Faculties declining, but dad still drives
Published 9:21 am, Wednesday, June 12, 2013
Q: My parents are in their mid 80s -- dad is 84 and mom is 83. They have been very happy and independent until recently. First, my dad was diagnosed with an eye condition called macular degeneration, which upset him greatly. Shortly thereafter, his doctor suggested to my mom that dad may have early stages of memory loss -- maybe even early Alzheimer's disease. We all knew dad was more forgetful, but he and mom managed so well. Needless to say, it was shocking to all of the family to learn that he may have dementia.
The biggest problem with this new turn of events is driving. My mom never drove, so my dad is the family driver. We now wonder if mom might have been covering up for his driving mistakes. Whenever we visit or spend time with my parents, we drive, so I actually have not been in my dad's car as a passenger for years. I asked my mom about dad's driving, but she wouldn't even consider him stopping. It sounds like she is the brain in the car and he is the muscle. We are not sure who takes care of the eyesight, as they both see poorly. How do we know when dad should stop driving and how should we go about telling him that?
A: Driving is a hugely sensitive subject for seniors. I am grateful for this story because the topic is extremely important, always relevant and not so simple.
There were more than 33 million licensed drivers in the U.S. over 65 in 2009, according to the Department of Transportation's National Highway Traffic Safety Administration. That's an increase of more than 20 percent from a decade earlier.
When talking about elderly drivers and safety, we worry not only about their injuries, but also about potential car accident victims, especially children.
In our country, driving means freedom. Without driving, many seniors, especially those living in more rural neighborhoods, feel truly isolated. Senior driving assistance is available, but often not adequate. No wonder aging Americans do not give up their right to driving easily.
Safe driving at any age requires both physical and mental agility. For the physical aspect of driving, good vision and neck mobility are particularly important, as are dexterity and reaction time. All of these tend to decline as we age. For instance, for older people with certain conditions, such as arthritis or neuropathy, the ability to grab the steering wheel or to push the brake pedal might be markedly impaired. Let's not forget about the side effects of medications, which can make drivers sleepy or even cloud judgment. The majority of seniors take at least few prescription and over the counter medications.
The situation changes over time as well. A safe 80-year-old driver may no longer be safe at age 81 due to variety of unpredictable health issues.
As for the mental faculties require for driving, memory, reaction time and the ability to perform executive tasks and decisions is a key. Driving is essentially multitasking. Since executive functioning impairment is not that easy to assess and measure, problems may be discovered late. Memory loss is actually easier to check for, but when it comes to driving many people with memory loss still drive for months, even years, without any problems. Are they lucky? I am not certain, but I know that if there is a worry about driving, a formal evaluation has to follow.
For a person with some physical and/or mental challenges who was a safe driver for many years, the best way to really assess his or her driving would be to take a formal evaluation. This is not done by the motor vehicle department but by specialized occupational therapy centers and some of driving schools. I also want to be very clear that no doctor can say with certainty that a person is an unsafe driver unless this person is clearly impaired. However, a visit to the primary doctor may be a great starting point for the discussion about driving.
Many seniors are excellent and safe drivers. Many do give up driving after an honest talk with their primary physician, a visit to an eye doctor or to the emergency room, or after a hospital stay. What we can do to help with this decision is to make sure that the non-driving family does not feel isolated or abandoned? This is not an easy task, but an important one and, frankly, without attacking this issue, the family will not be successful dealing with potentially unsafe driver.
What can you do if, despite the wishes of family, physicians and other experts, your loved one continues to drive?
If the person is truly impaired, his or her physician can write a letter to the DMV to revoke the driver's license. As you can imagine, doctors hate to do this and only proceed as a last resort. Some families take cars away or make them nonfunctional. This works for some situations, but not for all. The best approach continues to be thinking about the older person's safety, but also about the reality of life without a car.
If at all possible, Theresa should go back to her mom and try to have her as an ally. This may be easier if the family gathers in advance and comes with a practical strategy for when dad stops driving. Taking turns to assist with chores and shopping, hiring a helper-driver, investigating options for public transportation, and even reaching out to friends and neighbors are all viable alternatives to discuss. If we can present Theresa's parents with some options, there may be less resistance. The solution is out there -- I am certain of it.