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When it is time to hand over the keys: The driving dilemma for elders

Among the many questions posed regularly to AARP, elder care specialists, and other professionals who offer advice, counseling and treatment to seniors, is this one about driving. For a majority of people, driving represents one of the most powerful symbols of independence and freedom, starting from teenage years in many cases. Along with so many other physical and mental changes accompanying the aging process, the ability to drive safely and appropriately is sometimes challenged. Family members are often the first to notice, rather than the individual elder, who may still think s/he is handling the car as always.

Earlier this week, the American Academy of Neurology issued new practice guidelines for physicians regarding patients with Alzheimer’s, dementia or other cognitive impairments and driving. While family observation and reporting of accidents, tickets issued and other visible signs of difficulties are still the best evidence to use when deciding when it is time to surrender the keys (or take them away in some cases), the physician often wields a more powerful voice for elders. The new guidelines, which also point to a fairly high number of patients with cognitive impairments still functioning sufficiently well to drive, are based on a Clinical Dementia Rating (CDR) updated for the study. Neurology  listed the updated guidelines in its April 12, 2010 issue.

As the population ages, estimates are that the numbers of drivers over age 65 will double to nearly 57 million, or one quarter of all drivers, by the year 2030. While no one disputes that aging impacts effectiveness, there is little agreement about just how dangerous older drivers are. Studies released last year by the Government Accounting Office (GAO) suggest that there are fewer crashes among the elderly based on the number of drivers. Of course, older people drive less than their younger counterparts. On the other hand, there are more fatal crashes among those over age 75 and older based on miles driven.

Some states, such as Illinois and New Hampshire, require retesting for their citizens over age 75. Colorado has no such requirement, although people over age 65 cannot renew their licenses online. In-person renewal generally involves a simple eye test administered by a DMV associate.

AARP, the largest membership and advocacy organization for people over age 50, offers advice regarding the conversation loved ones might need to have with their elders regarding driving, along with information about driver safety courses, which AARP recommends for people of all ages. AARP also suggests asking some key questions of the elder before making any assumptions or forcibly taking away the keys. Asking more general questions before situations drive the need offer families some strategies for addressing the problems later on. For example, ask parents when they are still active in their 60s questions such as, “What would you do if you didn’t have a car?” or “What changes would you have to make to your life if you could never drive again?” Ask, too, for some agreement about behaviors that would indicate a problem, write them down, and each take a copy. While these approaches may not avoid future conflict, they open the door to difficult conversations well before action is actually needed. Planning for this eventuality, as for all aging related matters, puts families often in a much stronger position for handling concerns later on.

Linda Mitchell, President & CEO, Alzheimer’s Association of Colorado, headquartered in Denver, says that driving “may in fact mean the difference between continuing to live in your own home or in an assisted living facility of some kind.” Of the recently released report, Mitchell adds that “it makes clear there isn’t a ‘one size fits all’ answer to whether people with dementia should be driving. The report does talk about the importance of caregivers trusting their own instincts about the safety of a loved one continuing to drive as often those with the disease aren’t able to make their own evaluation about their safety and capability behind the wheel,”

Alzheimer’s Association of Colorado hosts Memories in the Making, auctions of art created by their clients with Alzheimer’s in over 45 classes throughout the course of the year. A jury of professional artists selects the pieces to be auctioned. The first of the auctions takes place on April 29, 2010 in Pueblo, CO at the Pueblo Convention Center, followed by one in May in Fort Collins, and two in June - in Colorado Springs on June 3 and in Denver at Invesco Field at Mile High Stadium on June 10.

Kathryn also writes as Denver Disability Examiner and Denver Mobility Products Examiner. Contact for inquiries and to suggest future topics. Select ‘subscribe” to receive Kathryn’s articles on a regular basis. Select "subscribe" above to receive Kathryn's articles on a regular basis at no charge.
 

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