Published: August 4, 2014

Andrew D. Sitkoff, DO, Internal Medicine
Chester County Hospital

Statistics show that people are living longer and there are more older drivers on the road than ever before. In the early 1970's, barely half of all Americans over age 65 had driver's licenses; by 2010 this number increased to 84%. One in six drivers on the road today is age 65 or older.

Normal aging is associated with many conditions that can affect driving such as decreased mobility, slowed reflexes and vision problems. More than 90% of older drivers take prescription medications, such as sleeping pills, pain or anxiety medications that may affect driving.

The likelihood of developing cognitive impairment increases with increasing age. The onset and progression of dementia is usually slow and gradual. People with early or mild dementia are often able to continue to drive safely. Driving represents independence and freedom and the idea of limiting or giving up driving can be very emotionally charged causing family friction, feelings of frustration, anger and resentment and guilt on the part of family caregivers. Knowing when it's time to restrict or stop driving can be a difficult judgment call.

Some warning signs that should raise red flags about unsafe driving are:

  • Diminished attention span
  • Becoming lost in familiar places
  • Irritability (road rage)
  • Difficulty with decision-making
  • Driving too slowly
  • Failing to observe traffic signals
  • Drifting into other lanes
  • Multiple scrapes or dents in car

There is really no substitute for first-hand observation of someone's driving ability. Responsible family members or caregivers trying to determine if it's time to stop driving should try to directly observe driving abilities as a passenger. The issue of giving up driving is best approached as early as possible, ideally long before any decisions need to be made. Establishing a plan early is obviously preferable to one day having no choice but to take away car keys. It allows time to consider alternative strategies of transportation. This may involve organizing family members to be available for transportation, accessing senior transportation services and beginning to think about a residential move closer to available support.

Individuals with dementia may be completely unaware of any cognitive decline. This can make any discussion about driving difficult. In this circumstance, caregivers and families can elicit help from a physician, lawyer, or close family member or friend. At times, having a written directive such as "YOU MAY NO LONGER DRIVE" can help families to remind the individual with dementia about a forgotten conversation regarding driving.

A discussion with the physician of the individual with dementia may prompt a formal report to the Department of Transportation recommending surrender of a driver's license or referral to a driver evaluation program.

If the individual with dementia stubbornly insists on driving in spite of posing a clear danger to themselves or others, some tactics can be to disable the car, hide the car keys or provide keys that don't fit the ignition. A mechanic can install a switch so the car can only be driven by a caregiver.

No one strategy for limiting or stopping driving fits all circumstances, but the best approach is to have a non-confrontational discussion long before the time comes that the driver must stop.

This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.

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