Lewis Morgenstern, a professor of neurology, neurosurgery, and emergency medicine at the University of Michigan, has a clear plan for when he turns 65 in four years – he's going to sign an advance directive for driving. This directive will empower his children to make decisions about his driving when the time comes, acknowledging that he may not be the best judge of his driving capabilities at a certain point.
Morgenstern's decision is based on a thoughtful consideration of the often-debated issue of when older adults should stop driving. He co-authored a recent article in the Journal of the American Geriatrics Society, revealing that 61% of older adults with cognitive impairment continued driving, even as 36% of their caregivers expressed concerns about their performance.
The lack of national standards on when seniors should relinquish their car keys raises concerns, especially with the aging population. In 2021, almost 50 million individuals aged 65 and older held driver's licenses, marking a 38% increase from 2012. As this demographic continues to grow, addressing the risks associated with aging and driving becomes crucial.
While older adults generally drive safely, the risks escalate with age and the onset of conditions like arthritis, glaucoma, and Parkinson's disease. Cognitive impairment and dementia pose additional challenges due to compromised decision-making, attention, judgment, and risk assessment.
Lewis Morgenstern's personal connection to this issue stems from his father-in-law's experience with Alzheimer's disease, where he remained convinced of his driving fitness despite evidence to the contrary. Morgenstern advocates for advance directives for driving, suggesting several types that involve family members in the decision-making process.
One type of directive involves appointing a family member or friend to discuss the person's driving safety. Another, endorsed by the Alzheimer's Association, acknowledges that individuals with dementia may forget they cannot drive and gives permission to take actions, including removing or disabling their car, to ensure safety.
Occupational therapists, like Lori Dee Grismore at the University of South Florida Health, conduct comprehensive evaluations to assess seniors' driving capabilities. Grismore's evaluations include interviews, medical history reviews, vision exams, physical assessments, and cognitive tests. While most older adults with mild cognitive impairment pass these tests, Grismore often recommends periodic retesting and imposing restrictions to enhance safety.
However, these evaluations come with a cost, and Medicare does not cover them, creating a barrier for seniors with limited incomes. Elin Schold Davis, who coordinates the Older Driver Initiative, encourages planning for changing transportation needs in later years, emphasizing the emotional aspect of driving independence. She recommends seeking evaluations when cognitive impairment is diagnosed or when family members notice problems.
In conclusion, addressing the challenges of aging and driving requires a proactive approach, including advance directives, comprehensive evaluations, and planning for changing transportation needs in later years. By embracing these strategies, older adults can maintain choice and control over their mobility while ensuring safety on the road.
