An objective third party can help.
Giving up driving is a tangible loss of independence for your elder. It’s no wonder they resist the topic. If you are truly worried about not only the safety of your elder, but everyone else on the road, then understanding what motivates them can help initiate the conversation. If finances motivate them, talking about how much you pay for car insurance and the increased cost of gasoline can be the start of moving them from no to yes. They may be secretly concerned about the safety of others when they drive, so an expression of concern about driving at night can be another motivator.
Either way, I suspect in very few instances will your loved one just give up the keys. This is where a disinterested third party can be a huge help in one of the most elemental and difficult conversations. A third party does not have the emotional investment of family members, nor are they caught up in family dynamics. They can have a rational discussion in a way that helps an elder decide not to drive. As much as possible, they can keep the control with you elder and allow them to make the decision to stop driving.
Getting your loved one to take a formal driving evaluation can be an uphill battle when it means leaving the home and getting on the road. If that is the case, consider the program “Beyond Driving with Dignity.” This program was developed by a former state policeman in Ohio and is owned by Senior Care Authority. It helps seniors self-assess if they are at risk for a vehicle accident and it does the evaluation in their own home. Being in familiar territory can go a long way in getting them to agree, especially in cases of dementia when new environments are stressful.
A 2.5 to 3 hour assessment.
The assessment starts with a conversation designed to learn about the driver and to give them a level of comfort with the tester. Open ended questions like “Tell me about where you grew up” or “What was the first car you owned” allows the elder time for “legacy processing” through the retelling of fond memories. Legacy processing is an evaluation of our lives and is one of the last developmental tasks that we do. This conversational technique opens the door for the elder to reevaluate their lives, including driving, while it keeps the control of the conversation with them.
During this conversation, the tester is looking for holes or inconsistencies in the story telling. Not being able to name where they worked for 40 years is a red flag.
- Driving Assessments
The remaining time together moves into driving assessments, which do not require getting behind the wheel. One of the most telling assessments is a clock test, developed by Dr. Barbara Fraud, it is an indicator of cognitive impairment. Studies show the inability to do this task puts the elder at an elevated risk for getting behind the wheel.
For this test, the elder is given a piece of paper with the following instructions:
- Draw the face of the clock.
- Add the numbers to the clock.
- Mark the clock at 11:10.
The clock test may sound simple, but it requires executing all the steps correctly and in the right order, a processing ability that gets progressively worse for anyone living with Alzheimer’s and other forms of dementia.
The second test, the Mini Mental State Examination (MMSE), is used by many professionals to assess cognitive skills. You are probably familiar with a physician asking an older loved one questions like “What day is it?” or “Who is the president?”. Executing simple tasks is another skill assessed by the MMSE. For example, a list of three words is given (apple, chair, car) and the elder is asked to repeat them. In ten minutes they are asked to name the three items again.
The final assessment is the Snellgrove Maze task designed by Dr. Carol Snellgrove to test attention, visuoconstructional ability and the executive functions of planning and foresight. This simple pencil and paper test has the elder navigate a maze without crossing lines or back tracking.
3. Written report
The result is a written report with recommendations. About one third of the respondents are fine to drive with limitations, like staying off highways or not driving at night. Another two thirds should not be driving and are advised they are at an elevated risk to be in a vehicle accident.
If they are at an elevated risk, the tester might say “it is my suggestion that you retire from driving.” This is followed up with the objective data to support why the suggestion was made. The goal is to get the person to acknowledge and decide for themselves to stop. The report is given to the person who completed the self-assessment and, with permission, is shared with family members and doctors.
Ideally, the tester and driver would sit with the family and let them know the decision. At this point, the conversation turns to how the person will get around. A discussion around transportation help from family, friends, home care agencies and service businesses like GoGo Grandparent follows. At no point is the elder to feel “stranded.”
If you are concerned about your elder driving and they are adamant about not taking a behind-the-wheel test, for a $350.00 investment you can have them tested at home. Then based on the results, gain their cooperation or, at the very least, move a conversation about driving forward.
With thanks to David Stamberg of Senior Care Authority for his help in writing this article.
Deb is available as a caregiver consultant. She will answer the question: “Where do I start?” and find the resources to alleviate your stress. If you would like to invest a half hour to learn how she can help you, please contact her at: Free 30 minute consulting call
Deb is the author of “Your Caregiver Relationship Contract.” This book explains how to have an intentional conversation and how unspoken expectations can cause communication problems. Click here to learn more about Your Caregiver Relationship Contract.