COMMENTARY

Should You Tell Elderly Patients to Stop Driving?

Arthur L. Caplan, PhD

Disclosures

December 13, 2017

Hi. I'm Art Caplan and I'm at the Division of Medical Ethics at NYU. What do you do when you're worried about an elderly parent or grandparent who drives? A really common problem that's presented to me time after time is, "I worry that my dad or grandmother is somewhat demented/has lost the ability to hear well/has lost the capability to pay close attention to what's going on around them (cognitive decline for one reason or another). I don't think that they should drive."

How many of you have heard stories about elderly drivers who have gotten into trouble because they lost their ability to know where they were going, or they made the wrong turn, or they simply got their foot stuck on the accelerator, and so on? Is it important for doctors to report concern about older drivers? If doctors want to do that, who should they report it to?

Elderly people sometimes say, "Look, I'm not going to give up my independence. I live somewhere where if I don't have a car, I can't make this work." Sometimes I've heard elderly people say, "Look, you let teenagers drive and they get in trouble too. We're not talking about yanking their license or taking away their ability to drive."

However, it is true that we do somewhat restrict what teenagers can do. There are some states that license them to drive only when there's somebody else in the car, or to drive only during daylight hours. Insurance for teenagers is very high. It costs a lot to put a teenager on the road.

What should you do when you get that request? The reality is that it's hard to take away somebody's license on medical grounds—really difficult. Doctors can report people to the Department of Motor Vehicles (DMV) in their states, but often, the most that's going to happen is that they give them a vision test or a rules-of-the-road test, and off they go. You could be fairly well cognitively impaired and not lose your license from the DMV. I would suggest a different strategy.

I think it's important to talk to concerned relatives and realize that if you're going to take away your grandfather's or grandmother's driving privileges, they're going to resist and they're not going to go for that. What has to happen is something has to be set up to give them transportation possibilities. They don't want to be trapped in their homes any more than anybody else would. We live in an age of Uber and Lyft. There are taxi services available. While those are expensive, they're often cheaper than maintaining a car, gassing it up, doing the maintenance, and paying the insurance.

[You can advise your patients to] say, "We have an alternative for you. We've set it up so that you can get an Uber at your house" or "There's a driver on call who's going to come by, and we're going to pay for it." I think you'll get farther with families who are concerned about the harm that an elderly driver might do to themselves or to others if they are becoming impaired than if you try to get their license taken away.

I'm not saying don't try to get the license taken away, and I think the reporting ought to be done. But I know firsthand that it doesn't get you very far. What you need to do is work with families to come up with alternative means of transportation that lets the impaired older driver know that there's still a way to get to the grocery store, there's still a way to get to the beauty salon. There's still a way to see friends. There's still a way to get out of the house. If that's achieved, I think the goal of trying to reduce danger from impaired elderly drivers will be met.

I'm Art Caplan at the Division of Medical Ethics at NYU. Thanks for watching.

Talking Points: Should You Tell Elderly Patients to Stop Driving?

Issues to Consider:

  • In 2014, more than 5700 older adults were killed and more than 236,000 were treated in emergency departments for motor vehicle crash injuries. This amounts to 16 older adults killed and 648 injured in crashes on average every day.[1]

  • Fifty percent of the middle-aged population and 80% of people in their 70s suffer from arthritis, crippling inflammation of the joints, which makes turning, flexing, and twisting painful.[2]

  • More than 75% of drivers age 65 or older reported using one or more medications, but less than one third acknowledged awareness of the potential impact of the medications on driving performance.[2]

  • Per mile traveled, fatal crash rates increase beginning at age 75 and rise sharply after age 80. This is mainly due to increased risk for injury and medical complications rather than an increased tendency to get into crashes.[2]

  • Some healthcare professionals contend that restricted mobility can lead to a decrease in social activity, which in turn can lead to impaired cognitive status and mental health, such as higher rates of depression.[3]

  • A study with more than 1500 participants showed that people who stopped driving a car for more than 6 months were five times more likely to end up in an assisted living situation than were active drivers, independent of confounding factors such as health state.[3]

  • Driving one's own car enables older people to have self-determined mobility. Particularly in rural regions, where an above-average proportion of the elderly live, driving is very important because local public transportation is scarce. However, even in congested urban areas with options for public transportation, many older people prefer driving their own cars for fear of assaults on buses and trains.[3]

  • In a study by Ross and colleagues,[4] most older persons (85.14%) rated themselves as either good or excellent drivers, regardless of their previous citations or crash rates.

  • Self-rated driving proficiency is probably not accurate with actual driving proficiency, as indicated by previous crash involvement in older adults. Suggestions from other individuals to limit or cease driving may be more influential on self-ratings.[4]

  • Older drivers with the greatest mismatch between actual and self-rated driving ability pose the greatest risk to road safety.[5]

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