Driving While Elderly

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    Driving is a risk at any age. With the 85+ group of drivers, the risk is magnified. The author discusses ways nurses can help their patients confront and cope with the risks.

    Driving While Elderly

    Two stories, same basic question. Story #1: Elderly gentleman, kyphosis with limited neck mobility, oxygen dependent, severe COPD, walker dependent, very mentally sharp but medically fragile- refuses to stop driving in spite of his family doctor's order to do so. Office nurse fills out state referral form requiring him to be retested by the Department of Transportation. The patient becomes angry and leaves the practice. Story #2: Elderly woman with mild to moderate dementia, designated driver for a couple. One family member works hard to get all of family in unity to get driving, especially on busy interstates, limited. In spite of strong advocacy from one son, their internist supplies letter to husband, per his request, that she is "clear to drive." When questions arise in the family, he sites the written memo as proof that she is ok to drive. The family and the parents are at bitter odds over this difference of opinion and are at an impasse. In both of these cases, the persons involved are hovering at around 90 years of age

    So what is going on here? Is this a common problem? As nurses, it seems that we often face questions in our practice, in our families, and in our communities about what to do and how to proceed when there is a question about whether or not an elder is safe to continue to drive. While cities with extensive public transport may not face this issue in exactly the same way, large swaths of our suburban-based country are inaccessible unless someone is able to drive. When driving is restricted or prohibited, the affected person finds their independence drastically curtailed. In a culture where self-reliance is a high value, this can be tantamount to a sentence of isolation and confinement, a perceived end to life as it has been.

    As a whole, seniors tend to be careful, safe, responsible drivers. Many studies confirm the fact that age alone does not preclude safe driving (https://crashstats.nhtsa.dot.gov/Api...ication/812273). However, as age and co-morbidities increase, so do numbers of accidents with fatalities. This is especially noticeable in the 85+ age group, where increasing loses associated with aging-hearing, vision, neck mobility and reflexes-appear to hamper safe driving. "Three behavioral factors in particular may contribute to these statistics: poor judgement in making left-hand turns; drifting within the traffic lane; and decreased ability to change behavior in response to an unexpected or rapidly changing situation.(Older Drivers, Elderly Driving, Seniors at the Wheel)."

    The CDC site states:

    • Involvement in fatal crashes, per mile traveled, begins increasing among drivers ages 70‒74 and are highest among drivers ages 85 and older. This trend has been attributed more to an increased susceptibility to injury and medical complications among older drivers rather than an increased risk of crash involvement.
    • Age-related declines in vision and cognitive functioning (ability to reason and remember), as well as physical changes, may affect some older adults' driving abilities. (Older Adult Drivers | Motor Vehicle Safety | CDC Injury Center)

    The problem of impaired drivers affects us all and as nurses we are part of the supportive community that surrounds our seniors. How can we best contribute to assisting with a solution-oriented approach?

    Encourage our seniors to self-monitor. If we begin to make driving safety a part of our "normal" conversation and assessments, it will seem less accusatory and invasive when the topic comes up. This suggestion is not intended to add another check box to the already cluttered EMR but to simply add another topic to our usual office-visit preventive medicine conversations or even our discharge plans post-op. Sometimes simply asking the question can plant the seed of more careful thought. By being good listeners, we can pick up on cues that our patients have concerns about their own driving; when we realize this, then we can focus in on their concerns and help them decide whether or not to limit driving. If someone says, "I wonder if I am ok to drive at night? I don't feel like I can see as well at night," then it is our professional responsibility to pick up on this and follow through: do they need an appointment with an ophthalmologist? Can the patient themselves suggest what they need to do about it? Many times, if our patients are able to suggest their own solutions, they are more able to accept the limitations rather than those imposed on them by outside forces.

    Involve family and physician - Many seniors have family or significant others that are concerned about their driving. Most families will admit that they simply do not know whether their elders are ok to drive. When a nurse opens the topic, in a non-threatening way, it can help push the conversation forward, to a point where action is possible. If the patient has a family physician/internist, these professionals can also be valuable allies in the decision-making process. A nurse who has experience with her own family in this process once told me: "It was a tricky subject for me to discuss with my dad when the time came to do so. I found it was easier for him (and me) to have the doctor discuss it and let him deliver the news that driving needed to cease. It helps the senior 'save face' by being able to say, 'My doctor says it's time for me to leave the driving to others because of my health condition,' rather than having to say 'My daughter won't let me drive any more because I am too old.' It helps keep family relations open and supportive which is so important as health issues start cropping up."

