Like most of us in our car-centric country, my mother got her driver's license as soon as she possibly could, when she turned 16. This was in the mid-1930s, when the world behind the wheel was very different — no power steering or power brakes, sparse traffic, the rumble seat still in vogue and seat belts and air bags decades away.
Fast forward 74 years: The GPS barks out directions at each corner, cars can park themselves and some don't even need drivers. But despite this technological revolution, the process of renewing one's license remains virtually unchanged from the day my mother, Mildred Harris, now 90, passed her driver's test. That day was also the last time the commonwealth of Massachusetts assessed her driving skill.
(MORE: Taking Away an Older Driver's Keys)
How We License Our Parents
Welcome to America's patchwork quilt of licensing provisions. According to the Insurance Institute for Highway Safety, an independent research group supported by the nation's major auto insurers, Illinois is the only state that requires drivers age 75 and over to take a road test for license renewal. Many states don't ask elderly drivers to take a vision test and fewer than half have instituted a shorter renewal cycle, even though, as the institute's general counsel, Michele Fields, says, "A lot can happen with older drivers between long renewals."
By 2030, all baby boomers — and 1 in 5 U.S. adults overall — will be at least 65 years old. What are the country's registries doing to prepare to assess their skills and accommodate for their limitations? So far, not much.
"The motor vehicle is so dominant in our culture, states are reluctant to impose restrictions on older drivers," Fields says. In general, an incompetent senior motorist will come to the state's attention only if a neighbor, relative or police officer makes a report.
In many ways, my mom has been a model older driver, gradually steering herself away from situations that make her uneasy, like night driving, rush hour and frenetic highway traffic. For the past few years, she has driven her 1999 Buick only a few times a week, usually to shop for groceries and run errands within a few miles of her independent living complex.
Putting Off the Conversation
My sister and I never underestimate how important Mom's car is to her sense of independence, but that's no excuse for our delay in having "the driving talk" with her. Experts advise adult children to discuss driving with an older parent long before it becomes a crisis. It's a difficult conversation – who among us would voluntarily surrender our keys?
It can also be tricky to judge how much a parent's skills have declined, especially for adult children who don't live close by.
Having a physician or independent driving evaluator make the call instead can spare hard feelings, and drivers are more likely to surrender their keys willingly if advised by a doctor instead of an adult child, according to Fordham University research. "But even physicians don't want to be the bad guy" in a society where "we're born and bred for the day we get a license," says Kim Stuckart, clinical rehab supervisor at Spaulding Rehabilitation Hospital in Salem, Mass., near mom's home. (Get more advice from Next Avenue on talking to your parents about taking away their keys.)
In the end, like all too many adult children, we avoided the discussion until circumstances forced our hand. Last September, just prior to her 90th birthday, Mom fell in her kitchen and banged her head, requiring a hospital stay followed by rehabilitation. Her cardiologist determined that she had fainted and so, under Massachusetts law, given her age, she had to stop driving for six months. During this moratorium, Mom was fortunate to be able to access alternative transportation, including a public senior ride service and a shuttle bus run by her retirement complex. She also hired a woman to drive her on errands once a week.
Coincidentally, during this six-month break, Mom's license expired — but renewing it for four more years required only that she show up at the Registry of Motor Vehicles and take an eye exam. She did so in February and passed the eye test, even though the tester pronounced Mom's vision "border line" and strongly suggested she visit an ophthalmologist for a new eyeglass prescription. (She didn't.)
Given Mom's new need for a walker to steady her gait after the fall, we saw this as the right moment to step in and suggest she get an independent evaluation before getting back behind the wheel. Mom was blessed with a still-sharp mind and had a green light from her cardiologist to resume driving, but we wondered if she still had the reflexes to react quickly if someone else on the road did something stupid or dangerous.
