When to Stop Driving: Who Decides, & How?

 

No-one wants to cause an accident. But for many older adults, being able to drive is a sign that they are still in control of their own destiny, and a strong symbol of liberty and freedom.

So the question "When to stop driving?" is a thorny one. Equally important are the questions: "Who should decide it's time to stop driving?" and "How to decide?"

 

This has been a recurring topic at our Longevity Explorer circle meetings over the last few years, and as we listened to groups of older adults discussing the topic, it became clear that:

  • this is a complex topic, involving feelings of self-worth and independence;
  • older adults themselves have differing views on this, although they fall largely into a handful of categories;
  • the logical government entities you might imagine would be handling this, by and large are not; and
  • while the internet is full of articles on topics like: "How to stop elderly parents from driving", the older adults in our Longevity Explorer circles see things differently than do the writers of most of those articles.
  • the questions of How to Decide, and Who should Decide are deeply intertwined. 

 

Explorer Insights, Plus an "App for That"

We created this synthesis of the learnings from a number of Longevity Explorer circle discussions, with the idea that it should be helpful for both older adults who are starting to wonder about whether they really should be driving, and family members who worry about this too.

If you want to dig deeper into the discussions, many of them are audio recorded and attached to this page (on the side if you are on a large screen, and below if you are on a small screen), although we also drew this material from some additional discussions that have not been published here.

In addition, our explorers have an idea for a "driver testing app" that they think would help a lot with this issue.

We brainstormed at some length about what that app would need to do. Many of our explorers think they would use such a product, and the technical ones think it should be do-able. Maybe it already exists, but we were not able to find it? If you know of one, please add it in the comments.

We are hoping a developer, or insurance company, or government organization will read about our ideas for an App, and decide that implementing them is aligned with their mission. And we would love to help them get it right. :)

 

Why Do We Care So Much About Driving Anyway?

Every time the topic of "giving up the car keys" comes up in a Longevity Explorer discussion, it is clear this is a very important issue about which people have strong opinions. Basically, most older adults are not at all keen on the idea that at some point they may have to stop driving themselves. Some of our discussions dug more deeply into just why this is such a hot button. Here are what these older adults thought.

 

Getting from Point A to Point B

There were a range of important, but perhaps less passion-inducing reasons including: 

  • convenience; and 
  • necessity in circumstances like a vacation in a spot without other transportation alternatives; and
  • the need for one's own car to carry the groceries back from the store.

These fell into the category of helping people get from Point A to Point B.

This was especially important to our explorers who lived in suburban settings, where public transport is inconvenient at best and often almost non-existent. Those who live in a city (San Francisco) seemed less likely to talk about the convenience of using their own car for everyday tasks, as things like parking offset that convenience quite a bit.

In a number of discussion threads, people voiced the opinion that this whole issue of convenience to get from one place to another was far more critical before the days of Uber and Lyft. Or in parts of the world where these convenient forms of on-demand transport have not yet caught on.

In fact, in a separate discussion of the most important "milestones along the path to lost independence", participants agreed that in the past losing the ability to drive would have been one of the most severe indications of loss of independence. Whereas now, because of ride sharing services, it was much further down the list.

 

Autonomy, Self Determination, Freedom, Being in Control.

As we moved beyond the initial responses, people started to talk about the importance of having a "feeling of autonomy", or of "being in control of their own destiny".

One older adult talked passionately about the idea that whenever he wanted he could just "get up and go", and how the "feel of the open road" held an almost mythical attraction — even if he rarely availed himself of it. 

People talked of the memories of a car as a symbol of freedom when they were a teenager, and of the memories of coming of age experiences in which cars figured prominently. 

Clearly, the idea that they could drive if they wanted to had very important implications to many of our discussion participants.

On the other hand, there was a minority view that felt:

I am still "in control" if I can just call a  taxi or an Uber. I don't need to actually drive myself.

 

Ego

Some of our explorers felt that ego played a role in why some older adults care so deeply about being able to drive. They felt that American culture places great weight on things like what car you drive, and where you live, and what your job is, and that giving up the car symbolized some type of "loss of societal status".

 

Who Should Decide it's Time to Stop Driving?

We kicked off many of the conversations by talking about who should decide it is time for an older adult to stop driving.

Opinions differed substantially, but fell into three categories, each representing a major fraction of the discussion participants.

  • One view was that the DMV (Dept. of Motor Vehicles) is responsible for deciding who has a driving license, and that therefore they should decide when an older adult should no longer drive.
  • A second view was that some other independent and objective third party (not the government) should decide (doctors were the most frequently mentioned group).
  • A third view was "I want to be the person who decides". 

 

What About the DMV?

