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Elderly Care

© Daria Filimonova | Dreamstime.com

Getting your parent to hang up the car keys permanently is as tricky as grabbing an angry tiger by the tail then wondering how you can safely let go and remain unscathed. After all, driving is one of the last forms of independence, autonomy, and identity an older person has left.

Driving is a way of life in today’s society. Getting your first driver’s license was exhilarating, a ticket to freedom and a sign of maturity. Independence and autonomy go hand-in-hand with a driver’s license and, without that license to drive, your identity and independence are threatened. Having to hang up the car keys for good can be incredibly devastating and traumatic.

“The most dangerous people on the roads are males under 20 and all people over 75.”

~Virginia Morris, How to Care for Aging Parents

Instead of being able to go out on the spur of the moment, your elderly parent now has to plan, in advance, the logistics of how to get to where he or she is going, how to get back home, check public transportation schedules and making sure they have the correct fare on hand, schedule a ride with transportation companies providing rides to elderly people, figure out how to juggle coat, purse, and cane while navigating the often iffy sidewalks in many cities, and worry about strangers invading their personal space. If there is grocery shopping involved, the logistics are even trickier.

Contemplating having to stop driving is very scary for anyone, especially an elderly person. Elderly people often vehemently deny their diminished driving capabilities, stoutly maintaining that they can drive just fine, thank you very much. However, it’s a fact of life that driving skills decline as a person gets into their 70’s and higher. Virginia Morris, in her book titled How to Care for Aging Parents (p. 140), identifies five driving skills that decline as people get older:

  • Sensory Input—Information the brain receives from eyes, muscles and joints, and vestibular organs found in the ear that monitor motion, equilibrium, and spatial orientation (the body’s orientation and posture in relation to the physical space around it). Indications that an older person’s sensitivity to their environment and ability to respond to sensory input is declining include a narrowed field of vision, eyes more sensitive to glare during the daytime or at night, the need for more light to be able to see clearly, and an inability to follow moving objects easily.
  • Information Processing—Information gathered from the environment around us and processed by the brain. The information gathered impacts mental activities such as memory, perception, and attention, as well as physical activities such as reflexes, coordination, and flexibility.

Psychologists compare the brain’s information processing activities with the way a computer processes information. For example, the ear receives input in the form of sounds, such as horns honking or tires squealing, codes those sounds into electrical signals that travel to the brain where they are stored in the brain to be used by other parts of the brain that relate to other mental activity. The brain then grabs that stored and coded information and sends it out to the eyes and muscles causing the head to turn, the eyes to look around, the foot to get ready to apply the brake or push on the gas pedal, and the hands to tighten on the steering wheel.

As people age, the ability to process information at high speed slows down, along with reflexes and coordination—everything necessary to react quickly to potential hazards or emergency situations.

  • Reflexes—Automatic, involuntary and nearly instantaneous movements the body makes in response to something happening around it. The faster the brain can process sensory input the quicker your reflexes are. As the brain ages, it slows down in its ability to process sensory input which slows down the reflexes and reaction time.
  • Coordination—The ability of the body to use its different parts smoothly and efficiently. An example of coordination is pulling into a parking spot, applying the brakes, putting the car in park, turning off the ignition and removing the keys from the ignition. As a person ages, coordination suffers as does sensory processing. The brain processes sensory input at a slower rate causing the coordination to slow down and the brain to panic.
  • Flexibility—Range of motion in a joint or series of joints and the length of the muscles over the joints that allow a bending or twisting movement or motion. An inactive person’s joints and muscles stiffen up and become less flexible, especially as they age. Flexibility increases a person’s ability to drive safely by allowing them a greater range of motion for turning their head or body in order to see what is beside or behind them.

If an elderly person doesn’t recognize or acknowledge any of the signs indicating diminished driving skills, what risk factors should family members be aware of that contribute to deterioration of an elderly person’s driving skills?

