Hearing decline - Individuals may be unable to hear other driver's horns, police or emergency vehicle sirens, and other roadway safety indicators. They may frequently miss verbal directions and become confused on the road. Older drivers should have their hearing checked annually and wear a hearing aid when necessary, to prevent the likelihood of accidents.
- Cognitive decline caused by dementia - Alzheimer's disease is the most common form of dementia among older adults. Those diagnosed with Alzheimer's disease or other forms of dementia will experience a noticeable decline in cognitive function. This can affect driving skills in the following ways:
- Familiar routes may no longer be recognizable. It's very easy for the driver to become lost.
- Response time may decrease. A driver may become confused by some of the vehicle's functions, such as when to press the brake versus the accelerator.
- Driver may become confused by difficult traffic situations. These may require quick problem solving skills.
- Verbal directions or suggestions may take longer to process. A driver with dementia cannot understand these actions in time to act appropriately or may even forget them.
Those experiencing dementia usually will not recognize that their driving abilities have been compromised. Regular driving exams and physical exams will determine if a person remains competent to continue driving.
- Physical decline - Limitations caused by Arthritis, Parkinson's disease, stroke, diabetes, heart disease, and other such chronic conditions can decrease traffic safety.
- Arthritis, Parkinson's, and stroke — Individuals with these conditions experience physical limitations such as decreased mobility that reduces reaction time to difficult traffic situations.
- Diabetes — Diabetics experience a loss of sensation in the feet, which prevents them from applying appropriate pressure to brake and gas pedals.
- Heart Disease — These individuals may experience dizziness or lightheadedness, impairing their judgment and delaying response time.
Individuals with chronic conditions should receive regular exams and obtain a physician's approval before driving. Occupational and physical therapy, however, can improve strength and coordination to help individuals drive more safely.
- Increased Medications - Medications including, but not limited to, blood pressure medication, heart medication, anti-depressants, and pain medication can make an individual drowsy, dizzy, confused, or slow to respond. All of these symptoms can interfere with proper driving techniques and make driving a hazard. Those who experience side effects to important medications should work with their physician in adjusting doses or finding alternative medications with fewer side effects. Individuals experiencing side effects from such medications should not drive.
Maintaining Good Driving Skills — Older drivers can maintain and improve their driving skills and avoid accidents and traffic violations with a few simple steps. Encourage your loved one to follow this advice:
- Plan your trip before you go. Review directions or maps in advance so you are familiar with your route and destination. There will be fewer distractions, allowing you to focus.
- Give yourself plenty of time. You may make more mistakes when you are in a hurry. With extra time you can relax and focus on the road.
- Avoid night driving, high traffic times, and poor weather conditions. In these conditions, you may be less alert and perhaps more nervous, increasing the likelihood of an accident.
- Leave enough space between you and the other cars around you. Reaction time decreases with age, so leave a good distance between you and the car in front of you. Don't follow other vehicles too closely. It should take about four to five seconds to travel the distance between your car and the other driver's. This extra space will give you more time to stop, which may be crucial in an emergency.
- Wear your seatbelt. Seatbelts, when worn correctly, can minimize injury and prevent fatalities in traffic incidents.
- Take a defensive driving course. These courses review the rules of the road and good driving techniques. AARP offers a Driver Safety Program for older adults online. In-person classes are also offered in most states. Drivers can find out more about this program and locate a class at AARP's website http://www.aarp.org/families/driver_safety In addition, most insurance companies offer discounts on rates to older drivers who have taken a defensive driving course.
- Get annual exams. Vision, hearing, and other physical changes can affect driving. Annual exams can insure driving safety and provide peace of mind.
- Maintain your vehicle. A well functioning vehicle can improve road safety. Regular oil changes, window cleanings, lights inspection, brake inspection, and tire inspection can help avoid problems on the road.
- Evaluate driving periodically. It is a good idea to ask your friends' and family's feedback on how well you are driving. Ask them to objectively evaluate your road awareness skills and reaction times. A regular driving evaluation through the local department of motor vehicles can also help to indicate safe driving skills.