    Support community transportation initiatives - Safe communities don't just happen. We all have to invest our tax dollars to make general accessibility happen. While this sounds like more government intervention, it is, in reality, contributing to all our convenience and safety and well-being. If our seniors are able to get around, then we are all better off. Sometimes our seniors need help in figuring out the logistics of using uber, taxi service, bus routes or volunteer community drivers. Nurses can play an important role in getting their patients comfortable using alternative transportation.

    Encourage seniors to take a safe driving class - The AARP offers classes to help seniors be better drivers, helping them learn how to compensate for deficits and how to improve their driving habits.

    Use Department of Transportation reporting as a tool-if all else fails - While most states have a form for reporting an unsafe driver, these are most useful when an unsafe driver is unwilling to acknowledge that he/she has any limitations and refuses all other offered interventions.

    As professional nurses, we are concerned about promoting safe driving for people of all ages. When it comes to our elders, we approach the topic with respect for their dignity and with an eye toward positive outcomes. What practical suggestions do you have in terms of addressing this community challenge?
    Last edit by Joe V on Jun 14
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    33 Comments

  3. by   3ringnursing
    This can be a bone of contention when the family must approach the PCP to intervene with a letter to DMV - I've seen people continue to drive when they shouldn't and weren't supposed to. But I still remember my grandma Eleanor: the world's best and most cautious driver even in advanced years, quoting, "I live and drive within the letter of the law" while driving. And she did too, bless her heart - she was the greatest.
  4. by   Oldmahubbard
    There was a very sad case in my county, some 20 years ago. An elderly couple went out for lunch one summer day, and never came back. Their daughter was an RN.

    A massive search ensued, and foul play was thought to be involved. Still no evidence of the couple or their car.

    Finally their car, with 2 decomposed bodies, was found well off the road in a farmer's field that fall.

    It was believed the husband who was driving, had a cardiac event, and his wife, who had Alzheimer's, died of exposure after the car went off the road.
  5. by   amoLucia
    Interesting article. But the bottom line is that seniors still need to drive to accomplish many activities for simple daily living.

    From a sociological point of view, perhaps more study needs to be directed to determining which activities can decreased, modified or eliminated by SUBSTITUTING alternative and acceptable services. How are you going to stop a senior from driving to the local store to buy a lottery ticket? Just a simple activity of living to have a lottery ticket for the great American dream, but can you figure out how to otherwise get him a ticket?

    Services out there in the community are needed, but little is being done to address that.
  6. by   jeastridge
    Quote from amoLucia
    Interesting article. But the bottom line is that seniors still need to drive to accomplish many activities for simple daily living.

    From a sociological point of view, perhaps more study needs to be directed to determining which activities can decreased, modified or eliminated by SUBSTITUTING alternative and acceptable services. How are you going to stop a senior from driving to the local store to buy a lottery ticket? Just a simple activity of living to have a lottery ticket for the great American dream, but can you figure out how to otherwise get him a ticket?

    Services out there in the community are needed, but little is being done to address that.
    Thank you for your comment. You make a good point. It is not as simple as telling the very elderly they can no longer drive. We also have to be part of finding ways to provide services for them--and sometimes that means volunteering and at other times it means supporting more community taxes so that as a group we can support services. The solutions are not simple--or easy. Joy
  7. by   jeastridge
    Quote from Oldmahubbard
    There was a very sad case in my county, some 20 years ago. An elderly couple went out for lunch one summer day, and never came back. Their daughter was an RN.

    A massive search ensued, and foul play was thought to be involved. Still no evidence of the couple or their car.

    Finally their car, with 2 decomposed bodies, was found well off the road in a farmer's field that fall.

    It was believed the husband who was driving, had a cardiac event, and his wife, who had Alzheimer's, died of exposure after the car went off the road.
    So sad when something like this happens. It's everyone's nightmare scenario...Joy
  8. by   FranEMTnurse
    As an experienced past school bus driver, I was at a stop on a state highway to pick up children. My side stop sign with a strobe light was already flashing.An elderly gentleman driving his car approached my bus from the opposite direction. (mind you he was approaching my bus on the same side the strobe light was flashing) and he drove right past my bus. Had those children been crossing the road then one or several would have been killed.

    I reported the incident to the police and the state trooper asked me to not press charges because he lives in a rural area. I refused, because I consider this extremely dangerous.

    Another incident occurred just two days ago. I am currently living in a senior housing complex, and there is a grocery store located about 3 blocks away. A caregiver I currently have was driving into the store parking lot and a senior driver backed out of her parking spot right in front of the caregiver totaling the caregiver's car. She now is forced to purchase another car. THIS IS THE REASON I AM AGAINST HEAD - IN PARKING. Numerous people of all ages have been killed due to the blind spots behind the older cars, and most drivers cannot afford the newer cars with the rear view backup mirror.

