Dr. Val Farmer
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When Should An Older Person Quit Driving

November 18, 1996

Do you worry about the driving safety of your aging parents? Do you worry that they might injure themselves or other innocent people in a car accident? It is a delicate task to communicate with elderly parents about their driving competency.

Transportation and shopping are important elements of independence and well-being. It is difficult to give up driving and accept a more dependent role. Older men have a harder time than older women in giving up driving. For some couples, one safe solution would be for their wife to do the driving and for the older husband to be content to be a passenger.

Older parents don’t always plan for the day when they have to give up driving. Car pooling, volunteer programs, convenient housing and accepting assistance from friends or relatives help make giving up driving palatable. Older drivers with few alternatives will resist giving up their driving. Part of the solution is to think through the alternatives so that basic needs are being met.

Older drivers cut back on their own. Older drivers are generally dutiful and aware of their loss of functioning. They restrict their own driving by not driving at night, driving only on certain kinds of roads or familiar roads, enlisting the aid of a passenger who serves as a second pair of "eyes" for road hazards, staying off roads during hazardous driving conditions and by driving slowly.

Sometimes it takes a "close call" experience or a minor accident to drive home the message. It is after these occasions that older people often reevaluate and scale back their driving. This is also a time when adult children attempt to intervene and help their parents think through the issue.

Many concerned family members bring this issue of driving competency to their parent's physician and try to enlist his or her support. Often the physician doesn't know how to answer this question and depends on others for information. The physician may be reluctant to take a strong stand without objective data.

Loss of competency. According to Dr. Karlene Ball, a psychologist at the University of Alabama at Birmingham, there are three main risk factors for loss of driving ability - loss of vision, decrease in visual attention and loss of mental ability.

Not counting those in nursing homes, about 13 percent of those over 65 have vision problems. This increases to 27 percent for those 85 and above. Half of those over 84 have some degree of hearing loss. A third of those over 84 suffer some loss of mental capacity. People with vision problems usually correct their problem or modify their driving.

A decrease in visual attention is usually the main problem. Visual attention means attending to numerous visual cues. Then the information is quickly processed and quick mental judgments are made.

The top three problems for older drivers are merging into traffic, dealing with busy intersections and making left-hand turns. All three situations require quick processing of information. Some drivers look but they do not see. It is the "thinking" reaction time that is a problem for many older drivers. It may take them as much as ten times longer to understand what they are looking at.

A new test. To identify high-risk older drivers that are more likely to be in an accident, Ball and her associates have developed a test for visual attention called "Useful Field of View" or UFOV. They are starting to market this test to physicians and to the Departments of Motor Vehicles.

This test takes five minutes to administer. Mass screening could be done for less that $20 per test. This test can also be given to younger people with poor driving records and who have been crash prone. Using the UFOV, researchers have found that one out of five of those 65 and older have impaired visual attention.

Drivers with a reduced field of view are 16 times more likely to have been in an accident the previous five years than those with normal visual attention. A follow-up study found that only a quarter of the drivers with a moderate or severe reduced field of view remained crash free for the next three years while almost all of the older drivers with normal visual attention remained crash free. Drivers with a reduced field of view also do poorly on driving simulation tests.

UFOV has proven useful as an early detector of Alzheimer's disease. It helps to identify Alzheimer's patients who should stop driving.

When older drivers were given a series of four to seven one-hour training sessions with attention skills, 60 percent were able to improve and maintain their driving skills over an 18-month test period. They reduced the number of dangerous driving maneuvers and could stop quicker in an emergency, both in a simulator and on the road. Forty percent failed to benefit by this training.

This test and training program will help to ease the minds of older parents and their adult children about safety concerns. It helps make hard and delicate decisions a little easier to make.