Driving As We Age

As we age, it’s normal for our driving abilities to change. By reducing risk factors and incorporating safe driving practices, many can continue driving safely.

"At Newton-Wellesley our goal is to help keep older drivers on the road safely for as long as possible,” says Debbie Kerrigan, MS, OTR/L, Senior Occupational Therapist in Rehabilitation Services. “We work with drivers to help them adapt to the changes that come with aging and ease the transition to other transportation alternatives when driving is no longer safe."

Warning Signs
Because everyone ages differently, there is not a clear cut age when driving should stop. However, there are warning signs that age is interfering with driving safety and may require making adjustments. Factors such as decreased vision, impaired hearing and slowed motor reflexes may interfere with the ability to safely operate an automobile.

"Aging also causes decreased strength, coordination and flexibility, which can all impact driving," says Debbie. "Patients may have a chronic condition that gradually worsens over time, or they may have to adjust to a sudden change, such as a stroke. It is important to understand the warning signs, if you are concerned about your own driving or worried about a friend or loved one."

Individual warning signs may seem minor, but can add up to a more substantial risk.

"For example, pain or stiffness in your neck can make it harder to look over your shoulder to change lanes or look left and right at intersections to check for other traffic or pedestrians," adds Debbie. "Leg pain or weakness can make it difficult to move your foot from the gas to the brake pedal and diminished arm strength can make it hard to turn the steering wheel quickly and effectively. As our reaction times slow down, it may be harder to react to vehicles emerging from side streets and driveways, or to realize that the vehicle ahead of you has slowed or stopped." 

Other Factors Than Can Affect Driving Ability Include:

  • Medications: Certain medications or combinations of medications can affect alertness and reflexes. It is important to consult your health care team if you are taking several medications or are starting a new medication.
  • Eyesight: Some eye conditions or failing eyesight can interfere with depth perception or peripheral vision, or cause you to experience extra sensitivity to light, trouble seeing in the dark or blurred vision.
  • Hearing: Decreasing hearing can cause you to miss important cues to drive safely such as emergency sirens and honking horns.
  • Reaction times: As we age, our reaction times slow down making it difficult to execute left hand turns or to react quickly in unexpected or emergency situations.
  • Memory: It’s normal to have the occasional lapse in memory, but if this becomes a pattern, you should consult your physician


"When I meet with patients to discuss driving concerns, I always advise them to discuss their medications with their physician," says Debbie. "On average, an older adult is taking six prescription medications plus over-the-counter medications. It is very important to understand how they interact and what the possible side effects could be."

Being Proactive
Debbie recommends that older adults and their families and friends stay proactive in order to continue driving safely.

"Regular health evaluations with your primary care physician are crucial to safe driving and knowing your limitations behind the wheel," says Debbie. "These check ups should include conversations about medications as well as vision and hearing screenings. You can also speak with your physician about a referral to an occupational therapist or a certified driving rehabilitation specialist who can conduct a comprehensive driving evaluation and make recommendations about special equipment that may make driving easier or modifications to driving habits."

Drive Safe Program
The occupational therapists in the Rehabilitation Services Department at Newton-Wellesley work with patients to identify modifications such as steering wheel and pedal adjustments and mirror changes that all lead to better control of the car on the road.

"We work with older adults to evaluate their driving and offer solutions to the physical issues that interfere with driving," she adds. "The Drive Safe Program at Newton-Wellesley provides a complete driving evaluation. We work with drivers, their families and their primary care physicians to answer questions and make sure the driver can remain safely on the road."

The Drive Safe Program serves adult drivers who are experiencing changes due to medical conditions, trauma, surgery, neurological incidents or aging. The first part of the comprehensive driving evaluation is conducted in the Clinic. During the clinical assessment, an occupational therapist tests the physical, cognitive and visual skills that are needed for driving. Rules of the road and driving safety knowledge are also reviewed.

Clients who demonstrate the underlying skills for driving proceed with the next step in the driving evaluation process – an on-road assessment with a licensed driving instructor in a specially equipped vehicle. The on-road assessment evaluates the client’s performance in real traffic situations. The results of the on-road assessment are combined with the clinical assessment to determine fitness to drive. Client and family/ caregiver education about driving with specific medical conditions, planning for the future and community resources is an integral part of the Drive Safe Program.

Tips for Safe Travel on the Road

• Always adjust your side-view mirrors to minimize the “blind spot” in the rear of the vehicle.
• If left turns are a problem, try planning a route with more right turns and minimize or eliminate left turns.
• If busy road traffic presents a problem, try planning an outing during quieter times such as the middle of the day on a weekday.
• When you start taking a new medicine, ask your physician or pharmacist about side effects. Many medications may affect your driving even when you feel fine. If your medication makes you dizzy or drowsy, talk to your physician to find out ways to take your medicine so it doesn’t affect your driving.

 
Giving Up the Keys
"On average older adults outlive their ability to drive by seven to 10 years," says Debbie. "Through the Drive Safe Program we are able to educate people and determine if they are safely able to stay on the road. There will be a time when driving needs to stop. We work as a team with our patients to plan for driving cessation while they can still drive so that it’s not a crisis when it happens."

When it is time to give up the keys, adjusting to life without a car may be challenging at first.

"It is important for older drivers to realize that reducing the amount of driving or stopping does not have to mean the end of independence," says Debbie. "There are many alternatives that can keep patients participating in their everyday activities. It’s normal to be frustrated or angry. However, it takes a lot of courage to stop driving and put the safety of yourself and others first."

When it is necessary to stop driving, the more options someone has to remain independent, the easier it will be. It is important to make arrangements for essentials like physician’s appointments, but also for social outings and to participate in everyday activities. Feeling isolated can lead to depression.

"The smoothest transition is one that is planned for in advance," says Debbie. “There are many alternatives like public transportation, senior center options, medical rides and grocery and prescription delivery services that can help the older adult still feel independent."

Initiating a conversation about safe driving with an older adult, especially a parent, is challenging for most people.

"This is a difficult conversation to have, but we want people to know there are many resources that can help," says Debbie. "Your loved one may experience a great sense of loss. Don’t dismiss their feelings but try to help with the transition as much as possible. Remember, Newton-Wellesley has experts who can help you through this time and wants to ensure safety on the road and happiness for the aging adult."

For more information about the programs and services offered at Newton-Wellesley Hospital, please call CareFinder at 1-866-NWH-DOCS (694-3627) or visit www.nwh.org/drivesafe.

Debbie Kerrigan, MS, OTR/L
Senior Occupational Therapist, Rehabilitation
Services, Newton-Wellesley Hospital
Debbie received her master of science degree in occupational therapy from Boston University. Her clinical interests include working with adults to help them function at their highest level of independence and participate in everyday activities. She created the Drive Safe Program at Newton-Wellesley in 2004. Debbie is a certified CarFit technician and event coordinator and a trained “We Need to Talk” facilitator.

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