In 2002, about one-half of seniors living in private households (1.9 million) were driving a car, minivan or light truck. Driving is not just a matter of getting from point A to point B; it is a matter of freedom, independence and mobility. However, if an individual’s driving skills have declined due to age or illness, the driver’s right to independence can’t outweigh the risk to individuals and public safety. Getting someone to agree to stop driving can be a stressful and emotional undertaking for the driver and the caregiver.

Many older drivers voluntarily change their driving habits – avoiding rush hours, night-time driving and highways – to compensate for disabilities related to aging. However people in the moderate and later stages of dementia lack insight into their actions because of their illness and may continue driving long past the time they should stop. In some circumstances, taking away the keys may be the only option, if lives and property are at risk.

Things You Should Know

• Old age per se does not reduce driving skills. Older people, however, tend to have more of the health conditions that affect driving ability;
• Car crashes are the second-leading cause of injury among seniors and the leading cause of injury-related deaths;
• 30 – 40% of people with dementia drive;
• 30 – 50 % have an accident within a few years of diagnosis;
• 80% of those who have an accident continue to drive;
• 40% of these have at least one more accident;
• As many as 27% of those asked to stop driving are still on the road.

Things To Look For

• Illness and medications that cause a decline in perception, mobility and understanding;
• Poor vision – especially night vision, failing eyesight;
• Problems with depth perception;
• Hearing problems;
• Slow reflexes;
• Memory problems;
• Disorientation;
• Reduced mobility, such as difficulty turning head;
• Physical weakness and impairments;
• Drowsiness;
• Fatigue;
• Poor Concentration;
• Lack of judgment;
• Lack of awareness.

Questions To Ask

• How often is the person driving? Where? Why?
• Have there been incidences of getting lost or not arriving?
• Have there been accidents or near misses? (Check car frequently id possible for new marks or dents).
• Is there a vision problem that can be corrected?
• Are driving problems related to illness?
• Would a change in medication help?
• Would you feel safe as a passenger in the car?
• Would you feel safe as a pedestrian knowing this person is on the road?
• Would you feel safe as another driver on the highway?
• Should someone always be in the car with the driver? Is this a viable option?
• Is it just a matter of time before the person has a serious accident?
• Is a public transportation service available?
• Can family members take turns driving the person?
• Would the driver acknowledge or be able to understand that there is a problem?
• Is it time to take the car keys?

Signs of Impaired Driving Ability That May Be Related To Aging and Illness

• Weaving, lane shifting
• Unsafe left turns;
• Ignoring signs and signals;
• Stopping at green lights;
• Inappropriate turns, including turns that are too wide and too sharp;
• Unsafe passing;
• Lane changing without checking;
• Failure to yield right of way;
• Difficulty backing up;
• Improper entrances onto an exit from highway;
• Confusion at highway entrances and merges
• Driving wrong way on highways;
• Slow driving;
• Slow response to changes in driving and traffic conditions;
• Taking too long to reach the destination;
• Not reaching destination;
• Getting lost;
• Unexplained dents in the car;
• Fender benders/accidents;
• Traffic tickets.

At Home Coping Strategies

• Be cautious when discussing the driving issue with a person whose illness may cause aggressive behavior. Have a family member, health professional, police officer, or a trusted person, such as a friend or clergy present, if you have concerns the discussion might upset the person.
• Help the person understand that the illness is at fault, not them.
• Let them know that they or someone else could be injured.
• Compare cost of owning and maintaining a car with the cost of using alternative transportation.
• Help the former driver remain independent by suggesting viable alternatives.
• Have the news come from a third party – a letter from the family physician, a letter from the insurance company advising that they will no longer insure them.
• Respect the person’s right to drive, if he can still drive safely and has a valid license.
• Try to involve the person in discussions, as much as possible, unless the person refuses to recognize that there is a problem – if so, it would be counter productive to attempt to rationally discuss the situation.
• Seek professional driving evaluation.
• Advise the family physician of your concerns and ask for a medical assessment:
  Physical Exam
  Eye Exam
  Cognitive assessment, if Alzheimer Disease or other dementia is suspected.

If The Person Should Discontinue Driving:

• Find out whether family members and friends will be able to drive the person to regular activities and appointments.
• Investigate alternative transportation arrangements such as public transit, taxis, and transportation services.
• Discuss the situation with the driver in a non-threatening environment.
• Offer alternatives.
• Have someone the driver trust ask him to hand over his license.
• Hide the care keys, modify the car so that it cannot be driven, or remove it from sight, if necessary.
• Report the driver to the authorities, if you have no other option.
• Ask the family doctor to send a letter to licensing authorities Note – Physician’s who report patients are immune from prosecution).
• Contact the auto insurance company and explain the situation.

If The Person With Driving Difficulties Is Permitted To Continue Driving:

• Suggest that they avoid heavy traffic, unfamiliar routes, long drives, night-time driving, highway driving, driving heavy vehicles and motorcycles, and driving alone.
• Encourage the driver to take a driver retraining course.
• Keep monitoring the situation, so that you are aware of any changes.
• Some safety organizations and driving schools offer driver improvement programs for older adults.