Mary Beth Schweigert
The world is aging. In the 1960s, people aged 65 and over accounted for just 4.9 percent of the global population. But according to a report from The World Bank, by 2050, that number will more than triple. The rapid increase in the senior population over the next few decades will have a significant impact on many aspects of life, from bigger picture issues such as health care spending and economic growth, to everyday issues affecting individuals and families, such as how aging can affect the ability to drive safely.
Though it may seem small in comparison to changes to the labor force and other areas that have a global impact, talking to an aging loved one about when it’s time to stop driving is often necessary to ensure the safety of the driver and others on the road.
The U.S. Centers for Disease Control and Prevention (CDC) reports that there were more than 42 million licensed drivers ages 65 and older in 2016, representing a 56 percent increase from 1999. That same year, more than 7,400 older adults were killed and more than 290,000 were treated in emergency departments for crash-related injuries.
“Age is not the sole predictor of safe driving, but age-related declines in physical and mental abilities can lead to a greater risk of having accidents,” said Nancy Estep, CRNP, a nurse practitioner with Lancaster General Health Physicians Geriatrics. “These changes may occur very gradually over time, so the driver and his or her loved ones may be unaware that their skill levels have declined.”
In fact, age-related declines in vision and cognitive functioning – the ability to reason and remember – as well as physical changes, can affect some older adults’ driving abilities, according to the CDC. In addition, older adults more commonly suffer from health conditions that can impair driving, such as dementia and stroke, Estep said.
According to AAA, even common physical changes associated with aging can limit an older adult’s ability to safely perform tasks related to driving. Arthritis, for example, can make turning, flexing and twisting painful. Weaker muscles, reduced flexibility and limited range of motion can affect the ability to grip and turn the steering wheel, press the accelerator or brake, or reach to open doors and windows.
Unlike many other states, Pennsylvania does not require behind-the-wheel testing for drivers over a certain age. However, a voluntary behind-the-wheel test or an occupational therapy assessment – an objective evaluation of reaction time and other skills needed for safe driving – can provide valuable information on driving abilities. Following the assessment, an occupational therapist can help a patient and their family take appropriate next steps, whether that means taking a behind-the-wheel test to provide additional information or no longer driving.
Jesse Main, PsyD, a fellow with LG Health Physicians Neuropsychology, says that for many of his patients, driving is a practical representation of autonomy, making the conversation all the more difficult. It’s important, he says, to approach the topic with a delicate balance between allowing an older adult to maintain their independence and ensuring the safety of themselves and others.
Before raising the subject of driving safety with an aging loved one, Estep and Main recommend preparing specific observations and potential solutions.
Spending time in the passenger seat, for example, can offer a valuable up-close perspective of a loved one’s driving ability, Estep said. Signs that it’s time to discuss driving safety include accidents – big and small – or near-misses, citations for traffic violations, or dings or scrapes on their car. Older drivers may also become lost, even when driving on familiar roads. Seeing warning signs first hand, Estep said, can help validate concerns and provide a starting point for the conversation.
If an aging loved one does not want to discuss the topic, Main and Estep suggest enlisting medical providers for support. Medical providers are mandated by law to report to the Pennsylvania Department of Transportation any concerns about an older driver and if the driver’s license should be revoked. Providers also can order further testing, if necessary.
“Accompanying someone to a medical appointment can be a good opportunity to raise the topic of driving safety,” Main said. “The provider can help guide a productive discussion where concerns can be expressed and dealt with appropriately.”
The ability to drive affects many areas of an older adult’s life, including routine errands, doctor visits, church services, and special events. Being proactive about alternate transportation arrangements, Main says, can keep people from feeling trapped in their own home or apartment, or that their independence is being taken away.
Because Pennsylvania does not require behind-the-wheel testing for older drivers, it’s even more important for family members and medical providers to identify concerns and perhaps seek additional information through voluntary assessments, Estep said.
“Taking the keys from a loved one is not easy, but in many cases, it may be necessary,” she said. “It’s critical to bring this to the attention of your loved one and their medical provider, and to take action to keep an older adult from getting behind the wheel if they are unsafe.”