Here are some things for relatives and caregivers to think about if they want a loved one with a neurologic condition to stop driving or if they anticipate that happening in the future.
Look into advance directives. Advance directives exist for health care decisions; they also can be made for driving. An advance directive for driving is typically prepared when a person is in good health; it authorizes somebody—usually a family member or friend—to decide when it's time for that person to retire the keys. The document must clearly state that the decision to stop driving will be made by the designee rather than the driver, says Lewis Morgenstern, MD, FAAN, professor of neurology, neurosurgery, and emergency medicine at the University of Michigan School of Public Health in Ann Arbor.
Request an assessment. As people age, they should get their driving skills evaluated regularly, says Elin Schold Davis, coordinator of the older driver initiative at the American Occupational Therapy Association (AOTA). They should check with their doctors first to see if they have any physical or mental changes that might affect driving. They can complete the self-rated driving assessment offered by the American Automobile Association (AAA) to see if they are still safe to drive, or take a mock written test and simulated driving test online. In addition, the AOTA has a national database of driving programs and specialists. During an evaluation, an occupational therapist (OT) tests functional, visual, cognitive, perceptual, and physical abilities and interviews seniors about their driving behaviors. OTs also review a person's medical history and conduct a vision test, a physical examination, and a series of cognitive tests. Depending on the results, OTs might recommend driver rehabilitation or license revocation. For a fee, professional driving centers and driving schools also will oversee an assessment of someone's fitness to drive.
File a DMV report. If no amount of discussion or professional evaluation persuades the person to give up the keys, an “unsafe driver” report can be filed with the state department of motor vehicles (DMV). Ideally this report would be filed by a doctor or other health care provider, but almost all states allow family members to do so, and 38 states allow friends or acquaintances to file. “Be prepared to provide a comprehensive explanation outlining the concerns,” says Gary J. Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, NY. “The DMV will expect a detailed account, including medical information.” The AAA and some DMVs can require an evaluation of a driver whose deteriorating skills and abilities have been brought to their attention.
Lose the car. In some cases, it's necessary to remove the car from the person's possession or property. That might mean selling it, asking a friend to store it, or moving it elsewhere. If that's not an option, some caregivers will hide the keys, unhook the battery cables, or take off the distributor caps on older cars. “These approaches should never be used as the first line of defense,” says Dr. Kennedy. “But even with a revoked license, people may try to continue to drive.”
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