older people’s health issues
The Older Driver
A Driving Decision
At some point, most older drivers (especially those with significant medical impairment) face the decision of whether it is safe to continue to drive. A decline in the abilities required for safe driving may make driving dangerous. Not being able to drive may mean a loss of freedom and independence. It is very important to help an older adult who needs to stop driving find acceptable ways to get to important daily or weekly activities. Many of the same factors that raise concerns about driving safety can also affect an older adult’s ability to use public transportation. Sometimes the family doctor or a family member realizes that it is time for an older driver to “give up the car keys.” Dealing with this issue is always difficult, but ignoring it can bring even greater misery. There are some practical steps that may help older drivers feel more comfortable about stopping driving: Involve the driver in the decision to limit or stop driving. Help find other ways to get around. Investigate driving and delivery services. Keep the older adult active and work to ensure the person has rides to activities. Enlist the family doctor or a friend to discuss the issue. Many publications and online resources can help older drivers decide whether they should continue to drive (see AAA'sEvaluate Your Driving Ability). Resources available for family members and friends who may be concerned about an older driver include the following: The Hartford:At the Crossroads: Family Conversations About Alzheimer’s Disease, Dementia & Driving AARP:We Need to Talk National Highway Traffic Safety Administration (NHTSA):Understanding Older Drivers Alzheimer's Association:Having the conversation Most older drivers, sometimes with advice from family members or their doctors, can determine when to stop driving. However, some drivers, for example many people with dementia, lack insight into their driving ability and continue to drive even after a doctor has recommended they stop. One approach in this situation is to suggest that the older driver be tested by a driving rehabilitation specialist or the state agency that oversees or regulates licensure. If doctors are concerned about an older driver, they often refer the driver to a driving rehabilitation specialist. These specialists are often occupational therapists who provide comprehensive driving evaluations and rehabilitation for drivers with medical problems. They are often located at hospitals or in universities, but some have private clinics. They are able to evaluate drivers for safety, provide vehicle modification or adaptive equipment, and give mobility counseling or advice on alternative methods of transportation. The American Occupational Therapy Association'sweb sitehas information on finding driving rehabilitation services. After the driver is seen by a driving rehabilitation specialist and has implemented recommended changes, doctors may request the driver be retested by the state licensing agency. A retest also can be requested by the driver or by an immediate family member. It can include vision testing and written and on-road testing. Different states' regulations regarding licensing vary. For example, in some states drivers must retake an on-road test with the state licensing authority to maintain a license. State regulations requiring doctors to report drivers with certain medical conditions and/or safety concerns also vary. In a few states, doctors are required to report any driver believed to be unsafe. Other states have ways for family members to confidentially report an older driver in the family for driving concerns. It is important for people to contact their own state licensing department (such as the Department of Motor Vehicles) for regulations specific to their state. Laws regulating the possession and renewal of a driver’s license by older drivers also vary from country to country. Older drivers and their family members may want to consider the following factors as they determine whether it is still safe to continue driving: Do they get lost while driving, forget the destination while driving, or return home late from a routine drive? Do friends or family members worry about their driving or have stopped accepting rides? Have they had more near-misses lately? Do they have difficulty seeing other vehicles and reading and reacting to road signs? Does traffic congestion, a busy intersection, or making left turns make them anxious? Do they drive too slow or too fast? Do they feel other drivers drive too fast? Is driving stressful or tiring for them, or do they become angry or confused while driving? Is the glare from oncoming headlights or street lamps bothersome? Do they have trouble turning the steering wheel, pushing foot pedals, looking over their shoulder when backing up, avoiding curbs, staying in the lane, or parking? Do they sometimes confuse the gas and the brake pedals? Have they had accidents in which they were at fault in the past year, or have they been stopped by the police because of their driving? Have they fallen in the last 1 to 2 years? Do they make slow or poor decisions when driving? Do they sometimes forget to use mirrors or signals or to check for oncoming traffic? Older drivers and their family members who are concerned about any of these issues may want to talk with their doctor or consult a driving rehabilitation specialist about ways to improve driving safety. 