Seniors, Dementia and Driver’s Licenses
A Critical Challenge for Families and Physicians
As the baby boomers age, Stats Canada is projecting a ‘tsunami of seniors’ – most with drivers licenses. And the numbers of people diagnosed with dementia and Alzheimer’s are increasing at an alarming rate. In fact, some analysts suggest the number of drivers with dementia in Ontario will more than double from about 45,000 today to nearly 100,000 in 2028. Many will continue to drive as long as they can stay under the radar.
The Numbers Tell a Story
Since January 2011, more than 10,000 baby boomers turn 65 years old every day, a pattern that will continue for the next 19 years.
The number of drivers with dementia in Ontario will more than double from about 45,000 today to nearly 100,000 in 2028, according to a Queen’s University study.
The National Highway Traffic Safety Administration (US) reports that most older drivers can expect to outlive their driving ability by about 7-10 years.
Research on age-related driving concerns has shown that at around the age of 65 drivers face an increased risk of being involved in a vehicle crash. After the age of 75, the risk of driver fatality increases sharply because older drivers are more vulnerable to both crash-related injury and death.
It is not surprising that a question on the minds of many family members and physicians these days is focused on the driving ability of the older person. The topic has been getting attention in mainstream media as well as medical journals and there is a common theme…
How do sons and daughters approach the topic of a retirement from driving with their parent?
How does a family doctor make an informed assessment during a routine medical appointment?
“Driving with Dementia - the new impaired driving?” was a headline in the Toronto Star in February 2012; and an article entitled “Physicians open to ideas on how to assess and discuss fitness to drive” appeared in the Canadian Medical Association Journal in March 2012.
A challenge for both family members and physicians
Although physicians are obligated under the province’s Highway Traffic Act to report any patient who is suffering from a condition that “may make it dangerous for the person to operate a motor vehicle” the judgment is not always straightforward.
Even though Ontario drivers over the age of 80 must take a written test, get their eyes checked every 2 years and some may be asked to take a road test – these measures do not catch all drivers who should not be operating a vehicle.
Unfortunately, a driving assessment is not one size fits all. And blanket statements that suggest all older drivers are unsafe are simply false. But the older driver does have two basic risk factors to take into consideration: physical and mental health. And generally speaking, there is a difference between the physical strength, reaction time and ability to make a quick decision between a 30 year old and an 85 year old.
Changes in health can be slow and subtle. Warning signs may not be evident in a routine visit to the doctor. Families – if they live close by – often see the signs first. Evidence of diminished physical strength, slower reaction time, a lesser ability to problem-solve quickly in a crisis, and problems with memory slowly start to add up.
In an ideal world, talking about a potential retirement from driving should be a topic that everyone is comfortable with. Unfortunately the issue is often avoided at all costs by the older person and their family.
In the list of topics to discuss as a parent ages, retiring from driving can be a tougher subject to broach than talking about assisted living, financial plans, and even funeral arrangements. It is understandable that both loved ones and the family physician feel reluctant to talk about mom or dad’s potential need to retire from driving.
The older driver and emerging vehicle safety technologies
Today’s 85-year-old driver probably began driving at around the age of 15 or 16, which dates the start of one’s driving career back to 1943-44, at the height of WWII. In 1943, the Pentagon was completed and became the largest office building in the world, Franklin D. Roosevelt was president and there were only 48 states in the Union. Gasoline prices rose to 18 cents a gallon, and construction on the country’s first interstate highway would not begin for another 13 years.
But this is not 1943. Vehicle safety advancements have made almost unbelievable progress over the past half-century. Many of us remember when cars were not yet equipped with padded dashboards, lap belts, rounded door handles, hydraulic brakes, automatic transmissions, or emergency brakes.
Some will remember the addition of new safety features like back-up lamps, hazard flashers, 3-point safety belts, laminated windshields, airbags, smoother dashboards with recessed controls, bumper shocks, disc brakes, a driver’s side airbag, antilock brakes, GPS, collapsible steering columns and heads-up (HUD) displays.
And then we come to today’s advances in automobile technology. A new car may be equipped with such advances as intelligent brake lights - brake lights that communicate with other vehicles, smart windshields that will highlight obstacles like a running animal, night vision enhancement, automated parking systems, lane departure warning systems, crash notification and avoidance technologies, electronic blind-spot detection, back-over prevention systems, fatigue warning systems, forward collision warning with auto brake, and now…the advent of self-driving cars.
On one hand these technological advances would appear to be helpful for drivers of all ages. However, there is much debate on how well the older driver will be able to process these changes and how well the older driver will be able to keep up with the cognitive workload these new technologies will require.
The older driver may find himself overwhelmed by the bombardment of new technology commands such as audio warnings, alerts, tones, and visual cues. We may be entering into an era of ‘older driver’ information overload. And the information such as audio warnings and alerts requires a specific action by the driver – often a quick reaction.
Matt Gurwell, the developer of a self-assessment program for the older driver called ‘Beyond Driving with Dignity’ sees the benefits and challenges of the new technologies.
