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12/13/2021

When is it time to give up the car keys?

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Nothing defines personal freedom and independence in America as does the ability to come and go as you please in your car. One of the main reasons seniors are reluctant to give up driving is that it is one of the few ways they can continue to feel self-sufficient and empowered. The conversation with a loved one about his or her need to stop driving is one of the most difficult discussions you may ever face. The discussion becomes even more difficult when the person still maintains most of his or her faculties, just not those that enable safe driving.
There is no short answer to this problem, or a one size fits all solution. The admission from mom, dad or your loved one that they no longer feel like a “safe driver” rarely comes from either of their lips. However, it’s better if it comes in the form of advice from you or someone he or she knows rather than by an order from a judge or the DMV.
Warning Signals That Say “Stay Off The Road”
According to the National Institute on Aging, there are several critical indications that a senior may be losing the judgment or ability to drive.

Incompetent driving at night, even if competent during the day
Frequently startled, claiming that cars or pedestrians seem to appear out of nowhere
Drastically reduced peripheral vision, even if 20/20 with corrective lenses
At-fault accidents or more frequent near-crashes or dents and scrapes on the car or on fences, mailboxes, garage doors, and curbs
Struggling to drive at high speed even if he or she drives well locally at slow speeds
Failing to use turn signals or keeping them on without changing lanes
Erratic driving, such as abrupt lane changes, braking or acceleration, hitting curbs, missing turns or scaring pedestrians
Drifting into other lanes or driving on the wrong side of the road
Getting lost frequently, even while driving on familiar roads
Range-of-motion issues, such as failing to look over the shoulder, trouble shifting gears or confusing gas and brake pedals
Trouble reading street signs or navigating directions
Increased traffic tickets or “warnings” by traffic or law enforcement officers

   
The realities of aging include changes in vision, slowed reflex ability, memory loss and cognitive issues, physical limitations and side effects of prescription medication. The Department of Motor Vehicle (DMV) will not take away a license based on age unless it is determined that one’s mental and/or physical condition or inability to follow traffic laws and rules is compromised.

Cognitive Functions
Cognitive function refers to one’s ability to process incoming information. Cognition is your awareness of your surroundings using your perception, reasoning, judgment, intuition, and memory. Any cognitive impairment will negatively affect an individual’s ability to drive safely.
The following diseases are some of the causes of an individual's cognitive impairment:

Dementia (Alzheimer's disease and other dementia); Brain Tumor; Multiple sclerosis; Parkinson's disease; Seizure disorder (lapse of consciousness condition); Sleep disorders (Narcolepsy, sleep apnea - lapse of consciousness condition); Stroke; Vertigo

Many cognitive impairments are progressive. Early diagnosis and treatment is vital to ensure that one will be able to drive for as long as possible. If their condition remains mild, they should be able to continue driving. However, once the condition reaches the moderate or severe stages, it is too dangerous for them to continue driving.
Dementia is one of the most serious cognitive disorders affecting the older population. Dementia is frequently unrecognized and undocumented. Seniors suffering from dementia present a significant challenge to driving safety and individuals with progressive dementia ultimately lose their ability to drive safely.
Unlike senior drivers with motor function or vision impairments who tend to self-restrict their driving, senior drivers with dementia will continue driving even when it is unsafe for them to do so. It is often up to family members and caregivers to put a stop to the senior's driving and arrange alternative transportation for them.
What actions does DMV take on cognitive impairment?
Link to the CA DMV Website re: Dementia

If you have been referred to DMV or have been diagnosed with mild cognitive impairment, you SHOULD be scheduled for a driver safety reexamination (MOST DOCTORS OFFICES FAIL TO REPORT THIS). The reexamination is conducted in-person by a DMV hearing officer.

You will be required to take a written test and you may also be required to take a vision test.
If you pass the written test and the hearing officer determines that a Supplemental driving test is appropriate, you will be scheduled for one.
If you pass the Supplemental driving test, you will be allowed to continue driving, but you will be scheduled for another reexamination within 6 to 12 months to reassess your driving abilities.

What actions can be taken after the reexamination?

After your reexamination, the DMV hearing officer may:

Determine that no condition exists that makes you unsafe to drive.
Reexamine your driving ability at a future date.
Tell you that you must comply with your medical regimen and report any changes to DMV.

