When a Privilege Yields to Age
Of all the insults of growing older, losing one’s driving privileges can be one of the most difficult to bear. A new driver’s license is a symbolic rite of passage from youth into adulthood, but giving up the car keys as physical and mental faculties diminish is a passage of another sort.
“Driving is the ultimate symbol of independence and self-reliance,” said Gloria E. Gesas, a clinical social worker with Jewish Family Service of Los Angeles. Older adults often feel that their life is essentially over without a car, she said. And they may stubbornly resist relying on their children or others for transportation. For families of an elderly driver, the issue is emotionally charged, one that can drive a wedge between husband and wife, parent and child. Family members, often the first to observe an older adult’s diminished driving abilities, don’t want to feel responsible for curtailing a loved one’s independence--the ability to drive to the grocery store, to religious services or to pick up a grandchild after school. The need for mobility is especially acute in regions such as Southern California, where urban sprawl, inadequate mass transit and access to commerce, culture and social activities make automobile transportation a near-necessity.
Though there is little debate about when people are ready to start driving--age 16 in most states--there is no consensus or standard age for relinquishing the privilege.
“One thing that just keeps coming through loud and clear is how different seniors are from each other,” said Arline Dillman, traffic safety manager for the Automobile Club of Southern California. “I know some people in their 90s who are still marvelous drivers, and some in their 50s and 60s--or for that matter in their 30s and 40s--who ought not to be driving.”
One thing’s certain: More older drivers will be on the road as the nation’s population ages. In 1990, older drivers accounted for 6.7% of all travel on U.S. roads, but that figure will increase nearly threefold by 2030, when they’ll account for about 19%, according to federal estimates. The responsibility for the safety of older drivers is shared by many people, including family, doctors and the government.
Often, changes in someone’s physical or mental health condition will prompt discussion about whether an older driver is still fit to be behind the wheel.
Glaucoma, cataracts, diabetic changes in the eye or macular degeneration may impair the ability to read signs or gauge distances. Arthritis, for example, may make it impossible to turn the head to drive in reverse, or maneuver the foot from brake to accelerator. Certain prescription drugs, such as high blood pressure medications, can create drowsiness and slow reaction time. Although dementia alone doesn’t preclude driving, those people with moderate to severe dementia lack insight into their behavior and may make poor judgments.
Although relatives are in a position to make valuable observations about an older driver, they often resist confronting the issue of a loved one’s deteriorating skills because they fear the consequences. They may worry that a spouse or parent will stop talking to them or become deeply depressed if they broach the subject. Another factor is the guilt and resentment of realizing they may have to become the primary driver, said Gesas, who counsels families on how to handle situations involving an older person’s loss of driving privileges. She guides them to transportation services, in-home help and mental health support.
Sometimes an accident--or series of accidents--or other troubling event, such as a driver getting lost, will force a family into action.
Esty LaHive’s first inkling that her husband, Joseph, was losing his driving abilities came in August 1997, when he took the car and disappeared for hours, missing their anniversary celebration, and then couldn’t account for his time. Then another incident: After leaving the couple’s Studio City home one morning and failing to show up for a golf game, he called hours later from a shopping mall in Calabasas. He couldn’t find his car, he told his wife. A Sheriff’s Department helicopter eventually located the badly damaged car in a ditch several miles away.
After that incident, Joseph LaHive, now 80 and living in a nursing home with dementia, still wanted to drive and his wife sometimes allowed him to borrow her car. She eventually removed the car key from his key ring.
In 1999, a neurologist diagnosed Joseph with dementia and filed a report with the DMV. Months later, the agency informed him he’d have to take a written test. After he had trouble concentrating on the study guide at home, Esty decided against having him take the written test, hoping to spare him the indignity of failing.
“It was very traumatic for him,” Esty said. “He didn’t want to give up driving.”
Sometimes a professional assessment is the best way to determine someone’s driving fitness, said Dr. Richard A. Marottoli, a geriatrician at the VA Connecticut Health Care System in West Haven. The assessments, often done by an occupational therapist and costing about $500, are usually covered by health insurance if related to traumatic injury or stroke. They often are not covered if the patient’s diagnosis is dementia, Marottoli said. In some cases, it may pay for the driver to brush up skills with on-road training or a course sponsored by such organizations as AARP.
When a decision is being made to have someone stop driving, family members should try to reach consensus and form a united front, Gesas said. If there is disagreement among the family about the best course of action, a social worker or counselor can help by discussing safety versus autonomy issues.
They also need to decide how best to break the news to the older driver. They may try loving appeals to the person’s sense of safety, saying: “We care about you, and you’re not safe anymore.”
Sometimes, however, reason doesn’t work, especially when the older driver shuts them out or can’t listen because of dementia. In such cases, family members may try deceptions, such as saying the car is being repaired. They may resort to canceling car insurance, hiding the keys or disabling the car. But these actions often enrage the driver and can potentially damage family bonds. Social workers can ease the transition by arranging access to alternative transportation, grocery delivery, home meal preparation and other services so the person doesn’t become cut off from friends and peers.
