Fall 1997 , Vol 1 , Issue 2
Older Adults and Driving

The second issue of this newsletter is devoted to the subject of older adults and driving. We are a society that values independence. What represents independence more than an automobile? Every teenager strives for the keys to the car and every adult views driving as their inalienable right. What happens when disability strikes and one's ability to drive is in question?

The Facts

The accident rate per mile driven for older adults is second only to that of young adults. The elderly are more likely to be injured in a car accident; vehicle accidents are the leading cause of accidental death for those between ages 65 to 74.

Age alone is not an appropriate determination of the ability to drive. It is the individual's cognitive and sensory functioning that affects driving skills.

Warning Signs

• Reduced Vision: Can result in trouble seeing vehicles and pedestrians, especially at night; missing traffic signs, difficulty with headlight glare; and trouble in judging distance between vehicles.
• Cognitive Impairment: Often results in poor or slow decisions, confusion and disorientation in emergencies and difficulty in finding one"s way to familiar places.
• Traffic Incidents: Collisions, near misses, traffic citations or warnings that occur on a frequent basis are additional indications of a problem.

How To Determine If There Is A Problem

If you are concerned about the driving skills of an older adult, the first thing to do is check out your concern. This is difficult for everyone involved and it is important to make sure you have evidence of impairment.

• Ride as a Passenger: Do this a couple of times and refrain from distractions such as conversation, playing the radio, or traveling in particularly difficult situations (rush hour, detours or construction). This experience will help you determine if your concerns are real.
• Self-Evaluation: The AAA Foundation for Traffic Safety offers a self-assessment of driving performance. It may be more comfortable for older adults to conduct this assessment in the privacy of their homes, and it can help open the door to discuss the issue.
• Professional Evaluation: Rehabilitation Centers provide driver evaluation and behind-the-wheel assessments. St. Lawrence Rehabilitation Center in Lawrenceville, N.J. provides such a service (see resource list at end of article).

Strategies for Improving Driving Safety

Providing that the older adult is not experiencing cognitive, hearing or limitations in vision that are adversely affecting his or her ability to drive, the following steps can be encouraged to support driving safety.

• Car Maintenance/Improvement: Are the mirrors working?; are the pedals in good condition?; is the seat adjusted properly?; is a cushion required?
• Enroll in Driver Safety Courses: AARP offers a two-day "55 Alive” driving course. Many insurance companies will discount premiums for those who pass the course.
• Encourage Coping Skills: Discuss limiting risk by driving only in the daylight, avoiding rush hour traffic, traveling familiar routes and, whenever possible, avoiding trouble spots such as congested intersections.

When Safety Is An Issue

No adult child, friend or physician relishes approaching an older adult about relinquishing his or her privilege to drive. Remember that driving is a privilege and not a right. It is earned as a result of being a certain age and passing tests which demonstrate ability. When the safety of the older driver and others on the road are in jeopardy, then the issue must be addressed.

• Enlist Help: Involve the person(s) who have the most influence on the older adult. It helps to practice what you are going to say, and to say it from the heart with concern and caring for the person. It is important that you are clear and specific about your requests and can offer some solutions about how daily tasks will be accomplished without the car.
• Help From The Physician: For some older adults, a doctor’s advice is very influential, and a discussion about one’s medical condition and the dangers of driving is sufficient. The physician by law is required to report within 24 hours to the Division of Motor Vehicles any individual who has a medical condition that is not responsive to treatment that interferes with driving. A medical form is then completed by the physician and the driver. The Division of Motor Vehicles makes a determination regarding: maintaining the license, re-examining for licensure or suspending driving privileges. Family members and friends may also report their concernsto the DMV, and medical forms will be sent to the physician.

Case Studies

1. Mr. Walsh was 82 years of age and suffered from severe dementia when we became involved in the case. He was still driving, although it had been reported that he had gotten lost very close to home. We hired a male companion with a car to drive Mr. Walsh. Mr. Walsh was continually misplacing his keys; after one such occurrence, the keys were permanently lost. The car remained in the garage, and Mr. Walsh would go sit in it from time to time. When this occurred, the companion would ask him if there was anywhere Mr. Walsh wished to go. Occasionally Mr. Walsh would ask to be driven somewhere; at other times, it was sufficient for Mr. Walsh just to see and sit in his car.
2. Mrs. Logan was 72 years of age when she had a stroke affecting the left side of her body, causing significant weakness and some brain damage affecting judgment. Mrs. Logan was adamant about continuing to drive after her stroke. She felt that driving was a symbol of independence. She had help who could provide transportation. Her care manager discussed her condition and its limitations, but she refused to accept that she could not drive. The care manager and the client came to the agreement that if she passed the driving assessment at the rehabilitation center, then she could indeed drive. The appointment was set up; she cancelled the appointment and the issue was not brought up again. She discontinued driving.

Resources

AAA Foundation for Traffic Safety, 1440 New York Ave. NW, Suite 201, Washington, DC 20005.
Drivers 55 Plus: Test Your Own Performance
202/638.1073

American Association of Retired Persons, 55 Alive Defensive Driving.
For courses in your location, call: 800/424.3410

St. Lawrence Rehabilitation Center, 2381 Lawrenceville Rd., Lawrenceville, NJ 08648.
Conducts Clinical Pre-driver Evaluations and Behind-the-wheel Assessments.
609/896.9500

Senior Care Management®/Bristow & McCurdy, 261 Upper Ferry Road
Ewing, NJ 08628.
In-home Assessments, Home health aides and Care management.
(609) 882-0322.

If you would like copies of this newsletter, or copies of our previous newsletter Who is a Geriatric Care Manager?, please contact Senior Care Management® at (609) 882-0322, or email us at info@seniorcaremgt.com.