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How to approach conversation when it's time to evaluate driving capabilities in an elderly relative, friend

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Dealing with a relative or friend who wants to continue to drive -- but shouldn't -- is a dilemma many people would rather not face, but more and more do.

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It's a sensitive issue that thrusts adult offspring into something of a parental stance when they begin to notice diminishing physical or mental capabilities that affect their parents' driving.

"It's tough," said Jerry Vein, AARP regional coordinator for northeast North Dakota. "It's something that people don't want to talk about."

Vein, retired from the Grand Forks Fire Department, has been involved in safety issues for more than 40 years.

Through AARP, he offers a course, called "We need to talk," which is aimed at helping people "start that conversation way ahead of time," he said. "It shouldn't be started when they need to quit."

Loss of driving skills due to failing eyesight, physical deficiencies and the onset of dementia -- "for example, they can't find home" -- can signal the need for change, said Myron Bender, a safe driving course instructor for AARP, Grand Forks.

If this occurs, those who are involved "probably should be thinking about alternative modes of transportation," he said.

Difficult transition

But reaching that decision and acting on it are often tough on families and relationships.

"It can be a smooth transition and, in other cases, it's a difficult transition," Bender said.

Research shows most older drivers who are having difficulty operating a motor vehicle would prefer to be approached by their spouse, adult children or doctor, he said.

"It's very hard for them to give up driving," said Brenda Pauley-Colter, supervisor in the physical medicine and therapy services department at Altru Health System.

What makes it so difficult is "these are the people who looked after us," she said. "Now, it's flipped. The child is in more of a caretaker role.

"They're faced with, 'if my parent isn't going to drive, I'm going to have to get them to their appointments.' The burden shifts to the child."

Drivers who must forfeit their keys face "loss of freedom and self-esteem," Vein said.

"In North Dakota, you can't do anything without driving," especially in rural areas, although in the Grand Cities, the bus system, cabs and Dial-a-Ride offer alternatives.

Special challenges

Advanced age brings an array of health issues that can affect driving. Eyesight begins to decline around age 40, Bender said. Reaction time becomes slower. "With poor reaction time, nine out of 10 times you'll have a rear-end collision."

Older people may have trouble turning their heads to check for blind spots, a deficit that can compromise one's ability to safely change lanes, merge into traffic and back out of a parking spot.

He recommends drivers park the car front-forward in paired spaces, "so you can drive ahead to leave," eliminating the need to back out.Left turns can be hazardous for elderly drivers, he said. Those who are leery can opt to make three right turns instead. Oftentimes, seniors are taking prescription drugs that may affect their ability to drive and increase risk of accidents and injury. "Anytime they change medications, they need to observe how they drive," he said.

Human error

In the vast majority of accidents, human error -- not mechanical malfunction or problems with the roadways -- is to blame, Bender said. "Ninety percent of crashes are due to human failure." For people in their 70s and 80s, most crashes occur at intersections, Vein said.

Common misconceptions about older drivers persist. For example, the belief that older drivers are bad drivers is not true, Bender said. "As a group, mature drivers are relatively safe drivers."

Vein agrees. "On average, seniors are pretty safe drivers," he said. "They're cautious. They take their time." Statistics indicate older drivers have high safety belt use and few citations for speeding, reckless driving or alcohol-related charges. However, older drivers, especially after age 75, have a higher risk of being involved in a collision for every mile they drive. The rate of risk is nearly equal to that of drivers age 16 to 24.

When involved in a crash, drivers older than 65 have a higher rate of death compared to other drivers mostly because of their inability to withstand the physical trauma that often occurs with age, according to new research by the AAA Foundation for Traffic Safety.

"Their fatality rate, at age 75 and up, goes up dramatically," Bender said.

Yet, more people ages 65 and older are involved in motor vehicle accidents than any other age group, said Brenda Pauley-Colter, supervisor of physical medicine and therapy services at Altru Health System of Grand Forks that offers a driver evaluation program for seniors.

That may be linked to the fact that they don't drive as often, she said. "They lose cognitive ability." Also, the idea that, at some age "everyone will have to stop driving" is a myth, Bender said. "Driving has nothing to do with age. It has to do with health and ability."

That has led to an emphasis on physical fitness, he said.

"If an older person is having trouble maneuvering and walking, they probably will have difficulty with driving too."

Evaluating fitness to drive

Therapists at Altru Health System's physical medicine and therapy services department evaluate older drivers to provide "very objective and concrete information" which the physician can use to decide whether or not the person should continue to drive.

An increasing number of drivers are being referred for evaluation, said Pauley-Colter.

"People are living longer and wanting to drive longer," she said. Also family concerns are prompting more referrals.

In their evaluation, occupational therapists do a physical examination, checking for range of motion, strength-testing, endurance, cognition and vision status.

If the patient "passes," the evaluation continues with a driving test for which an occupational therapist joins the driver in a specially equipped car.

Occupational therapists on her staff sometimes see people more than once, Pauley-Colter said. Patients may be given activities they can practice, such as techniques to compensate for lack of strength or to better focus their attention, and return later for re-evaluation.

Vision problems constitute one of the leading factors that prompt evaluation, she said. People often don't notice deterioration in their eyesight. "We get used to our vision getting worse," she said. Also, memory affects driving capability and cognition affects one's ability to pay attention and not become distracted.

"Driving is a routine activity, it's innate," she said. "But once it becomes not innate, you can have distractibility."

People can seek evaluation on their own at Altru, but she said her department prefers referral by a physician who can follow up on information that's provided.

Concerns related to driving can lead into other health issues, such as memory loss, that a physician should address, she said.

"Ultimately, it comes down to the doctor" to make the decision about driving. No reports on patient evaluations are given to the state, she said. Whether it's about an elderly person's ability to live alone, needing more help or quitting driving, the role she and her colleagues play is "to help with determining whether it's time to have those conversations."

Safe-driving course

For those mature drivers who want to maintain and improve their driving knowledge and skills, AARP offers safe driving courses that cover strategies to compensate for any physical deficiencies, Bender said.

In North Dakota, AARP offers about 35 such courses every year. In Grand Forks, the four-hour class is presented the first Wednesday of the month at the Grand Forks Senior Center.

The curriculum is "very well-researched" by the national Highway Safety Administration office as well as medical and pharmaceutical societies, Bender said.

Those who complete it receive a three-year certificate for a discount on auto insurance.

"Most companies give a 5 percent discount," he said. Minnesota state law mandates a 10 percent discount.

The course covers strategies to maintain confidence behind the wheel such as defensive driving; new traffic laws and rules of the road; how to deal with aggressive drivers; and much more.

"I tell people in my class, 'I'm here to help you hang on to your car keys as long as it's safe to do so. But when you endanger others, we need to look at alternatives.'"

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