Health Info & Resources for Seniors
Remember your sense of freedom when you passed the driver’s test and got that coveted license? Suddenly, with keys in hand, you were no longer dependent on others to take you where you wanted to go. It is no wonder then, that taking away a license can be heartbreaking for both the driver and those forced to revoke it, says geriatrician Roopa Anmolsingh, MD.
“There’s a well-defined entry point for starting to drive, but there’s no exit point that tells you when you should stop driving,” says Anmolsingh, of St. Luke’s Senior Care Associates. “I always get asked if driving is a right or a privilege. Regardless, we know it’s very important for a person’s self-esteem and independence. It provides a sense of freedom.”
By the year 2030, 74 million Americans will exceed age 65 and more than 75% of those people will carry a driver’s license. However, not all should, she says. As people get older, they typically have poorer vision, slower reaction time, and decreased motor coordination and flexibility. Some physical conditions, such as seizures, stroke, and severe arthritis, could prevent them from being able to drive safely. Also, medications can affect driving, especially those that cause drowsiness.
Family members should also watch for signs of cognitive deficits. Do they have memory issues? When they are driving, do they make good judgement calls, such as taking the right exit or knowing when to go at a four-way stop?
If you suspect a loved one should never again get behind the wheel, Dr. Anmolsingh encourages caution and suggests you get help from a professional who can make an objective assessment of the individual’s driving abilities. Telling someone that they should no longer drive can destroy your relationship. She has seen older adults become very angry, blame family members for “ruining their lives,” and even threaten to cut them out of their will.
In Pennsylvania, health care professionals are required to report to the Pennsylvania Department of Transportation (PennDOT) any individual who has medical conditions that impair their ability to drive safely. Of approximately 35,000 reports submitted each year to PennDOT, about 10,000 individuals have medical impairments significant enough to merit recall of their driving privilege. An additional 21% of reports result in restrictions placed on the individual’s driving privilege and half involve drivers over 65 years of age.
What should I do if I suspect a loved one should not drive?
First, go to the individual’s family doctor for a general physical examination, as well as a vision test. Often your doctor will suggest further testing to determine whether it is safe for the patient to drive. For example, Senior Care Associates typically refers patients to the St. Luke’s Occupational Therapy Department, that offers a Fit to Drive evaluation that includes a test to gauge functions such as reaction time, information processing, and fine motor skills. Some organizations, such as Good Shepherd Rehabilitation, provide behind-the-wheel driving tests, while other independent organizations even go to the patient’s home to conduct driver’s tests.
In addition, Senior Care Associates provides comprehensive geriatric assessments that include cognitive screening that measures short-term memory and attention span, as well as how well the patient can perceive what is seen, organize thoughts, and plan next steps. Sometimes, conditions can be treated, improving the patient’s ability to drive.
Should the results of the tests determine that the license should be revoked, Dr. Anmolsingh suggests a family conference with the patient and the physician or other professional who conducted the driving or cognitive testing. The professional should review the evaluation results and provide reasons why the patient should no longer drive.
Additionally, Senior Care Associates offers suggestions for alternate transportation methods, such as having a friend drive them or taking public transportation. In some cases, they encourage patients to order their groceries on-line and have them delivered. In addition, St. Luke’s offers patients who cannot drive free rides to doctor’s appointments through St. Luke's Lyft. But these suggestions often do little to comfort the patient.
“You must be understanding, particularly with patients with cognitive deficits. The only thing they hear is that they can no longer drive and do the things that they like to do,” says Dr. Anmolsingh.
Taking away a license doesn’t necessarily prevent people from driving. In such cases, she suggests that family members take away the keys, park the vehicle down the street, or even remove the battery, because some patients may not even realize their own deficits.
“We had a patient who lived alone. One day, she told her brother that she was going to the store,” Dr. Anmolsingh said. “He received a call later that day from a police officer. His sister had been stopped driving in the wrong direction on a heavily-traveled interstate in upstate New York, after which the family had to drive eight hours to pick her up.”
When considering whether to confront a loved one about the need to stop driving, remember that you are doing this because you care about them.
“They’re at risk and other people on the road are at risk,” she says. “You want to make sure that neither they, or anyone else, could be harmed or even killed, because they are behind the wheel.”
To schedule an appointment with Dr. Anmolsingh, call St. Luke’s Senior Care Associates at 484-526-7035.
What signs should we look for?
If your family members draw straws to determine who has to be your passenger, it might be time to hang up the car keys for the last time. While families may sometimes joke about their poor drivers, it’s no laughing matter for the person who fears losing the ability to drive.
Geriatrician Roopa Anmolsingh, MD, encourages family members and friends of older adults to monitor their driving. Notice how they drive: Are they getting more traffic tickets or warnings; are they telling you they had a close call; does their car have scratches or dents; are they easily distracted? These are all signs that it may be time to stop driving.
Also, do they:
- get lost, even when driving short, familiar routes?
- fail to obey traffic signs or signals?
- cut off other drivers, straddling lanes, or making wide turns?
- react slowly to emergencies?
- fall asleep behind the wheel or appearing inattentive?
- become easily angered or agitated?
- use poor judgment, such as not yielding right-of-way?
- forget to use mirrors or turn signals or check for blind spots?
- have trouble judging distances?
According to PennDOT, conditions that would disqualify one from driving are:
- unstable or brittle diabetes or hypoglycemia.
- cerebral vascular insufficiency or cardiovascular disease that resulted in loss of consciousness vertigo, paralysis or loss of qualifying visual fields
- periodic episodes of loss of consciousness or of attention or awareness
- loss or impairment of a joint or extremity as a functional defect or limitation
- cerebral vascular insufficiency or cardiovascular disease which, within the last 6 months, that has resulted in lack of coordination, confusion, loss of awareness, dyspnea upon mild exertion, or any other symptom that impairs the ability to drive safely
- mental disorder
- use of any drug or substance, including alcohol, known to impair skill or functions, regardless of whether it is medically-prescribed
- any other conditions that, in the opinion of a provider, is likely to impair the ability to control and safely operate a motor vehicle