Article

Thursday, September 2, 2010

Making the "Key" Decision
When should an older adult surrender their keys?

by Rod Clark

For many older Americans for whom driving is the key to independence, the prospect of losing their car is a little like losing their legs. Suddenly, the grocery store, the doctor's office, the library, the home of a friend seem impossibly distant. With the loss of a car, their sense of independence diminishes and isolation increases. Nevertheless, as Americans live longer, and baby boomers begin to age, more and more older adults are staying on the road in this country-- sometimes with disastrous results. The AAA reports that almost a fifth of the fatalities on US roads in 1997 were elderly people. This is a substantial number, especially when you consider that older adults generally avoid driving at night, during rush hour, and under other high-risk conditions.

While age alone is never a determining factor, and many older adults are excellent drivers, age-related changes in the body do affect the ability to drive. By the age of forty, even individuals who have 20/20 daytime vision will have considerably weakened nighttime vision. By the time drivers reach the age of sixty, they need three times the amount of light they did at age twenty in order to drive safely at night. As we age, many of us develop arthritis, which slows our responses, and makes us more reluctant to turn our necks and check out blind spots when we are on the road. Many of the physical assets necessary for safe driving, good vision, hearing, flexibility and reflexes-- all begin to decay fairly seriously around the age of 55. At the age of 75, the decay accelerates. Almost a third of those over 65 have significant hearing loss. That jumps to 75% at age 75. Strokes, or diseases such as Alzheimer's may seriously impair an older individual's ability or recognize his or her own limitations. The AAA estimates that often we have only half a second to avoid most accidents. (At sixty-five miles an hour, a car is traveling the length of a football field every three seconds!) Drivers who cannot assess and respond quickly can endanger themselves and others. At age 85 and beyond, older drivers have more serious-injury and fatal accidents per mile driven than teenaged drivers.

Assessing Whether There's a Problem

Is your aging parent still a safe driver? There is no defined age at which driving must cease, and each instance should be judged individually. Although aging drivers can adopt safer driving practices to offset some of these physical changes as time passes, it is not an easy goal to accomplish. To achieve it, older adults must be able to recognize their limitations, identify unsafe practices, and educate themselves in ways that they can continue to drive safely. The following is a useful checklist that defines some of the danger points that an older driver needs to consider. Some of these questions an adult child or friend of the driver or a caregiver can answer. Some can probably only be answered by the older driver herself/himself.

CHECKLIST: "Can I still drive safely in spite of my age?"
To find out, answer the following questions yes or no.

Questions YES NO

I sometimes drive without buckling my seat belt YES NO

I haven't had an eye examination recently YES NO

I have had an accident or a ticket in the last six months YES NO

I take medications that can affect my concentration on the road YES NO

My thoughts sometimes wander when I'm driving YES NO

I am subject to seizures YES NO

I cannot respond as quickly to traffic situations as I used to YES NO

I have had at least one stroke YES NO

I sometimes have a drink before going on the road YES NO

Traffic situations sometimes make me angry YES NO

I sometimes feel confused at complex intersections YES NO

It's hard for me to decide when to join traffic on a busy interstate highway YES NO

I sometimes drive when I am under stress or emotionally upset. YES NO

I sometimes forget where I am going YES NO

I am sometimes short of breath while driving YES NO

I experience periods of sudden weakness or dizziness while driving YES NO

I have a limited range of motion in my arms and legs. YES NO

I sometimes drive at night even when it is difficult to see YES NO

I have diabetes or heart disease YES NO

I sometimes forget to signal or check to the rear before changing lanes YES NO

My children, family members, or friends are concerned about my driving YES NO

I don't always look over my shoulder to check blind spots YES NO

If the answer to one or more of the above questions is YES, continued driving may be a serious problem for the individual, and some sort of action needs to be considered. How should you proceed and what are the options?

First: Explore Ways of Discussing The Topic

Someone who has been driving for many years will be naturally reluctant to give up their license for all the reasons discussed earlier. Hence, persuasion, tact and humor will be necessary. In approaching the subject, it will be better to ask questions rather than make demands:

Do you think your vision is in good shape?
Are you ever frightened when you drive?
Would you consider not driving at night?
Does traffic make you nervous?
Is maintaining the car an expensive proposition?
Is parking difficult? Expensive?

Steps you can take before taking the keys away

Here are some steps that can be taken (short of taking keys away) to enhance the safety factor for older adults who drive, and others on the road. Children, caregivers, or friends can offer valuable assistance by helping older drivers:

Look at ways of lessening the need to drive:

Check out alternatives to shopping by car, including: --mail order catalogs, on-line catalogs, home deliveries. Also check out radio and television buying programs. In addition, Customer Service Departments in stores sometimes have home assistance divisions.
Arrange for home deliveries of groceries and other goods, and try to arrange for home visits by clergy, medical and personal care providers, and government service providers.
Use financial services that don't require bank visits, like automatic bill paying, direct deposit, and bank-by-phone or on-line banking services.