Quite a large proportion of the explorers felt that the DMV (Dept of Motor Vehicles) is responsible for deciding who has a driving license, and that therefore they should decide when an older adult is no longer fit to be driving.

The trouble is that almost all of the discussion participants agreed that, even though the DMV should fill this role, it does not.

Anecdotes and some Googling make it clear that the DMV policy on driving and older adults varies from state to state. Here is an example of a popular sentiment from a California-based explorer.

They just renewed my license for 5 years. I will be 96 when that expires. That is crazy.

And, as he pointed out, to get that licence renewed all he had to do was a written driver's test and an eye exam. No actual testing of driving skills. There was no evaluation whatsoever of whether his reaction times were still good, whether he could still safely park or back up the vehicle, whether he could turn his head far enough to the side to see traffic coming from the side, or of the various other ways that aging can interfere with driving ability.

 

Are Doctors the Answer?

Many explorers felt that some independent objective third party should make the decision it is time to stop driving. As we discussed who might fill that role, a popular idea was that one's primary care physician, geriatrician, or ophthalmologist might fill that role.

It seemed clear that these types of doctors are often trusted authority figures, and that many of the older adults would be willing to have the decision to give up the car keys be made by their doctor.

Since our explorer groups include a number of retired physicians, they contributed their views too. And it seems that recommending a person give up driving is indeed something geriatricians and ophthalmologists frequently do. If a patient has a clear physical or mental impairment that the doctor feels would be an impediment to safe driving, they commonly inform the DMV of that, and trigger a process that typically leads to driving cessation. And it's common that the family of an older adult enlists the help of their doctor to help "take away the car keys".

We talked, though, about whether opthalmologists are really equipped to evaluate non-vision-related aspects of driving competence. And we speculated about whether geriatricians commonly administer a comprehensive "driving capability" test? And for the large fraction of older adults who see a primary care provider who is not a geriatrician, do they adminster such driving evaluations? And is this a skill set taught in medical school?

Two important take-aways from this part of the discussion were:

  • the doctor who provides primary care to an older adult is often a trusted, independent, objective third party.
  • If they truly have the time and tools to do an objective driving evaluation, that might be an excellent solution to the question of "who should decide".

 

I Want to Make the Decision for Myself

A sizeable portion of the older adults in these discussions felt that they wanted to be the person who "decided" it was time to stop driving. This fits with the overall theme of the importance of being in charge of one's own destiny, which comes up time and again in our explorations.

However there was quite a bit of debate on this issue, centering around a few themes.

  1. Will one really be able to make that decision when the time comes? Maybe, by definition, once you are no longer fit to drive you also are not able to see that for yourself?
     
  2. You typically will wait until you have a few "near misses" before deciding you don't want to drive anymore. But what if those "near misses" are actually accidents in which someone else gets hurt? Is that really what we want?
     
  3. Are there really appropriate tools to help you make this decision? Or do we need some new tools (here is where the "app" discussion comes in)?

 

What About Family Members?

The explorers had many anecdotes about how their family members (spouses and adult children) had pressured them not to continue to drive. This obviously plays an important role as a sort of background pressure that helps force the individual to think about the topic.

But, almost no-one in our older adult group felt that it should be the role of other family members to decide it was time for them to stop driving. The idea that "my children will take away the car keys when it is time" was not a popular concept.

 

How to Decide?

Deeply intertwined with the question of "who should decide I need to stop driving" is the question of "how will they decide?".

 

The Right Objective Test for Third Parties to Use

Many explorers thought some third party should be in charge of deciding driving was no longer a good idea — for example, the DMV or a doctor.

But then we started discussing how they would make that decision. We realized there was quite a big danger that the decision would become rather subjective and arbitrary, if the right tools for evaluating driving skills did not exist. And that made people very uncomfortable.

As we touched on in the section above about doctors, it's not just about whether they could administer a suitable battery of tests. It's about whether they really have the time and inclination to do that in the absence of some obvious condition that makes it clear driving is a bad idea.

And in the case of the DMV, it seems clear that at present, at least in the states we discussed at our explorer meetings, the tests are limited to eyesight and written knowledge of the rules. Certainly, if one fails those then stopping driving is the right answer. But what if you have other driving imperfections that don't show up as vision impairments or lack of knowledge of the rules of driving? Should there be a routine actual driving test for older adults once they reach a certain age? And should it be administered annually?

 

Deciding for Oneself

Quite a lot of our explorers had the opinion that they would decide for themselves when it was time to give up driving themselves around.

When we pressed people on how they would really know "it was time", there was divergence.

Many felt that "we will just know". As we discussed it, this self knowledge was likely related to near misses, a sense of lack of confidence, and a general decreasing comfort at being behind the wheel.

Others felt there was a missing piece, though. And that missing piece was some tool they could use to monitor their own driving skills over time.

