When is it time to take away the car keys?

Younger woman taking car keys away from older woman
 
At some point in many families, the tables begin to turn. Children become the caregivers for their parents. In the complex, sometimes frustrating or painful world of family caregiving, one especially touchy subject can be when to tell Mom or Dad they can’t drive any longer.
 
If you’re the adult child of an aging parent, you’ve probably already realized roles don’t completely reverse. You’ll always be their child and they’ll always be your parent. Your aging mother or father may need your help in new ways, but you’ll never become their parent. Yet, when it comes to driving, you may get into a power struggle.
 
It’s important for family members to keep an eye on their loved ones to spot potential problems early. Driving is crucial to independence, and most people are very resistant to anyone taking away their independence. What makes it especially hard for families is that some people with early dementia are safe to drive. When this happens, it’s tough for families and physicians to decide who has reached that point of being a danger to themselves or others on the road.
 
Where to find help
 
The National Highway Transportation and Safety Administration has an excellent guide for families and for physicians to help them make this determination. Office tests that primary care physicians use have cutoffs, and those scoring below the cutoff are clearly unsafe to drive.
 
The 4-Turn Test, developed at Ohio State University Wexner Medical Center, consists of having the patient follow the examiner along a short course in the clinic. The course arrives at 4 separate intersections where the individual turns to the right twice and to the left twice.
 
The patient is provided visual clues at each intersection to remind them where to make a turn. They are then brought back to the starting point and asked to lead the way along the same path.
 
One study shows that of the mild Alzheimer’s disease individuals who went in the wrong direction, 88 percent failed a behind-the-wheel assessment by a professional driving instructor. Of those making all four turns correctly, 92 percent passed the driver evaluation.
 
In addition, there are centers devoted to testing elderly drivers to see if they’re safe, such as The Ohio State University Wexner Medical Center’s Occupational Therapy Driver Rehabilitation Program. Our program provides driving evaluation and skill development services for older drivers, including those with early-onset dementia, Alzheimer’s disease or 
Parkinson’s disease.
 
What to look for
 
There are a few ways adult children or other family members can help assess driving skills.
 
  • Have a family member ride with or follow the individual at least once a month to evaluate for impaired driving judgement issues.
  • Monitor the mileage on the car. If the mileage is longer than the short trips they’re taking, it could mean they’re getting lost.
  • Look for any new dents or scrapes on the car, as this can show that there is trouble when driving.
Other options
 
For many families, this is an extremely difficult conversation to start with a parent or grandparent. One way is to briefly try to get the older driver to agree it’s unsafe for others on the road and, if they want to avoid hurting others, they should voluntarily stop driving. If they won’t, then talk to their doctor.
 
One way a doctor can help is to write a prescription that tells the patient to “temporarily stop driving.” The doctor can explain that, while the patient is being evaluated or while a new medication is being tested, it’s best to hold off driving temporarily.
 
The doctor can also encourage the family to make driving impossible by hiding keys, disabling the car or even selling the car. If the situation is bad enough and the family won’t or can’t do these things, the doctor should send a letter to the state motor vehicles bureau informing authorities that the patient is an unsafe driver.
 
Since multiple studies agree that a medical recommendation for driving retirement has a strong correlation with depression, it can be helpful to work programs such as Ohio State’s Occupational Therapy Driver Rehabilitation Program to develop a “driving retirement plan” prior to the recommendation of driving cessation.
 
Studies have shown there is a steep reduction in the incidence of depression if the patient is involved in the planning transition process, and a transportation plan is in place prior to the recommendation.
 
Families often are afraid to be the “bad guys,” even though this is truly the only safe option. Remember that taking the tough action with Mom or Dad now is far better than dealing with the consequences of an accident due to unsafe driving later. 
 

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