Is it time for “the talk” - about driving?

If you’re in your senior years, have you thought about when you should give up driving?

What would you do if you couldn’t drive? Have you planned for that eventuality, if and when it becomes necessary for yourself or a loved one? Do you suspect you, or perhaps a family member, may already have lost some of the physical or mental abilities needed to drive safely?

It can be a very tough decision.

“For the elder, for the family, it’s not easy for anyone to begin the conversation,” said Kathleen Hallman, a licensed independent clinical social worker with the Visiting Nurse Association of Cape Cod.

On one hand, at stake is potential loss of independence for the driver, and a blow to their self-image, said Internist Marcia L. Franklin, MD, of Bourne Primary Care. On the other, there’s the risk they may harm or kill themselves or someone else.

Knowing when to broach the subject is important, said Gillian Norton, who is also a licensed independent clinical social worker with the VNA.

“People should have this conversation earlier in life,” she said. “Then, when the time comes, people feel more secure.”

It’s a growing concern nationwide. As more people live longer, the number of older drivers increases. According to the National Highway Traffic Safety Administration (NHTSA), the amount of U.S. licensed drivers over 65 grew from 14 percent in 2001 to 21 percent in 2021. Over the same 20 years, the number of fatal crashes involving a driver over 65 grew from 11 percent to 19 percent.

Physical and Mental Health

Driving requires a host of skills – among them good vision, hearing, reaction time, concentration, decision-making, adequate strength and flexibility, Dr. Franklin said. The Massachusetts Registry of Motor Vehicles’ medical standards for automobile and motorcycle licenses sets forth allowable limits for vision (with or without corrective lenses), and for heart disease, pulmonary/respiratory function, seizure/loss of consciousness conditions and musculoskeletal problems. The RMV notes if some condition not specifically mentioned in the standards is suspected of causing a driver to operate unsafely, it will assess the person’s abilities.

“Some things are fixable. That’s why it’s good to get the doctor involved,” Hallman said.

Impairments such as slow reaction time or poor night vision may be able to be improved with exercise or cataract surgery, for example. Assistive devices, such as a steering wheel knob, supportive seat cushion or hand controls, can help keep drivers on the road.

But, other problems, including the ability to think clearly, remain roadblocks.

In addition to physical deficits, the RMV standards also cover cognitive impairment – problems with adequate judgment, attention, reasoning, memory, perception, and comprehension.

How to Tell If You’re Safe to Drive

Some health organizations and driver education schools offer evaluations for a fee. These can be in-vehicle skill assessments or clinical exams by an occupational therapist specializing in rehabilitation driving, according to the American Automobile Association (AAA). A patient might ask their primary care physician to perform an evaluation, which may involve referral to an occupational therapist, Dr. Franklin said.

If you want to privately explore whether you may be at risk, the NHTSA has an online self-assessment with useful tips to counter some problems and improve abilities. Some of those tips:

• Get annual eye exams and keep up with glasses prescriptions
• Exercise and stretch regularly
• Get stiffness and pain in neck and limbs checked by a doctor
• Have your doctor review your medications and whether any may affect driving
• Drive during daylight and avoid heavy traffic times
• Plan your route
• Be aware of changes in your body and how they affect your driving
• Pay attention to what people who care about you say about your driving

AAA also has a short 15-question brochure for self-assessment called Drivers 65 Plus.

AARP has a Smart Driver course for people over 50 taught both in person or online that discusses compensating for age-related changes, effects of some medications, use of technology in newer cars, and ways to reduce distractions, execute left turns and keep a safe distance from vehicles ahead of you.

How to Discuss Loss of Driving Abilities

If family members are concerned about a senior’s driving skills, they might look for new dents or scratches on the individual’s car and garage, Hallman said. They could also ask to ride with the person and watch how they perform.

“Most patients are not telling their primary they’re having difficulties,” she said. “Families should make sure the doctor is on board.”

It’s best to approach the topic calmly, with compassion and understanding, and not during an argument, Hallman said.

“It’s the last piece of independence,” Norton said. “Not being able to drive – it really can lead to significant depression.”

Older drivers may be aware that their driving abilities are fading. You may have gotten lost, are more anxious driving in unfamiliar areas or busy traffic or at night, or have had some near misses or minor accidents.

If the driver is having mental lapses, the discussion can be harder.

“Because of their cognitive difficulties, there’s a lack of insight to understand,” Norton said.

A doctor can write the RMV to have a patient’s license revoked. Dr. Franklin said it’s preferable if the patient chooses to give up their keys or hand them over to an adult child, perhaps with the understanding that that person will step up and provide rides and run errands for them.

“Having to go to the RMV is kind of a last resort,” Norton said.

The Importance of a Plan

“As soon as they hit 75, I start asking people, ‘What’s the plan?’” Dr. Franklin said.

Cape Cod has limited public transportation, and many people retire here away from family. Patients may need to downsize and move to an assisted living facility that provides rides into the surrounding community, she said.

“A lot of people end up very isolated when they retire here,” Norton said.

Transportation resources do exist, including:

• The Cape Cod Regional Transit Authority’s DART vans, a door-to-door service that can take a person from home to a store or medical appointment and back again. The service can accommodate people in wheelchairs. Rides must be scheduled at least 24 hours in advance and the time between being dropped off and brought back may be several hours.
• The nonprofit Village Movement, which utilizes volunteers over 60 to provide services, has four groups serving the region: Neighborhood Falmouth, Barnstable Neighbor 2 Neighbor, Bay to Sound Neighbors and Nauset Neighbors.
• Some area town senior centers can arrange for medical transportation or help around the house, Hallman said.
• Older people uncomfortable with phone apps can call GoGoGrandparent, which uses Uber and Lyft drivers to provide rides and make deliveries, Norton suggested.
• Groceries can be ordered and delivered through services such as Peapod and Instacart.

Older people should realize they are more than just their ability to drive, Dr. Franklin said. Planning ahead can make the adjustment easier by having a support network in place.

“You can still be independent,” she said.