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When You Are Concerned - A guide for families, friends and caregivers concerned about the safety of an older driver

(When You Are Concerned is also available as a PDF)

Chapter 4

DISCUSSIONS, INTERVENTIONS AND MORE

"The driver was a 75 year old male. He got on (Interstate I-87) at exit 6 on a Sunday afternoon and went NORTH in the SOUTHBOUND lane. We had peak summer traffic coming south out of the Adirondacks. Vacationers headed back to New York City. Somehow he made it almost to the Twin Bridges (2 miles) before involving 3 other vehicles and a total of 6 occupants. We had to shutdown the southbound lanes for an hour to clean it up. Fortunately, no one was very seriously injured. I did the follow-up investigation with his family. They said he had been diagnosed with Alzheimer 's disease. They didn't do anything about it. I'd say we were lucky this time."

ACCEPTING THE EVIDENCE

The process of addressing an unsafe driving situation begins with accepting the evidence that your loved one is at-risk or unsafe behind the wheel. If the family in the above vignette had been able to accept the evidence, they may have been able to prevent a crash involving five innocent people. Where does the evidence come from? It comes from the person's physical/medical condition, their behavior and driving performance. Use the checklists below to identify and categorize your concerns.

DRIVING SAFETY CONCERNS

  • ____ Doesn't obey stop signs, traffic lights or yield right-of-way.
  • ____ Doesn't obey other traffic signs (no left turn, no turn on red, etc.)
  • ____ Drives too slowly - usually well below the speed limit
  • ____ Gets lost routinely - is taking 2 hours to get to the hairdresser or home
  • ____ Drives aggressively
  • ____ Stops inappropriately
  • ____ Doesn't pay attention to other vehicles, bicyclists, pedestrians, road hazards
  • ____ Doesn't stay in lane when turning and driving straight
  • ____ Driver's spouse, companion, driver's friends or passengers, repeatedly comments about close calls, near   misses, driver not seeing other vehicles or unsafe driving
  • ____ Has been involved in multiple fender benders
  • ____ Has been ticketed for moving violations
  • ____ Gets honked at often

MEDICAL AND BEHAVIORAL CONCERNS

  • ____ Vision problems (cataracts, glaucoma, macular degeneration, retinitis pigmentosa, diabetic retinopathy)
  • ____ Memory loss
  • ____ Problems with judgment
  • ____ Indecisiveness Disorientation Unadaptability
  • ____ Disinhibition (no longer feeling inhibited - improper behavior in social situations)
  • ____ Dysmobility (loss of coordination)
  • ____ Fatigue
  • ____ Not being quick verbally
  • ____ Squinting, not following visual patterns
  • ____ Confusion
  • ____ Not hearing or following verbal instructions
  • ____ Giving inappropriate response
  • ____ Tripping and falling, especially when changing positions or walking on uneven ground
  • ____ Trouble with fine or gross motor tasks, especially stiff joints
  • ____ Dizziness when changing positions
  • ____ Shortness of breath

REALIZE THE UNTHINKABLE CAN HAPPEN

With human nature being what it is, it is natural for you to avoid thinking about the implications of a crash. Yet, if you identified any of the concerns listed above, a crash is now a real possibility. Consider for a moment what might happen if your driver were involved in an accident:

  • Your loved one or someone riding with them might be severely injured ot killed. The parents of a child on a bicycle might be left with an incalculable sadness for the rest of their days.
  • You might be left to forever question why you did not act when you knew there was a problem.
  • Your loved one's estate might be tangled up in legal action for years or even lost in a court judgment.
  • Your driver's own lifetime record of safe and injury-free driving might end in sadness and unspeakable regret.

LEAVING THE WHEEL: HOW TO PREPARE FOR A DISCUSSION

A discussion about leaving the wheel is a serious event. If your loved one is capable of understanding the seriousness of their driving behavior and/or health/medical condition, do the following:

  • Put together a list of your safety, medical and behavioral concerns. The information you just checked in the boxes above will help you.
  • Discuss your concerns, implications of continued driving, and ramifications of a crash with your family members, the family attorney (implications of a crash on the driver's estate). See which of them will help you when you have your discussion with the driver.
  • If the driver's physician and other professional "no drive" recommendations have been made or suggested, get them in writing and have them available for your discussion.
  • Find out what the pharmaceutical printouts say about driving for all the medications (including over the counter meds) your driver is taking. Your pharmacist will help you.
  • Have some kind of transportation arrangements worked out for the driver. At the conclusion of your discussion, you want to be able to say, "Dad, we've made these arrangements for you so you can still get around."

