When You Are Concerned - A guide for families, friends and caregivers concerned about the safety of an older driver(When You Are Concerned is also available as a PDF)
"I got this call. It was the daughter of an older driver. She said to me, "my mother is 85 and I'm concerned about her driving." I asked her what was the problem with the driving. She said, `My mother is 85 and I am concerned about her driving.' So I asked her again what was it that her mother was doing that gave her such concern. She said she didn't know anything about her actual driving because she hadn't seen her drive! Her only concern was that she was 85!"
AGE OF THE DRIVER
Safety research has shown that age alone is not a good predictor of driving safety or ability. Some interesting examples support this point: Steve Wittman of Oshkosh, WI, competed in airplane races at age 80 and continued air racing until he was 85. He was still piloting a plane at age 90!
Dan Carmichael of Dayton, Ohio raced in the fastest class of SCCA amateur open wheel car racing. At age 75, he beat all the young Indy aspirants and won the championship! It was hardly a fluke. The year before, at age 74, he finished 2nd! Here was a case where the driver got better as he got older! And Paul Newman (yes, that Paul Newman), at age 70, co-drove the night shift(!) of the Rolex 24 hour race in Daytona to a class win. At age 74, he was still considered capable of running at the front in prolevel sports car endurance racing events.
These three examples highlight the wide range of ability and skills found in the third age (50-75) and even fourth ages (75+) of life. They also point to the inequity of using age as the sole predictor of driving ability and safety.
As in the opening vignette, just being 85 doesn't necessarily make a person unsafe or at-risk driving. But there is ample evidence to show that when advancing age combines with other signs, it can signal a crash risk or unsafe driving. One key to knowing when your older driver is at risk, rests in being attentive and in knowing what to look for. In this chapter, you will learn about the signs and indicators which can signal that your aging loved one is at-risk or driving unsafely.
TAKING STOCK OF THE SITUATION
Begin your process of "keeping tabs" by taking stock of the person's driving, physical/mental condition and behavior. Some safety related declines can be so slight that you might not see anything unusual. But if you keep notes on what you find, over time you will be able to identify trends which signal the person may be at-risk driving. Make sure to date your notes. If they are dated they will also be helpful if you have to talk to the driver's health care provider.
Should I go for a ride?
Absolutely! Unlike the caller in the opening vignette, you really need to see if the person is having a problem with driving safely. Riding with the driver is the best way to find out. Ask the driver if you can ride along when he or she runs an errand. You may be asked why you want to come along. If you know the person, you will know how to respond. Sometimes the driver will want you to ride with them or it may just be easier to follow them with your car. Either way is fine. But if you ride with the driver, check the following:
- Did the driver wear their eye glasses or contact lenses?
- Did the driver use the safety belts on their own or did they take their cue from you?
- Was the driver sitting at least 10 inches (25.4cm) from the steering wheel airbag?
- Could the driver see the road adequately? Some older drivers need to sit higher to see properly out of the vehicle.
- Was the driver able to twist around to see what was happening when backing up or were they able to rely on their mirrors? Were the mirrors adjusted to decrease blind spots?
- Could the driver reach and satisfactorily operate the brake pedal, gas pedal, steering wheel and directional signals? Did they select the right transmission gear?
Keeping a driver safe begins with seeing clearly and putting on a safety belt. Being 10 inches (25.4cm) or more from the airbag will prevent injury or death if the airbag activates. Proper seating position and mirror settings are needed for safe maneuvering. Reaching and satisfactorily operating the vehicle's controls are prerequisites for safe operation.
What should I say?
If you ride with the driver, DON'T say anything about their driving while you are in the car. This is where silence is golden. You also don't want to make the person nervous. So, just observe. If you are good about keeping silent, the odds are the driver may say to you later, "Well, how did I do?" If the driver did well, it is good news for both of you. But if the person had some problems and knows they did not drive well, they may not want to hear about it from you just at that moment. On the other hand, this may be your opportunity to begin a dialogue about ceasing driving or getting help to improve skills and judgment. Use your knowledge of the person and their receptivity to this very sensitive issue to guide you as to whether this is the time to say anything critical of their driving. You will find more information about broaching the subject of cessation from driving in Chapter 4.
