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The AAA Companion

Feature Article

Keys to Independence

Keeping seniors safe, connected and in control begins with an important conversation.

By Alicia Abell

While conducting a recent study of senior drivers, Dr. Jean Shope, of the University of Michigan Transportation Research Institute, discovered a curious thing: “Some people in the group said they'd rather die than give up driving,” she says.

If you think about it, the reaction isn't so surprising. Driving isn't just a matter of convenience—it's a symbol of independence, of competence, of being in control. Suggesting that a parent or older relative stop driving is “almost as tense an issue as saying it's time to move,” Shope says. “These are decisions that grownups like to make for themselves.”

Unfortunately, it's a conversation that families can't afford to postpone. Senior drivers have a higher rate of fatal crashes than any other group except teenagers. In fact, the fatality rates of drivers 65 and older are a whopping seven times higher than 25- to 64-year-olds.

If you have concerns about a relative's driving ability, how and when should you raise this touchy topic?

First, it's helpful for both sides to understand the physical and mental changes that come with age. For most people, this part of the conversation is easy to discuss without tension or implied criticism.

Ninety percent of driving is vision-related, so visual changes—cataracts, glaucoma, loss of peripheral vision—are particularly important. Because many of these problems occur gradually, and are often easily treatable, older drivers should get their eyesight checked regularly.

The decreased strength and flexibility that come with age also affect driving. Weaker muscles and diminished limb mobility can slow down reaction times and make it harder to check blind spots.

Cognitive changes have an impact, too. As people get older, their processing speeds decline—just slightly, but enough to increase the chance of accidents, says Essie Wagner of the National Highway Traffic Safety Administration. What's more difficult is when a relative has a cognitive impairment such as Alzheimer's or dementia. People with such conditions—or those who are simply stubborn—often won't recognize that they have a problem.

One option is to ask a family physician to talk to the person. If this doesn't work, there are more drastic alternatives. In most states, a physician, family member or law enforcement official can report a driver to the Department of Motor Vehicles, which can prompt a relicensing test. Some families resort to taking away the car keys, disabling the vehicle or having it sold; these measures, while harsh, are sometimes the only options to prevent loved ones from harming themselves and others.

Another key to a productive conversation about driving is to see it as a continuum, says Jeff Finn of the American Society on Aging. It doesn't have to be a yes-or-no decision. Many older people simply limit their driving, avoiding trips at night or during rush hour.

Driver rehabilitation specialists can evaluate driving skills and help set parameters. “Getting a formal driving assessment is the best thing you can do for a parent,” says Finn. Such evaluations don't have legal weight, but the results usually go to a physician. In the rare case of a person who fails an evaluation and refuses to stop driving, the physician can report the driver to the Department of Motor Vehicles (DMV). In some instances, the results go directly to the DMV.

Driver refresher courses are another option. “For many people, there would be things to learn,” says Shope. This is especially true for people who learned to drive before driver's ed existed—and when roads were less busy and complicated.

When to raise the subject?

If you observe a relative making poor driving judgments or narrowly escaping accidents, it's time. If you are a mature driver yourself, be alert for signs of decreased driving ability: frequent traffic tickets, an increase in fender-benders and even honking from other drivers are clues.

The best time to talk is before it becomes a problem. The worst time? Right after a news story involving a senior driver, such as the Santa Monica crash in 2003, when an 86-year-old man drove through a farmers' market and killed 10 people. “People are defensive then,” Finn says.

Almost every older person knows someone who's unfit to drive, so the subject may come up naturally. If that happens, “it's reasonable to say, ‘Maybe it's a good idea for you to get checked,'” Shope says. Another way to approach the topic is to ask your parents what they plan to do if they can't drive for an extended period of time—if their car is in the shop, for example.

Once a person decides to retire from driving, how will he or she get around? Even seniors who self-limit their driving can become isolated. By doing only the essentials—driving to the grocery store and doctor's appointments, for example—they cut back on socializing and other activities that improve their quality of life. Consequences include depression and other health problems.

