Alice, 85, has just gotten off the phone with her daughter Janet. Alice has had her third minor automobile accident this month. Her daughter, Janet, is understandably concerned. She arranged for Alice to have her eyes checked and to speak with her primary care doctor about her driving abilities.
Alice’s eye exam reveals that she has a significant loss of peripheral vision. Her ophthalmologist explains that her loss of peripheral vision will make it difficult for her to see moving vehicles outside her direct line of sight. In all three of her recent auto accidents, Alice was in a shopping mall. In two cases, she backed out of a parking spot into a moving vehicle, and in the third instance; she collided with a car passing through a four-way stop.
Alice does not drive much, but she values the ability to go to the local mall during the week, to church on Sundays, and to meet her friends for an occasional lunch at Bob Evans.
When Alice and Janet meet with her primary care doctor, after reviewing her vision exam and testing her reflexes, he expresses concern about her continuing to drive. Alice leaves the appointment upset. Janet lives an hour away from Alice, and public transportation is not an option in their suburban community. Nevertheless, Janet promises her mother that she will investigate transportation options, so Alice can continue taking part in these social activities she enjoys.
How to Tell When It is Time to Stop Driving?
There are several physical and mental changes associated with aging that can impair driving ability, including:
- Loss of peripheral vision
- Decreased ability to see in the dark
- Decreased muscle tone and strength
- Slower reflexes
- Medication side-effects
Older adults are more likely to be involved in angle crashes, overtaking and merging crashes, and intersection crashes due to their decreased peripheral vision.
Failure to yield the right of way is the most common error seniors make when driving, leading to a crash. Other common errors are crashes when turning or disregarding a traffic signal.
A recent study showed that factors that affected the rate at which older adults were involved in auto crashes included:
- Time of day
- Lighting
- Weather conditions
- Speed limit
- Estimated driving speed
- Day of the week
- Roadway type
- Number of lanes
- Presence of visible traffic controls
The Risk to Older Drivers
According to the Insurance Institute for Highway Safety (IIHS), drivers over the age of 70 have higher fatal crash rates per mile traveled than their middle-aged counterparts. However, older drivers are involved in fewer fatal collisions than they had been, 12% fewer when comparing the rates in 2019 to 1997. This may be because older drivers may limit their driving and avoid nighttime driving.
In most fatal auto accidents, the victim is the driver or their passenger. In 2019, 73% of people killed in crashes involving drivers 70 and older were either the driver (59%) or their passenger (14%).
Vehicle Modifications to Improve Safety
Vehicle modifications may help decrease the risk for older adults who choose to continue driving. These modifications are more standard on vehicles and may include frontal airbags, improved seatbelts, front crash prevention systems, blind-spot detection, and lane departure warning systems. In addition, according to IIHS, rearview cameras and rear parking sensors are especially effective at decreasing the risk of auto accidents for drivers aged 70 and older.
Renewing Driver’s Licenses
Most U.S. states have modified license renewal requirements for older drivers. These modifications may include shorter renewal cycles and require vision or road testing or in-person renewal rather than mail or electronic renewal.
For example, in Arizona, the license renewal cycle for the general population is every 12 years, but it is every five years for people 65 years and older. Vision testing is required for everyone for each renewal, and mail or online renewal options are not available.
In one study, for drivers over age 85, requiring in-person renewal and passing a vision test were associated with significant reductions in population-based fatal crashes for drivers aged 85 and older. However, taking a knowledge test or an on-road driving test was not found to reduce the rate of fatal crashes in older drivers.
When Older Adults Refuse to Stop Driving
Unless a person has dementia, the first step is to discuss your concerns with an older adult, especially regarding their safety and the safety of others. Then, as Janet did, make an appointment for them to have their vision checked and to undergo a physical exam. If these medical exams show health concerns that impact driving abilities, this may start a conversation about alternatives to driving from a problem-solving perspective.
Another option is to make an appointment with a family attorney to discuss the risk and potential lawsuits that could occur if an older adult continues to drive beyond a point where they are physically or mentally able to do so safely.
If these discussions are not fruitful, consider scheduling a clinical driving assessment. AAA offers several clinical driving assessment options on their website, as well as driving courses that can lead to insurance discounts.
If none of these options work and an older adult persists in driving past the point where it is safe for them to do so, consider reporting them to the Department of Motor Vehicles. Many will allow you to make a report anonymously.
If you report a driver to the DMV, they will probably be called in to take a driver retest, regardless of when their license expires. A letter from a physician outlining the medical reasons for your concerns can help substantiate your case.
When all else fails, and you feel the driver is a risk to themselves or others, other options include:
- Having a relative borrow the car
- Hide or lose the car keys
- Take the car for repairs and don’t return it
- Disable the car
- Sell the car
As drastic as these measures sound, when the alternative is to put your loved ones or other people’s lives at risk, they are necessary steps to take once you have tried the other options.
How can home healthcare help you manage when an older adult is losing their independence?
Having a car and driving it are associated with freedom and independence. It is hard for someone who has experienced that independence their entire life to give it up.
Janet and Alice discussed her recent accidents and the results of her vision and medical exam. Together, after much discussion, they came to an agreement. Janet contacted Sunland Home and Medical to arrange for a caregiver to come to Alice’s home three times a week to take Alice shopping and to her social engagements.
Janet has visited Alice about once per week. She will arrange these visits for Sundays so she can accompany Alice to her church service, and the two can go to lunch afterward. Alice was satisfied with these arrangements but insisted that her car remains at her home in case of an emergency. She promised Janet she would call before ever using the car, but she needed the security of knowing it was there.
Sunland Home Care & Medical can provide transportation to:
- Medical appointments
- Personal appointments
- Visiting family and friends
- Shopping
- Entertainment
