How to Tell When It’s Time to Relinquish the Car Keys

Not everyone who should give up driving because of age or infirmity is willing to do it, we hear from Elizabeth Dugan, PhD, a researcher and associate professor at the University of Massachusetts Boston and author of The Driving Dilemma. She explained that giving up your car keys is emotionally loaded. “It’s important to realize that driving means more than getting from point A to point B. It is autonomy and independence.” If someone in your life needs to move to the passenger seat or you’re wondering whether it’s time for you to consider doing so yourself, it’s important to address the topic openly and honestly. You need to objectively evaluate abilities and deficiencies, and if evidence shows it’s time to stop driving, to come up with a plan for maintaining safety, independence and dignity, Dr. Dugan said.

GETTING AN ASSESSMENT

A logical first step is a consultation with a health care provider, such as the family physician… to assess the individual’s abilities. Specific areas to review include:

  • Cognitive skills. Tests of an older driver’s functioning can help determine driving fitness, which is even more critical if dementia is an issue. While some experts believe people with early dementia can drive safely, studies show that drivers with dementia are at greater risk for accidents — one recent one, from the University of Iowa, assessed the cognitive, visual, motor and on-the-road skills of 40 drivers with early Alzheimer’s disease and 115 drivers without any neurological diseases. People with AD had 27% more driving errors, leading researchers to conclude that performance on vision, cognition and motor skill tests is important in determining whether a patient with Alzheimer’s disease can safely drive.
  • Vision. The state of Florida now has mandatory vision screening for drivers 80 years of age and older. A study recently published in the Archives of Ophthalmology, by researchers at the University of Alabama at Birmingham, suggests that this program brought about a 17% lower death from traffic crashes in this age group. Vision should be checked by an ophthalmologist or optometrist every one to two years if 65 or over, or two to four years for those 40 to 64, even if your state doesn’t mandate it.
  • Motor skills. Motor function, range of motion and motor strength should be evaluated.
  • Medications. The doctor will review regular medications to see if any might interfere with the ability to drive safely.

A formalized multidisciplinary assessment is the gold standard for determining driving fitness, according to Dr. Dugan. These are programs in which a geriatrician or geriatric nurse practitioner assesses physical function… a social worker assesses driving history and driving needs… a geriatric neurologist or neuropsychologist provides a cognitive workup… and an occupational therapist takes the person for a road test and/or helps find adaptive products. Clinics providing these assessments are usually associated with medical schools or rehab centers. To find a clinic in your area, log onto the Web site of The Association for Driver Rehabilitation Specialists, and click on membership directory. While such an assessment is usually expensive and not covered by Medicare, it may turn out to be money well spent.

SAFER DRIVING TIPS FOR SENIORS

Even if an assessment concludes that it’s safe to drive, it may be wise to maintain or improve driving fitness with these steps:

  • Stay physically fit. Yale University researchers found that physical conditioning helps maintain older adults’ driving performance, decreasing errors by more than a third.
  • Take a refresher course for older drivers. The AARP, for example, offers a driver safety education class for drivers 50 and over. Go to AARP.org/families/driver_safety/.
  • Use low-tech modifications (for instance, larger convex side- and rear-view mirrors) to compensate for reduced flexibility and other physical challenges.
  • Have your vision checked at least every two years. Also, keep the windshield of the car clean.

Don’t minimize concerns about safe driving — if you or a family member is worried about it, chances are there is good reason. A heart-to-heart conversation emphasizing your concerns about safety while also expressing respect for your loved one’s feelings is an act of love, for your family and others in the community.