When the idea came up that there might be a simple self-evaluation test (eg an App) that could keep track of how one's driving was compared to both the past and to others, there was quite a bit of enthusiasm.

 

Today's Options for Deciding 

As many explorers pointed out, there already exist various resources that are relevant to the whole topic of driving and age.

For example, there are various online courses, and self evaluation quizzes. (See Ref 3, 6).

It's hard to argue against the idea of a course and more training. But that's different than a tool for evaluating one's performance. And it's not clear how a course helps you make that annual decision of "should I still be driving?". Especially if you don't retake the course each year.

The most comprehensive online evaluation tool we know of is called the Fitness to Drive Screening Measure (Ref 6). It allows an older adult, or some third party, to input (subjective) evaluations of 54 separate parameters of relevance to driving skills. It produces a score and recommendations.

Our explorers also shared a copy of an AARP self evaluation test, that helps an older adult think about some specific questions relating to how well they drive.

In addition to the above, you can always retain someone to evaluate your driving skills for you (with an actual road test). If you are interested in this type of hands-on test, the things to research are "Certified Driving Rehabilitation Specialists", and "Driving Skills Evaluators". The AAA has more information on finding both these types of resource (Ref 4).

With respect to this sort of hands-on evaluation, some of our explorers worried about whether there is a chance their decision will be subjective, and that the evaluators will "report you" if they feel your ability falls below their threshold of acceptability. 

 

What About the Financial Aspects

In discussions like these, money always comes up.

Does giving up your car cost more or less than keeping it?

A number of our explorers have studied this very question. One in particular, who lives in San Francisco, was ready to share a detailed analysis he has made. His conclusion: After you include the cost of a car, the cost of insurance, and the cost of parking, he actually saves quite a lot of money by giving up his car and replacing it with Uber and Taxis.

Explorer Ron K's analysis:

You can afford a very abundant taxi budget if you give up your car.

This analysis might look quite different if one lives in the country or the distant suburbs, and Uber and taxi's are hard to find, and public transport non-existent.

It makes you realize how important the availability of transportation is in deciding where to grow old.

 

An "App for That": Am I Safe to Drive?

An important theme that emerged from these discussions is that we would really like some type of objective tool for evaluating driving. Maybe this tool would live at the DMV and be used by them to do a real driving test for older adults? Or maybe it would live on one's smartphone and be used by us.

We spent some time brainstorming just what we would like an App to do that evaluated our driving skills. Below are the highlights. If you want our help further defining such an app, or helping to develop it, please contact us.

 

Brainstorming Highlights: An App for That

Brainstorming discussions are at various points throughout the audio recordings attached to this page. A particularly good one starts at minute 22.57 in this discussion.

Here are some of the key ideas from the brainstorming.

  1. The "tool" (App) should provide an objective measurement of how well I am likely to drive / can actually drive.
     
  2. It should be properly validated (ie there should be some proof it actually "works" beyond the claims of the manufacturer / developer).
     
  3. The information should be private (i.e. for me, and not for others such as insurance companies or the government).
     
  4. It would be great if it could watch my driving as I go along, and later tell me about errors or near misses.
     
  5. Have it keep a time record of my abilities, and tell me how I am doing compared to last year. 
     
  6. Have it tell me how my score compares to the norm for people like me. And to the general driving population.
     
  7. Suggest things that need improving, and ways I can do better — including recommending courses etc if appropriate.
     
  8. Have the App connect to the car's intelligence, and use that to help evaluate performance of the driver.
     
  9. Let me get lower insurance rates, if I choose to share the results with my insurance company (but I want to decide whether or not to do that).
     
  10. Ultimately, maybe this could be regulated or mandated, or become a tool used by the DMV.

 

Existing Tools

The explorers only spent a small amount of time speculating about whether or not tools like this already exist.

Things like games, and driving simulators were mentioned. Cognitive training games came up. Dash-cams are relevant of course.

Overall, we did not know of quite the right product. If you know of one, feel free to mention it in the comments below — ideally along with an explanation of what it actually does, and how that relates to what we think we need.

 

Feedback?

Know of a suitable existing product? Want to create one? Feel free to reach out to us through the comment section below, or our contact form (bottom of page).

 

 

 

References

  1.  The NIH provides information on older drivers and their challenges.
  2.  AARP on Driver Safety and AARP Smart Driver Course.
  3.  AAA on "Senior Driving" and AAA Self-Rating Form for 65+ Drivers.
  4. AAA on Professional Assessment.
  5. National Highway Traffic Safety Administration on "Clinicians Guide to Assesing Older Drivers" (PDF).
  6. Fitness to Drive Screening Measure (Developed by U Florida researchers, available to take online).

 

 

 

 

 

 

 

 

 

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