WHY INVOLVE OTHER FAMILY MEMBERS?

Having the support of your family members is one of the keys to a successful discussion about driving cessation. Involving them in the discussion is another. Here is what those discussing driving cessation said of the importance of involving other family members:

"All my family members...brothers, sisters and my mom helped to persuade him." "Her son was very supportive and helped to reinforce the decision." "My brother, sister and I had a meeting to determine what needed to be done." "My brother was in agreement with me." "My sister also helped to persuade our mother to give up driving." "My mother and brother agreed to help with discussion(s) and make suggestions. "We strategize a bit ahead of time..."

OTHERS WHO CAN HELP WHEN YOU HAVE YOUR DISCUSSION

  • Friends of the driver
  • Clergy
  • Driver's physician(s)
  • amily attorney
  • Family insurance agent
  • Residence advisor, senior center director, adult protective services case manager
  • Caregiver case manager from local area agency on aging
  • Driver rehabilitation specialist or professional driving instructor

FRIENDS

Studies have shown the driver's friends can be especially helpful in convincing the driver to leave the wheel. If the driver's friends believe your loved one is no longer driving safely, it is likely they want to help. Talk to them. See if they will help you when you have your discussion.

WHO SHOULD LEAD THE DISCUSSION WITH THE DRIVER?

Usually it is the person the driver responds to best. This is the person who has the "tug" with the driver. But there are exceptions. Family hierarchal concerns can also dictate who speaks to mom or dad about their driving. Dad listens to (son) John but not (daughter) Ann. Mom listens to (daughter) Ann but not (son) John. Got the picture?

If you realize the discussion is going to create one of those situations "where the driver is never going to let you hear the end of it," you may want the person leading the discussion to be the family member who lives the greatest distance away!

THE DISCUSSION

What you say and how you say it will depend on a variety of family dynamics and whether the subject has been broached before.

Assuming your driver has the ability to comprehend, your safety, medical and behavioral concerns should get center stage. Share them with your driver. They are the reason for your discussion.

Additionally, any crash reports, physician recommendations, driving assessment reports and "no drive" information related to the medications your driver is taking should also be presented at this time.

Use all of this to make your case with your driver that he or she is in jeopardy and needs to cease driving before there is an accident.

If need be, you should discuss the implications of continued driving and the ramifications of a crash. Be sure to touch on the following points:

  • Injury to oneself, recuperation, impairments from an accident which could seriously change the driver's quality of life much more than cessation from driving.
  • Injuring or killing a companion or friend riding with them. Injuring or killing another road user, a pedestrian or a child on bicycle.
  • The legal aspects of continuing to drive when the driver is at-risk or unsafe. The legal ramifications of a crash. Lawsuits. Judgments which might have implications for their estate.
  • You will also need to address how the person will get around and how they can remain independent when they leave the wheel. This is the time to present the transportation arrangements you have worked out for them.

Your driver's response will depend upon many things, including whether you talked about the driving issue before. Don't be put off by negative, defensive or even abusive responses. Don't get into an argument or a debate, either. Give it some time to sink in. Do not be surprised at some point to hear your driver say, "I've been thinking about what you have said to me."

DISCUSSION STYLES

Discussion styles vary according to the receptivity of the driver and the urgency of the situation. Your approach as well, will be predicated upon these and other factors. When we asked families to tell us about the approaches they used, here is a sampling of what we found:

  • Frank - to the point. "I told him he could not drive anymore."
  • "Her driving was too slow and very bad. I told her directly."
  • "You have to stop driving."
  • "Stop now before you have an accident."
  • Deflective or deceptive* "We told her the car was no longer safe."
  • "When he wanted to drive, I made excuses like the car was broke or it won't start."
  • "We said the car might break down."
  • "Told him I needed his car."