Often we ignore the red flags, and risk factors causing the red flags, because we don’t want to acknowledge our parents are getting on in years (we are in denial) or because we don’t know how to go about bringing up the touchy topic of safe driving or even that it might be time to hang up the car keys for good. Let’s take a few minutes and identify some of the more common risk factors that contribute to diminished driving skills, some of the red flags, and what can be done to reduce the impact of the risk factors:

  • Vision—Cataracts, macular degeneration, glaucoma, diabetic retinopathy all hamper driving ability. Kathy N. Johnson, in an article titled Taking the Car Keys Away from Elderly Parents, talks about the dangers of changing vision for elderly drivers. Decreased depth perception for the driver often has the passengers stomping on the floor trying to apply brakes as the elderly parent comes perilously close to the person in front when stopping. Narrowed peripheral vision or poor night vision gives cause for concern as the elderly driver cuts other drivers off with abrupt lane changes or weaves side to side at night trying to avoid bright oncoming lights.

Marlo Sollitto, in an article titled Is It Time to Take Away the Car Keys? states that an optometrist or ophthalmologist will be able to spot vision problems or identify any visual limitations with an elderly parent’s sight. If your elderly parent struggles with night driving, then his or her eye doctor can accommodate their continuing to drive by limiting their driving to daytime only. Some eye conditions, such as cataracts or glaucoma, can be corrected with simple surgical procedures, prolonging the amount of time your parent can safely drive.

  • Hearing—Hearing acuity diminishes over time, just like eyesight, often without the person clueing in. According to the American Speech-Language-Hearing Association, an estimated 28 million individuals in the United States experience some sort of hearing loss or deafness. If your elderly parent doesn’t hear car horns, sirens or noises their car is making, it is time to get the hearing checked to see if anything can be done to improve their hearing. Not being able to hear these kinds of warnings can cause your parents to get into an accident or be the cause of one.
  • Physical ability—Joints stiffen, muscles weaken and turning the steering wheel quickly or braking safely become more difficult.
  • Physical activity—Reduced daily physical activity leads to a higher incidence of mature adult drivers dying in auto accidents than any other age bracket.
  • Disease/Illness—Not every disease or illness contributes to diminished driving skills but there are some that can raise warning flags. These include Alzheimer’s disease, dementia, diabetes, Parkinson’s disease, stroke, arthritis, sleep apnea, and heart disease.

If you notice your elderly parent gets lost frequently, especially on familiar roads; has trouble reading street signs; struggles with navigating directions; is frequently startled or claims that cars or pedestrians appear out of nowhere; drowsiness or dozing off while driving or during the daytime; confusion; delayed reactions; pay attention to these red flags and talk to your parent’s doctors. Whatever you do, don’t drop into denial and ignore these potentially serious red flags or warning signs. Denial can get your parent, or someone else, killed.

  • Medications—The older we get the more medications we tend to take. Medications have side effects in and of themselves but, when they are mixed with alcohol in any amount or are taken in combination with other medications, they often result in unpredictable and dangerous side effects and drug interactions. Monitoring your elderly parent’s medications and alcohol consumption can help mitigate medication caused red flags.
  • Erratic driving/Accidents/Traffic tickets—Erratic driving habits can lead to accidents and an increase in traffic tickets by elderly drivers. The Home Care Assistance newsletter and Temma Ehrenfeld, in an article titled Taking Away an Older Driver’s Keys, discuss when you should consider taking steps to reduce or stop the driving privileges of your elderly parent if you notice such things as abrupt lane changes; sudden braking or acceleration for no apparent reason; hitting curbs; missing turns; scaring pedestrians; near crashes; and dents and scrapes on the car or on fences, mailboxes, garage doors, curbs and other objects; an increase in at-fault accidents; an increasing number of traffic tickets or warnings by police officers; failure to use turn signals or keeping them on without changing lanes; drifting into other lanes; driving on the wrong side of the road.

