Do you have a parent who is getting older? My mom will be 88 years old this month. She's proud of her car, a huge 2000 Cadillac in mint condition with only 50,000 miles on it. Most of the time it sits in the garage of her condo where she lives independently.
"Mom," I said, "How much are you driving your car?"
"I only drive to the grocery store?" Then silence. "And to the post office to mail you cookies, the ones you love." More silence.
If you have older parents who still drive, you know that's when it gets awkward. When you wonder, "Is this the right time to step in?" We want our parents to remain independent. But we also want them, and the people around them, to be safe.
As an article in the August issue of Psychiatric Times pointed out, there are 22 million older adults (78 percent) still driving with a valid drivers license. And with 79.6 million baby boomers out there, those numbers are going to keep increasing.
We all know that with age, we react slower, see less well, and find it more challenging to multitask. Throw in the possibility of mild dementia and Parkinson's Disease and it's not surprising that drivers older than 80 have the highest rate of accidents of every other group -- except teenagers. So like many of you, I've got to deal with the car keys of both groups because I have a teenage son. But that's another blog.
Now I'm not saying that every individual over a certain age should stop driving. Many are excellent drivers. But there are no standardized national guidelines for what constitutes a "dangerous" driver.
So here are some ways you can assess your parents to decide if you should have the "car key talk" with them, along with some things that can help them be as safe as possible:
1. Talk with their doctor about your parents' vision, mental status and physical limitations. Ethical guidelines from the American Medical Association permit doctors to contact their state's Department of Motor Vehicles (DMV) if they think a patient puts the public at risk.
2. Make sure their eyes are checked annually for vision changes, macular degeneration, glaucoma and cataracts. This helps prevent falls as well.
3. Ask your parent's doctor about a test called the UFOV (Useful Field of View). This test is defined as "the area over which a person can extract information in a single glance without moving his or her head or eye." The test isn't perfect, but a 40 percent reduction suggests the driver is unsafe.
4. Refer them to a hospital-based occupational therapy program for a road test.
5. If possible, make sure their car has automatic transmission, power steering, power brakes, and large mirrors.
6. Avoid high-traffic areas and times of day, and avoid driving in bad weather.
7. Limit night driving.
8. If they need a hearing aid, make sure they use it when driving.
9. Use common sense. Do you feel safe when you drive with them? Would you feel comfortable letting them drive your child? Would you feel comfortable walking on the sidewalk near them or driving in the lane next to where they are driving?
The ramifications of "taking away the keys" are potentially great. Studies show that people who don't drive are more likely to become isolated, have lower self-esteem, become depressed, and end up in a nursing home.
If your parent has stopped driving either voluntarily or involuntarily, there are two important things to prevent. The first is immobilization.
Older people need to shop, go to the doctor, the post office, the drugstore and much more. So help your parent find people to help them get around. It may demand more of you. But the money saved from not owning a car will provide some transportation money for taxis and other means. Many community centers have vans. Churches and synagogues may be a source of volunteers. Be creative -- maybe the dog walker can also help with running an errand.
The second precaution is preventing isolation. No one wants to be stranded, and that may be just how your parent may feel. Isolation is one of the major causes of depression. Helping our parents get involved in hobbies, activities, and arranging visitors can help. It's also important for you to stay in touch regularly.
From talking with my friends and patients, and also from my personal experience, I know how difficult this problem is. It's not easy to take the cars keys from the ones who originally gave them to us. But it's becoming a bigger issue as people live longer, and we can't ignore it.
Have you had similar issues with your parents? Please leave a comment and let me know. Tell me how you handled it.
Oh yes, and about my mother... Last week she called me to say she had come to the decision that it was time for her to "hang up her keys." Silence. Then she said, "I'm giving my car to your son."
"Thanks, Mom." I said. "Now I can stop worrying about you and start worrying about him!"
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