Should Doctors Decide When a Patient Is Too Old to Drive?

Gregory A. Hood, MD

Disclosures

January 23, 2019

In This Article

Editor's note: This article was updated from an article that was originally posted on August 29, 2017.

Prince Philip, the 97-year-old Duke of Edinburgh, was involved in a car accident on January 17. The SUV he was driving crashed and overturned.

While there may not be many among his family or entourage who would tell him that he should no longer be in the driver's seat, the incident recalls an issue that many physicians face: Should doctors decide when a patient is too old to drive?

When Seniors' Ability to Drive Becomes Questionable

Changes in vision. Forgetting directions, routes, and locations. Physical problems that are associated with arthritis and Parkinson's. These are just a few of the changes that can affect many seniors' ability to drive. Combine these factors with the growing number of Americans who are living longer and it's no wonder that the issue of whether they should be behind the wheel is fast becoming a problem for many seniors' families and loved ones. Is this an issue that physicians are willing and able to address?

The topic of driving, particularly for the elderly, has entered the most unusual phase of history since laws were passed in Vermont in 1894 requiring that all motor carriages have a man walk in front waving a red light for the safety of others.

The owner or person in charge of a carriage, vehicle ... shall not cause or permit the same to pass over, through or upon any public street or highway...unless he sends, at least one-eighth of a mile in advance of the same, a person of mature age to notify and warn all persons traveling upon or using the street or highway with horses or other domestic animals; and at night such person shall, except in an incorporated village or city, carry a red light.[1]

The safety of others is still very important. Given the aging of the American population and the advances of society, there are challenges and opportunities that are unique in the history of human transportation.

Many Factors Impair Driving Ability

Many seniors are able to drive without cause for concern, but a number of factors contribute to a safe driving environment.

When a car is not in proper working order, the driver or a family member contacts a mechanic who then checks the fluids, pressures, and engine. If the car is deemed unsafe, then the mechanic is expected to state that it is unsafe.

But when it comes to maintaining the driver, the old joke about the mechanic and the surgeon comes to mind: "Try working on it while it's still running." The human machine is vastly more complicated than an automobile and is responsible in toto for a safe driving experience.

Driving skills may change quickly, such as when a person has a paralyzing stroke, but often performance abilities degrade gradually. Vision fades; memory for directions, locations, and routes may dim; arthritic and neck conditions may affect the ability to stay aware of other drivers' locations; and parkinsonism and other neurodegenerative changes may affect reaction times.

There are so many medical conditions and potential combinations of conditions—or medications—that can affect driving ability. Nevertheless, healthcare providers are expected to be aware of all of these conditions.

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