At some point it becomes painfully obvious. Maybe it’s the near misses, another fender bender, traffic tickets, getting lost on errands, poor night vision, or increasing confusion. Whatever the mix of warning signs, the message is clear and deeply concerning. An aging parent is no longer safe to drive, and something has to be done about it.
Statistics confirm the urgency to act. Motor vehicle injuries are the leading cause of injury-related deaths among 65 to 74 year olds and are the second leading cause (after falls) among 75 to 84 year olds. It’s not a question of if, but how.
There’s the rub. For aging parents, the car is more than transportation. It is an icon of independence and self-esteem that’s about to be taken away for good. To make matters worse, the car is emotionally comingled with the developmental need to preserve control. Not surprising, attempts by adult children to direct, persuade, or pressure aging parents to stop driving provokes intense passive or overt resistance. In this environment, messy conversations quickly turn hostile and recriminating. Now what?
When engaging this type of dilemma facing aging parents, preparation is everything. You can’t control outcome but you can control how the conversation is framed and the participants. This won’t necessarily reduce the volatility of the issue, but it will provide a focus and rationale to help you withstand heated discussions.
Here are eight framing and participant suggestions for “no longer safe to drive” situations:
1. Map out the big picture of your concerns about the aging parent using the No Longer Safe To Drive Mind Map. It offers families a one-page diagram of the risk factors affecting driving.
2. Meet with the aging parent’s primary care physician and present your concerns. Give him or her a copy of the No Longer Safe To Drive Mind Map to put in the medical file.
3. Based on the mind map information, request that the physician complete an assessment of the aging parent’s fitness for driving including an assessment of the key functional abilities related to driving.
4. If the assessment confirms the aging parent is no longer safe to drive, have the physician lead the initial conversation about stopping driving.
5. If the assessment confirms the aging parent is still able to drive with restrictions or rehabilitation, have the physician lead the initial conversation about the constraints and retraining obligations.
6. If the recommendation is for the aging parent to stop driving, be ready with a big picture diagram of alternative transportation that you have confirmed is available your area.
7. The goal is to support the physician’s stop driving recommendation. One way to reinforce the messaging is to ask the physician to give the aging parent a “Do Not Drive, For your Safety and the Safety of Others” prescription. This reminder is especially effective when combined with a physician follow up letter to the aging parent outlining the recommendation and the reasons for it:
8. Verify with the physician that state reporting requirements have been filed.
This approach is designed to enhance the family’s effectiveness in “no longer safe to drive” situations in two ways:
1. The No Longer Safe To Drive mind map provides a compelling profile of an at-risk driver that can help mobilize physician involvement. Physicians are influential in a patient’s decision to stop driving, and their role is critical to the success of an intervention. Physicians also have access to a specialized guide created by the American Medical Association and National Highway Traffic Safety Administration entitled Physician’s Guide to Assessing and Counseling Older Drivers that contains screening protocols, assessment tools, checklists, patient handouts and state-by-state reporting requirements (click here for a PDF version of the guide).
2. This approach positions the physician to lead the inquiry, assess the findings and present the recommendations. The family simply supports the facts and recommendations.
None of this guarantees a happy ending. Intervening in the unsafe driving of an aging parent is a no win intergenerational moment where choices regarding the safety of all parties have to be made. But as with all dilemmas of aging, doing nothing is the least desirable option.
[i] Carr DB; Schwartzberg JG; Manning L; Sempek J, Physician’s Guide to Assessing and Counseling Older Drivers (American Medical Association, 2010).