One of the most significant strikes to an aging adult's independence occurs when his or her driving ability is called into question.
Concerned family members are often the catalysts of such conversations, many of which tend to follow a similar script:
"Dad should not drive anymore and we have tried to nicely tell him this. While talking about driving, he makes excuses. He says he has to drive or he will go nuts," laments one frustrated family member on the AgingCare Caregiver Support Group. "I say that's better than killing someone or yourself. I think he is being selfish with no regards for others."
Not driving could hasten depression
Nearly every family will face a similar scenario at some point. And while a loved one's defensive comments may seem like an overly dramatic last-ditch effort to stay on the road, there's actually some truth to the idea that—especially for older adults—driving and mental well-being are interrelated.
Having a purpose and feeling connected to family and friends is crucial for fending off depression in older adults, and the ability to drive is key to maintaining these relationships.
A University of Missouri (MU) study found that when one spouse in an older couple stops driving, the other spouse also becomes less likely to work or volunteer, effectively isolating both partners.
"Individuals should recognize that making the decision to stop driving is a major life change that needs to be taken seriously," according to MU College of Human Environmental Sciences assistant professor, Angela Curl. "These are complicated, difficult decisions, and mediation can often be helpful through, for example, a social worker or counselor."
Where to start
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 relinquish their keys. "It's important to recognize that each person is different," says Marian Betz, M.D., assistant professor at the University of Colorado Anschutz Medical Campus. "Some adults may prefer advice from a doctor, others from family or friends or peers."
For concerned family members, seeking the assistance of a medical professional to get a 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," writes Betz in an article in the Journal of 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 to report an unsafe driver. These rules and regulations matter because doctors can feel uneasy about reporting to state licensing authorities, says Betz. For example, in Colorado, physicians don't have to report an unsafe driver, but they are encouraged to, and are offered protection against professional liability if they do.
To better understand the barriers that health care providers face when talking about driving, Betz and her team interviewed 15 doctors, nurses and social workers on the issue.
The interviewees identified several major roadblocks to engaging in dialogues about driving with older patients: not having enough time during a typical appointment slot, not being able to accurately evaluate a patient's driving fitness (Doctors have to rely mainly on hearsay from patients and families because there's no way for them observe a patient on the road.), not being trained in the best way to approach driving discussions with patients, and not having enough information to offer 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.’ ”
Is it easier to talk about death or driving?
Some physicians also face philosophical conflict when weighing whether to intervene on driving decisions.
Along with dialogues about advance directives and end-of-life care, conversations about driving are often grouped into the category of "difficult discussions." But not all of these are created equal.
A doctor who is board certified in geriatrics, internal medicine and palliative care described her dilemma to 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 also 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."
Safer roads without sacrificing independence
Better communication between older drivers, their families and their doctors is essential for developing effective solutions to the driving dilemmas that accompany aging.
Betz's findings revealed a number of areas for improvement in the clinical setting.
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 agreed that making questions about driving a routine part of the annual Medicare Wellness Visit would be worthwhile (currently, driving is only a suggested topic of discussion).
Identify Affordable Resources
Most doctors are unaware of the services that are available to help older drivers stay safe, 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. Giving doctors easy access to resources that provide information on transportation alternatives would help them feel more comfortable addressing the topic with their patients because they could offer a viable solution, according to Betz.
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 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)."