Family: Mom's driving is unsafe, but she won't stop
Published 6:42 pm, Monday, January 28, 2013
Q: We have a major problem with my mom I need your advice on. She is 82 and in reasonable health although recently she started to forget more. She is able to compensate and still lives alone with minimal assistance -- partially because she will not allow us to help her. She does take few medications, but just for blood pressure, high cholesterol and arthritis. I do not think that her vision is the best, but she has not seen an eye doctor recently.
The problem my family and I worry most about is my mom's driving. She got her license more than 60 years ago and, until last year, had no accidents or speeding tickets. Then, out of blue she had a fender-bender and then two more. She got lost while driving shortly thereafter. Finally, a month ago, my brother sat in her car while she was driving. He told me that he did not feel comfortable at all. We have gently tried to bring the subject up, but my mom gets very defensive and angry. She told us if we take her car away, we may just as well shoot her. Is there a way to approach this sensitive subject in a way that will be a little less confrontational?
A: I cannot tell you how often I am the person who advocates for my patients to give up driving and, by doing so, not only upset the person but also their family. A big part of the problem is that our cities and small towns do not have the infrastructure and capacity to accommodate seniors who are no longer driving. No wonder that stopping driving is often seen as a "death sentence" that puts a true limitation on a person's ability to socialize and access even the most basic needs like food and medical care.
There were 33 million licensed older drivers in 2009, which, according to the Centers for Disease Control and Prevention, was a 23 percent increase from 1999. The CDC also report that roughly 5,500 adult drivers age 65 and older die each year in vehicle crashes.
We all remember the 2003 horror crash in Santa Monica, Calif., when an 86-year old man drove into a farmer's market crowd killing 10 and injuring more than 60 people. These events are quite rare but they underscore how important the issue of unsafe driving truly is.
When it comes to the specifics of when and why an elderly driver should give up the keys, it is definitely not just about age. Many other factors play a very important role. First, vision and hearing have to be assessed, mostly because they are often overlooked and, in many instances, can be improved by a hearing aid or a cataract surgery. Many seniors experience glare, especially during evening hours, as a result of the visual impairment caused by a variety of diseases that are common as people age.
Mobility plays a very important role, especially the ability to turn one's neck easily and quickly, as well as the dexterity to properly use the clutch and other parts of the car, including the brake. Patients with neuropathy, a disease of the peripheral nerves, may not be able to fully feel how strongly they press on the brake. Reaction time slows down with aging, making emergent turns, passes and other maneuvers challenging to master. Pain from arthritis can make it difficult for a driver to quickly move to avoid a collision.
Then there are medications and their side effects. Over 95 percent of seniors take a medication that may impact their ability to drive. Some seniors may have an undiagnosed memory disease, such as dementia, which often impairs the judgment and the insight into the consequences of unsafe driving.
Just like everyone else, seniors may also drink and drive. Since tolerance to alcohol is much less as we age the consequences of drunk driving are even more serious at this age.
Please do not misunderstand me -- there are millions of safe mature drivers on the roads in our country. Many of them have never had an accident and drive better than their children and grandchildren. Nevertheless, we need to be able to recognize the signs of unsafe driving and be ready to act.
Many aging drivers volunteer to limit and to even stop their driving. They are aware of the potential risks and do not want to take their chances. Some people, however, are unable to see what their loved ones' fear and stubbornly want to continue driving at any cost. In the households with only one driver, the spouse may be aware of the danger their loved one exposes them and others to, but may be unwilling to act, as stopping driving will impact them both. I see this in dealing with my patients way too often.
When analyzing driving safety one has to look at patterns. One fender-bender is different than three. One episode of getting lost may not constitute the verdict of unsafe driving just yet.
If you do worry about your loved one's, or your own, ability to drive safely, there are steps to take to minimize the risk. The best is to take a formal driving evaluation, which is usually offered by local occupational therapy sites. The evaluation takes place on the back roads and the highway and the report at the end is thorough and honest. It isn't legal binding, so it will actually not take a person's driver's license away. It is a very reliable way to know if the person is safe to continue to drive. Unfortunately, it is not covered by any insurance so there is a cost involved.
The AARP offers a drivers' safety course, which can help as well and the cost is very reasonable.
For many families like Carol's, where the loved one refuses to accept that there may be a problem with driving, next steps are necessary. A physician, such primary doctor or a specialist like me, can write a formal letter to the DMV requesting that the driver's license be revoked given sufficient evidence. Obviously, we do not do this lightly. Some families take the car keys away.
If at all possible, seeking the impaired driver's input and buy in is the best and needs to be attempted. Discussion in the doctor's office may be the first step. At the end, we have to do the right thing. We are not only responsible for the safety of our family but also of all potential victims who can be harmed by unsafe driving.
Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or firstname.lastname@example.org.