Another way that children or spouses seek help is through the family doctor. A 1997 study by the New York State Office for the Aging found that more than 70% of families struggling with this issue of an elderly driver’s competence said getting the doctor involved was helpful.
That’s what happened in the case of a 77-year-old San Fernando woman who suffers from short-term memory loss and dementia. Her 81-year-old husband sought the advice of a doctor, who said it wasn’t safe for her to continue driving.
The doctor sent a report to the California Department of Motor Vehicles. (California is the only state that requires doctors to report a diagnosis of dementia to county health authorities, who then forward it to the DMV.) The state revoked the woman’s driver’s license two weeks ago. Now she’s frustrated and angry.
“When she got that letter, she virtually ripped it up and said she was going to drive anyway,” said the husband, a retired civil engineer who asked that his and his wife’s names not be published.
He tried convincing his wife the decision was for her own health and safety. But she said it was making her a prisoner at home. Although “willing to do all I can,” he said the strain of caring for her and doing all the driving for both of them is taking a toll on his health.
Although his wife’s doctor followed the law and sent a report to state authorities, most doctors don’t note the diagnosis of dementia in the patient’s medical record because they don’t want to assume the resulting legal responsibility, said Dr. Alison Moore, a UCLA geriatrician. In some cases, primary care or family doctors may be concerned that their relationship with the patient may suffer if that person holds them responsible for the loss of driving privileges.
Actually, though, doctors can’t revoke anyone’s driver’s license. That’s the responsibility of the DMV.
In California, anyone may file a report with the DMV about a suspected unsafe driver. The DMV may conduct an evaluation that includes vision testing, an interview and a driving test; the agency is developing new tests to better screen existing drivers for physical and mental declines that could impair driving. It can revoke a license or issue a provisional license that limits someone to driving during the day, a certain geographic area or only on surface streets. It can call the driver back for additional tests at a later time.
Many doctors worry, however, that taking away the patient’s ability to drive can lead to an inexorable decline.
Yale’s Marottoli cited a study that found that seniors who stopped driving were less active and more depressed. Marottoli said is it crucial to provide transportation alternatives for seniors and to keep them engaged in the world around them.
In some situations, it’s not necessary to take away a driver’s key entirely. Temporary steps can be taken that help preserve an older drivers’ dignity and mobility, while keeping them out of unsafe situations.
Experts say these steps often work best if they are voluntary, or adopted with support from family and friends. And many seniors voluntarily limit their driving to situations in which they feel safer.
Esther Joffe, 90, of North Hollywood, hasn’t driven after dark since she turned 85.
“I do not drive after dark because I am not positive about my vision, although it’s OK,” said Joffe, who underwent successful cataract surgery but still sticks to daytime driving. “I think discretion was the better part of valor here,” she says.
Joffe, who hopes to continue driving “as long as I live,” travels to yoga classes, doctors’ appointments and the supermarket--avoiding the freeway. She and a friend take turns driving to the local movie theater and, for longer trips, sometimes take the bus and Metro Rail.
“You have a feeling of liberation and independence when you have a car,” she said. “You go when you want, where you what, and that’s important.”
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Signs of Declining Driving Skills
When evaluating the performance of an older driver, bear in mind that the safety of many other people--including passengers, pedestrians and other drivers--is at stake.
Some warning signs that driving skills may be impaired:
Failure to stay in proper lane when making a turn.
Getting lost frequently.
Ignoring traffic signs or signals.
Failing to yield the right-of-way.
Turning left from the wrong lane.
Driving slower than the posted speed limit.
Inattention to other vehicles, pedestrians and bikers.
Not checking blind spots when driving in reverse--sometimes a sign of physical limitations, such as neck problems.
Difficulty parking.
Confusing the brake and gas pedals.
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Assistance for Seniors at the Wheel
Here are some organizations that offer assistance or information about older drivers:
* AARP offers a 55 ALIVE driving program. Information: (888) 227-7669 or www.aarp.org/55alive.
* Automobile Club of Southern California offers “Safe Driving for Seniors” classes and brochures.
For class schedules or to get copies of the brochures, call (877) 428-2277.
* Family Caregiver Alliance, an advocacy group in San Francisco, has fact sheets on dementia, driving and California law and also offers workshops and classes. Information: (800) 445-8106 or www.caregiver.org/factsheets/dementiadriving.html.
* Jewish Family Service of Los Angeles offers referrals for counseling, assessments, transportation and in-home help. Call (323) 761-8800.
* Los Angeles County Area Agency on Aging provides information and referrals. For information: (213) 738-4004 in Los Angeles or (800) 510-2020 to have your call routed to the office nearest you.
* Los Angeles City Area Agency on Aging provides local referrals to agencies that provide counseling and information about the City Ride transportation program for those age 65 and older: (213) 368-4030.
* The National Highway Traffic Safety Administration has a brochure, “Driving Safely While Aging Gracefully.”
For information, call (888) 327-4236 or www.nhtsa.dot.gov/people/injury/olddrive.
