I often tell patients that with age comes privilege, one of which is not having to drive, but that seldom gets past them. They see my meaning and immediately balk at giving up their independence. Since most areas of this country have pitiful (at best, if any) public transportation, not being able to drive one’s self around can inflict quite a disadvantage and even hardship on the elderly. And the loss of driving privileges is perceived as one step closer to the grave. But it doesn’t take many stories of a senior citizen driving into a crowd of people with resultant injuries and death to spark debate specifically and generally as to when someone should stop driving. Who is to decide? There are also some studies out there that show teens are more dangerous behind the wheel than our elderly. Both groups share the feeling that they are safe behind the wheel, and both groups are responsible for a large portion of accidents.

           
Over the years I have had family members come to me to ask me to “take away____ driver’s license”. I’ve also had patients demand/ask that I write a letter ensuring that they keep their license. This is never an easy discussion with the patient who needs to stop driving. One way I have begun to address this is to say that it is a question of when to stop driving, not if. I think that as with end-of-life discussions that are sequential and informative, frequent discussions about when to stop driving can make it easier when the time comes, and perhaps be less of a shock. Pre-planning alternate means of transportation can help. Knowing the community resources pertaining to this issue can help.

           
Diagnoses that will lead to a need to stop driving:

    Dementia, and progression of

    Diabetes with resultant deficiencies of eyesight or nervous system strength

    Musculoskeletal dysfunction that limits ability to respond behind the wheel

    Generalized or specific frailty

    Other eyesight issues: such as glaucoma or cataracts (severe)

    Parkinson’s and other neuromuscular diseases

                                        This is an incomplete list
The link below is to the article I have taken some of this information to: Driving Retirement: Help with counseling older patients; Family Practice Recertification: Vol.29, No. 6, June 2007

                                http://www.fpronline.com/Article.cfm?ID=344