11/05/2010 08:41 am ET | Updated Nov 17, 2011

When Seniors Begin to Have Difficulty Driving

"I can barely hear, barely see and barely walk. Things could be worse, though. At least I can still drive." These words, spoken by a participant in one study on the safety of elderly drivers,1 make many family caregivers cringe. We all know someone who struggles with whether or not an older family member can safely continue to drive. These doubts may develop slowly, or suddenly after an accident. But either way, there is evidence to suggest that the physical capabilities for safe driving decline markedly after age 75.2 In addition to declines in visual acuity and peripheral vision, the elderly experience increasing rates of Alzheimer's disease and other forms of dementia, which make it harder from them to remember routes and make decisions when faced with challenging situations.

Family members are often the first to express concern about a senior's driving, but they are often reluctant to say anything because they fear their loved one will lose autonomy, or it will cause anxiety that this loss of independence is the first step toward isolation or eventual institutionalization. And truth be told, these fears are valid. Studies show that cessation of driving does negatively affect a senior's social integration, especially when it comes to friends and peers.3 At the Visiting Nurse Service of New York, social workers and nurses consult with families everyday about how to approach these difficult conversations. Click here for some helpful insight.

Milton is a 74-year old former truck driver who lives alone. He suffers chronic leg edema and mild memory impairment, though he has not been formally diagnosed with Alzheimer's disease. Joan, his daughter, who lives about 20 minutes away, is his family caregiver, handling all of his doctor's appointments, home health care, and finances. For years, Milton has been driving to Joan's house every Sunday for family lunch. It's a ritual that he enjoys immensely because he has the chance to visit with his grandchildren and the family dog, Bruno.

Lately, Joan has begun worrying about her father's driving. She doesn't let him take the kids in his car anymore, and whenever possible, she sends her husband John to pick him up on Sundays. But with the kids' sports and other obligations, it's often not possible for John to make that round-trip twice on a Sunday. And Joan doesn't have the heart to cancel on her father.

She has tried to broach the subject of her father coming to live in her neighborhood, so that it would be a quick trip to pick him up. "I've mentioned this idea to him, but Dad wants none of it. He watches football with friends on Monday nights, and feels comfortable in the neighborhood he's lived in for 40 years," says Joan. "And the one time I told him I was worried about his driving, he wouldn't talk to me for days. I guess he figures as long as he's still driving, he's not that old!"

Joan's experience is not unusual. Studies show that older people themselves want to be the ones to make the decision to stop driving.4 If they have to hear it from someone else, they want it to be their physician. Only as a last resort do they want to hear it from a family member.

While many family caregivers would prefer that their physician raise the topic of driving, or, in extreme cases, report unsafe driving to the DMV, states have varying laws regarding when and if physicians should report what they suspect is unsafe driving. Physicians fear breaking patient confidentiality and also know that limiting a person's driving can negatively affect their quality of life.

Joan decided that the best way to approach the topic would be to do it right away, while her father seemed still able to do most of his driving. She knew this would be a series of conversations over time, rather than just "one big talk." "I started pointing out accident stories in the paper," she said, "and also talked with Dad about how I was glad he was coming here for lunch rather than dinner, because I wouldn't want him to drive at night. Also, his physical therapist mentioned that there were some hand controls that could be installed in the car to compensate for any weakness in his legs."

Family members should realize that these early conversations are just a first step in what may be a long process of getting a family member to give up the keys. But it helps to keep things in perspective. The fact is that many older drivers, especially those who impose some limits on themselves, can continue to drive safely for some time. In fact, many older drivers model very safe driving behavior -- they are more likely to wear seat belts and less likely to speed, tailgate, consume alcohol prior to driving, or go "hot-rodding" with friends. Plus, they're not the most dangerous drivers on the road, especially when you compare them to teen drivers. In fact, if you compare drivers over 75 with those under the age of 25, those under 25 have a much higher fatality rate per mile driven!

Of course, when a senior has cognitive impairment, it's even harder for a family caregiver to trust their ability to self-regulate their driving. In these cases, family members are more likely to seek the involvement of a physician. However, a diagnosis of Alzheimer's disease does not necessarily mean that a person must give up driving immediately, particularly for those who have been diagnosed early and are on appropriate medications. Click here to learn more about living with Alzheimer's disease.

The most important part of getting your family member to give up driving is to ensure that there are other transportation options available. Whether it's arranging rides with family members, using the money formerly spent on a car to get an account with a local taxi company, or accessing public transportation, it's imperative to make transportation available so seniors do not feel trapped at home and isolated. Giving up the keys may be a hard nut to swallow, but giving a supportive environment in which your family member can get from place to place will ensure that they can continue to live an active and fulfilling life.

The American Medical Association's "Physician's Guide to Assessing and Counseling Older Drivers" suggests that if any of the following statements is true for a particular driver, it's time to evaluate driving performance:

  1. I get lost while driving.
  2. My friends and family members say they are worried about my driving.
  3. Other cars seem to appear out of nowhere.
  4. I have trouble seeing signs in time to respond to them.
  5. Other drivers drive too fast.
  6. Other drivers often honk at me.
  7. Driving stresses me out.
  8. After driving, I feel tired.
  9. I have had more "near misses" lately.
  10. Busy intersections bother me.
  11. Left-hand turns make me nervous.
  12. The glare from oncoming headlights bothers me.
  13. My medication makes me dizzy or drowsy.
  14. I have trouble turning the steering wheel.
  15. I have trouble pushing down on the gas pedal or brakes.
  16. I have trouble looking over my shoulder when I back up.
  17. I have been stopped by the police for my driving recently.
  18. People will no longer accept rides from me.
  19. I don't like to drive at night.
  20. I have more trouble parking lately.

Have you discovered a unique way to talk to an aging loved one about giving up the keys, or found alternatives to driving that help ease the transition? Please comment below and share your experiences--your solutions might help others too.

1"The elderly driver: Deciding when to stop," Persson, Diane, The Gerontologist; Feb 1993; 33, 1; Research Library pg. 88.
3"Social Integration and Social Support Among Older Adults Following Driving Cessation," Briana Mezuk and George W. Rebok, The Journals of Gerontology: Series B Volume 63, Issue 5, 2008, pgs. S298-S303.
4Persson, p. 90.

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