The Association for Driver Rehabilitation Specialists has more than 500 members available around the country certified to assess older drivers. We discovered that Spaulding offered one such program for $375. (You can find a site in your area here; costs will vary.) It's a two-part evaluation: first, cognitive and vision tests from an occupational therapist, then a driving test administered by a certified driver rehabilitation specialist. The results would be sent to her physician and to the Registry of Motor Vehicles, which could then decide to call her in for a road test to retain her license.
(MORE: Is Your Hometown a Place to Grow Old? Mine Is)
At first Mom was reluctant, but we pointed out that we would all have peace of mind if professionals evaluated her. Whether or not they deemed her fit to drive, we told her, it would be worth the cost.
Before heading to the hospital for Mom's evaluation last month — I drove — I asked her to pretend I wasn't there and show me that she could get to the car, open the back door, collapse her light aluminum walker, stow it in the back seat, get in the passenger side and close the door. If she couldn't complete these tasks by herself, I said, there was no point in a driving evaluation. She was slow, but handled it all with ease.
At the evaluation, the therapist seemed pleased with the results of her cognition and memory tests. So far, so good. But neither Mom nor I anticipated what happened next: She put on her glasses to take the eye exam but couldn't read enough of the letters to pass. She didn't qualify for the driving test. Mom should have listened to that Registry of Motor Vehicles tester.
Determined to take, and pass, the driving test, Mom returned to her eye doctor, got a new prescription and scheduled a re-evaluation. This time, she passed the eye exam and was sent to a Ford Crown Victoria for her road test. She stowed her walker in the back seat and got behind the wheel for the first time in seven months. The evaluator, Mark Whitehouse, sat in the passenger seat, which had access to a brake he could pull if need be. I observed from the back seat with the occupational therapist. At that moment, I recalled my mom coming along with me when I was preparing for my own driver's test. It was an odd role reversal.
Bringing Her Up to Speed
For 30 minutes, Mom followed Whitehouse's instructions to turn here and there, drive through narrow side streets and change lanes on busy four-lane roads. She stopped at red lights and stop signs, used her directional signals and reacted calmly when cars (driven by stereotypical Boston drivers) suddenly turned and whizzed in front of her.
Back at the hospital, as Mom braced herself for the results, she told me, with some resignation, "Whatever happens, happens."
"Overall," Whitehouse told her, "very good skills. We need to look at some things and work on some things. One is you tend to use the inside mirror as opposed to the outside mirrors."
"I've always done that," Mom replied. "I don't know why."
Whitehouse laughed. "Probably one of the reasons is when you started driving, you didn't have outside mirrors."
He was right; I checked. The mid-1930's Oldsmobile she first drove did not have side mirrors. And so for more than 70 years, she has apparently relied exclusively on the rearview mirror in whatever car she's driven.
"On the spectrum of should you continue to drive or retire from driving," Whitehouse concluded, "I'd like to see you keep driving, but I'd like to see you have some lessons to improve your visual wherewithal."
By learning to use the side mirrors, he said, she would improve her visibility "and not run the risk of backing into people, a common low-speed accident among older drivers."
(MORE: Are You Bullying Your Aging Parents?)
Mom agreed not to resume driving until she took some lessons and worked on the issues the evaluation raised. So, it's not the end of her driving days after all. And beginning later this month, my mother, at age 90, will take her first driving lessons in 74 years.
The risks of staying on the road too long are clear: Women, on average, outlive their ability to drive by seven to 10 years, Elizabeth Dugan, a gerontologist at the University of Massachusetts in Boston, has found; for men, the average is six years. And while older drivers actually have fewer accidents than others because they tend to be more careful, they are much more likely to die if they do get into an accident. Car crashes are nine times more likely to be fatal for drivers 85 and over than for drivers 25 to 69.
As for my mother, I'm actually happy this chapter in her life is not over. I'm proud that she was willing to submit to the evaluation and I take comfort in knowing that when it's time for her to hang up the keys, she'll know it and won't fight it. Thanks to her time out of the driver's seat, she also knows that when that day comes, she'll have good alternatives to get out and about.