Wondering if your elderly father should drive?

When do I take away the keys?

That is a question I am asked all of the time. When is it time to tell your aging parent to stop driving? And more importantly should you intervene at all? Many caregivers struggle with these questions as they become more involved with the care of an aging parent or spouse. Is there an age when everyone is too old to drive? Maybe but age really is not the biggest risk factor of one’s ability to drive. As a caregiver you might have to be the one who has to make this very difficult decision. So how do you know?

Driving = Freedom

First, remember what driving represents to all of us. Think back to when you were a teenager and couldn’t wait to get your driver’s license. The sense of freedom, autonomy and independence it gave you. You could go where you wanted to go and when. No more waiting for someone to take you somewhere, pick you up, and even more important have an opinion about where you where going,  when and why (normal parental concerns aside).

So as you think about limiting or eliminating your loved one’s ability to drive remember that you are not just taking away keys and assuring their personal safety but you are also limiting their autonomy and independence. If they are unable to drive themselves then someone else (probably you)  will have to drive them or do the errands that they would be doing independently.

How do you know when?

Making the decision for someone else that they should not be driving has the potential to create significant amount of conflict and should be done so cautiously and only as a last resort. It is a difficult decision that is best handled as compassionately as possible. Working through alternatives and finding compromises is the best approach. Slowly reducing their need or opportunity to drive will also help alleviate the sense of loss they will feel and may be a more acceptable compromise than not driving at all.

Normal Aging and Driving

Most people as they age become aware that they are not able to drive as well anymore. They become aware that it is more difficult to see at night and that driving is much more stressful than in the past.  Most aging adults will naturally limit or reduce their driving as a way to reduce the stress. And most people decide to stop driving on their own. They have one too many accidents, or close calls to feel comfortable behind the wheel, so many will naturally limit themselves to only driving when necessary, only at certain times or only to known local places. But some drivers seem to be less aware and continue to drive long after they are able. And those are the ones of greatest concern to family caregivers

So how do you know if and when you need to intervene for your loved one? To begin with let’s discuss why people who were previously very good drivers are now a cause for concern. There are two factors that influence a person’s ability to drive safely a their physical ability and their cognitive or mental ability. Understanding and identifying the difference is the key to deciding if, when and how you might need to intervene.

PHYSICAL ABILITY

VISION

Normal aging diminishes a person’s physical ability to drive. As we age our eyesight weakens, it diminishes our range of vision and peripheral vision is narrowed. Our ability to judge distances and   “see” as wide a field becomes impaired as our field of vision shortens (front/back) and narrows (side to side). Most times these changes occur slowly over time so a person adapts and adjusts their driving skills to meet the changing physical ability. Many people will naturally reduce the amount of night driving or drive much more slowly and cautiously in rainy or low light conditions. Sometimes they are less aware of the changes and are caught by surprise finding it more difficult to merge or change lanes, noticing that the “blind spots” have gotten larger. Left hand turns become more stressful because it is more difficult to accurately judge the distance and speed of the on coming traffic.  An increase number of accidents and fender benders driving in parking lots or in reverse due to misjudging distances or not seeing obstacles.

REACTION TIME

Aging’s most significant impact on our driving is in slower reaction times. As our brains age the ability to respond quickly tends to diminish. So many find that they are unable to stop in time, merge or change lanes quickly or easily, make turns either across traffic (left hand turns) or into traffic (from a parking lot onto a busy road). In a crisis, a driver might accidentally accelerate rather than stop because they couldn’t switch their foot to the brake pedal quickly enough.

So how do you know when you as the caregiver need to intervene? Begin by observing their behavior to gauge if they are aware that driving is becoming a problem for them. Generally you do not need to do anything if you notice that your loved one is already making changes to their usual driving habits.

Clear thinking adults are aware that their physical abilities are diminishing and will naturally change their behavior and routine to maintain their personal safety.

They will naturally engage in self-regulating behaviors such as:

• Not driving at night or in bad weather
• Not driving on highways or on very busy roads.
• Only going to and from routine places
• Limiting the number of trips in a day or week
• Driving during the day or when traffic is light
• Letting others drive them more often than in the past.

Most people decide to stop driving on their own when they no longer feel safe.

You might need to intervene when you sense a reluctance to accept their physical inability to drive safely. And to do that you must understand what the real issue they are struggling with

• Are they afraid losing their freedom and independence?
• Do they not wanting to be a burden others with their needs?
• Are they afraid to be homebound and not able to enjoy their usual outside activities?

So how do you help? By encouraging an open conversation to talk about their concerns. Help them find alternative solutions including the self-limiting behaviors to maintain safety. And in the end you may need to just step back and let them make their own benefits versus risk decision.

COGNITIVE ABILITY

Memory loss and impaired judgment will significantly impact a person’s ability to drive. Someone who has even the earliest signs of cognitive impairment or memory loss may still be physically able to drive but may find themselves getting lost or easily confused. Some people in early stages of cognitive decline are aware of their increasing inability to drive. They will find themselves frightened and confused when they are lost or cannot find their way to usual places even back home. While they may physically be able to drive well it is best that they not drive alone, to new places or drive far distances. These individuals will usually stop driving on their own or with very little prompting.

But some are unaware of their cognitive decline at all and least of all it’s impact on their driving ability. These circumstances create a much more challenging situation for family caregivers. Any lack of awareness of their diminished capacity (either physical or cognitive) is a warning sign that a caregiver needs to intervene in a more assertive manner. Their inability to be an active part of the solution requires more creative interventions to avoid conflict and confusion.

No one agrees to a solution to a problem they don’t know or believe they have.

Convincing someone who is consistently forgetful or easily confused that they cannot drive will only work for a limited time – until they forget the conversation. Someone who is unable to think logically and in the present moment is unable to unable to understand the consequences or process an alternative solution. So how do you get someone to stop driving in these circumstances with the least amount of stress and prevent on going conflict.

• Avoid direct confrontation, their inability to understand or remember will only create, escalate or perpetuate conflict. More creative solutions are required.
• Begin by asking where they wanted to go to and why
  • Offer an alternative – why don’t I drive you
  • Redirect “You can go there later” but we need to do this now
  • Postpone – it is the wrong day or time – the store is closed, that is not until next week or that person is not home today.

Usually there is an underlying need that can be met another way and so redirect them to something that will meet that need.

• Suggestions to prevent someone from driving on their own
  • The key is “missing” or “doesn’t work”
  • The car won’t start (battery is removed or disconnected)
  • The car is “in the shop” (out of sight is usually the easiest solution)

SUMMARY

The inability to drive is a significant loss that most people fear more than any illness or symptom. The loss of independence and self-determination can have a devastating impact on a person’s mental and emotional well being. Families and caregivers should move cautiously and compassionately as they help someone through this difficult life transition.

I hope you found this helpful

Please be sure to send me your comments and questions

So until next time – take care of yourself and know that there is

…help for the journey