Have the "Driving Retirement" Talk Sooner Than Later

It's inevitable. We hear of a traffic accident caused by a senior driver, usually older than 70 years, and people think "why was he or she driving at that age?" There's some  head shaking and opinions. This is usually closely followed with opposing opinions that say that younger drivers (teens and inexperienced drivers) cause and have more accidents that result in more fatalities. While this may be true, one doesn't negate the other.

Young, inexperienced drivers cause and have some accidents. Inattentive or distracted middle-aged drivers cause and have some accidents. And seniors who have decreased abilities cause and have some accidents. Note, I didn't say seniors in general. I said seniors with decreased abilities. That's not ageism. That's reality.

Some barriers to safe driving

We can't deny that there are barriers to safe driving that affect more older people than young people. They can include:

- Declining eyesight, including reduced peripheral vision
- Slower reflexes
- Difficulty moving
- Forgetfulness
- Dementia
- Ill health
- Reactions to medications

Not all people over the age of 70 years experience those problems, but it is important to recognize that those who do could be a danger on the streets, both to themselves, as well as pedestrians, cyclists, and other drivers. The problem is, giving up those car keys is more than just giving up driving. It's giving up independence and it's giving up another stage of life. For many people, this is a very difficult step.

"Advanced Driving Directives"

Not unlike advanced directives for how to manage someone who is sick or incapacitated, researchers from the University of Colorado School of Medicine and the CU College of Nursing are recommending that people develop advanced driving directives - plan ahead for the day you can no longer drive safely.

The idea behind the advanced planning is that the suggestion that a senior stop driving isn't a shock, doesn't seem like a punishment for getting older and perhaps frailer. It is simply another stage in life, but one that has been anticipated and prepared.

The study

The researchers conducted a small study of 33 older drivers and eight healthcare professionals (physicians, physician assistants, and nurses) to see when the topic of safe driving and perhaps stopping driving was introduced.

The results showed that there were five dominant themes:

 (1) clinicians usually initiate conversations, but typically not until there are “red flags;” (2) drivers are open to conversations, especially if focused on prevention rather than interventions; (3) family input influences clinicians and drivers; (4) clinical setting factors like short appointments affect conversations; and (5) both clinicians and drivers thought ADDs could be useful in some situations and recommended making general questions about driving a part of routine care.

So what does this mean?

The authors wrote: "Both clinicians and drivers supported the idea of regular questioning about driving as a way to make it an easier topic, as patients might be more receptive if they heard it once before."

So, by using "anticipatory guidance," healthcare professionals can start looking for signs for changes in mental or physical status that could affect driving skill before they become obvious. The discussions between the caregiver and the patient become a normal part of the examination so if the issue does come up, it's not a surprise.

"It's not just about taking the keys, it's about making plans," said Marian Betz, MD, MPH, lead author of the study and an emergency room physician. "Drivers in our studies reported needing help in preparing for that transition, including learning about transportation alternatives."