Reduce their sense of isolation:

Encourage them to take advantage of car pooling to attend church and other events.
Arrange for friends and relatives to visit regularly.
Invite them to family and group events and provide transportation.

Agree to consider:

taking a driver refresher course
not driving at night
getting their vision checked
not driving on busy thoroughfares or at rush hours
keeping the windshield clean
using mirrors more and/or getting a wide angle rear view mirror
taking shorter trips
not driving under adverse weather conditions

ALTERNATIVE TRANSPORTATION

Of course, people need cars for other things besides errands and getting supplies--and it is essential to remember that an automobile answers social needs as well. Sometimes it's important to simply get out of the house and interact with others. Even when we stop driving, those needs remain--so it is vital to explore alternative transportation options. Check out city buses, routes and timetables. Find out what cab services are available and what they charge. "Zone" cabs are generally the cheapest. In most communities, some kind of senior citizen taxi coupons are also available.

There are costs for these public transportation options, but they are generally less than what it would cost you to maintain a car if you include gas, insurance, and repairs. Don't forget other low cost or no cost alternatives. Assisted Living services sometimes provide transportation for a modest fee. Community transit groups often provide transportation with volunteer drivers, or car pooling for some events. Check with your church to see what they have to offer in terms of providing transportation to and from church services and other activities. Finally, check with your local Senior Center. Many provide transportation to and from a variety of social activities.

Here's another piece of useful advice. AARP recommends that older drivers keep a three second "safety cushion" between themselves and the car ahead. This can be measured by watching the car ahead pass a stationary point like a post, tree, or overhead bridge, and then counting "1001...1002...1003." If the following driver cannot count to three in this fashion before passing the same point-- they are following too closely.

Remember, it is important to get the older driver involved in exploring these issues. A sense of independence is always a factor, and there are always ways that older adults can participate in the driving review and decision-making process. This builds a sense of personal control, brings the affected individual into the process, and lays the ground for participation in the decision-making process.

Talking about it

Most older drivers when intelligently engaged on the issue will lessen, self-monitor or stop driving when it is time to do so--but some may require more persuasion than others. It is important to keep in mind that resistance has a positive side. It indicates that an older driver is determined to be self-reliant, and wishes to demonstrate their ability to run their own lives. These individuals deserved to be approached with intelligence, diplomacy and tact. Even a little humor may be helpful. In one case where a driver was a veteran, two daughters turned the surrender of the keys into a little ceremony that had a bit of military flavor and made their Dad laugh.

Taking the keys away, how?

Most older adults will surrender their keys when it becomes imperative to do so, especially if they are kept in the discussion, education, and decision-making loops discussed earlier. In few instances, however, an older driver will refuse to stop or alter driving practices even when they are becoming dangerous. In some instances, when all other options have been exhausted, you may have to consider going to the state Department of Transportation (DOT) to get them off the road for their own protection and the protection of others. DOTs have serious concerns about the functional ability of drivers to operate vehicles safely, and have established criteria and procedures for removing drivers from the road. For example, in Wisconsin, decisions about impaired drivers are based on symptoms, behaviors, and the observations of others, rather than the type of condition or a diagnosis. In order to take action on a given driver, the WDOT must receive:

Positive identification of the driver-- not a just a plate (anyone might be driving a given vehicle).
A signed report. If the report comes from a citizen, another individual must also sign.
A description of behaviors, observations or impairments related to driving.

The WDOT will not take action on the basis of age alone, but depending on the nature and content of the materials submitted the WDOT may:

require a road test
require a written test
require a medical report
require a vision exam or screening
take no further action
cancel the license (which would require a behavior report signed by a physician)
any combination of the above

Contacting the DOT should be considered only as a last resort when other options fail--or when safety issues for the driver and others become paramount. The best decisions are the ones that older adult drivers make themselves or share with caregivers, relatives and friends. That's the best way to make the "key" decision.

Organizations & Resources To Check Out:

American Automobile Association

Try your local chapter first. Ask for information on older drivers, traffic safety, and driving assessment. Their national address is:

1000 AAA Dr.
Heathrow, FL 32746
(407) 444-4300

Auto Safety Hotline
(800) 424-9393

Community Transportation Association of America
www.ctaa.org

American Automobile Association Foundation for Traffic Safety
12600 Fair Lakes Circle
Fairfax, VA 22033
(703) AAA-6000

National Community Transportation Association of America
1440 New York Ave.
NW, Suite 440
Washington, DC 20005
(202) 628-1480

Association of Driver Educators for the Disabled
(608) 884-8833

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