Should Aging Drivers Give Up the Wheel?

Aug. 4, 2004 -- Is it time for "the talk"? No, not the one you have with your kids about the birds and bees.The one you have with their elderly parents about … driving.

Aging drivers are everywhere — there are whopping 66 million of them over age 50, according to the Federal Highway Administration. And as the baby boomer generation ages, the number riding the roads will only increase.

When is it time to talk to your loved ones about giving up the wheel? Since cars are such an essential means of getting around in our society, it's not a transition to be treated lightly.

"We think of a driver's license as a license for a life, and nobody wants to give that up," notes Dr. Joe Coughlin, director of the Age Lab at Massachusetts Institute of Technology in Cambridge, Mass., "No matter what age they are."

Once a senior relinquishes his/her license, feelings of dependence can grow, Coughlin warns.

The impact of losing a license may have consequences besides transportation, adds Dr. Cynthia Owsley, professor of ophthalmology at the University of Alabama School of Medicine in Birmingham. "Epidemiological studies have shown that loss of driving in the older population is related to increased depression and social isolation."

Yet poor driving is a serious matter, as the nation was reminded last summer when 86-year-old Russell Weller plowed into a Santa Monica, Calif., farmer's market, killing 10 and injuring more than 50, 15 of them critically. A National Transportation Safety Board finding issued Tuesday, a year after the incident, found Weller inadvertently stepped on his gas instead of his brake.

For more on the finding in the Santa Monica incident, click here.

So how do we know when it's time for those we love to stop driving?

First, says Coughlin, it's important to recognize the question is not just about age: "We age at different paces, so the question shouldn't revolve around age, it should be about health."

Agreeing is Jean Piantedosi, 62, of Nahant, Mass. "We always see [elderly accidents] played on the news anytime a senior gets into an accident," she complains. "But many of us are fine drivers. … We just get a bad rap."

By contrast, notes Dr. R. Malcolm Stewart, a neurologist at the Presbyterian Hospital of Dallas, who works with movement disorders, "There are tons of people that you'd think could drive, but based on their tests, they just can't."

Adds Coughlin: "What you look like is very much a factor in getting your license renewed. … If you look like your competent and capable, the odds are that you'll get your license. … If your cognition is off, that superficial check won't [notice]. Similarly, a person with a cane, even with good cognition, vision, etc., might not get their license for the same reason."

Back to the Basics

How can you tell if your parents' driving days are past them?

With growing numbers of older drivers, it may not be possible for local Departments of Motor Vehicles to pick up on past accidents that might indicate a deadly future crash, as was the case with Weller.

Instead, the ideal scenario, many say, is when older drivers "self-regulate." Drivers who feel uncomfortable driving at night or on the highway, for instance, could limit or even eliminate their driving during those problem times.

But most seniors and their families often don't think about retiring their car keys until they have a motor vehicle collision, argues Dr. Cynthia Owsley, professor of ophthalmology at the University of Alabama School of Medicine in Birmingham.

Owsley adds: "You shouldn't have to have a collision before you re-examine your driving."

Some problems, such as vision, have easy solutions.

Owsley advocates that adult children should begin advising parents to re-check their vision or even looking toward cataract surgery — "one of the safest procedures we have in medicine" — if they are concerned for their elder's health. Owsley notes that simple vision adjustments are often enough to help an aging driver get an added boost.

In those cases where drivers suffer from dementia or other debilitating or degenerative diseases, the situation is much more difficult.

"Unfortunately," Owsley explains, "We don't have any procedures to reverse the effects caused by dementia, strokes," or other health problems with cognitive effects.

"It's often one of the hardest things to stop a person suffering from early Alzheimer's, for instance, from driving. That person will probably be in denial, maybe even caused by their dementia," she adds.

Another option, Owsley says, is the rising number of older driver education programs. These drivers' education classes are "refresher courses" meant to help drivers sharpen their skills, and are often quite helpful to borderline senior drivers.

The AARP, for instance, offers a "Driver Safety Program," now in its 25th year, geared towards educating drivers over 50. The eight-hour, volunteer-run course reinforces the rules of the road and educates drivers on new technology.

"We go over newer things like anti-lock brakes, and rear-view mirrors," Program Director Frank Carrol says. "It sounds funny, but many of our [students] often say they don't know how to adjust their mirrors." "We even had one gentleman who told us 'When I learned to drive, cars didn't have mirrors,' " he adds.

While many healthy seniors are capable and competent drivers, there are often definite signs that it's time for your loved one to retire the car keys.

When the Time Has Come

Paula Kartje , the manager-clinician at the "Drive-Ability Program" at the University of Michigan in Ann Arbor, focuses her energies on evaluating patient's driving health and safety full-time.

Her program is multi-tiered for a completely comprehensive examination unlike those that the typical Department of Motor Vehicles can afford to offer. Occupational therapists and doctors put the patient through a series of physical and mental tests and then give the driver an hour-long road test in the areas in which they drive, times that often tripling or quadruple the average DMV road tests.

Kartje recommends that children concerned about their parents or loved ones' driving ability should look for one or many of these signs:

Loose lanes: "Look for difficulty staying in one lane or frequent drifting into another lane or even close to the barricade," she says.

Getting lost: Even the young do it sometimes, "but a senior who gets lost repeatedly or even in what was a once familiar area probably has a problem."

Road troubles: "Often people heading for trouble run through a red light or a stop sign and out into an intersection without even knowing it. … Some even stop for a blinking yellow light or even a green." She adds that some of the more impaired elderly drivers can find themselves going against the traffic or unable to turn properly, posing severe risks to themselves and others.

"Almost accidents": As Owsley also notes, Kartje says senior drivers and their families "often come in when they've had a very close call with another driver."

Pedal problems: "Sometimes [senior drivers] get confused and hit the gas instead of the brake or vice-versa…it can be a real problem."

Doctor says: "Doctors often recommend that [seniors and/or their families should consult] us if they are concerned." Patients who have had recent diagnoses of cognitive or physical problems such as vision or slow reflexes should also look into an assessment.

"The best thing to do, if you can," Kartje says, "is to get in the car and see [his/her driving ability] for yourself."