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Having “The Talk” with Your Aging Loved One: How to Approach a Conversation About Driving Cessation

You knew this day would come. You have knots in your stomach because you’re about 99.99% confident it isn’t going to go well. Approaching someone we love and sharing our concerns with them regarding their ability to drive isn’t easy. I can almost guarantee they’re going to remind you that they’ve been driving (insert number of years here) and they are perfectly capable to continue to drive. Taking their keys feels like taking their independence, and no one wants that on their conscience. However, driving cessation can be necessary to ensure safety of both our loved one and all other drivers on the road. Whether the decision to discontinue driving is one they have made themselves or one that has been made for them, it is usually difficult and brings unwanted change into their life. Before I get into the solution to your worries, let’s get a more in depth look at the components involved in this decision. Don’t let the next few paragraphs scare you off – it gets better, I promise.

The Impact of Driving Cessation on Older Adults

A group of researchers, most from Columbia University, organized a 2016 study which examined existing research on the impact of driving cessation on older adults (identified as 55 or older). They found that owning a car and driving were both highly correlated with independence and life satisfaction, which probably comes as no surprise. It is their other findings that I think are most important to consider:

  • Driving cessation nearly doubles the risk for depressive symptoms in older adults.
  • Driving cessation is associated with poor physical functioning due to less participation in activities outside the home, which are replaced with activities inside the home. These indoor activities do not benefit productivity or physical health such as the previous outside work, volunteerism, or social activities did prior.
  • Driving cessation is associated with a gradual reduction in the size of social networks (including friends and relatives) of up to 51% in a 13 year period which is a direct result of decreased availability to or access to alternative transportation.
The decline in social participation following driving cessation appears to impact women more than men.
  • In general, former drivers feel a decreased capacity to interact with society. They are likely to replace former social activities with solitary leisure or completely abandon the activities altogether. This type of decline appears to impact women more than men.
  • Former drivers present with decreased cognitive abilities per assessment performed using the Mini-Mental State Examination compared to current drivers.
  • Older adults who discontinue driving are nearly five times more likely than current drivers to be admitted to long-term care facilities, such as a skilled nursing facility or assisted living facility.
Participating in social activities outside of the home results in far more benefits related to physical health than engagement in solitary leisure within the home.

In summary, driving cessation was reported by the study “to be associated with declines in general health and physical, social, and cognitive function and with greater risks of admission to long-term care facilities and mortality.” Despite these alarming findings, the authors also discovered reduction or cessation of driving in older adults can have safety benefits as well. One study they examined “reported a 45% reduction in the annual rate of crash injury in medically unfit drivers after they received warnings from their physicians” (Chihuri, Mielenz, DiMaggio, Betz, DiGuiseppi, & Li, 2016).

Therefore, driving cessation is completely necessary when operating a motor vehicle truly becomes unsafe for our loved ones. If we determine it is time for them to hang up their keys, we must initiate some thorough planning with family, additional caregivers, and local transportation in order to ensure once driving has ceased our loved one can still actively participate in his or her current social activities outside of the home, including social outings with friends or family, doctor’s appointments, grocery shopping, pharmacy trips, volunteerism, church, or anything else that they value.

Determining the Right Time for Driving Cessation

Skills necessary for driving safely include both physical and cognitive components. There are a few warning signs you can watch for when it comes to your loved one’s driving abilities. If you begin to notice poor attention or delayed reaction times, these declines may also influence their ability to drive and respond to unexpected situations quickly while on roadways. An older adult may exhibit signs of or make statements indicating they are not as confident in their driving as they were in prior years. They may have increasing difficulty keeping up with the flow of traffic in reference to speed (too fast or too slow), switching lanes, or navigating new or updated roadways. The older adult’s driving record may include recent traffic violations or tickets.

The older adult may be experiencing frequent episodes of hitting curbs during turns or while in reverse. There may be evidence of small collisions, such as scrapes or dents on the car or garage, mailbox, etc. which are unexplained. Maybe you experience too many “close calls” for comfort while riding as a passenger in their vehicle, or find they seem to aimlessly drive around without having a clear destination or remembering where they were supposed to be going. All of these signs, especially in combination, can indicate that it may be unsafe for your loved one to continue driving.

