One of the most significant blows to an aging adult’s independence occurs when their driving abilities are called into question. Concerned family members are often the instigators of such conversations, which tend to follow a similar script and often serve only to increase frustrations.
“Dad should not drive anymore, and we have tried to tell him this nicely. While talking about driving, he makes excuses. He says he has to drive or he will go nuts,” laments one frustrated family caregiver on the AgingCare Caregiver Forum. “I tell him that going nuts is better than killing someone or himself. I think he is being selfish with no regard for others.”
Driving Cessation Affects Quality of Life
Nearly every family will face a similar scenario at some point. While a loved one’s defensive comments like the one above may seem like a dramatic attempt to keep their car keys, there’s actually some truth to the idea that driving and mental health are connected, especially for older adults.
Having a sense of purpose in life and feeling connected to family and friends are crucial for preventing depression in seniors. The ability to drive is integral to maintaining personal interests and relationships.
A study conducted by researchers at the University of Missouri (MU) found that when only one spouse in an older couple stops driving, the other spouse also becomes less likely to work or volunteer. Driving cessation doesn’t just affect individuals, it can effectively isolate both partners.
“Individuals should recognize that making the decision to stop driving is a major life change that needs to be taken seriously,” explains Angela Curl, MSW, PhD, study author and associate professor at Miami University in Oxford, Ohio. “These are complicated, difficult decisions and mediation of the discussion can often be helpful through, for example, a social worker or counselor.”
Involving Professionals in the Driving Discussion
Regardless of whether you choose to use an outside mediator to facilitate the conversation, there are a few key things to keep in mind when convincing an aging loved one to give up their car keys. “It’s important to recognize that each person is different,” notes Marian Betz, MD, MPH, associate professor of emergency medicine at the University of Colorado Anschutz Medical Campus. “Some adults may prefer advice from a doctor, while others prefer straight talk from family, friends or peers.”
For concerned family members, seeking the assistance of a medical professional to get a stubborn loved one to stop driving is often a logical course of action.
“Healthcare providers have been identified as playing a central role in older driver safety because they are trusted by patients and families and have a responsibility to public safety,” Dr. Betz writes in an article in the journal Injury Prevention. After all, a doctor is more likely to know if their patient has any physical or cognitive issues that could impair their ability to drive.
But there is no official clinical test that a doctor can use to determine if a patient has driving issues, and state laws vary when it comes to how much legal responsibility a health care professional has when it comes to reporting an unsafe driver. These rules and regulations matter because doctors can feel uneasy about making reports to state licensing authorities, says Dr. Betz. For example, in Colorado, physicians don’t have to report an unsafe driver, but they are encouraged to do so and offered protection against professional liability.
To better understand the barriers that health care providers face when discussing driving with seniors, Dr. Betz and her team interviewed 15 doctors, nurses and social workers on the issue. Participants identified several major obstacles to engaging in dialogues about driving with older patients:
- Insufficient time during typical appointment slots
- Inability to accurately evaluate a patient’s driving fitness (Doctors rely mainly on hearsay from patients and families because there’s no way for them observe a patient on the road)
- Lack of training on how to best approach driving discussions with patients
- Insufficient information on transportation alternatives for adults who should no longer be driving
Even though physicians have been informally given the duty of helping their patients navigate their “driving retirement,” they may not be totally prepared for these conversations. When asked why she thought doctors were perceived as the go-to resource for driving discussions, one physician said, “I think one of the reasons is that patients trust their doctors and believe their physicians are more knowledgeable about this topic. It’s just a default way of saying, ‘We don’t know how to address this, so we’ll go talk to somebody else about it.’ ”
Discussing Driving Is Difficult for Physicians, Too
Surprisingly, doctors often consider the topic of driving to be one of the most difficult to discuss with patients—even outranking conversations about advance directives and end-of-life care.
A physician who is board certified in geriatrics, internal medicine and palliative care described her dilemma to Dr. Betz and her fellow researchers: “One of the most significant lessons in geriatrics is helping patients maintain their independence and respecting them, even as they age. We are taught to respect their freedom and their autonomy, but then we are to tell them, ‘Don’t drive’? I feel really comfortable having the end of life discussion, and it is less contentious than driving. When I say driving is one of my least favorite issues in medicine, that is not hyperbole. It is truly one of my least favorite things, because it is so sad.”
How to Make the Driving Conversation Easier on Everyone
Better communication between older drivers, their families and their doctors is essential for developing effective solutions to the driving dilemmas that accompany aging. Dr. Betz’s findings revealed several areas for improvement in clinical settings, but two in particular stood out.
Start the Conversation Earlier
Several physicians said that they try to “plant the seed” of a driving discussion in their aging patients’ minds years before any real concerns arise. By asking simple, non-threatening questions about driving (e.g. “Do you drive?”) prior to the onset of any problems, doctors hope to normalize such conversations. Then, “Years down the road, whether that is two or five or however many years, this is something that it is okay for me, as your doctor, to check in about,” one female physician said. Many of the doctors and nurses Dr. Betz interviewed agreed that making questions about driving a routine part of patients’ annual Medicare wellness visits would be worthwhile. Currently, driving is only a suggested topic of discussion.
If a senior’s physician has not yet introduced this topic of conversation, family caregivers may want to request that the doctor address it. Even briefly touching on driving safety once a year can help build trust and take some of the surprise and shame out of the eventual conversation about giving up the car keys.
Identify Alternative Transportation Options
Most doctors are unaware of the services that are available to help older drivers stay safe behind the wheel, and the programs that physicians do know about are often too expensive to be practical for many patients. For instance, driving rehabilitation programs can identify and help solve driving problems for certain adults, but Medicare, Medicaid and most private health insurance plans don’t cover the cost of these services. Betz explains that giving doctors easy access to resources and information on transportation alternatives would help them feel more comfortable addressing the topic with their patients because they could offer a viable solution.
Caregivers can help support their loved ones’ physicians by performing some research of their own on transportation options for seniors who can’t drive. By sharing these resources with the doctor, they will be better equipped to navigate the discussion about stopping driving and you will be one step ahead when it comes to arranging transportation for your loved one. As with many hurdles in caregiving, driving tends to be a challenge that requires a team effort to address. Although seniors frequently shrug off their family members’ suggestions and concerns, they are more inclined to listen when the doctor says no driving.
For caregivers, balancing an older adult’s safety with their independence is a challenging yet essential task when discussing driving. “It’s important to respect an older adult’s autonomy in decision making (as much as is safe) and recognize how difficult and emotional driving cessation can be,” says Dr. Betz. “It can help to assure the older driver that his/her transportation needs will still be met, whether it’s through rides from friends or family or other services (like taxis or vans).”
Sources: Productive and Social Engagement Following Driving Cessation: A Couple-Based Analysis (https://journals.sagepub.com/doi/abs/10.1177/0164027514527624); System Facilitators and Barriers to Discussing Older Driver Safety in Primary Care Settings (https://injuryprevention.bmj.com/content/21/4/231.full)