Key Issues
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The Driving Dilemma
February 01, 2010What are the warning signs that an older person may be driving impaired? How can one accurately assess the ability of an older adult to drive safely? How can the subject of safe driving be sensitively and decisively approached with a family member?
THE DRIVING DILEMMA: The Complete Resource Guide for Older Drivers and Their Families.
By Elizabeth Dugan, Ph.D.
Harper Paperbacks, 2006.
What are the signs that an older driver may be impaired? How can someone assess the ability of an aging family member to drive safely? How can the subject of safe driving be brought up sensitively and respectfully?
Answers to these and other questions that confront families, caregivers, and health care professionals are given thoughtful consideration by Elizabeth Dugan in The Driving Dilemma, a comprehensive, resource-rich guide to an otherwise stressful issue.
The book includes assessment forms, research findings, and recommendations about nearly every aspect of aging drivers, as well as an extensive 30-page section on organizations and agencies that can help assess the situation and implement change.
Dugan, a geriatric researcher and instructor at the University of Massachusetts Medical School, recites some of the familiar facts:
- Most drivers in an aging American population will outlive their ability to drive safely by seven to 10 years.
- Giving up the car keys is an emotionally loaded experience.
- Many seniors don’t use public transportation because it’s hard for them to access and often inconvenient. (Public transportation is not door-to-door, and subway stairs and bus steps are can be hard for seniors to handle.)
The suggestions and advice in the book, Dugan says, come from her family's experience with her own mother, not from a purely statistical or academic point of view. By personalizing the “driving dilemma” and presenting it in imaginative ways, Dugan not only underscores the urgency of recognizing serious impairment problems, but offers real-life, practical solutions.
Red, Yellow, and Green Warnings
Dugan organizes driver-safety risks into red, yellow, and green categories, according to severity of the risk. Red points to the highest risks, and require an immediate talk with the driver and a driving-skills assessment by a professional. Green signs are those that can often be overcome with the help of physical therapy or through modifications to the car.
Red Signals of Risk:
- One or more car accidents in the last five years
- Recent driving tickets or police warnings
- Severe impairments of vision, thinking, or physical movement
Yellow Signals of Risk:
- Close calls while driving
- An accumulation of dents and dings (especially when the driver doesn't remember getting them)
- Changes in medications that could affect alertness, and slowed responses to driving situations
- Feeling stressed or exhausted when driving
- Getting lost, especially in familiar areas
- Trouble paying attention to traffic signals, road signs, and pavement markings
- Failing to notice vehicles or pedestrians on the sides of the road
- Having friends or relatives say they don’t want to ride with the driver
- Slow response to unexpected situations
- Hesitating over right-of-way decisions
Green Signals of Risk:
- Trouble seeing over the steering wheel
- Difficulty looking back over one’s shoulder
- Trouble using rear and side mirrors
- Difficulty getting in or out of the car
For drivers who experience any of these green-signal problems, Dugan recommends a do-it-yourself driver-fitness evaluation available online or in CD-ROM format from the American Automobile Association (AAA). The screening tool, called Roadwise Review, covers areas such as leg strength and overall mobility, head and neck flexibility, visual acuity and scanning, short-term memory, road-hazard recognition, and speed-processing ability. Areas that need further evaluation can be explored with a doctor’s help using an assessment tool developed by the American Medical Association (AMA).
Driver rehabilitation specialists (DRSs) also perform assessments. While these assessments can cost several hundred dollars out-of-pocket, they provide a clinically accurate picture of a driver's fitness, according to Dugan, who adds that "many older drivers and family members have reported that the peace of mind afforded by such a comprehensive assessment is worth every penny."
Effects of Aging, Illness, and Medications on Driving
Dugan addresses normal effects of aging such as vision changes, including reduced depth perception, reduced peripheral vision, macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Many of these changes, Dugan says, don't automatically mean the individual must stop driving. Drivers can make basic medical, mechanical, and lifestyle adjustments for their limitations, such as getting new glasses, adding more mirrors to the car, and not driving at night.
Drugs taken to treat conditions such as depression, arthritis, and anxiety can also impair driving ability. Older drivers taking certain medications should be closely monitored by a physician, as should drivers at high risk for stroke or heart attack. In fact, Dugan devotes an entire chapter to the effects of over-the-counter and prescription drugs, vitamins, and herbal supplements on driving.
Dugan places alcohol at the top of the list of drugs that can adversely affect driving, reminding us of the role of alcohol in serious and fatal car crashes. Anticholinergics, anticonvulsants, antidepressants, antiemetics, antihistamines, antihypertensives, antipsychotics, benzodiazepines, muscle relaxants, opiates, and some drugs for Parkinson's disease can all cause drowsiness and make driving risky. Dugan provides readers with a useful list of questions to ask a doctor or pharmacist about medications.
At the most serious end of the safety spectrum, Dugan notes that dementia and related cognitive disorders always mean that driving must stop. The only question is, when. As soon as a family member is diagnosed with dementia, a dialogue must begin. A plan for hanging up the car keys must be made—immediately, if the dementia is moderate to severe.
In these cases, possibly the single most useful section in The Driving Dilemma is the description of motivational interviewing techniques and sample dialogue scripts families can use with loved ones. How to begin this difficult dialogue, how to implement the assessment tools, and how to take interventional steps that can help older adults continue driving for as long as possible are particularly relevant to families dealing with those who are in denial about their driving skills to those who are outright resistant about ceasing to drive. Dugan’s compassionate approach, however, can teach all of us to be safer drivers.