It’s Time – What Do You Do Now?

You’ve done your research and you are confident it is time to sit down with your loved one to discuss driving cessation. Now what? A good place to start is by consulting with your loved one’s primary physician regarding their professional opinion. They may refer you to a driving evaluation by a driving rehabilitation specialist and can also provide a thorough assessment of physical, cognitive, visual, and hearing skills necessary for safe driving. These assessments can lead to the physician initiating the conversation of driving cessation, which takes some of the pressure off of you.

A driving cessation plan should be created well in advance. Creating a plan for gradual transition to driving cessation is most beneficial. This process can begin by developing a list of the places your loved one most frequently drives to. This typically includes (at minimum) the grocery store, pharmacy, bank, post office, hairdresser/barber, medical or dental offices, exercise facility, and locations of social activities. Next, you can determine the availability of alternative transportation. Will family be readily available for planned and spontaneous transportation? Does the older adult have friends who are safe and actively driving who would be willing to assist? Are there local transportation options in place? Once you have established this plan, follow through on it and revisit it often.

Tips for “The Talk”

The actual conversation with your loved one may be the most important piece of this all. It must be approached in a sensitive and respectful way. It can be helpful for the conversation to be initiated by someone whose opinion the older adult tends to value and often is viewed as less confrontational with one or two people present, as opposed to a room full of intimidating family members.

Choose “I” statements such as “I am worried about your safety while driving” instead of “you” statements such as “you are not a safe driver.” Generalize the statements by recognizing that aging affects each of us differently and many older adults begin to notice they prefer not to drive at night, during times of high traffic, or outside of familiar areas.

Be prepared for a negative reaction and remind yourself that the reaction is directed at the situation, not at you. Put yourself in their shoes and be empathetic to how they must feel. Change is never easy, but definitely becomes more difficult with age. Come prepared with some positive outcomes and highlight these during the conversation. It may be helpful to ask a friend of your loved one who has stopped driving to speak with them and provide comfort. You should also ensure the older adult has been allowed a chance gain familiarity and confidence using alternative transportation prior to complete driving cessation.

Be patient! The road to driving cessation may include multiple conversations and will take time. Try to work together with your loved one as much as possible. Remember that the focus of the plan is purely on their safety and enhancing their independence.

For more resources on the topic of driving cessation and driving rehabilitation, seek out your Area Agency on Aging or check out the resources below.

Resources for Older Adults and Safe Driving


AAA: https://seniordriving.aaa.com/tools-additional-resources/
AARP: https://www.aarp.org/auto/driver-safety/driving-assessment/
CHORUS: https://www.roadsafeseniors.org/
NHTSA: https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/812228-cliniciansguidetoolderdrivers.pdf

References:

Chihuri, S., Mielenz, T. J., DiMaggio, C. J., Betz, M. E., DiGuiseppi, C., Jones, V. C., & Li, G. (2016). Driving Cessation and Health Outcomes in Older Adults. Journal of the American Geriatrics Society, (2), 332.

Rakow, K. (n.d.). We need to talk: The difficult driving conversation. AARP. Retrieved from https://www.aarp.org/auto/driver-safety/info-2016/when-to-stop-driving-in-older-age.html.

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Fall Risk and the Impact of Multiple Falls on the Community-Dwelling Older Adult

Although my strongest passion is enabling older adults to age in place within their homes, a close second is fall prevention. Falls are the number one reason older adults in our country are injured, both fatal and non-fatal. If that doesn’t convince you that this is a big deal, let’s look at the statistics:

“29 million falls, 3 million emergency department (ED) visits, 800,000 hospitalizations, and 28,000 deaths” (CDC, 2017)

This is each year. One in four of our older adults will fall, according to the Centers for Disease Control and Prevention. In addition, these statistics don’t take into account that our baby Boomers are aging and unfortunately, these numbers will only rise. Here’s the real kicker though – they’re preventable. How, you ask? Exercise, medication management, regular eye exams, and (you knew it was coming) home modifications. 