* Deceptive - families did not like being deceptive. They found they had to say what the driver could comprehend in order to keep the person safe. Often the person was incapable of understanding or the "truth" was no longer relevant.

  • Reasoning and compassionate, "We agreed after the near-miss road situation that she had to stop driving."
  • "We advised him he was unsafe and was going to hurt himself, wife and someone else. We were looking out for his well-being."
  • "I just simply said that we needed to talk about the car and her driving as I had observed some things that had caused some concern for her safety as well as the safety of others."
  • "I promised him that we would always be available to take him shopping, to the bank, barber, wherever he needed to go."
  • "I wrote a letter since my father-in-law is very hard of hearing. I wrote we had hoped he would voluntarily stop driving and that we wouldn't have to help him make that decision. I noted that neighbors had commented on his driving and since he couldn't hear emergency vehicles and shouted warnings about children in the street. It wasn't just his safety which was at stake but that of the people, especially the many children in his condo development."

WORDS OR PHRASES WHICH MAY BE HELPFUL

One began "Dad, I love you."

Others stressed:

"I don't want you to cause an accident or seriously hurt someone else."

"I am concerned for your safety."

"I have been watching you drive."

"We know how important it is for you to drive. But your safety is a concern."

"I've always respected all the advice you have given me. I would like you to respect my opinion, as well."

SIGNIFICANCE OF A DRIVER'S LICENSE

"Sometimes it is the loss of the license that is more upsetting than actually giving up driving."

State Motor Vehicle Departments (DMVs) chronicle a surprising number of older persons who religiously renew their licenses even though they have sold their cars and given up driving! The reason is a driver's license is more than just authorization to drive a motor vehicle. It also signifies they are still part of society and/or that they are not impaired. Do you remember how good you felt when you got your driver's license even though you didn't own a car? Imagine now having to surrender it!

For this reason, keeping a license should not be an issue if the person agrees to give up driving. Your loved one may simply prefer to let their license expire rather than surrender it. Letting it expire is preferable to seeing it taken away.

"Dad, why don't you just let your license expire rather than renewing it? We'll get you a DMV Identification Card so you will have a legal photo ID."

THE DMV NON-DRIVER PHOTO IDENTIFICATION CARD

In New York, the Department of Motor Vehicles offers residents without a license, or those surrendering a driver's license a DMV non-driver photo identification card for a small fee. A "DMV non-driver photo ID card" is legal identification for check cashing and other purposes. If your driver surrenders his or her license or it expires, a DMV non-driver photo ID card may provide, among other things, a helpful and useful means of identification.

KEEPING TABS ON NOT DRIVING

There are situations where the person who gives up driving does not want to see their car taken away just yet. If your arrangement with the driver is to keep the car around, jot down the mileage on the vehicle's odometer and check the odometer to be certain the vehicle is not being driven. Remember, a car sitting in a driveway can be a terrible temptation. You don't have to be a teenager to feel the pull. Even with the plates turned in and insurance cancelled, police department files chronicle stories of "elderly couples taking the old buggy out for just one last ride." Lastly, not driving also means not driving anyone else's car. Use your feedback network to see that your driver is not driving someone else's car (includes rental vehicles, too!).

INTERVENTIONS

You will know it is time to intervene when your discussions do not or cannot work. Here is a look at some of the actions you can take when the likelihood of injury to person or property is immediate or imminent.

  • Seek an immediate license suspension. Have the driver's physician file a "no drive" medical condition report with DMV. In NY and other states, a physician's letter will produce an immediate license suspension. Eye care providers can do the same thing.
  • File a request with the DMV for the driver to be retested. In NY, the DMV will call the driver in for a retest AND keep your name confidential.
  • Get the keys away from the driver.
  • If door and ignition key are different, substitute a second door key for the ignition key.
  • Disable the vehicle. An effective way to disable the vehicle is to remove the battery. If you don't know how to do it, get help from a friend, local garage or your automobile association. You can't jump start a car that doesn't have a battery.
  • Remove the car. Have a family member borrow it and never give it back. Have a garage tow it in for repairs.

