Safety vs. Independence: When Is a Person Too Old to Drive?

I’d venture that many of us have had family discussions about whether it’s safe for a grandparent or elderly aunt or uncle to be driving. Driving is often the last vestige of independence and one that is fiercely held onto.

I had an aunt and uncle who worked out a unique and very shaky scheme so they could still get around independently: he couldn’t drive because of severely diminished eyesight, but he would direct his wife, my aunt, who had early Alzheimer’s, as she drove. Between the two of them, they could get to grocery stores, church, medical appointments, and bingo.

And one colleague, to prevent her father from driving after multiple accidents, told him she needed the car to get to work; in reality, she just drove it a few blocks from the house and parked it.

While author Loren Staplin and his colleagues note in ”Can Your Older Patients Drive Safely?” that “decline in driving abilities is related to functional status, not chronological age,” they also observe that the “greater risk associated with driving at age 75 and older is . . . evident in these drivers’ greater level of involvement in fatal motor vehicle accidents relative to their representation in the licensed driver population.”

They describe the many age-related causes that can lead to safety issues, including failing sight, slower reaction times, cognitive impairment, and influence of medications.

From the abstract:

The authors discuss the specific driving risks adults face as they age and how nurses can raise older patients’ awareness of these risks. They also discuss the importance of connecting older adults to commu­nity resources that may help them continue driving safely for a longer period or find alternative transpor­tation options.

The article is free to read and offers 1.5 contact hours of CE. You can also listen to a podcast with the lead author.

2017-09-13T09:26:54+00:00 September 13th, 2017|Public health|1 Comment
Editor-in-chief, AJN

One Comment

  1. Castorag September 13, 2017 at 11:56 am

    This will likely spark many of us to share personal stories. In my case, my 82-yr-old mother hit a teenager head on, in the middle of a crosswalk, in broad daylight, at mid-day, causing very serious injury. We all agreed she had to stop driving, but she didn’t see it that way. “It wasn’t my fault, she was using her phone.” The police cited her for failure to take care and the court fined her $300, and done, no license restrictions. In our state, anyone can report an impaired person to the DMV, prompting them to have the person come in for a driving exam. But the person is entitled to know who makes the report … so none of my siblings would do it.
    Physicians are allowed to report, so I called her PCP, explained the situation, and begged them to report her after her next checkup in a week. The physician administered the Mini-mental Exam (only) and, as my mother reported it, told her she was in great shape and would live to 100. We prevailed upon the car repair shop to tell her they couldn’t get parts to rebuild the grill, fenders, and hood for almost 8 weeks, but she eventually got it back. She kept driving until she fell and broke a hip, at which point we sold the car while she was in the SNF and moved her to ALF, and that was that.
    We know the MmE doesn’t check for abilities critical for driving, such as reaction time, peripheral vision, coordination, and judgment. Yet somehow it’s still used as a proxy for a comprehensive driver safety eval for elders. And though the DMV does a cursory screen for peripheral vision (only), you can still get a 5-year (or longer) license at any age with no requirement for periodic retests. Around here, a big retirement area, we get news reports of elder drivers plowing into hairdressers, post offices, churches, salt marshes, and crowds pretty much weekly. As we boomers get older, this is only going to get worse. The legislature refuses to touch this, so we shoulder on … Perhaps the best gift for an elder who has everything is a prepaid driving-service or taxi gift card, as a matter of public health.

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