When I ride with or follow the driver, what should I look for?
Stopping at all stop signs and actually looking both ways to check cross traffic
- Stopping at red lights
- Yielding right of way
- Paying attention to other vehicles, bicyclists, pedestrians and road hazards
- Not stopping or slowing inappropriately, such as at green lights
- Not driving so slowly as to be an impediment to the safe flow of traffic
- Not driving too fast for conditions
- Staying in lane when turning and driving straight
- Safe merging and lane changing
- Cancelling directional signals
- Not getting lost (see comments about getting lost on page 10)
Which of these should be of immediate concern?
Not obeying stop signs (also not checking for cross traffic after stopping), traffic lights and not yielding pose the most immediate risk of injury to the driver and others sharing the highway. If your driver is going through stop signs, red lights, not checking cross traffic and not yielding, you should, of course, know the situation is very serious. The driver is in immediate danger of crashing or causing other vehicles to crash. Stopping for stop signs and red lights is automatic behavior for all drivers and especially those who have been driving most of their lives. When this behavior is absent or intermit-tent, your driver is at extreme risk and must not continue driving.
Yielding the right of way requires a driver to interact with changing traffic patterns rather than giving an automatic response. Repeated failure to yield right of way is dangerous and unsafe driving. Your driver is at extreme risk and must not continue driving.
What other driving behaviors should I be concerned about?
- Not obeying other traffic signs ("no left turn, no turn on red, etc.")
- Driving too slowly - usually well below the speed limit
- Getting lost routinely - taking 2 hours to get to the hairdresser or home
- Driving aggressively (such as not yielding)
- Not paying attention to other vehicles, bicyclists, pedestrians and/or road hazards
- Failure to stay in lane when turning or driving straight
What may indicate the person is having a problem driving?
- Repeated comments from the driver's spouse, companion, friends or passengers about close calls, near misses, not seeing other vehicles or unsafe driving
- Damage to vehicle, new paint
- Traffic tickets
- Increases in the driver's car insurance premium may indicate that the driver had a crash you didn't know about or that the driver was ticketed
- Problems with daily living and personal care activities, such as grooming, dressing
- Changes in behavior, personality
What situations might suddenly trigger a problem with driving?
- Loss of a spouse or friend
- A recent hospitalization
- A change in medication
- A recent illness
What warning signs indicate the driver may be at risk? (look for several signs)
- Forgetfulness (look for significant lapses combined with other signs)
- Fatigue, sleeping more, being crabby
- Not being quick verbally
- Skin breakdowns
- Squinting, not following visual patterns
- Not hearing or following verbal instructions, loud radio, television
- Withdrawal from social situations
- Giving inappropriate response
- Tripping and falling, especially when changing positions or walking on uneven ground
- Trouble with fine or gross motor tasks, especially stiff joints
- Dizziness when changing positions
- Accidents in the home, burns, cuts
- Shortness of breath
- Not eating
- Stopping readin g (newspapers, books)
- Not grooming
What are the danger signals to watch for in an aging driver? (two or more signs may translate into a safety problem driving)
- Memory loss (not occasional and combined with other signs)
- Problems with judgment
- Disinhibition (no longer feeling inhibited - improper behavior in social situations)
- Dysmobility (loss of coordination)
- Functional losses, such as trouble walking, incontinence, swallowing.
Everyone gets lost at one time or another. But when your loved one is losing his or her way in settings which have always been familiar, it is a sign something is going on with the driver. Even if your loved one is still driving safely, you absolutely need to find out what is happening and whether there will be coming implications for driving safely. Only a medical AND in-car driving assessment can provide you with the information you need to determine whether your driver can remain behind the wheel or has to cease driving.
PERCEIVED RISK VS. ACTUAL RISK
A word of caution. It is not uncommon for families, caregivers and even health care professionals to be incorrect in their judgment of a driver's risk or driving ability. Formal scientific studies have shown significant judgment error rates. This means that older persons who were perceived as being at-risk by family AND health care professionals were actually operating safely when in-car driving assessments were conducted!