Tell you that you must submit annual medical reports to DMV on specified dates.
Issue you a limited term driver license. A limited term driver license is one that is issued for a term shorter than a regular term license. This type of license requires you to return to DMV for more frequent reevaluation and/or testing.
Restrict your driving privilege.
Suspend or revoke your driving privilege.

HAVING THE TALK
Here are some strategies to help you talk to seniors sensitively about giving up driving and present them with practical transportation alternatives.

1. Become The Silent Observer – Make the time to determine your loved one’s ability to drive.

Ride along: Take several rides with your loved one and observe his or her physical ability in controlling the vehicle, staying within the lane, how turns are handled, their driving speed, ability to scan from left to right, any visual susceptibility to glare, and for any possible confusion in traffic. Observe without creating conflict or distraction, nagging or shaming. At your earliest opportunity, create notes of your experience, you may need to share them with an expert.
Inspect the vehicle regularly: Occasionally check the outside of the car for any possible dents or scrapes. Also examine the parking area/garage for any structural damage.
Advocacy & Escort Service: Accompany your loved one at least once to every medical specialist and service or treatment center and, and have him or her sign a release of confidentiality/HIPPA authorization form naming you as a relative with whom they can share any and all medical and mental information without their violating federal confidentiality laws. This will ensure that you are aware of every one and service involved medically. These steps will guarantee that you can ask questions and express concerns privately as well as invoke professional assistance.

2. Set the Stage

Be empathetic - Imagine how you would feel if you were in your parent’s place. Note that they may become defensive, like a wild animal being surrounded by trappers.
Depression or thoughts of suicide can be linked to this – Establish a support system to surround them through this process.
Delete the need to defend - Become aware of conversation patterns and triggers that often turn your discussion into an argument. Choose to stay focused and remain calm. You are truly in their corner.
Work to keep the conversation non-confrontational, honest and between “mature adults,” not “child and parent”, and/or the role reversal of child parenting-parent. Honor your loved one regardless of whether they deserve respect or not.
You may be too close to the problem. If you have an adult child, spouse or other relative whom your loved one trusts, consider having that individual talk to them about the giving up driving on their own. (Have them read through this guide to equip them for the conversation.)

3. Get The Entire Family On Board – United Front

Be reminded that you are dealing with a mature adult driver. You are most likely viewed by them as a child. Do your best to help them keep their role as the “Elder/Parent/Adult/Decision Maker”.

4. Get A Plan Put In Place

Transportation Plan – Plan A/Plan B… The Back Up Plan:

a. Having a plan for how your mature adult drivers transportation needs are going to be met (How will I get to the doctors, hairdressers, grocery store…)
b. Explore the transportation alternatives in your community. Some transportation options include:

Carpooling with family and friends
Taxi cabs, Uber, Lyft
Shuttle buses or vans
Public buses, trains, and light rails

Local community-based services
Walking

c. You may want to begin implementing some of these options as a support system while they are still driving to help them realize that they have options.

5. Attempt To Talk With Your Loved One:
a. Conversation Starters – Bring up current/historical events re: driver safety (article re: mature adult drivers in accidents…).
b. Find out if they think the time is right to stop driving. They may be waiting for you to take the pressure off of them. You may attempt to focus on:
i.Liability issues in the event of an accident
1. Ask them how they would feel if another mature adult driver had an accident and injured or killed their grandchild. Discuss how the tables could easily be turned and they could be that elderly driver.  How would they feel?  As tough as this question is, it’s really tough love and is a valid concern.
ii. Financial savings – insurance, gas, car payment, routine upkeep
iii. Medication side effects
1. Vision
2. Cognition
3. Physical Function
iv. Their general well-being
c. You may want to let them know, “We’re concerned…”, “I feel afraid…”, “We care…”, “I get scared…” or “We don’t want you to get hurt or to hurt others…”.
d. It’s Not A Personal Attack – Use FACTS to remind them that:
i. accidents happen regardless of age
ii. teenagers, as an age bracket, statistically get into more accidents
   iii. Mature adult drivers die in auto accidents at a rate higher than other age bracket because, they are more often than not physically inactive. Driving takes
dexterity, ability and strength in both arms and legs/feet to control the vehicle at all times.