Obviously, families can pitch in, but there's only so much they can do. Public transportation is an option that's better in theory than reality: seniors may feel unsafe, stops aren't always within easy walking distance, and getting on and off can be difficult for some. In rural areas, services are limited or non-existent. It's not surprising that only about 3% of U.S. adults aged 60 and older use public transportation.

One solution is for a group of seniors to share ownership of a car and the use of a driver. Another idea is to look for “supplemental transportation programs” (STP) in your area. Offered by government agencies, church groups, geriatric providers and others, STPs complement public transportation with services that provide greater flexibility. (See the AAA Foundation for Traffic Safety website, seniordrivers.org, to check for programs in your area.)

Families should advocate for public policy changes to keep seniors safe and mobile. Try getting around in your community for four days without a car; see what options exist, and lobby for services to fill the gaps. Urge your local authorities to adopt the federal Highway Design Handbook for Older Drivers and Pedestrians, as well as Guidelines and Recommendations to Accommodate Older Drivers and Pedestrians (see www.fhwa.dog.gov for details). In Detroit, for example, a recent road improvement program followed these guidelines by installing larger street signs, bigger and brighter stoplights, and more left-turn lanes—resulting in a 35% decrease in injury crashes for drivers 65 and older.

If families and communities work together, maybe older drivers won't feel so devastated about turning in their keys. And by being open and honest, adult children can help keep their parents connected and in control—whether they're in or out of the driver's seat.

Alicia Abell has written for U.S. News & World Report and health magazines. “Keys to Independence” was first published in AAA World magazine and is reprinted with permission.

Two seniors, two solutions

Nicholas Varga, 80: Alternative Transportation

For Nicholas Varga, the decision to stop driving was common sense. “As a driver, I always put safety first,” he says. So when he backed up in a parking lot and tapped another car, he took note. When the same thing happened the following day, and then a third time—“I realized I might be a danger to others,” the 80-year-old says.

His son Colin, already worried about his father falling asleep at the wheel, made another point—a financial one. Varga and his wife didn't use their car much. With the same amount of money they spent on car insurance and maintenance, they could just as easily afford to use taxis.

Since giving away his car, Varga relies on a taxi for doctor's appointments and his work as an archivist. Family members take him anywhere else he wants to go. The adjustment has been an easy one.

Colin thinks a gentle approach was key. “I felt the harder my siblings and I pushed, the more my dad would push back,” he says. “I knew he would have to make this decision for himself.”

Lester Henninger, 91: Passing the Test

Many of the conditions that affect driving—visual changes, slowing reflexes, medical problems—come as we grow older, but whether someone should be driving depends on ability, not age, experts say. Lester Henninger proves their point.

A doctor advised the 91-year-old Philadelphian to undergo a driving assessment: “I wasn't too happy about it,” says Henninger, but he followed the doctor's recommendation anyway.

Tom Kalina, who directs the driver rehabilitation program at the Bryn Mawr Rehabilitation Hospital, took Henninger through a two-part assessment, both in the lab and on the road. The verdict? Henninger passed with flying colors. “If I'm still driving as well as he is at age 90, I'll be very, very happy,” says Kalina.

Henninger is glad he got evaluated. Not only is he confident that it's safe for him to drive now, but his daughter, who was worried about him, feels better too. “It might be a good idea for all seniors to get checked,” he says.

Senior Driver Resources

AAA Exchange: aaaexchange.com, go to “Senior Driver Safety and Mobility.” Includes information on senior-friendly road design, driver-screening tools, educational programs, vehicle safety improvements and alternative transportation options.

AAA Foundation for Traffic Safety's Senior Driver website: seniordrivers.org. Comprehensive website on senior driving, including self-assessments, driving tips and senior transportation resources.

American Association of Motor Vehicle Administrators' GrandDriver Program: granddriver.info. Information on aging and driving.

National Highway Traffic Safety Administration: nhtsa.gov. Click on “Injury Prevention” and scroll to “Older Road Users.” Includes information on physical conditions and diseases that affect driving.