Giving up the keys

Losing ability to drive is one of the biggest blows to an elderly person’s independence

Whether it’s due to dementia or other age-related health conditions, elderly people at some point often find they must give up driving.

It might be something they realize on their own, or others might have to take the lead on the issue, but the road to that decision is anything but clearly marked. And it’s one that many people have to take.

“People don’t realize we spend about seven to eight years (in old age) without the ability to drive a car. How can we plan for that?” asked speaker Dr. David Carr at a recent public forum on dementia, presented by the Institute for Dementia Research and Prevention at Pennington Biomedical Research Center, with a focus on driving.

While it’s often imperative for the safety of the driver and others on the road, losing the ability to drive is one of the biggest blows to an elderly person’s independence, he said.

“Private cars account for over 90 percent of trips made by seniors,” said Carr, a geriatrician and a professor at Washington University in St. Louis.

The ability to drive gives people autonomy, identity and social connectedness, which correlates with psychological and physical health, he said.

Other speakers on a panel of experts at the public forum included Jeff Keller, Ph.D., director of the Institute for Dementia Research and Prevention; Barbara Auten, executive director of Alzheimer’s Services of the Capital Area; and Dr. Patrick Gahan, a Baton Rouge geriatrician.

The risk for being in a car crash climbs steadily after the age of 65 (although it’s not as high as the risk for drivers at the other end of the scale, those ages 16 to 19), Carr said.

Causes for problems in the elderly group are the increasing numbers of people in that age range and the prevalence of chronic disease that accompanies those years, he said.

Dementia adds the difficult element of others making the decision on driving for another person, and, like a hot potato, it’s often handed off from family members to physicians or others.

“One of the challenges we have is ... how do you measure driving success or failure?”

As of yet, there is no one set criteria, Carr said.

There’s plenty of research on the subject.

Older adults are over-represented, for instance, in crashes involving left-hand turns, he said.

And research shows that drivers older than 70 who don’t drive frequently, keeping up their skills, are at higher risk for being in car wrecks, Carr said.

But still, the issue of deciding who should and shouldn’t drive is murky.

In the country of Finland, Carr said, people get a driver’s license for life. In Sweden, people must reapply for their license every two years, yet there’s no difference in the mortalities from car crashes between the two countries, Carr said.

There are higher pedestrian fatalities in Sweden, however, Carr said — evidently because more people are having to walk instead of drive.

Michelle Rayburn, the public information officer for the Louisiana Office of Motor Vehicles, said that law enforcement, immediate family and physicians can send a “behavior report” to the office, if they’re concerned about someone’s driving.

The Office of Motor Vehicles then sends a medical form to that person to take to their treating physician, Rayburn said, in a phone interview this week.

The physician fills it out, indicating whether the person should continue to drive, and returns it to the OMV, she said.

The doctor might also say that the OMV should take the person on a road skills test, to get more information, Rayburn said.

But easy answers are still hard to find.

Gahan said he once signed a medical form for a patient, saying the patient shouldn’t drive.

“The next time I saw him, he drove himself, from Denham Springs,” Gahan said.

“It’s more than telling them they can’t drive, there’s also access” to the car and keys.

At the forum, people had the chance to turn in questions that were then turned over to the panel to answer. Some of them follow here:

Do you believe all people with a diagnosis of Alzheimer’s or dementia should be forbidden to drive?

Gahan and Carr both said “No.”

“People may start developing short-term memory impairment. In that setting, there’s not a (strong) association with memory impairment and difficulties behind the wheel,” Carr said.

“People with mild cognitive impairment or early disease are oftentimes very capable drivers,” Gahan said.

As they decline, however, that situation will change.

What is a good litmus test to determine if a person can drive?

“I’ve got mine,” Gahan said and offered an imaginary conversation, based on real-life ones he’s had, between himself and, for the purposes of the forum, a mom of a young child, concerned about her elderly father’s driving.

Gahan: “How do you feel about your dad driving across town?”

Daughter: “There’s no trouble with it, he does it all the time.”

Gahan: “Would you let your daughter ride with him?”

Daughter: “Not on your life.”

If that’s the case, then dad shouldn’t drive, Gahan said.

Some people are concerned about a loved one’s driving skills, but don’t know the particulars.

“If you don’t know the answer and you’re asking the question” about a parent’s driving abilities, Gahan said, “you’d better find out. You need to go driving with dad.”

What are some of the things people can do personally to improve driving?

People can take classes with local driving schools, the panel said.

And traffic safety courses are offered by organizations liked AARP and AAA.

Carr added that “a lot of data suggest women stop driving prematurely.”

“If you’re a team, husband and wife, I would make the case to share time behind the wheel.”

Is there any particular car or standard feature that helps prolong the ability to drive?

Carr: The data shows the larger the car, the better.

What other medical conditions beside dementia influence an elderly person’s ability to drive?

Three requirements to be an able driver are vision, cognition and motor ability. There are numerous health conditions that can affect each of those abilities, the physicians said.

For vision alone, conditions such as macular degeneration, glaucoma, diabetic retinopathy and cataracts can impact a person’s ability to drive.

“Research shows that individuals who had cataract surgery had a lower crash risk almost immediately,” Carr said.

At the forum, Keller told the audience a little of the history of the Institute for Dementia Research and Prevention.

It was founded at Pennington a little less than five years ago, with a goal of 200 people to initiate studies.

Today, there are 1,800 participants in its two major, longitudinal studies, and it now also has offices in Shreveport, Alexandria and Monroe, Keller said.

“Because of you, we have a world-class research program that will develop interventions, prevent falls and reduce dementia,” he told the audience, many of whom have participated in studies there.