6. Gaining Outside Counsel, Support And Intervention
Feel comfortable contacting your loved ones physician(s), accountant, lawyer, barber/hair dresser, clergy or confidant… and share with them your concerns re: your loved ones current driving ability.  You may request that they speak with your loved one regarding their driving ability and also request for them to complete a Request for Reexamination form.

The Physician: Older adults often readily accept recommendations from their physicians. Medical doctors are now being encouraged by the American Medical Association (AMA) to counsel caregivers regarding medical and health conditions, side effects of medications and other concerns. The AMA also recommends that they counsel the patient directly and even ask for and accept the car keys.
a. The optometrist/ophthalmologist: (based on AMA recommendation) an appropriate eye specialist can conduct a meeting w/the mature adult driver, also asking for the keys.
State Dept of Motor Vehicles (DMV): The DMV will not take away a license regarding your age unless it is determined that your mental and/or physical condition or inability to follow traffic laws and rules is compromised. As a family member you may contact your state DMV and submit a Request for Reexamination form.
b. The DMV will not accept an anonymous request. The only way that a name is to be revealed is if the process is taken through the courts and ordered by a judge.
i. Confidentiality:  Each request must be signed for authentication purposes. However, you may request that your name not be revealed to the individual being reported. Confidentiality will be honored to the fullest extent possible; the DMV does not want to harm your relationship with that person. All records received by DMV which report a physical or mental condition are confidential and cannot be made public (CVC §1808.5) unless mandated by law.
ii. One of the DMV's major responsibilities is to make sure that potentially unsafe drivers are evaluated and promote traffic safety. The DMV also understands the importance of a driver license and a person's independence.
c. Family attorney: The attorney representing the family or mature adult driver can consult with them regarding the risks to their estate in the event of a serious accident. The risks may also cost younger family members their shares if the estate can be sued successfully by a victim or the victims’ family. They may also include reasons why giving up the car keys are an important step.
d. Involve the police: To seek counsel of the police may trigger the creation of an official report, even if there is no follow through. That document can be used as a record that can be accessed and/or used if/or when there is an accident or driving violation. If there is an accident or violation in the future, the police have their established processes for covering, investigating and even making changes that could cause the DMV to require re-testing and even cancellation of a driver’s license.
e. Care manager: Hiring a senior specialist who can assist you with creating a plan to transition the mature adult driver and secure that the support systems are in place.  This will allow you to not have to be the bad guy and preserve your existing relationship with the mature adult driver.

7. DMV Retest/Keeping the Car in Running Condition
If the DMV requests a mandatory test, OR if their car is in need of maintenance/repair in order for them to continue driving…

DO NOT ASSIST/GUIDE THEM – If they are to retest at the DMV or have their car fixed/checked do not help them navigate their appointment.

a. You are strongly encourage to accompany them, but do not lead them through the process.
b. Self-efficacy is a necessary skill for every safe driver on the road (Self efficacy is commonly defined as the belief in one's capabilities to achieve a goal or an outcome). If they are capable of completing the entire process on their own (informing the counter person of their need…) and passing the test then they can legally still drive.

8. Theraputic Fibs/Trickery
When all else fails…
-disconnect the battery
-put a potato in the tailpipe
-swap otherwise identical keys on the keyring

If the situation is critical, you need to act immediately. These are the initial steps that can be taken. A seasoned care manager will have additional strategies in their arsenal of support systems to help you facilitate this process with a greater measure of ease.

Additional Safety Information for Senior Drivers 
The following links provide additional information on driver safety for seniors. 
AAA Foundation for Traffic Safety (American Automobile Association (AAA)) 
AARP Driver Safety for Seniors (American Association for Retired Persons (AARP)) 
Alzheimer's Association  American Society on Aging  Congress of California Seniors 
Family Conversations with Older Drivers  Mature Driver Improvement Programs  ElderSafety.org 
GrandDriver.info (American Association of Motor Vehicle Administrators (AAMVA)) 
Older Driver Safety (American Medical Association (AMA)) 
Older Drivers Program (National Transportation Highway Safety Act (NTHSA)) 
seniordriving.aaa.com (American Automobile Association (AAA) senior driver website) 

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