    There are numerous home care agencies around now, even in rural areas. The areas who are not equipped with them yet have visiting nurses who can go to the elderly people's homes. There have been several advancements in this area in the past few years.

    I fully understand why elderly people want to keep their independence. I myself am 74 years old and desperately miss my own and have to rely on others or on public transportation now, and I was completely independent until 10 years ago when I no longer had my own transportation.
    Last edit by FranEMTnurse on Jan 6 : Reason: spelling
  9. by   Munch
    My opinion is biased so take it for what its worth. Obviously I think when it comes to seniors driving I don't want to make a blanket statement and say anyone over the age of 85 shouldn't drive. That being said I think they should definitely have to repeat their roadtest when they hit the age of say 80(do some states have that requirement in not sure)?

    Now that I gave my disclaimer..I'm going to say this. An 83 year old woman hit me because she got the accelerator mixed up with the brakes. Totaled my car. I was furious. If you can't get something basic like knowing the difference between the brake and accelerator you shouldn't be driving period. Also I live in the suburbs right outside New York City so there are a lot of parkways near to get into Manhattan and the other boroughs and I can't even tell you how many times I've seen a senior driving not even the minimum speed. The speed limit where I live and the surrounding areas is 55..50 in some with the minimum speed being 40. On a busy parkway in a heavily populated area doing 35MPH is downright dangerous.

    I feel like a lot of seniors don't have a good grasp of their surroundings when in the car either. I can't even tell you how many times Ive been driving on a main road and a senior is coming out of a residential road and they cut right in front of me coming so dangerously close to causing an accident and they don't even know why I honked the horn. Its almost of well we need to watch out for them and they don't need to watch out for us. My favorite is driving on a main two way road and there is a line of cars behind one senior doing 20MPH when the speed limit is 40. I remember a little while ago a little boy was getting ice cream with his mother and a 84 year old man plowed into the store front killing the little boy. A family now has to live without their child because a senior found it necessary to drive? Plowing into stores seems like a hard thing to do unless you are drunk or high.

    So there is my answer I guess. If a senior can keep up with the speed limit can, knows the difference between the accelerator and the brake and doesn't cut right into on coming traffic then no problem. My grandma was in her 70s when she died. She had no problem driving during the day but at night and during the rain she just didn't feel comfortable driving. I guess in an area where mass transit is so abundant its easier for anyone to get around. They also have able-ride and access-a-ride that provides people that need medical care to medical appointments. I know its not the case in other areas of the country but that also shouldn't allow for people to be afraid for their lives on the road.
    Last edit by Munch on Jan 6 : Reason: Spelling
  10. by   Not_A_Hat_Person
    If it was up to me, all license renewals would require a road test. Once a driver hit 65, they would get a "senior license" valid for 2 years, with a road test required for renewal. In my experience, the government won't do a thing about elderly drivers because old people vote.

    When I lived in MA, there was a rash of bad accidents involving elderly drivers. An 85-year-old woman with a long history of accidents, including one that killed her husband, ran down a family in a crosswalk in broad daylight, killing a 4-year-old. Her license was revoked, but the DA refused to press charges because she was old.
    Last edit by Not_A_Hat_Person on Jan 6
  11. by   Kitiger
    Quote from Munch
    Obviously I think when it comes to seniors driving I don't want to make a blanket statement and say anyone over the age of 85 shouldn't drive. That being said I think they should definitely have to repeat their roadtest when they hit the age of say 80 (do some states have that requirement in not sure)?
    I think this is reasonable. Or perhaps, the road tests should start at age 80 and then be every other year. I'd like to hear what others think.
  12. by   amoLucia
    It's very easy to point a finger at some elderly driver when an accident occurred. Their age seems to be the distinguishing factor. Hell, even the newspaper and TV news latch on to "elderly driver ..." headlines. Looking beyond what the police report says re the senior hitting the gas pedal instead of the brakes, does society try to figure out why the senior driver is out on the road??? And then, what could have been done to have the senior NOT on the road?

    There doesn't seem to be the discriminatory age stigma attached to the young 16/17 yo driver like there is with the older driver. Yet auto industry statistics bear out their significantly higher risk.

    Again, society seems to age-bash - not without some validity, I will concede. I have no problem with periodic ongoing mandatory driver testing of the elderly driver, incl road testing. This might be the easiest and most 'official' approach I can think of. Start at age 70 and coordinate when car registration or license is due. And State Motor Vehicles needs to be computer aggressive for compliance.

    OP - you ask for some suggestions. My suggestions would reflect large scope approaches. Primarily, society needed to see the 'bigger problem' but I don't see that happening anytime soon. Individual needs will need to be addressed.

