Despite failing her vision test and losing her driver’s license, my own (previously) law-abiding mother was so intent on continuing to drive that she just ignored those pesky new restrictions. It was a shock when my sister and I stopped by unexpectedly to find her AND her car missing.

Knowing we were now aware of her behavior, she was embarrassed and angry and refused to be “lectured.” We gave her a bit of space and with time and consideration she decided to gift her car to her grandson.  There was a huge sigh of relief that our family did not have to have a conversation about “the keys.” While facilitating caregiver support groups and during home care visits, I have heard many stories from families who are grappling with keeping a loved one safe on (or off) the road.

Understandably, stepping back from driving is emotional territory, and I thought twice about approaching it. However, having navigated this minefield both personally and professionally, it could be helpful to discuss it and provide some information and resources. The bottom line is to keep all of us safe out on the road and to support those who may need to step away from the wheel.

Getting a driver’s license is a rite of passage, and owning a car is often the next step toward adulthood. After years of readily available transportation and autonomy, medical conditions, changes in mobility, memory issues, vision impairment or side effects of medications, can all potentially impair driving performance. This could happen suddenly or develop slowly over time.

To compensate, some may stop driving at night, avoid highways, or reduce the distance they travel. Others simply decide to put the keys down or there may need to be difficult and anxiety provoking conversations prior to a decision.

Approaching the conversation

Ideally, acknowledgement of any changes in driving abilities should happen early rather than following a serious accident or injury. It is one thing to take personal risks, but if our driving or that of a family member or friend could impact the safety of others, that is another matter.

Discussions around limiting or stopping driving will require patience and maybe a stepwise approach to allow for time to transition. Those discussions will also require honesty, empathy, and respect. Frequent casual conversations about driving rather than a one-time heavy-handed approach are more likely to be successful. Winter weather reports or an example of someone else who has stopped driving could be ice breakers.

A conversation could also begin with asking the driver how they feel about their own driving. They may or may not share any concerns, but this could open the door and help determine how or if to proceed.  “I” statements are recommended, such as, “I am worried that your driving is not as safe as it could be.” This is less threatening than saying, “you are no longer a safe driver.”

Have concrete examples of any changes in health status, function, medications or any driving accidents or near misses. Be prepared and do some research on alternative transportation options available.  Some are listed at the end of this article. AARP offers an online seminar titled “We Need to Talk” that includes warning signs for older drivers and videos with examples of conversations regarding driver safety. https://www.aarp.org/auto/driver-safety/we-need-to-talk/

Self-assessment of driving skills

It may be appropriate for someone who is becoming less confident in their driving ability to start with a self-assessment. AAA offers a self-rating form, and based on the score, recommendations are made with comprehensive suggestions for improvement when applicable. They state in this brochure that, “one of the most critical assets for safe driving is experience, and experience does not decline with age. It’s important to recognize your limitations and to be aware of everything you can do to be safe on the road.”

https://exchange.aaa.com/wp-content/uploads/2021/03/Driver-65-Plus.pdf

There are AAA-Approved Driving Schools that can perform driving skills evaluations, which include an in-car assessment and recommendations for further training. Contact AAA Northeast at (401) 868-2000 or visit northeast.aaa.com/driving-school/ri.html

There are also numerous outlets for professional driving assessments (see box).

Cognitive issues

If there is cognitive impairment or dementia, the Alzheimer’s Association of Rhode Island offers a Dementia & Driving Resource Center with guidance on assessing driving ability. They can be contacted at (401) 421-0008 or visit their website for resources https://www.alz.org/help-support/caregiving/safety/dementia-driving

Alternative transportation options

Planning ahead for the transportation needs of an older driver and finding the resources in their community are important steps to help smooth the transition away from driving. The Rhode Island Office of Healthy Aging has some general information:  https://oha.ri.gov/what-we-do/connect/transportation, as does RIPTA, where you can look up services in your community.  https://www.ripta.com/community.

The website for RI ElderInfo can link you to senior centers and their transportation options: https://rielderinfo.com/senior-centers-2/ .

Develop a list of local taxi and private car services. Ride sharing may be a newer concept for some and AARP offers a very informative article about using this option called “Uber and Lyft for Older Adults: What you need to know.” Both companies offer special apps and simplified services for seniors. Scheduling and taking a few rides with a companion are recommended to gain confidence using ride sharing services. https://www.aarp.org/personal-technology/dial-uber-ride/

Check to see if your town has established a Village Common, a non-profit, volunteer-driven program of seniors helping seniors to stay in their homes and community. For a monthly fee, among other services, they offer transportation for medical appointments, errands, groceries and more. Check  https://www.providencevillageri.org/

Having to talk about “the keys” can be challenging. Every situation is unique, but getting to the point where they need to be taken is not ideal. This can threaten a person’s personhood and dignity, damage relationships, and compromise safety.

Having conversations early and often and learning about transportation that is available to maintain independence and social connection may help if we or someone we love needs to consider limiting their driving or stopping altogether.

Bonnie Evans, RN, MS, GNP-BC, GC-C, lives in Bristol and is a geriatric nurse practitioner, End of Life Doula, and certified grief counselor. She can be reached at bonnie@bonnieevansdoula.com.