Driving Happily Ever After

I've just finished reading another article about "How to Get Mom (or Dad) to Give Up Their Car Keys." It left me feeling frustrated and sorry for poor ol' Mom, which could be me, I suppose. Where are the articles about "How to Figure Out if Mom Is Still a Safe Driver and Ways to Help Her Be an Even Better One?"

Here, dear readers, is an article I have wanted to read. Rather than being about taking something away, it's about empowering people to continue driving as long as they can do so safely.

You can consult with a driving instructor about this, but there may a better route (pun intended!): an occupational therapist.

"Occupational therapists are skilled professionals whose goals are helping people to craft their lives," says Elin Schold Davis, coordinator of the Older Driver Initiative at the American Occupational Therapy Association. "We assess physical, cognitive and motor abilities to determine ways to compensate for whatever limitations might be present."

In addition to helping older adults safely stay behind the wheel, occupational therapists can help them function better at work and resume daily living activities after an injury.

While the stereotype is that older drivers are dangerous, the reality these days is quite different. A 2020 study by the Insurance Institute for Highway Safety found that while the number of drivers in their 70s is growing and they drive more miles each year, they are less likely to be involved in fatal crashes than drivers aged 35 to 54. Older drivers also have fewer police-reported crashes per mile traveled, the study found.

Experts ascribe better driving by older adults to several factors. Improved health care delays the onset of poor vision and cognitive decline, and chronic health conditions such as high blood pressure can be well controlled with medication. Vehicles have gotten safer, and features such as side airbags have been proven to be especially beneficial for older drivers.

Advanced driver-assistance technologies such as lane-keeping assistance, blind-spot warnings, adaptive cruise control and forward automatic emergency braking also help drivers who have slower reflexes or difficulty judging the speed and distance of other vehicles. Infrastructure changes, such as converting intersections to roundabouts, help to address common problems faced by older drivers.

"Aging is not a medical condition, but there are changes that are a normal part of the aging process," says Davis. People get shorter, stiff joints may make it harder for them to turn their head, their hearing may be less acute and their reflexes and reaction time tend to slow. Declines in color recognition, depth perception, night vision and peripheral vision, as well as more difficulty with glare from oncoming headlights, can all cause problems.

The AAA Foundation for Traffic Safety offers a 15 question self-rating tool, "Drivers 65 Plus: Check Your Performance," that includes facts and suggestions for safer driving.

If you, or someone you love, has concerns that their driving skills are diminished, or if someone has recommended an evaluation, there are two types of professional driving assessments.

A Driving Skills Evaluation, done in your car, appraises whether or not you need special driving training or a more-intensive clinical driving skills assessment. These evaluations usually cost between $100 and $200.

A Clinical Driving Assessment is used to look for medical causes of any driving deficits and offers ways to address them. The assessments are usually reserved for people with arthritis or other physical conditions, cognitive issues such as dementia or neurological disorders like Parkinson's disease.

Occupational Therapist Driving Rehabilitation Specialists perform clinical assessments, which include a review of a driver's medical history, an evaluation of cognitive function and an on-road observation. Driving rehabilitation specialists near you can be found on the American Occupational Therapy website.

In addition to identifying disabilities or medical conditions that may affect your driving, assessments can help medical professionals to recommend ways to overcome the issues. This could range from taking a class to using adaptive equipment such as a left-foot accelerator or hand controls. Some driving schools work with occupational therapists to conduct evaluations, which can cost between $200 and $400.

CarFit, an initiative of the Automobile Association of America (AAA), AARP and the American Occupational Therapy Association, provides a 12-point in-car check, which takes about 20 minutes to complete. These free consultations, done by occupational therapists or occupational therapy assistants, include checking on seatbelt positioning, steering wheel tilt, mirror placement, line of sight above the steering wheel and neck mobility.

Drivers are given guidance regarding adjustments, such as making sure that they sit at least 10 inches from the steering wheel, which can increase comfort and reduce injuries if a crash occurs.

1. Before buying a new car, check out a Smart Driver TEK Virtual workshop, which discusses vehicle technologies that can keep you safe on the road.

2. If your medications make you sleepy, talk to your doctor about possibly changing the time you take it or switching to a non-drowsy alternative.

3. When in doubt, don't go out. If the weather is awful, or you're feeling dizzy or lightheaded, stay home.

4. Keep your regular medical appointments to monitor and treat chronic conditions, and go for vision and hearing screenings at least once a year after age 60. Speak with your health care provider about driving recommendations or restrictions.

5. Know what is difficult for you — merging on a highway, making left turns or driving at sunset — and try to find alternatives, even if they take you a bit longer.

6. To improve your view of the road, raise your seat until you can see over the dashboard. Do not sit on phone books or pillows to boost yourself over the dashboard; phone books and pillows are unsteady and can cause a dangerous "submarining" movement when you slow down. If the seat does not rise enough to let you see, sit on a firm foam cushion.

If you move to a different state, Davis suggests you consider taking a refresher course in driving, to get a feel for how road configurations may differ. "Many driving schools are now incorporating older driver services," she points out. "Being proactive about continuing to drive safely is one of the best things you can do for yourself."

If retirement includes moving to a new place, consider what that will mean if you or someone you love eventually needs to stop driving. "The ideal thing for the aging-well population is to start planning for, or actually transitioning to, multiple ways of getting places before the need is actually there," says Davis. "This means exploring the availability of Ubers, public transportation and ride services for older adults."

Moving to the passenger seat, even if it is a voluntary "retirement" from driving, is one of the most difficult transitions for people to make but it does not need to be confrontational. "It doesn't have to be about an adult child shaking a finger in a parent's face or ripping the car keys out of someone's hand," says Davis.

"Hopefully, it can be a collaborative venture, with family members or friends sitting down together to make plans for continued activity," she adds. "The goal is to help people keep doing what they want or need to do, whether it's getting to a doctor's appointment, meeting friends for lunch or doing volunteer work."

Barbra Williams Cosentino RN, LCSW, is a psychotherapist in Queens, N.Y., and a freelance writer whose essays and articles on health, parenting and mental health have appeared in the New York Times, Medscape, BabyCenter and many other national and online publications. Read More