How can you be certain that the safety risk you perceive translates into actual risk to the driver? One way is with an in-car assessment by a driver rehabilitation specialist or professional driving instructor. See end of this chapter and Chapter 3 for more information about in-car driving evaluations.
What can I do on a regular basis to keep tabs on my aging mother, father or relative who is still driving?
- ide with (or follow) your driver on a regular basis
- Talk to your driver's spouse, companion, friends, passengers and neighbors about how they are driving
- Pay particular attention to your driver's health, disposition and behavior
- Inspect your driver's vehicle for signs of damage or new paint which might be covering up recent crash damage
- See if the mailbox is still standing at the end of the driveway
KEEPING TABS WITH A FEEDBACK NETWORK
It is difficult to know how well your loved one is driving when you don't live nearby. One way to keep tabs is by developing your own feedback network. It works like this: You identify people who can keep an eye out for your driver and will call you when they see a problem.
If your feedback network has some of the following folks helping, it is likely you will be alerted by one of them when the driver is having a problem:
- The driver's spouse or companion. This person is in the best position to alert you to any safety problems. But like the driver, they will be directly impacted if they say anything. Still, self preservation is a powerful force. You may not have to read too far between the lines to under-stand what the driver's spouse or companion is really trying to convey!
- Passengers and friends. Passengers, like the driver's spouse, often know how the driver is doing. But, like the driver's spouse or companion, they too may be reluctant to say anything negative because they rely on the driver to get around. You will need to pay attention when they speak. In time, their concern for the driver (and their own safety) will provide helpful necessary feedback.
- Neighbors. If the truth be known, good neighbors never miss a thing. Get to know your loved one's neighbors. This is one place where you can put their curiosity to good use.
- Family members are often a good source of feedback when they visit your loved one. Let them know you are interested in keeping tabs on driving. Your interest in shouldering the burden will often stimulate their assistance. Encourage them to call you following any visit to your loved one.
- Driver's pharmacist is a key player. Your driver's pharmacist may be able to alert you when your loved one's latest prescription requires restraint from driving or has side effects which would place the driver in jeopardy. The pharmacist may require the driver to sign a release for you to get the information.
- Driver's physician. Your driver's physician is another key player in any feedback program. Make sure you are listed as the key contact in the doctor's medical folder. If possible, meet with the physician and find out what you need to do to keep tabs on your driver's condition.
- Driver's eye care provider. Another key player. Find out from the eye care provider how you can keep apprised of changes which may impact the driver's quality of vision. Often he can tell you if the glasses he prescribed are even being used! Important if your loved one is supposed to wear corrective lenses when driving!
- Clergy. Your driver's spiritual leader (minister, priest, rabbi, imam) has a role in your feedback network, especially if the driver is actively involved in religious services or the organization's volunteer activities.
- Insurance agent. Your loved one's insurance agent may have known your driver for years and even be a family friend. Since many older drivers like to come in and pay their premiums in person, the agent may see your driver on a regular basis. Contact the agent and ask him to alert you to any changes noticed in the driver. Also ask the agent to alert you if your driver misses a premium payment.
- Banker. Depending on the size of the community, the manager of the local bank may know your loved one. Due to an increase in scams, bank managers and tellers are becoming more watchful of their aging customers. They will call for help if they perceive a problem. Go to the bank with your loved one, introduce yourself to the manager and leave contact information with them.
- Grocery store manager. It is not uncommon for a store manager to get a report from customers about an aging motorist having difficulty in the store parking lot. If the store manager knows you and your driver, he or she may be willing to alert you to problems occurring in the store or parking lot.
- Senior meal program site manager, senior housing residence manager and senior center director. These aging services professionals may be observing your loved one's driving on a regular basis. Touch base with them. Most will be happy to help. Make sure their emergency contact information is up to date.
Spouses, friends, neighbors, service providers, and even the mechanic at the local garage who sees your loved one pumping gas each week, have potential feedback roles to play in helping you keep your driver safe. Find out who will help. Put them on your contact list.