We’ve looked at five driving skills that diminish over time and talked about risk factors that can contribute to diminishing driving skills, so what can you do to keep your elderly parent driving safely? Should they be allowed to continue driving? Let’s look at some ways you can help improve your elderly parents’ safety behind the wheel.

  • See the eye doctor—The American Academy of Ophthalmology recommends people between the ages of 40 and 64 get their vision checked every two to four years and every one to two years for those over the age of 65, according to Marlo Sollitto in her article titled Should You Be Worried About Your Parent Driving A Car? If your elderly parent wears prescription lenses, make sure the prescription is up-to-date and that your parent wears them every time they drive.
  • Visit a hearing specialist—The American Speech-Language-Hearing Association recommends adults get their hearing tested once every decade until the age of 50 then every three years after age 50. This type of testing should be done by a hearing specialist, or audiologist, trained to screen for, and detect, ear disorders and hearing disabilities.

Ear disorders are screened for by looking at a person’s history of noise exposure, medical conditions, and symptoms of hearing loss. A complete audiologic screening process takes approximately ten minutes and identifies whether an individual has normal hearing or should be referred for a comprehensive audiologic evaluation.

  • Ride along—Take time to go for a ride with your elderly parent. Be the passenger for a while and observe how well they perform behind the wheel. Does he or she appear stiff when turning to look behind them? Do they squint while driving? Do they ask you to read the signs ahead of them? Are they able to keep up with traffic around them or do they drive more slowly than the other drivers? How is their reaction time for stopping, avoiding other cars, etc.?
  • Check the vehicle—Make sure your parents’ car is in excellent working order. Virginia Morris, in her book titled How to Care for Aging Parents (p. 142-143), offers up some excellent suggestion for things to pay special attention to when checking out your elderly parent’s vehicle, including brakes, defroster, defogger, battery, wipers, dashboard lights, exterior lights and turn signals.

Clean the headlights and replace wiper blades periodically. Schedule regular visits to the mechanic to keep the vehicle in good working order, install large or extra mirrors or other adaptive devices to make it easier for your parent to drive, and whenever possible, make sure the new car is an automatic with power everything. Check out a program called CarFit, found both in the United States and Canada, dedicated to improving your elderly parent’s car to fit their specific needs.

  • Exercise— Encourage less TV time and more physical activity to maintain or build their strength, agility and aerobic ability. An easy form of physical activity is to engage in a daily walk, even if it is only around the block. Simple stretches, including neck stretches, and lifting light weights such as small cans of food are also easy for an elderly parent to do at home.
  • Safety in the car—In addition to checking your elderly parent’s vehicle to make sure it’s in excellent working order, Virginia Morris, in her book titled How to Care for Aging Parents, also talks about your parent practicing safety while in the car. Your elderly parent can increase his or her own safety by wearing a seatbelt at all times while in the car; planning trips ahead of time so he or she know exactly where they are going without having to refer to a map or GPS; planning a route that avoids complex intersections; minimizing distractions while driving such as playing the radio, chatty passengers, or cell phones going off.

In an effort to keep your elderly parent independent and driving safely for as long as possible, the following list, put together by Virginia Morris in her book titled How to Care for Aging Parents, contains evaluations and refresher courses designed to test and refresh the driving skills of elderly drivers:

  • AAA Foundation for Traffic Safety LINK
  • Driving evaluator such as an occupational therapist trained to evaluate driving skills
  • American Occupational Therapy Association LINK (referrals on the website)
  • Association for Driver Rehabilitation Specialists LINK

Additional resources for refresher courses include senior centers, driving school, and the Department of Motor Vehicles.

Getting old isn’t for the faint of heart. Having to step in and become a more integral part of your elderly parent’s daily lives isn’t what most of us plan on doing or even want to do. However, an increasing level of day-to-day contact and helping to manage their lives is part of the process of aging. Knowing how to help your aging parents navigate this challenging time in their lives will help ease some of the inevitable clashes and struggles as familiar roles change and evolve.