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Taking the keys from an older driver

Last updated: January 2011

The man, a retired scientist, had finished his dental appointment and couldn't understand why his wife had failed to pick him up. After calling the house repeatedly, he finally reached his wife, who reminded him that he had driven himself there. His agitation and determination to drive himself home concerned her enough that she drove there to help him find the car. She followed him home in her car, but she could not prevent him from rear-ending another vehicle. Being able to drive was important to his independence, but it was clearly time for him to stop.

Road fitness

Seventy-eight percent of Americans 70 and older had driver's licenses in 2008, according to the Insurance Institute for Highway Safety. That's up from 73 percent in 1997, a trend expected to continue as baby boomers age.

Several skills, specifically vision, response time, and neuromuscular control, worsen with age. It's also clear that driving skills can deteriorate as cognitive abilities—memory, language, perception, reasoning, and thinking—decline. People with mild dementia are higher-risk drivers, but as many as 76 percent are still able to pass a driving test and drive safely, according to a report in a recent online issue of the journal Neurology. Drivers with dementia may not know when it's time to restrict or stop driving, and they are unlikely to benefit from retraining or vehicle modification. The challenge for families and medical experts is to identify unsafe drivers without restricting those who drive safely.

In April 2010, the American Academy of Neurology issued guidelines to help doctors decide when a patient with dementia should stop driving. The guidelines also offer a few indicators of decreased driving ability: a crash in the past year to five years, a traffic citation in the past two to three years, or an aggressive or impulsive personality. Other ailments that can impede driving include glaucoma, angina, arthritis, respiratory illness, and neurologic conditions such as Parkinson's disease.

To avoid a tragedy, family and caregivers should discuss a loved one's recent driving history and health, and solicit observations about driving behaviors. The holidays are a great time to get together to discuss a senior's driving ability and agree on the next steps. It's also a good time to go for a drive with your parent and see whether you'd feel comfortable putting your little ones in the backseat.

What you can do

Get the family together. The more cohesive the message, the better.

Check with a doctor. He or she might recommend talking to a specialist. Doctors can also help by telling someone to stop driving or by "prescribing" it.

Check your state laws. Regulations impose varying restrictions on older drivers. For example, Georgia residents who are 64 or older are required to have an eye exam every five years to renew their license. For specifics on your state, go to www.iihs.org/laws/olderdrivers.aspx.

Consult a driving rehabilitation expert.
He or she can evaluate off-road tests of cognition, vision, and motor skills and make an on-road assessment. Find a certified specialist in your state at www.driver-ed.org.

Arrange for other transportation.
A social worker can help.

Call in an attorney. A lawyer can discuss the potential financial and legal consequences of a crash or injury. If all else fails, take away the keys or the car.

Orly Avitzur, M.D.

Medical Adviser
   

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