MAKING YOUR FEEDBACK NETWORK WORK
The key to making your feedback network work rests with calling your contacts on a regular basis. The calls should be short and sweet:
- "Hi, this is Judy Jones. I'm just checking on Dad. When did you see him last? How's he been doing? How's he driving? I really appreciate that you are keeping an eye out for him. If it is OK, I'll check in with you again next month. Thanks."
If you are good about staying in contact, most likely your contacts will do the same when they see something of concern. Don't forget, if it involves a long distance call, tell them to reverse the charges when they call. After all, you don't want anything to stand in their way.
DRIVING RECORD ABSTRACT
Concerned about violations or crashes which may have happened in your absence? Your state DMV office may be able to provide you with your loved one's driving record abstract. Yes, it is true. In many states a person's driving record is public information and available to anyone for a small fee. Welcome to the information age!
An in-car driving evaluation is one of the most effective and helpful ways to keep tabs on the fitness and ability of an aging driver. It is also an excellent way for the driver to get independent feedback on how well they are doing. You can arrange for a driving evaluation by contacting a driving school, hospital or clinic which has a driver rehabilitation specialist.
AN EVALUATION BY A DRIVER REHABILITATION SPECIALIST
The evaluation conducted by a driver rehabilitation specialist consists of both a clinical and road evaluation. The clinical portion involves vision, reaction and cognitive screening and is followed by an up to one hour on-the-road evaluation. A written report will be provided. There are usually no loss of license penalties if the person performs poorly. See Chapter 3 for more information about the driver rehabilitation specialist and where to find one.
AN ASSESSMENT BY A PROFESSIONAL DRIVING INSTRUCTOR
Driving schools are another helpful source for in-car assessments. Schools with state certified professional instructors experienced with older or disabled persons, are best able to assess how well your driver is doing. As with an evaluation from a driver rehabilitation specialist, the driving school can also provide a written report detailing the performance of the driver. There are no loss of license penalties if the driver does not perform well. Driving schools are listed in the Yellow Pages. Look for a school which specializes in older driver evaluations.
HOW TO ENCOURAGE YOUR DRIVER TO GET AN ASSESSMENT
- "Dad, I know you don't believe me. But what if we got an independent opinion from a driving school or driver rehabilitation specialist? Would you agree to stop driving if they felt you were not driving safely?"
- "Mom, I will not say anything more, if they say you are driving safely." "Let's be sure. You don't want to injure anyone, right?"
- "Dad, I know you don't want to see anything happen to you and I don't want to see anything happen to you or anyone else either. Let's see what a professional driving instructor thinks about how you are doing. It's a reasonable way for the both of us to be assured you are safe when driving."
ALZHEIMER'S AND OTHER DEMENTIAS
- "My husband had Alzheimer's. He flunked the DMV driving test and his license was revoked. He paid no attention to the revocation, he didn't understand it. Then he tried to break into my car, other cars. He didn't understand what the problem was and didn't do anything about it because he couldn't."
A diagnosis of Alzheimer's usually means that your loved one is going to have to cease driving. Perhaps immediately. While there is evidence that some in the early stages of the disease are able to drive safely even though they get lost, there is also countering evidence showing those in early stages of the disease are involved in crashes. It may be that both observations are correct. If so, that poses an even greater dilemma. How will you know which applies to your driver?
One solution is for the person to have both a clinical and driving evaluation to ascertain to what extent they can continue driving. Another is to begin a transition from driving when there is a diagnosis of early Alzheimer's. An advantage is that the person is still able to understand the growing implications of their condition and what the risk is to themselves and other road users. On the other hand, the person may not feel they are driving unsafely and be fully opposed to any transition from the wheel.
If you know the person, you have some idea about how to handle the situation. Your Alzheimer's Association, Alzheimer's Disease Assistance Center, or local Alzheimer's group can be an especially valuable resource for assistance. They can chart out the likely progression of the disease, help with your loved one's transition from the wheel, advise about interventions, and provide emotional support to you and your driver. See Chapter 3 for information about finding help.