“I have worked with older drivers that will undoubtedly adapt to these new technologies with ease. They possess the cognitive abilities to handle these emerging technologies without ever missing a beat. I know of older drivers that will bask in this new era and would even serve the rest of us very well as instructors for this new gadgetry.
I have also worked with just as many older drivers that shouldn’t so much as have the AM radio turned on while driving.
I have ridden shotgun with older drivers that did not realize their outside mirrors were adjustable, or that they could unlock their vehicle by simply pushing on one of the key’s little black buttons. “Amazing!” one older driver told me after I showed him how to unlock the car remotely. There are drivers who do not know how to activate their four-way flashers in case of an emergency, and have always wondered, “What is that red triangle button for?”
I once enjoyed the good fortune of riding with an older driver that asked me “what is that funny clicking sound…is that your phone making that noise?”
“No ma’am” I replied, “that’s your left turn signal…it’s been on now for several miles.” Acknowledging the error, she promptly turned the left turn signal off and was immediately pleased with herself. Now we were driving down the road with her right turn signal on, and she seemed to no longer notice that “funny clicking sound."
I have spent time with more than one older driver that has become lost while driving blocks from their home of 50 years. When that happens, older drivers seemingly fall apart cognitively. On more than one occasion I have been with a lost, older driver who has found himself as the lead vehicle stopped at a red traffic signal. In the mounting confusion, they have sat through the entire green cycle because they were so distracted and confused that they could not process that the signal changed from red to green (this despite the sounding horns from the cars driving around us).
Many older drivers purchase vehicles equipped with in-dash navigation systems to help keep them from getting lost, but have no idea how to turn it on. “They showed me once, but I forget”. One elderly gentleman explained that he gets lost often, so his adult children purchased a GPS unit for his dashboard. He then explained “I don’t use it though; it’s too distracting."
One has to wonder how this same driver would respond to an emergency audio alert being chirped or chimed from the vehicle’s lane departure warning system. The meshing of new technologies with current driver skills and abilities must be handled with care."
Aging parents, new technologies and driver safety
Sons, daughters and health care providers are looking for options and services to refer their families and patients to when the topic of a retirement from driving becomes inevitable. And a proactive approach is always better than a reactive approach.
Thanks to a lot of hard work by Matt Gurwell, Beyond Driving with Dignity (BDD) has recently been launched in Ontario and may be the answer for many health care professionals and families struggling with the problem.
Beyond Driving with Dignity helps the older driver – and their family – make a rationale decision based on fact to plan for a retirement from driving when the time comes.
Matt is a former Ohio State Trooper. He explained, “The program was the result of 20-plus years of holding dying people in my arms at terrible car accidents, and delivering dozens and dozens of death notifications to families. I would much rather work with families bringing a peaceful resolve to this sensitive and uncomfortable issue now, rather than having them deal with it when an Ohio State Trooper is knocking on their front door."
As the name of the program suggests, dignity is an important element of the process. The goal of the Beyond Driving with Dignity program is to help keep seniors independent and driving for as long as possible, but when in the interest of safety a driving retirement becomes appropriate, the assessment facilitates the transfer from the drivers seat to the passenger seat.
A Certified BDD Professional guides the self-assessment. The 3-hour in-home program utilizes exercises, tools and screenings designed to help the older driver and concerned family members make appropriate driving-related decisions. The process is designed to provide guidance and support to help the driver make a smooth transition into driving retirement, if and when it is necessary. It is a common-sense approach to facilitate - and often times mediate - rational driving related solutions based on tangible facts and personal observations. It is a proactive approach, which includes the older driver in the decision making process.
The BDD program is designed to work in conjunction with the “Beyond Driving with Dignity Workbook for Older Drivers and their Families.” The workbook complements the efforts of the BDD Professional. Both work in tandem to help bring a peaceful resolution to the complex and sensitive issues surroundings an older driver’s diminishing driving skills. The Workbook covers such topics as understanding an older driver’s fears and helps the family identify concerns around vision, hearing, memory, reflex and reaction time, medications, strength and flexibility and general health concerns. It also covers the critical topics of making tough decisions and maintaining independence.
Families who may wish to work through the assessment on their own can purchase the Workbook separately.
A Proactive Solution is available
Programs such as Beyond Driving with Dignity will certainly help to bring the topic of diminishing driving skills into the open. By getting the conversation started, planning ahead for a future retirement from driving may become as common as other aspects of retirement planning.
Contact Suzanne Mulligan-Born in the Grimsby, Beamsville and surrounding communities to discuss or book a BDD Assessment. She can be reached by email at SMulliganBorn@gmail.com. You can also purchase a Beyond Driving with Dignity Workbook directly from Suzanne.
John Bauslaugh is also available to do BDD Assessments in the Hamilton/Halton and GTA areas. John can be reached at email@example.com. The Silver Pages is a proud Sponsor of Beyond Driving with Dignity in Ontario. Check out the many other resources available for Boomers, Seniors and Caregivers at www.TheSilverPages.ca
For more information on Matt Gurwell, you can read more about Beyond Driving with Dignity and his Keeping us Safe initiatives at http://www.keepingussafe.org/.
Or email Matt at firstname.lastname@example.org.
Back To Top