By Dr. Golnosh Sharafsaleh
Do you ever wonder when it may be time to stop driving?
In the United States, driving is an essential part of most people's lives. For older adults, driving can help maintain independence. Only a handful of cities in the United States are considered pedestrian-friendly, meaning most individuals need a car to get around. In 2018, the United States Federal Highway Administration estimated that the number of drivers over 70 was approximately 29 million. Drivers over the age of 75 are at higher risk of dying after a car crash than middle-aged drivers. This isn't because they are bad drivers, it is because they are generally more frail.
Often, older patients stop driving after realizing that their driving is impaired. However, occasionally some older drivers are hesitant to stop driving even when safety becomes an issue. Sometimes, despite warning signs, adult children of older adults have difficulty talking to their parents about retiring from driving.
This blog will discuss some of the risk factors that can impair driving ability in older age and common warning signs.
Age should not be the reason to stop driving!
You don't need to stop driving because you reach a certain age but consider the combination of problems that can increase your risk of getting into a car accident. Common conditions can impair driving ability.
Changes in eye site or diseases of the eye, including cataracts, glaucoma, and macular degeneration, can impair driving. Older patients may have more difficulty seeing in the dark or experience blurred vision. Sometimes, it is difficult to see signs, go around curves, or distinguish how far a car or a pedestrian may actually be.
Hearing loss may interfere with hearing emergency sirens and horns.
In the neck and upper extremities, arthritis can limit the range of motion and interfere with backing-up or turning. Arthritis in the knees and hips may cause difficulty moving the legs and interfere with speeding up or using the breaks.
Neuropathy or numbness and tingling in the feet can cause the inability to feel the difference between the gas pedal and breaks.
Memory disorders such as dementia can impair attention span, following two-step commands, and reacting quickly in emergency situations. Dementia can also increase the chance of getting lost and the ability to detect unsafe conditions.
The use of multiple medications, called polypharmacy, mainly some pain medications, can limit awareness and reaction speed.
Older drivers sometimes drive older cars, which may not have the same safety features as newer cars.
For family and loved ones who are concerned and worry about driving, consider the following:
Have you been a passenger in the car with your loved one? If not, why not?
If you have been a passenger in the car with your loved one, list your concerns.
If you have not been a passenger in the car with your loved one, consider going for a drive with them, and consider some warning signs.
Warning Signs
An occasional mistake on the road may not indicate that a person is no longer safe to drive. However, a pattern of repeat incidents may be a concern. Common warning signs that driving is no longer safe can include:
Easily distracted while driving
Other drivers often honk the horn
Incorrect signaling
Difficulty parking within a defined space
Hitting curbs
Increased agitation or irritation while driving
Driving at inappropriate speeds
Near misses
Confusion at exits
Getting lost in familiar places
Confusing the gas and brake pedals
Stopping in traffic without a reason
Bad judgment on making left-hand turns
Moving into the wrong lane
Failure to stop at a red light or stop signs
Delayed response to situations or unexpected activity on the road
If you find that your loved one does not exhibit the signs above, then maybe they are safe to drive, but you should talk to their medical provider if you still have concerns.
If you find that your loved one is exhibiting the signs above, then you need to talk to their medical provider as soon as possible.
You can also reach out to your states motor vehicle division for assistance. Some states allow confidential reporting of unsafe drivers.
Consider a professional driving evaluation
Throughout the United States, some licensed therapists specialize in evaluating driver safety. A driving evaluation is generally performed by an occupational therapist who is a certified driving instructor and a certified driving rehabilitation specialist. A driving specialist's evaluation involves an in-clinic review of medical history, driving license status, driving record, physical, visual, and decision-making capacity. Depending on the in-clinic assessment, the therapist may perform a behind-the-wheel evaluation.
During a behind-the-wheel evaluation, the therapist assesses how the driver sits in their seat, exits the vehicle, maneuvers on roadways, follows signs, directions, and awareness. If needed, the therapist also evaluates the best way drivers can carry their wheelchair, walker, or scooter in and out of the vehicle.
A little about dementia and driving
A diagnosis of dementia does not necessarily mean that a person is impaired to drive. Patients with mild dementia may still be able to drive. However, dementia is a progressive disease. As symptoms progress over time, it becomes less safe to drive. Patients with dementia have difficulty following multi-step commands. They are slower to react to emergency conditions. They are at risk of getting lost, even on familiar roads. It is safer to start the conversation of retiring driving earlier with a person who suffers from dementia. As dementia progresses, patients lose the ability to comprehend safety. It may become more challenging to encourage them to voluntarily give up driving.
In one research study, most older lost drivers had dementia. When found, only 15% were still driving, and most were found near their parked car. 40% were found in the county where they were lost, while 10% were found in a different state. 15% of older lost drivers were found in dangerous situations, such as on railroad tracks, and 5% were found dead.
As difficult as it may be to take the keys away from a loved one with dementia, it will become necessary at some point in the disease journey.
Summary
I hope you enjoyed reading about driving safety and aging. Check out other blog posts on GeriAcademy. Also, consider looking at your state laws to determine what the state requirement for impaired driving are.
Remember, safety needs to come first.
Meredeth A. Rowe, Catherine A. Greenblum, Marie Boltz and James E. Galvin: "Missing Drivers with Dementia: Antecedents and Recovery." Journal of the American Geriatrics Society, Volume 60, Issue 11, Nov. 2012.