Driving Safety: When to Take the Keys Away From Your Aging Parent

It doesn't seem that long ago that my wife and I had to make the decision to not let our young son ride in the car when my father-in-law was driving. Now we are the grandparents and our children have to make that decision.

When I was growing up in Chicago I couldn't wait until summer came and I could go to Riverview Amusement Park. At the Fun House I could walk from mirror to mirror and transform myself from skinny to fat; from tall to short; and then back again.

Computers came along and 20 to 30-somethings could take a picture of themselves and have software wizardry transform their appearance to that of a 70-year-old. But, how does it actually "feel" to be 75-years-old and to have to drive to the grocery store, doctor's appointments or to a grandchild's birthday? The mirrors and computers never told me that story.

There is a national discussion on aging that is starting to take place and none too soon. The fastest growing segment of our population is 85 years and older with the Baby Boomers right behind them. It is an "Aging Tsunami." Part of this national discussion was an event at New York's Grand Central Station, which was part of Liberty Mutual's, "National Conversation Drive." It is an effort to raise the level of awareness among baby boomers and their children of the driving problems that occur as we age and the need to plan for a time when we should no longer be driving.

As We Age
The mirrors and computers can play games, but our bodies tell us the truth. As we age, changes take place in our bodies that affect our ability to drive:

• Vision: The lens in our eyes form cataracts and let in less light. We may get macular degeneration and lose our central vision. Depth perception is impaired.

• Cognition: Our judgment and planning skills deteriorate and we react more slowly to sudden changes like a car stopping in front of us.

• Motor Function: Our joints lose their mobility, restricting our motion and affecting our ability to move our neck from side to side or quickly move our foot from the gas pedal to the brake.

• Sensory Function: We lose sensation in our hands and feet and our balance becomes impaired.

As a newly minted 65-year-old, I already know how some of these afflictions feel, but while I was in New York City, I took the opportunity to try out the Liberty Mutual aging simulator. With my Medicare card in hand, I went behind a blue curtain and two young people "aged" me at least 20 years in five minutes. A weighted vest and straps hunched me forward, while lower leg braces restricted my motion. Weighted gloves impaired my hand mobility and sensation while a neck collar restricted my ability to look from side to side. As I felt myself widening my stance to improve my balance, I was handed a pair of glasses with their centers fogged to simulate macular degeneration. I felt as if someone had nailed my feet to the ground and I dare not try to move. With someone at my side to keep me from falling, I shuffled toward a medium sized car, feeling with every step that I had aged 20 years.

A video clip highlights my journey through this process. Watch it, here.

For now, I can take the suit off and lose the 20 years, but some day I will not have that luxury.

What Can We Do?
A recent article in JAMA makes it clear that everyone, including physicians are uncomfortable dealing with taking away someone's ability to drive. It is devastating to tell someone who is independent in their driving that they can no longer drive. The article recommends that physicians administer a screening test, the Assessment of Driving-Related Skills (ADReS) during a routine office visit. However, one-third of those who failed this screening test were still able to pass a behind the wheel test. Their recommendation was to refer the person to a rehabilitation driving specialist, usually an occupational therapist who has more sophisticated tools to help make this difficult decision.

One such device is DriveABLE™, a computer based test that evaluates critical skills that are utilized in driving. It incorporates components of neuropsychological testing in an easy to use test that looks at:

• Motor speed and reaction time

• The ability to pay and shift attention

• Decision making abilities in driving situations

• Judgment in spatial decisions

Tests like DriveABLE™ give the family and their physician hard data to show the person that they may no longer be a candidate to drive. Taking a ride with your loved one is probably the most valuable tool. Why is Mom taking so long to apply her brakes when the car in front slows down? Did she just cruise through that school zone or ignore the stop sign?

Older Employees
I never really thought about the issue of aging employees until it was brought to my attention by David Melton, the Director of The Transportation Consulting Research Institute for Safety at Liberty Mutual. With baby boomers having to work longer we will see more older truck drivers, couriers, service workers and taxi drivers. What would be your reaction to jumping into a cab and finding a 75 year old at the wheel? I know of two people who went to truck driving school after the age of 70 and are driving big rigs. It was something they always dreamed of doing. Are they safe? Did anyone check their reaction time and attentional abilities? Do we know how they will react in an emergency?

The Transportation Research Board has published a literature review on older commercial drivers. The results are somewhat counter intuitive in that older drivers did not have an increase in accidents. Some believe that older drivers become senior drivers, with seniority at their place of work, can select themselves out of those higher risk jobs and situations that are more likely to lead to fatigue and accidents. Mr. Melton is more worried that older sales and service drivers who stay employed longer and will be a larger part of the driving public; driving more "senior" miles than if they were not employed. As we have to work later in life we will be forced to keep driving in situations we might otherwise avoid. The study noted that, "most important is the evidence showing that loss of function for any driver underlies a higher risk of crash causation, regardless of age."

It is time for a national conversation on driving in the elderly and it is encouraging that both the insurance industry and the medical community are addressing the problem. So, "suit up" and a take a look at your family and employees. Should everyone still be driving?

