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Aging drivers need to plan ahead for relinquishing the keys, experts say

Many older Americans stay mentally and physically active long after they retire from their jobs. But when is it time to retire from driving? A panel of experts offered some answers to this question at the 24th annual Stratton Lecture on Aging Successfully. The March 30 panel discussion was moderated by Dr. William M. Kettyle, gerontologist and director of MIT Medical.

Although age alone does not predict driving ability, everyone’s physical and cognitive skills decline as they age, panelists said. As we get older, reflexes are slower and pupils don’t dilate as widely as they once did, making it harder to see at night, said panelist Dr. Anne Fabiny, chief of geriatrics at Cambridge Health Alliance. Cognitive processing speed also goes down. In driving terms, this means “when you’re confronted with an abnormal situation like someone cutting you off, it’s going to take you a little bit longer to decide what to do about it, like brake or swerve,” she said.

Many older drivers compensate for their diminished abilities by not driving at night, or driving only locally. However, statistics show that the majority of accidents happen within five miles of the driver’s residence, “so just staying close to home doesn’t mean you’re going to avoid an accident,” Fabiny said.

Objective testing

Two of the panelists were from the DriveWise program at Beth Israel Deaconess Medical Center, which evaluates people of any age for the ability to drive safely by looking at:
  • Vision — acuity, depth perception, visual field and contrast sensitivity, which is necessary for driving in rain and low light
  • Cognition and mental status — attention, memory and processing speed
  • Physical functions — strength, range of motion, coordination, reaction time
  • Real-time driving skills — a road test with a driving instructor
“The road test is really the gold standard,” said panelist Ann Hollis, an occupational therapist and DriveWise clinician. “We can do all the office tests we want, but the most important thing is how a person actually drives.”

If someone fails the DriveWise test, the clinicians will recommend that the patient no longer drive and will offer emotional and practical support such as help in finding transportation alternatives. However, if the patient refuses to give up driving, the program may notify the Massachusetts Registry of Motor Vehicles (RMV), which may ask the patient to voluntarily surrender his or her driver’s license.

A difficult conversation

The prospect of taking away a relative’s keys “brings family members to their knees like no other issue does,” said social worker and DriveWise clinician Lissa Kapust. “Nobody wants to be the bad guy.” She reported that one DriveWise client, when told she needed to stop driving, said, “Not being able to drive is like being stuck in prison.”

When broaching the subject of driving with older patients, “the important thing is to ease into it,” Kettyle said. “If they say they don’t drive at night or they don’t go on the highway, you can say, ‘Tell me how you made that decision’ as a way to start a discussion about driving.”

Panelists pointed to several resources to help both older drivers and family members tackle the issue, including “We Need to Talk… Family Conversations with Older Drivers,” published jointly by the MIT AgeLab and The Hartford insurance company, a founding sponsor of the lab. See “More information” below.

The automobile is king

The biggest obstacle to older people retiring from driving is our car-dependent society. Seventy percent of Americans live in suburban and rural areas with inadequate public transportation, said panelist Joseph F. Coughlin, director of the MIT AgeLab and the U.S. Department of Transportation’s New England University Transportation Center. Driving is “the glue that holds together the big and little things you call life,” he said, adding that 75 percent of all car trips are for purposes other than getting to and from work.

“Logic isn’t the issue,” Kettyle said. “The fundamental issue is independence and freedom, and giving up driving is a sign of aging and not being what you once were.”
Kettyle’s advice: “Think about the idea of retiring from driving ahead of time — plan for it, begin to develop alternatives, and begin to organize your life so you’re not so dependent on your automobile.”

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