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Shots - Health Blog
Mon October 8, 2012
When Should Seniors Hang Up The Car Keys?
Originally published on Mon October 8, 2012 2:35 am
With a growing population of baby boomers, officials are bracing for a surge in senior drivers. Statistics tell us that accidents increase after the age of 65, and fatal accidents are more likely after the age of 75.
Canada requires physicians to report any concern about a patient's ability to drive, and they are being paid every time they warn a patient. But there's no such requirement here in the U.S. While some seniors opt for public transportation, others stick to the roads. So, often it's up to family members to help seniors decide when it's time to give up the car keys.
Some families are already grappling with such decisions.
Comedian Dan Nainan travels across the country — and the world — telling tales that keep the laughs coming. Nainan is a funny guy, but there was nothing funny about what happened this year to his dad, who's 82. "One day I got a call, and he was in a parking lot. I guess he had accelerated into a brick wall and totaled his car," recalls Nainan.
Motor vehicle authorities took Dad's license away, but it wasn't so straightforward with Nainan's mother. If he hadn't decided to get in the car and see how she was driving, he wouldn't have known. "She was having trouble tracking, staying straight. But what scared me — she passed our house twice and did not turn in," he says
She was having trouble staying in her lane. Then she tried a U-turn. It was a disaster.
"That's when I decided that if she were to drive, she'd kill herself or somebody else, or both. And being a good son, I didn't want that to happen," he says. Nainan succeeded in having his mother's license taken away. He's relieved too that now his parents have a caregiver who drives them around.
Bunni Dybnis, a social worker at the Los Angeles-based geriatric care service LivHome, says this is typically how older drivers decide to give up the car keys: Their child or grandchild intervenes. "I could probably say it's 99.99 percent not the older adult saying, 'I want to stop driving; help me,' " says Dybnis, because giving up driving feels like giving up one's independence.
Dybnis has seen many very stubborn older drivers, which is why it's so important for children to be aware and notice changes in driving behavior, she says. For starters, inspect the car.
"You look at the car for dents; traffic tickets; get a call from the hairdresser that they've been to every week, and all of a sudden they didn't show up and you find out they got lost getting there," says Dybnis.
Minor fender benders, traffic citations and forgetting where you're going can all signal cognitive decline. Then there's the true test, says Dybnis. Would you let your parent or grandparent drive you or your children?
"I see older children say, 'My mother drives only to the hairdresser or market, and that's fine, but I would never let my children drive with her, and I'm even afraid to drive with her,' " says Dybnis. "Gee, not willing to risk your own life or your children's, but maybe somebody else and your parents? That's a huge red flag."
If that's the case, it might be time to suggest a driving evaluation by a doctor, rehab clinic or geriatric care service. Vision and hearing can be examined, and they can test reflexes and memory. Some problems can be easily remedied, like removing cataracts or adding hearing aids. But others are more serious and often mean it's time to stop driving.
Some physicians are attuned to the unfortunate position this puts families and caregivers in. Dr. Marian Betz, an ER doctor at the University of Colorado hospital in Denver, has developed a tool she hopes could make the conversation about driving easier: an advance driving directive. Like an advance health care directive, it would designate a trustworthy individual to start the conversation about driving when driving becomes hazardous.
"Lets say Dad's memory is going and he probably shouldn't be on the road anymore. If he had written down that he trusted his oldest son to help him make the decision, it would make it easier for the son to say, 'Dad, look, you told me to take away the keys,' " Betz says.
And when that happens, says Dybnis, be prepared to replace it with something. Offer to do the driving yourself. Hire a caregiver or a neighbor who needs a little extra cash. The point, of course, is not to leave your loved one stuck or isolated.
STEVE INSKEEP, HOST:
Now, the population of Americans over 65 is rapidly growing. And statistics tell us that 65 is the age when car accidents increase dramatically. The decision to quit driving can be a wrenching choice - not only for the elderly, but also for their families. NPR's Patti Neighmond reports.
PATTI NEIGHMOND, BYLINE: Legally, you can drive as long as you can get in the car, turn on the ignition, and go. There are no state laws that say drivers of a certain age should give up their license. Dr. Marian Betz, an ER doctor at the University of Colorado Hospital, says it can be challenging to figure out when an older driver isn't safe on the road.
DR. MARIAN BETZ: What's so hard about this issue is that there's no one age when someone's unsafe; so certainly, there are 50 year olds who probably should be off the road, and there are 90-year-olds who might be fine.
NEIGHMOND: Many states require people over 70 to renew their license in person. Some require vision tests. A handful insists doctors alert authorities if they diagnose dementia, or other conditions that could impair driving.
But geriatric social worker Bunni Dybnis says it's typically family members who are the best judge of whether an older person's driving has deteriorated. They can start with the car itself.
BUNNI DYBNIS: You look at the car for dents; if you see traffic tickets; if you get that call from the hairdresser that they've been to every week and all of a sudden, they didn't show up, and you find out they got lost getting there.
NEIGHMOND: Then there's the tried-and-true test, says Dybnis.
DYBNIS: I see older children saying, "Well my mom's driving, and she only goes to the hairdresser and the market, and she's really fine. But I would never let my children drive with her, and I'm starting to get afraid to drive with her"; and gee, we're not willing to risk our own life or our children's, but maybe somebody else, and maybe our parents' lives. So that's a huge red flag.
NEIGHMOND: Doctors can also evaluate age-related problems in vision and hearing. Some can be remedied - cataracts removed, hearing aids added. Others are more serious - slow reflexes, lack of peripheral vision, memory problems. Take for example, the parents of Dan Nainan. Nainan is a really funny guy; a comedian who travels cross-country. But there was nothing funny about what recently happened to his 82-year-old dad.
DAN NAINAN: One day, I got a call. And he was in a parking lot. And I guess he had accelerated into a brick wall, and totaled his car.
NEIGHMOND: Motor vehicle authorities took his license away. But Nainan's 79-year-old mother was still on the road. So Nainan got in the car and took a ride with her. He discovered she couldn't stay in her lane, make a U-turn, or remember where she lived.
NAINAN: That's when I decided that if she were to drive, she'd either kill herself or somebody else, or both. And obviously, you know, being a good son, I didn't want that to happen.
NEIGHMOND: So Nainan contacted the state's motor vehicle department.
NAINAN: I said hey - you know - I want to report, you know, someone like, an old person who's like, driving really erratically and they're - it's really, really dangerous, you know; you'll have to get this person off the road. (LAUGHTER) And I mean, I feel kind of bad because I was turning in my own mother but, you know, I was doing it for her own good.
NEIGHMOND: The state requested Nainan's mother to come in for a driving test. Ultimately, her license was not renewed. Like Nainan, most people don't want to blow the whistle on their parents; which is why Dr. Marian Betz says it's best to have the conversation early - when you're in your 60s, and mentally healthy. She suggests an advance driving directive.
DYBNIS: Let's say Dad's memory is going, and he probably shouldn't be on the road anymore. If he had written down that he trusted his oldest son to help him make the decision, then maybe having that on a piece of paper will make it easier for the son to go to the dad and say look, you told me to take away your keys.
NEIGHMOND: And, if that happens, find an alternative. Hire a driver; drive yourself; investigate public services. Bottom line: Don't leave an older, non-driving adult feeling stuck or isolated.
Patti Neighmond, NPR News.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.