Risk factors associated with falls include:

  • Hospitalizations
  • Broken bones
  • Head injury or traumatic brain injury (TBI)
  • Hip fractures
  • Increased chance of falling again
  • Increased fear of falling

The impact of falls, especially those which result in injury, are debilitating. Fear of falling, however, can be the most detrimental risk factor of all. An older adult who has experienced a fall is understandably more fearful that they will fall again. This can result in activity restriction, decreased community mobility, and isolation, causing weakness and decreased quality of life. This creates a snowball effect of fall after fall, slowly draining the older adult of their independence. 

Prevention

Prevention begins with talking to your doctor. Request a fall risk evaluation and a review of your medications to identify prescriptions which may cause you to feel dizzy or drowsy. You can also seek out a fall risk and home safety assessment by a healthcare professional (i.e. occupational or physical therapist). This includes assessment of a variety of things such as balance, strength, mobility, vision, and the environment. The simplest of risk factors, such as footwear, can be identified and resolved through collaboration of the professional and the client and the result is priceless – your safety, independence, and ability to remain in your home and community.  

Resources:

Important facts about falls (2017). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Take a stand on falls (2017). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/features/older-adult-falls/index.html

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Home for the Holidays

‘Tis the season for holiday gatherings! While many of us find joy in bringing all of the family together, we must consider how our aging loved ones are feeling during this time.  A room filled with laughter, conversation, and hugs can be an exciting experience for some, yet consecutively feel very stressful and overwhelming for others. Conditions such as Alzheimer’s (dementia), visual or hearing deficits, and anxiety create new challenges for both the individual and their caregivers. Below are a few tips to make your holiday gathering more comfortable for each guest at the table.

  • Prepare, Prepare, Prepare
    • Ask your loved one if they would like to be involved in the planning of the gathering and/or meal. This may be a tradition they began and hosted for many years. Completely cutting them out because you do not want to overwhelm them may be hurtful. Even if the only task they wish to take on is setting the table, you have let them know that their contribution is still valued. 
    • Flip through photo albums with your loved one prior to the gathering and prepare them for the guest list. There may be names that are difficult to remember or family members they have not seen in quite some time. Be understanding that they may not be able to recall this information later.
    • Invite your loved one to the gathering early and ask them if there is anything you can do to adjust the lighting or noise in the space to make them more comfortable. Low lighting and a beautifully decorated Christmas tree may be a peaceful scene for a youthful eye, but can create unnecessary barriers for a loved one with low vision. 
    • Update the guests of any new challenges your loved one is experiencing prior to the gathering. 
  • Maximize Visitability
    • Ensure that all of your guests can safely enter and exit the home – it is ideal to have at least one zero-step entrance if possible. 
    • If your loved one uses a walker or wheelchair for mobility, ensure that they can clear doorways and access the serving areas and bathroom safely.
    • Consider easy-open hardware such as lever door handles and faucets.
    • Prepare a comfortable seat for your loved one in the main area that they can transfer in and out of with the least amount of assistance possible.
    • Ensure all traffic areas are adequately lit.
  • Be Prepared for Change
    • Check in with your loved one regarding sound levels. They may be seated at the dining room table, surrounded by multiple different conversations happening around them, struggling to understand the person speaking to them. They may have difficulty distinguishing a person’s words over the swishing of the dishwasher that a guest just turned on in the next room or the squeals of children racing around the table. Offer to move to a quiet space to converse with them one-on-one. 
    • What used to be lengthy conversations with a loved one suffering from dementia may be replaced by an exchange of smiles and a simple touch on the hand. Cherish this form of communication from your loved one and know that your gesture is comforting for them. 
    • Enter the family gathering with the expectation that traditions may need to be adapted. Simplify as needed to make your loved one more comfortable. 
  • Reminisce 
    • Share stories with your loved one of past holiday gatherings.
    • Incorporate food dishes into the gathering that are familiar to them – recipes they used to prepare for the holiday or foods that were familiar to them as a child.
    • Bring familiar photo albums or mementos, or play music that they enjoy. These offer comfortable conversation pieces for your loved one with other guests. 

Each holiday spent with our loved ones is a memory to be cherished. With a little flexibility and consideration, we can ensure our aging loved ones enjoy their time with family and friends. Don’t be afraid to create new traditions, be patient with your loved one and yourself, and remember there is a much bigger reason for the season. 

Thank you for reading, and Merry Christmas!