Dad’s Driving is Driving Me Crazy: Don’t Forget to Check Your Blind Spot

Sep 14

By Gary Moak, M.D.

Author Gary Moak, M.D. writes a brief essay about unsafe older drivers, a major theme of his story set to be published soon in Issue 8.

Gary S. Moak, M.D. is a geriatric psychiatrist with many years of experience working with older adults and their families. He is associate professor of psychiatry at the Geisel Medical School at Dartmouth and director of the Geriatric Psychiatry Fellowship Program at Dartmouth-Hitchcock Medical Center. Dr. Moak is a past president of the American Association for Geriatric Psychiatry. He is author of the book, Beat Depression to Stay Healthier and Live Longer: A Guide for Older Adults and Their Families, published by Roman & Littlefield.

Have you ever cringed while watching an elderly driver ahead of you swerve in and out of his lane? Been horrified by headlines about elderly drivers careening onto sidewalks and running over pedestrians? Lost sleep worrying about the impaired driving of your aged parent? The children of some of my patients tell me they do. Some are emotional wrecks by the time they seek my help. I am a geriatric psychiatrist.

Eye doctors have it easy. If you can’t read far enough down the Snellen Eye Chart, you can’t drive. It’s black and white (pun intended). There’s little wiggle room for negotiation.

Poor vision is one of many old-age health problems, physical and mental, that can sap older adults of the vigor, slow them down, or stop them in their tracks. When this leads to a loss of independence, some navigate this crisis with wisdom, dignity, and equanimity. If they must give up driving, they bow out gracefully. Many others have a harder time.

In contrast to failing vision, things are murkier and messier when driving safety is compromised by slowed reaction time, poor memory, distorted perceptions of speed and distance, or impulsive or errant decision-making. Cognitive impairment also can bring about a psychological deficit called anosognosia, the inability to recognize that one has a problem, physical or mental. When this prevents older drivers from acknowledging that they are not safe behind the wheel things can get ugly fast. Especially for older men, who, on average, have a harder surrendering the keys than do women. For the generation that came of age in the heyday of the car culture of the 1950s and 1960s, no longer being able to drive frequently represents more than a minor inconvenience. Rather, it becomes a huge psychological loss; of Independence, autonomy, freedom, and self-esteem.

In my experience, family members’ attempts to cajole and convince older loved ones to quit driving often trigger unintended and unexpected defensive reactions. Denial, outrage, and distrust are common and turn adamant. People react in unpredictable, uncharacteristic, and unreasonable ways. I have treated patients who turned on family members with overt hostility and distrust. Some developed paranoid delusions about the ulterior motives of their family members. I’ve seen violence break out and estrangement occur. Family members feel dragged under the wheels of a damned-if-you-do-damned-if-you-do hit-and-run.

Neither cognitive impairment nor driving impairment is an inevitable outcome of old age. You might find it surprising that, on average, older drivers are safer than teenage drivers. Unlike teens, however, older adults are vulnerable to a range of chronic health problems that can impact driving ability. Unsafe driving among older adults is a growing problem in all countries with sizeable geriatric populations and high percentages of automobile ownership. The stakes are higher than with other risks related to old age because other people get injured, not only the older drivers. Other motorists and pedestrians become victims. Some die. Some are children. And it’s public: the police get involved; the news media pays attention. Motor vehicle authorities (the despised DMV), law enforcement, and other organs of government naturally focus on public safety. Families, too, worry about safety. Some also worry about legal liability – criminal charges get pressed and wrongful injury lawsuits are brought.

Families fret and wring their hands but, in my experience, few seem prepared to deal with the emotional pileup that their older relative is barreling into. Some spring into action, arranging transportation for their newly stranded relative, as if this will make everything right. Others become paralyzed, frozen, and unable to act. I’ve lost track of how many times I’ve heard family members say, “If I take away Dad’s keys it’ll kill him.” They dither and do nothing. Either way, there’s a failure to help the older adult pull over in an emotionally and psychologically safe way.

Of course, safety is job number one. But reflexive measures grounded in stereotypes, ignorance, or frank ageism are not the answer. Older adults comprise the most heterogeneous age strata of the population so one-size-fits-all solutions are unfair and prejudiced.

Driving impairment should be approached on a case-by-case basis as a healthcare problem requiring comprehensive medical evaluation. Not every older driver who gets lost, is pulled over repeatedly for moving violations, or whose car has unexplained dents and dings needs to give up driving. Some causes of driving impairment, such as diabetes, chronic lung disease, heart disease, arthritis, Parkinson’s disease, anxiety, depression, and bipolar disorder, can be treated. With proper geriatric medical or psychiatric intervention, driving ability often can be restored to safe levels. Even those with Alzheimer’s disease sometimes can improve enough with treatment to keep driving a little longer. It's not always easy, though, to find the requisite geriatric expertise, but this is the first step.

The second step, facing the emotional fallout and helping the older driver cope with it, is more difficult. To many older adults, having to give up driving feels like an ominous warning that the road of life is closed ahead, coming to a dead end. Dealing with the DMV can be confusing and Kafkaesque, adding insult to injury and leaving many bitter and resentful. And this may represent only the tip of the iceberg.

Studies show that driving cessation is a risk factor for a range of health problems in old age. Giving up driving is associated with increasing social isolation and loneliness. Clinical depression, accelerated cognitive decline, deteriorating physical health, worsening disability and premature death follow. Fears that taking away Dad’s keys will kill him are not that far off the mark.

In getting unsafe older drivers off the road let’s not leave them stranded by the side of it waiting for the senior van to pick them up. Let’s stop pretending that it’s no big deal. "Dad doesn't go anyplace any longer, anyway." "At his age, where does he have to go?" I hear such statements from family members all the time. They're surprised when their relative gets upset about being asked for the keys to the car or after receiving a formal license-revocation letter from the DMV. They resort to common sense appeals, pointing out that in practical terms not driving is no big deal. To the older adults whom I have worked with this smacks of insensitivity. Rationalizing that riding the senior van solves the problem, while true at one level, usually adds insult to injury at another. Bingo at the senior center is not everyone’s cup of tea. For many, having to give up driving is a big deal and there’s no way to make it not hurt. What’s needed is a healthy measure of understanding, empathy, and support.

Readers of Réapparition Journal who have grappled with these thorny dilemmas may find much that is familiar in my short story, Mercury Descending, scheduled to appear in Réapparition Journal’s eighth issue. Mercury Descending is about a ninety-one-year-old, highly decorated, Korean War combat veteran who struggles with the loss of his driver’s license and the physical and mental decline that brought it about. Narrated from the point of view of his neighbors, a young couple with small children, it depicts how their ageist insensitivity and indifference to him evolve, or fail to, as they get to know him personally and hear his life story.

I’m grateful to the editors of Réapparition Journal for their decision to publish Mercury Descending, and I hope that you choose to read it.