Deciding when someone should give up their privilege of driving is seldom going to be an easy discussion. Driving is associated with freedom and independence. Taking the keys away from someone can have dramatic effects on quality of life. It isn’t age that dictates when to stop driving, but physical and cognitive abilities do.
When someone is diagnosed with dementia it does not mean the end to driving immediately. However, the discussion as to when to give up driving must begin at that point. The decision will have to be made sooner than later. Any dementia-related disease is progressive and with no cure, only gets worse. Since the progress of the disease varies greatly between individuals, there are no hard and fast rules for how long someone can continue to drive.
Driving is a cognitively demanding task; orientation, attention, concentration, memory, processing speed, insight, and judgement are all essential skills. These are all impaired with dementia.
There are also physical limitations that we face as we age; arthritis, hand-eye coordination, hearing, eyesight, slower reaction time, and the effects of medications. These all impact our driving ability.
I became aware of my father’s risk of driving quite by accident. I was driving with my mother who had been forced years previously to give up her license due to macular degeneration. She commented on how it seemed that when driving with my father, he didn’t always know where to turn even when driving a familiar route. She claimed she had to give him instructions. Every alarm went off in my brain thinking no one was safe when the nearly blind person was the navigator.
In discussion with my father I shared with him that it might be best he stop driving. Luckily for me, he seemed almost relieved to admit it was a good idea. I realized he knew he was struggling with his cognitive abilities and that it was most likely the pressure of driving my mother that kept him behind the wheel. He gave up driving that very day.
This is not typically how these scenarios play out. What is anyone to do when aware that a person is no longer able to drive safely?
Firstly assess the ability of the person you are concerned for. Look at; their driving history, whether they are getting lost, dents and scratches on the car, collisions, and moving violations. Are they; less coordinated, less alert, having mood swings, having trouble multi-tasking, or needing reminders?
Remember that the person may minimize or even forget any collisions or near-collisions. Try taking a ride with the person and change the familiar route on the return trip.
You will no doubt hear any number of defenses when in discussion so be prepared. “I’ve never been in an accident…I only drive during the day…I only drive in good weather…I never drive on the highway…I only drive in the neighborhood…I only drive with my spouse…”
None of these factors have been consistently shown to reduce the risk of collisions.
No one wants to wait till a loved one gets lost or has an accident before having a conversation about giving up driving.
- Be prepared in your talk. Know what alternate transportation services are available.
- Avoid confrontation. Stay positive and supportive, discussing skills not age.
- It is a conversation you will need to have more than once.
- Focus on safety and appeal to their sense of responsibility.
- The hard cold reality of a potential lawsuit if they are the cause of an accident resulting in injuries, damages, or death, should be discussed.
If talking to the person does not result in giving up driving, enlist the support of the physician. Sometimes an outside professional can convince someone that it is time to stop driving; then you can escape being the bearer of bad news.
The physician can also file a Request for Medical Evaluation Report form to the state Registry of Motor Vehicles for the person to be tested as a new driver. This report is sent to the Medical Affairs department at the Registry of Motor Vehicles. There is no legal requirement for a physician or any interested party to report a possible unfit driver. Massachusetts is a self-reporting state.
A good resource for information can be found at the following website; http://www.massrmv.com/MedicalAffairs/ReportingRequirements.aspx
Medical Affairs will conduct an individualized assessment of the person’s qualifications. The individual will need to submit a medical evaluation from the health care provider which addresses the person’s reported condition and medical qualifications to operate a vehicle safely.
Another choice is to have a driver assessed through a private professional driving school like AARP or AAA.
The Registry has a brochure listing the driving evaluation programs in MA that you can find at this website link….http://www.massrmv.com/Portals/30/docs/Med_Affairs_Brochure.pdf
The Center for Healthy Aging at Lahey Outpatient Center in Danvers and at Addison Gilbert Hospital in Gloucester offers driving assessments. Check their website for further information at http://www.beverlyhospital.org/center-for-healthy-aging
The Hartford Center for Mature Market Excellence is a helpful source for various publications you can order online at https://www.thehartford.com/resources/mature-market-excellence/publications-on-aging and at https://www.thehartford.com/resources/mature-market-excellence/family-conversations-with-older-drivers for information about family discussions regarding driving.
Stopping someone from driving is usually challenging. When safety is in question however, it is not a negotiation. This can be a difficult transition for all but a necessary one when dealing with dementia.