 

 

 

Follow Richard C. Senelick, M.D. on Twitter: www.twitter.com/RichardSenelick

Comments

[Lahonda]

11:32 AM on 12/21/2010

When you won't get in the passenger seat and yet they're still driving, that's misplaced love.

[pooka47401]

11:08 AM on 12/21/2010

My Father's Doctor was requested to file a form in Florida that would suspend his Driver's License. The Doctor would not do it. I was appalled to see my Father's car with fenders sliced and doors dented. He had crashed so many times that his insurance would not cover his accidents anymore. He was having mini-strokes and still driving. It was a wonder that he did not kill anyone.

I can empathize with those who are older and have no one to drive them to the store and appointments. I live in a rural area and I am concerned about my driving in 15 yrs but hopefully the electronic cars will have an input for destinations and I will leave the driving to my car.

[Bizroot1]

04:12 AM on 12/21/2010

She no longer drives after missing her driveway and plowing into the side of a parked removalist truck. But two strokes and a heart-atta­ck later, she still remembers and resents that comment.
http://www.articlesmoz.com/extenze-male-enhancement

[snapshot1940]

10:36 PM on 12/20/2010

They'll get my keys when they pry them from my cold, dead fingers.

[Sergeant]

08:32 PM on 12/20/2010

Our country doesn't provide for it's elderly like europe. In most cities there is public transportation free for those over a certain age and almost to your door. Taking the keys is tatamount to a sentence of solitary confinement. However, sometimes for the greater good it must be done. Seeking guardianship...even against their will...may be the only answer. If unsure, search for local elder law attorneys. They frequently have the capacity to work with families in these most difficult of situations.

[anastasiabeaverhousen]

05:30 PM on 12/19/2010

I remember when we faced the issue with our dad. We all knew he was not going to take it lightly, so we took the easy way out: we had his doctor tell him he couldn't drive any more.

He accepted his doctor's authority and handed over the keys.

[Neontom69]

02:22 PM on 12/19/2010

My dad's 72, is extremely independent, and he's always been an excellent driver. But lately when I drive with him, I wish I had a 5-point harness, a helmet, and a HANS device. He's into technology, and has several hands-free devices, but refuses to use them properly. Instead of prepping his trip and setting up the bluetooth or magicjack or GPS before driving, he does it all en-route. He actually was pulled over by a policeman for smiling at the cop with his cellphone at his ear. He told the cop he was being friendly, and completely forgot he was talking on the phone. He drives a minivan, so he can transport as much cr@p as he can fit in it like toys for the grandkids and clothes for the shelter. He fidgets with every gadget and control, drinks coffee and eats his muffin while steering with his knees, and succeeds in giving me heart palpitations and panic attacks if we travel together. Sure it's funny now, but I wait for that phone call from the police or hospital whenever he's out doing his things (he still works, thanks to the wonderful economy and his refusal to receive social security). It'll kill him to admit one day that he can't drive, and I dread the day I have to bring up the topic.

[Halsey]

10:47 PM on 12/18/2010

I of course hope my father doesn't kill himself behind the wheel of his car. He was ALWAYS a terrible driver. Now, at age 87, with very weak legs (he complains about them 24/7) he goes into his usual rage; ugly at 40 and even uglier at 87, and uses the f-word freely. MY biggest fear IS the other people's grandchildren. At 87, my dad has outlived the stats, never being truly ill.

In the state of Montana, it is nearly impossible to get the DMV to rescind a license. OF course, I'm sorry he would lose independence but children need to be safe. Lots of articles say "have a heart to heart", etc. They've not met my father. Always controlling to the point of cruelty. I think the DMV should INSIST on a difficult written AND driving (parallel parking, merging, round-a-bouts, etc) for EVERY person over the age of 75 or 80, even IF they have a clean driving record. As a family, we cannot physically take his keys; I think he'd get violent. This is a time when, sadly, yes more state intervention is needed...for the sake of the people i my father's path.

[DrVeronicaEyeMD]

07:52 AM on 12/19/2010

I hope your father does not kill someone else. If you see what us physicians see in the Emergency Room you would be even more of an advocate. I agree that this is an area where the DMV and government needs to institute rules as they do for new teen drivers as the aged population has an extremely high rate of accidents.

Next, how do we help our older citizens keep some measure of indpendence? Until that issue is solved, nothing will happen.

[signgrrl]

11:10 AM on 12/21/2010

it's just as bad or worse in Florida, the elderly are a huge voting bloc and there is no way to get legislation to pass to test elderly drivers. you can still drive at 100 yrs old with no testing of your rapidly deteriorating skills. so glad i don't live there any more.

[Angelaaaa]

10:01 PM on 12/18/2010

My mother-in-law (partially blind, arthritis and a heart arrhythmia) reassured her concerned children that she would no longer drive her grandchildren anywhere. To which my sister-in-law responded, "You can't see the crossings properly. What about other people's grandchildren?"

She no longer drives after missing her driveway and plowing into the side of a parked removalist truck. But two strokes and a heart-attack later, she still remembers and resents that comment.

[bkerensa]

08:28 PM on 12/18/2010

My mother and aunt should have taken the keys from my grandmother years ago.... one time I was driving with her and she started driving down a one-way street and I told her and she didn't believe me until state troopers pulled her over.