If we are blessed to be old enough, we will all reach a condition where we can no longer safely drive. It may be our vision, cognition, or something physical, such as the limited range of moving the head and neck. This article is meant to be a primer on the dynamics when it may be time to trade in our keys in exchange for others to help us get around.
Whatever the limitation causing concern, it can be an awkward conversation. No one (not the family or a physician) wants to be the person to take away car keys, which are a symbol and a means of independence. There can also be many fond memories connected with driving.
Reaching a certain age does not mean that you stop driving, nor does receiving a particular diagnosis mean that you should stop driving. If the situation is approached in a reasonable way, the decision of driving retirement can be an objective and measured process.
When a person in my home state of Louisiana is ready to renew his or her driver’s license at age 70, they are no longer eligible to renew by mail. There is no test, just that you show up in person.
The Best Case Scenario – The Advanced Driving Directive
Perhaps the best case is creating an advanced driving directive (ADD) when a person names someone who they trust to have the conversation with when it’s time to talk about limiting driving. A 2013 study by Betz and colleagues stated that 86% of older adults surveyed “would” or “maybe would” complete an ADD and of those, 79% said that they would “likely” or “very likely” cooperate with the ADD in the future. This is should sound very comforting to the family to read!
The Common Scenario
More times than not – my sense – is that driving conversation gets delayed in fear of hurting feelings or receiving a less-than-appreciated reaction. Then you notice scratches, dings, and dents. You feel nervous when riding in the car with them driving. You don’t let them pick up your children from school. They may get lost on familiar routes. Sometimes these concerns are enough to convince them that is time to limit driving or have a driving assessment.
Not an Ideal Scenario
Let’s say that a family still cannot broach the topic or the family tries and the person flat-out refuses to limit driving. The not-ideal (not worst-case) scenario, in my opinion, is when a family member anonymously reports the driver to the Office of Motor Vehicles (OMV). Not long after, the driver receives a “medical/vision” form to be completed by a physician. The ball is now in the court of the primary care physician who must complete the form before the driver’s license is suspended. Hopefully, the physician is aware of this and refers the driver and family to an occupational therapist specializing in driving assessment.
A Driving Assessment
The three aforementioned scenarios can all lead to the driving assessment. These are appropriately conducted by Certified Driver Rehabilitation Specialist (CDRS) from the Association of Driver Rehabilitation Specialists. The first part of the assessment consists of an office visit with several cognitive tests that measure abilities in reaction time, planning, depth perception, and more. If the person does well enough on these tests, he or she will move on to the road test. The CDRS will ride with the driver (with no family present) in the areas that the driver is familiar with.
The CDRS will deliver their recommendation to the driver in a sensitive way. The possible recommendations will fall into three basic categories:
- Keep driving with no restrictions and continue to monitor
- Keep driving with some restrictions (e.g., day only, no interstate, only certain stores/locations) and continue to monitor
- Retire from driving and create a plan to continue activities outside the home
The recommendation is also sent to the referring physician to consider. Please note that driving assessments typically cost $500 cash (not covered by insurance) and that accessibility for assessments may be scarce depending on your location.
Alternatives to Driving
It is a good idea to be thinking about was for you or your loved one to get around if driving is limited. Here is a brief list to get you started:
- Having a neighbor who goes to the same places (grocery, church, pharmacy, etc.)
- Family members (older grandchildren can spend time driving grandparents)
- Church friends
- RideShare (Uber/Lyft)
- Public transportation / Council on Aging
- Non-medical sitter
Advantages of Not Driving
It is also sensible to focus on some of the good things that can happen if driving is limited. After the potential emotions of disappointment are addressed, see if their benefits have been considered:
- Not paying insurance, gas, or maintenance costs
- Sell the car or gift it to a family member (new high school grad!)
- Peace of mind
A Decision Aid for Driving
Last, and certainly not least, is to consider asking the driver to try this online “decsion aide” from Healthwise. It will provide some education, as well as allow the driver to assess which way they are leaning before and after the education. A 2022 study by Betz and colleagues found that the most of the older drivers surveyed found that the decision aide was balanced between driving and not driving, respectful of personal values, and would recommend to someone. You can try the decision aide for free here: https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=zx3961
As always, it takes time and prayer. Be patient with yourself and your loved one as you navigate the conversation.
St. Christopher, patron of travelers and motorists, Pray for us!
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