ONE PERSON'S STORY

"I contacted the DMV and asked them to keep my name confidential. They called my mother in for an interview and driving test. She thought I was the person who turned her in to the DMV. Since I will be her caregiver shortly - I told her I had no idea who did it. I told her so many drivers have cell phones... one of them could have done it. I needed her to keep communicating and trusting me. Dementia has made her mean and uncooperative. I lied... (it goes against what I stand for) but it was necessary. If there were no other options, I would do it again, same way!"

NON-CONFRONTATIONAL INTERVENTIONS

It is also possible to intervene in a non-confrontational manner. Here are some examples of nonconfrontational interventions.

  • Arrange for groceries to be delivered so the person doesn't have to drive.
  • Provide transportation so your driver will not have to use his or her car.
  • Take the person out during the a week to satisfy their need "to just go out for a ride."
  • Jump in the car first and say, "I'll drive."
  • Say to your driver, "I noticed you haven't been driving in a while, would it be better if I drove?"
  • Tell your driver, "I've arranged for a cab for you tomorrow afternoon. It will take you wherever you need to go."

Non-confrontational interventions have the best success when conditions such as mounting traffic, limited parking and waning confidence and skills conspire to make a driving a chore for your loved one. The driver may leave the driving to you and others if you are able to provide the person with an alternative to driving when difficult conditions prevail.

FAILED INTERVENTIONS

Nothing is more upsetting and frightening than taking action to protect the driver and then finding the person is back out behind the wheel. The following responses will hopefully provide you with some insights into why interventions fail and what you can do to make sure they don't.

  • "He had hidden a set of keys and kept getting them duplicated."
  • "When she couldn't find her keys, she called the locksmith and he made new ones for her."
  • "He requested a duplicate license."
  • "She rented a car after she crashed hers. Then she crashed the rental car. She was about to rent another one when we realized her credit card was just like a car key."
  • "He called the garage. They came out and fixed the ignition."
  • "His friends let him drive their car."

WHAT DO YOU DO IF YOUR DRIVER IS IN IMMEDIATE DANGER?

If your driver insists on driving but is so impaired (dazed, confused, disoriented) as to be in immediate danger of causing loss of life or damage to property, you have a situation requiring emergency action. CALL THE POLICE immediately. Try to do it before the driver gets on the road. Explain the situation to the desk officer or dispatcher. The police will come and investigate.

If your driver is clearly impaired (dazed, disoriented, confused or suffered a blackout), they will at-tempt to convince the person not to drive and if necessary arrange for medical help or transportation to a medical facility for examination.

If your driver is transported to a medical facility and the examining physician agrees that your loved one should not be driving, the doctor can report the medical condition directly to DMV. Upon receipt of the physician's letter, fax or e-mail, DMV will immediately issue an indefinite license suspension. The suspension will remain in effect until there is another physician letter stating that the person is safe to drive.

WORDS OF ADVICE

Families who successfully resolved an at-risk older driver situation offered the following advice ABOUT TIMELINESS & PERSISTENCE:

  • "Continue to intervene."
  • "Be firm, kind and persistent."
  • "Keep trying."
  • "Do not put it off."
  • "Keep at it! It isn't easy."
  • "It's a difficult situation (to address), but don 't postpone it."
  • "Do it quickly, do not hesitate!"
  • "Be persistent. Look at the reality of the situation."
  • "Observe, listen, be gentle and persist!"

ABOUT FAMILY AND OTHER HELP:

  • "Mobilize the family and present the problem to the driver."
  • "Get family support and agreement about the problem and solution. Don't wait."
  • "Help from the family is essential."

ABOUT YOUR APPROACH & OTHER POINTS:

  • "Face it head on. The well being of all is what is important."
  • "Don't assume the doctor knows they are driving."
  • "Involve the doctor."
  • "Don't be reluctant to request an (driving) evaluation. It takes the burden of the decision off you."
  • "Get the proper testing done by qualified people."
  • "Check with your local area agency on aging office for advice and assistance. helped us with our approach to the problem."
  • "Be prepared for anger."
  • "Use patience and kindness."
  • "Consider the possible consequences of not doing it. Accident, arrest, injury or even death of the driver and others."

FINAL THOUGHTS

What goes around, comes around. How you treat your family member will often set the stage for how your family may treat you when your driving becomes a concern.

Chapter 5



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