Aging places burdens on not just the person getting older, but the family as well. I have been in practice for over 36 years and I have seen many occasions where Grandpa refuses to quit driving even though he gets lost going to the store or gets in accidents. Older drivers comprise 19 percent of licensed drivers in the U.S. Although drivers over the age of 65 are more likely to respect speed limits, wear seatbelts, and avoid alcohol before driving, they are statistically more likely to be involved in fatal motor vehicle accidents. Drivers older than 75 years experience fatal accidents at rates higher than all other drivers over age 29. That said, studies have shown that older drivers who cease driving are at increased risk of social isolation, depression, the need for long-term care, and death.
Driving safely requires multiple intact cognitive capacities including complex attention, visuospatial skills, working memory, executive function, judgement, and insight into one’s own driving abilities. There have been multiple studies that have shown that even mild dementia impairs these abilities and raises the risk of accidents. Driving is a visually demanding task. Reductions in visual acuity, visual field, and contrast sensitivity are associated with common eye conditions such as cataracts, glaucoma, and macular degeneration. Because of this, many states require licensing agencies to mandate in-person license renewals for older individuals, especially those aged 85 and older. Physical impairments may also interfere with safe driving. For example, issues like upper or lower extremity weakness, loss of range of motion of the neck or extremities, or difficulty walking may negatively affect driving ability, as may conditions like hearing loss, vertigo, sleep apnea, seizure disorders, and heart disease. Medications that may affect consciousness could also be troublesome. These include antihypertensives, diabetic and seizure medications, antiparkinsonian agents, opioids, and benzodiazepines (Valium, Xanax).
The American Geriatrics Society (AGS) has developed the Clinician’s Guide to Assessing and Counseling Older Drivers, 4th edition. Physicians are often put into situations where family members express concern over their older loved one’s ability to drive safely. In my experience, once the physician has assessed the older driver and agrees with the family’s concerns, many older patients flat out refuse to quit driving. Some states require the physician to inform the patient who refuses to stop driving that the physician has both an ethical and legal responsibility to report the patient to the driver’s licensing agency. New York does not have this requirement. Most older adults will experience a period of driving retirement of at least six to 10 years before the end of their life. Alternative transportation options need to be considered, for example public transport, rides by friends or relatives, delivery services, or ride services. The hardest part, of course, is getting Grandma or Grandpa to agree to give up their car.
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