    I utilize a 'shop from home' grocery service. But I need a computer to do so. I need to coordinate my delivery time and dates, and there is a fee for the call-in shopping service and the delivery service. Not all 85 y/o seniors can coordinate those 3 factors. I wonder how many 85 y/o drivers were out on Wednesday (pre-snow) doing emergency shopping at the local Acme. Better still, I wonder & dread to think of how many were out on Thursday (snowing) and/or Friday (post-snow). Any suggestions for the seniors who have no relatives/close friends to do their shopping for them?

    Not all pharmacies offer delivery. And insurance companies often require designated providers at certain fixed costs. How does the senior choose between pharm costs, delivery of meds or the need to drive to a pharm that meets both needs?

    Not all doctors have liberal evening/weekend hours. (Just FYI - mine don't.) No one is readily avail to provide a ride without losing time off from a job. So the senior drives to the MD apt in busy center city and a corporate parking lot.

    The elderly lady who attends to a hairdresser weekly apt. What are her options?

    How will she get to her weekly church services and the volunteer group she serves.

    Inner city safety for the senior person is an issue. Is it safe for a 85 y/o to wait at a bus stop, alone & out in the open?

    Dang, can the senior even walk to a bus stop? Is there any pick up transport service doing door to door pickup/dropoff that will be cost friendly or cost prohibitive?

    I don't even want to think about those seniors who have responsibilities for family child care. What about those with pet care needs?

    Ours is an aging population and the problem of the elderly driver is only going to continue. The services needed for the continuity of daily living are just NOT conducive to the needs of the elder who is not only elderly with all the health issues, but also with insularity and isolation. Not too many Walton Family- types exist. So the elderly driver must continue driving as long as poss (even when problematic).

    And then there is always the financial picture to consider. Owning a car costs time and money. But all things considered, I'll venture that it is less problematic for the senior to just grab the keys and drive when there is a need rather try to coordinate and/or pay for transportation.

    To those PPs who pointed out real incidents that occurred, was there any determination WHY the seniors were out driving? What could have been done that would have kept that senior off the road??? The rest of the world is just not thinking of the senior who must drive to stay active as a member of society.
  13. by   jeastridge
    Quote from FranEMTnurse
    As an experienced past school bus driver, I was at a stop on a state highway to pick up children. My side stop sign with a strobe light was already flashing.An elderly gentleman driving his car approached my bus from the opposite direction. (mind you he was approaching my bus on the same side the strobe light was flashing) and he drove right past my bus. Had those children been crossing the road then one or several would have been killed.

    I reported the incident to the police and the state trooper asked me to not press charges because he lives in a rural area. I refused, because I consider this extremely dangerous.

    Another incident occurred just two days ago. I am currently living in a senior housing complex, and there is a grocery store located about 3 blocks away. A caregiver I currently have was driving into the store parking lot and a senior driver backed out of her parking spot right in front of the caregiver totaling the caregiver's car. She now is forced to purchase another car. THIS IS THE REASON I AM AGAINST HEAD - IN PARKING. Numerous people of all ages have been killed due to the blind spots behind the older cars, and most drivers cannot afford the newer cars with the rear view backup mirror.

    There are numerous home care agencies around now, even in rural areas. The areas who are not equipped with them yet have visiting nurses who can go to the elderly people's homes. There have been several advancements in this area in the past few years.

    I fully understand why elderly people want to keep their independence. I myself am 74 years old and desperately miss my own and have to rely on others or on public transportation now, and I was completely independent until 10 years ago when I no longer had my own transportation.
    Thank you for sharing your story. You have experience and perspective. Joy
  14. by   Mudpinesredneck
    My dad is proof that you can suffer 2 ischemic strokes in one night,overshoot the 101 Santa Rosa exit and take your car on a mud bogging adventure while having said stroke...

    Drive around for 2 hours not knowing who the heck you are or where you live, and still manage to come home, still quite dazed but there was not one scratch on that car! Just mud up to the top of the bumpers.

    Sometimes it ain't the age or the medical condition

    He was relatively young. The strokes happened on his 50th birthday...

    So I don't buy into the old age thing. Things happen at every age.

    I can't think of, when I was on Paxil, how many times I'd start getting palps, start sweating.

    I'd be on my dirt road with my truck just going home when even I would go "****, what part of my road AM I on?" and lose focus for a good few seconds.
    Albeit, no harm was done. In my 2 years here, I've never passed another car without seeing their dust or lights.
    And that's at 23, having a reaction to a drug my FNP prescribed to me....
    Last edit by dianah on Jan 9

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