- Know when to say when. Communicate openly with friends and family about driving limitations. Be aware of hazards and safety issues that may cause injury to you or those around you. Set limits for yourself and know when it is time to ask for assistance.
Giving up the Car Keys - For some older adults, the safest option is to give up driving. Many elders struggle with this decision, but it's a very important to ensure their safety and others on the road.
The following warning signs are outlined by the American Medical Association to help you evaluate the driving abilities of a loved one. Discuss your concerns with the older driver and if she/he is unresponsive or combative, consider contacting your state Department of Motor Vehicles.
- Forgetting to buckle up.
- Not obeying stop signs or traffic lights.
- Driving too slowly or too quickly.
- Often gets lost, even on familiar routes.
- Stoping at a green light or at the wrong time.
- Seeming not to notice other cars, walkers, or bike riders on the road.
- Not staying in his or her lane.
- Being honked at or passed often.
- Reacting slowly to driving situations.
- Making poor driving decisions.
Other signs of unsafe driving include:
- Recent near misses or fender benders.
- Recent tickets for moving violations.
- Comments from passengers about close calls, near misses, or the driver not seeing other vehicles.
- Recent increase in the car insurance premium.
Many struggle with knowing the right time to give up the car keys; others ignore obvious warning signs even when their driving is no longer safe. Giving up the ability to drive can be an emotional loss and a person may feel as if they are losing their independence.
Be sensitive to this loss. You can help by developing an alternative transportation plan to facilitate this person's continued independence and freedom.
Communicating About Driving - How do you talk to a loved one about giving up the car keys? It's a very difficult discussion, but if you feel this person is an unsafe driver, you owe it to him to share your feelings.
In your discussion, use specific examples and explain what has led to this concern. Allow your loved one to share his/her feelings and ask if he has noticed the same signs you have.
It's natural and expected for your loved one to be defensive or angry. If he does not want to talk about it, take a break and discuss it later. Use active listening skills to listen to your loved ones concerns and work to resolve their concerns.
A consultation with a physician may be helpful. A physician is a non-biased and trustworthy party. It may be easier for your loved one to accept your concerns when a physician validates them also. Your physician can also write a letter to the Department of Motor Vehicles requesting a reevaluation of driving skills.
Alternative Transportation Options - As you discuss these issues with a loved one, offer solutions by explaining alternative methods of transportation available to them. These show your loved one that he/she can still be independent. Alternative transportation includes:
- Local senior transportation - Most county senior programs offer a local shuttle bus for seniors. This bus may transport older adults to medical appointments, senior centers, and other activities. Usually the program requires an application and a nominal fee. In addition, most transportation programs require 24-48 hour notice.
- Taxi services
- Family or friends - Informal caregiver networks such as family or friends can be an excellent resource to assist with transportation options. Coordinate with your network to make transportation convenient for all parties involved.
- Local volunteer transportation programs - Some non-profit organizations offer transportation assistance to those in their community. Contact your local United Way or Area Agency on Aging to locate these organizations.
- Home health aides - Most home health agencies offer transportation assistance through their home health aide program. An individual can hire a home health aide to transport them to and from medical appointments and various errands. A waiver must be signed to allow the home health aide to drive the individual's vehicle. If the home health aide uses his/her personal vehicle, the elder may be responsible for mileage reimbursement.
- Delivery options - Medications, groceries, meals, and other catalog shopping can be delivered. Delivery services can provide increased convenience and reduce the amount of time spent on the road. Contact your local senior services agency to learn about services in your area.
Conclusion - As drivers age, they experience changes in physical capacity, vision, hearing, and other important functions which decrease their ability to react. As a result, driving may become dangerous. These changes occur over time and often the driver does not recognize them.
Continually evaluating physical health and driving skills is important to maintaining safe road handling. Recognizing when to give up the car keys and making the transition to alternative methods of transportation is an important step in ensuring and elder's safety and those sharing the road.