Should You Be The One Who Takes Your Parents Car Keys Away From Them?
A recent study published in the Journal of General Internal Medicine reveals that too often, clinicians wait too long before having a frank discussion with their elderly patients about when they should hang up their car keys and go into driving retirement.
The finding of this paper is the result of a new study from the University of Colorado School of Medicine and the CU College of Nursing where researchers conducted interviews and surveys with 8 practicing internal medicine healthcare providers and 33 community-dwelling current drivers aged 65 years or older.
The purpose of the study was to examine the feasibility of employing “Advance Driving Directives” (ADDs) to help negotiate the often difficult road of discussing when a patient needs to recognize that it may be time to discontinue driving. The idea of ADDs is that it could be used by physicians to help prepare patients by broaching the topic gradually during physical examinations while both patient and physician together monitor a patient’s eventual decline in motor skills, eyesight and cognitive abilities as they age.
According to a news release by the University of Colorado, physicians find that end-of-driving-life discussions are typically unpleasant and may not take place until after an accident has occurred.
"These conversations often don't happen until clinicians see a 'red flag' which could mean an accident or some physical problem that makes driving more difficult for the elderly," said Marian Betz, MD, MPH, at the CU School of Medicine and lead author of the study.
However, what researchers discovered from the study is that discussion about a patient needing to have his or her car keys taken away need not be confrontational between a physician and patient.
"Driving is linked to independence and asking for someone's keys is very emotional," says Dr. Betz, who conducted an earlier study on creating advanced directives to help drivers plan for future changes in driving. "Studies have shown that most people outlive their ability to drive safely by more than six years."
The study found that when surveyed with the topic of the eventual loss of driving privileges, elderly drivers in the study were receptive toward a recommended practice known as “anticipatory guidance.” Anticipatory guidance is where the physician gently prepares elderly drivers by monitoring their physical and mental changes as the patient approaches the day when he or she cannot operate a vehicle safely any longer.
"It's not just about taking the keys, it's about making plans," says Dr. Betz. "Drivers in our studies reported needing help in preparing for that transition, including learning about transportation alternatives."
The study states that this type of approach had a positive response from the elderly drivers surveyed and that they would be open to having these types of discussions with their physician―especially if focused on prevention rather than interventions. However, the CU news release also points out that the patients surveyed did not believe that their physician were aware of their driving abilities, nor did the patients appear to be as open toward having family members involved.
Which brings us to the point of the title—who should be the one to take the keys? The problem is that while physician-guiding a patient toward the day when he or she needs to stop driving sounds great in theory, in practice it may be an entirely different story.
For example, visits to the physician are notoriously brief. Can we really expect all physicians to take the time to focus and evaluate what a patient’s on-the-road driving abilities truly are and discuss this with the patient? Do we really expect an elderly patient who drives to be totally honest or self-aware of declining motor and cognitive skills?
How many of us have known a parent or grandparent who should not be driving continue to do so by compensating by trying to limit driving only on side streets? By driving 20 miles or more below the listed speed limit? Or by having “a copilot” along with them while driving?
While the study provides a hopeful solution to keeping elderly patients and innocent bystanders safe by opening communication lines between physicians and patients concerning “the car key issue,” historically it has always fallen on the children of the elderly to decide when to take a parent’s keys away.
So what can a son or daughter of an elderly parent do? The first step is to understand what the risks are and how to recognize that a driving problem may exist.
According to the Highway Loss Data Institute (HLDI), we should not expect a “silver tsunami” to drastically change the rate of incidence of elderly drivers involved in auto accidents. Although the Baby Boom generation is adding 10,000 new Senior Citizens per day to the population, experts are forecasting that driving accident claim frequency will actually will be lower in 2030 than in 2010.
The HLDI found that:
“Per mile traveled, rates of fatal crashes and all police-reported crashes begin rising around age 70. However, in recent years older drivers’ crash rates have fallen faster than the crash rates of middle-age drivers. The rate of fatal crashes per licensed driver 70 and older fell about 37 percent from 1997.”
Numbers aside, on an individual basis elderly drivers need to be monitored by friends and family members who are the ones most likely to notice when a person’s driving skills are beginning to deteriorate. Signs to look for recommended by the Highway Loss Data Institute include:
• Decrease in confidence while driving
• Difficulty turning to see when backing up
• Easily distracted while driving
• Other drivers often honk horns
• Hitting curbs
• Scrapes or dents on the car, mailbox or garage
• Increased agitation or irritation when driving
• Failure to notice traffic signs or important activity on the side of the road
• Trouble navigating turns
• Driving at inappropriate speeds
• Uses a "copilot"
• Bad judgment making left turns
• Delayed response to unexpected situations
• Moving into wrong lane or difficulty maintaining lane position
• Confusion at exits
• Ticketed moving violations or warnings
• Getting lost in familiar places
• Car accident
• Failure to stop at stop sign or red light
• Stopping in traffic for no apparent reason
Although taking a parent’s car keys from them when they begin to show signs of not being able to drive safely is a tough decision to be made, someone has to make it when the parent will not. Counting on physician intervention may be too little too late for both your parent and an innocent bystander such as a child darting onto the street.
That said, it does not mean that you have to go it alone on this difficult and touchy subject. One useful resource is a free online seminar provided by the American Association of Retired Persons (AARP) titled “We Need to Talk” that will help you to assess your elderly parent’s driving skills and provide you with tools that can help you have this life-saving conversation.
Image Source: Courtesy of PhotoBucket
“I Wish We Could Normalize Driving Health: A Qualitative Study of Clinician Discussions with Older Drivers” Journal of General Internal Medicine May 2013; Marian E. Betz MD, MPH, Jacqueline Jones RN, PhD; FRCNA, Emma Petroff BA and Robert Schwartz MD.
Highway Loss Data Institute: Status Report Vol. 47, No. 9 November 20, 2012—Despite worries, aging population won’t push up nation’s crash rate.