Procrastination is often the name of the game when it comes to talking about one of aging's off-limits topics: giving up the car keys for good.
Elders, their doctors and younger adult family members tend to avoid the dreaded driving discussion until certain signs that an elder is an unsafe driver —straddling lanes, excessive nervousness, sudden unnecessary stops or accelerations—start to appear, according to researchers from the University of Colorado, School of Medicine.
A series of in-depth interviews with dozens of older drivers and doctors found that, while elders and their physicians appear to be more open to having discussions about driving than one might initially assume, there is no formal structure (and little guidance) for how the topic should be approached.
Indeed, physicians tend to wait to get involved until a family member (usually an adult child) speaks up after having observed their aging parents driving in an erratic manner.
"Our most surprising finding was that many drivers said their doctors had no idea whether they were still driving, or not," says Marian Betz, M.D., lead study author and assistant professor at UC's Department of Emergency Medicine. "Doctors don't start to ask questions until concerns come up."
Driving cessation is an emotional topic, which is why many doctors avoid bringing it up until they absolutely have to. But asking questions after an accident occurs is akin to applying sunscreen after one has already been burnt—it might minimize the risk for future injury, but the damage has already been done.
Doctors feel obligated, yet unprepared for driving discussions
For an elder, a trip to the doctor's office can seem like a never-ending episode of "20 Questions," especially if they're dealing with multiple chronic health concerns.
How are you feeling? Are you sticking to your diet? On a scale of one to ten, how painful is your arthritis today?
"All I do when I go to the doctor is answer questions," one elder interviewee laments.
Despite the reams of information collected by doctors and physicians assistants, there's no specific set of inquiries designed to analyze an individual's overall driving fitness. An investigation conducted by the American Geriatrics Society found that only about 21 percent of physicians gather data on their patients' driving status.
Instead, the driving talk is typically ignited by a comment from a concerned family member or a noticeable change in an aging adult's health.
Whatever the cause for alarm, physicians overwhelmingly feel that they are the ones who have to initiate a dialogue with their older patients—a task that they view with an understandable feeling of trepidation. As one doctor puts it, "That's my job—to be the bad guy."
Driving discussions in the doctor's office are often neither scripted, nor planned for. They also tend to happen on the fly, increasing the uncertainty and frustration felt by everyone involved. "I've never had one person take it well," says one clinician. "They feel punished and, in a way, you're taking away their independence, which is a significant threat."
Balancing independence with safety
American adults tend to equate the ability to drive with freedom and self-sufficiency.
Consequently, the CU researchers were surprised to find that many of the elders they spoke with were willing to talk about the day when they would have to stop driving—as long as the issue was approached in a particular way.
Doctors and family members of aging adults must toe the line between ensuring that a loved one isn't endangering themselves (or anyone else) by driving unsafely, and allowing them to maintain a sense of purpose and autonomy.
Most people will outlive their ability to safely operate a motor vehicle by anywhere from six to ten years, according to Betz. On the other hand, recent research has yielded a compelling finding; older adults who give up driving too early are more likely to die than their peers who remain behind the wheel.
"The answer isn't to take away everyone's keys right now, nor is it for everyone to keep driving indefinitely," says Betz.
The bottom line: serious conversations between elders and their families, as well as between elders and their doctors need to start happening sooner—before an accident occurs. That way, everyone can work together to come up with a contingency plan for what happens when an elder has to stop driving.
Diffuse tension with an ‘Advance Driving Directive'
One way to kick off a conversation about driving is by encouraging your loved one to sign an "Advance Driving Directive."
Similar to its healthcare counterpart, the advance care directive, an advance driving directive essentially outlines an elder's wishes in the event that they should become incapable of safely remaining in the driver's seat. This document can help give your loved one more control over a future that may or may not involve driving.
The following, "Agreement with My Family about Driving" is one example of an advance driving directive developed by The Hartford Financial Services. It consists of a simple form that allows an aging adult to designate a person they trust to tell them when their driving habits are becoming unsafe.
Advance driving directives aren't legally binding; but they can provide you with an entree to get an aging family member to start thinking about, and planning for, how they would remain mobile if they were to have to stop driving.
"It's important to keep older adults mobile in the community and we need to help them," says Betz. "Everyone can benefit if families think through transportation needs and get a plan in place ahead of time."
The concept of an advance driving directive was well-received by most of the elders interviewed by Betz and her colleagues. As one interviewee puts it, "They're not telling you, ‘I want you to stop driving right now,' they're saying ‘If you get to the stage where somebody has concerns, would you listen to that person?' That's all the [advance driving directives] are saying. I think that's a good idea."
Your loved one may or may not be receptive to the idea of signing an advance driving directive, but such documents can provide you with another tool to use when dealing with a tricky—and often taboo—topic of aging.