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When to Give Up Driving and move to Assisted Living?

WHEN TO GIVE UP DRIVING? Story submission by blogger:   

When she was in her mid-1980s, my mother's car keys and license were taken away from her by a police officer who found her driving the wrong way down a major road at night. At first she was very angry but eventually, with the help of a social worker, she accepted the wisdom of giving up driving. This event turned out to be a blessing, but I shudder to think what kind of accident might have happened. I do think that at some point perhaps age 80 drivers should be routinely checked like the woman in the video by either their doctors or the DMV. We test younger drivers before allowing them to drive; I think testing older drivers is equally valid. Older drivers are far more likely to accept a decision from an authority figure such as a doctor or police officer than one of their grown children. (Spell checked sm)   Dr McGivney’s reply: The topic of what to do and how to help a senior balance personal freedom and loss of control over their life with risk to themselves and others when the time comes to give up driving is a difficult issue.  I had the same issues with many residents and both of my parents.

Negotiated Risk Agreement - Drive until you have two bad events.

 My approach was to set a standard of they can drive until they have two bad events. Then we will agree to take the keys. That way it is not just I am taking that life line away from her but am doing a more sensitive negotiated risk agreement that is based on events.

Senior adapt well, Don't just throw them under the buss or car.

 We all adapt in many ways and seniors drive slow, go during the day when traffic is less, and have other ways to adapt. Their feelings even if they rarely drive or drive only when you are in the car are also powerful things to consider and help them maintain control over what are small thing to you but big things for her.

Balance Senior and Societies Safety with Seniors Rights to life, independence, and Control over life.  This decision may be considered  more of a restraint that a wheelchair seat belt that might be needed but is deemed "unsafe" in many cases.  

Seniors have a right to take risk that is called Living!  Risks are choices and Seniors have a right to choose.  We can try to protect them but do not err on the side of controlling them.  I find that in many cases the use of the word safety is for the care persons convenience.  Would you give me your care keys at age 20 if I wanted to protect you from the leading cause of death up to age 40, Accidents and Motor Vehicle Accidents is number one. ?

Senior and society safety.  

My mom and dad drove well within their skills as most seniors do. One can easily make the case of young people who often do not know their limitations especially at night or after a social drink or two, and might be more reckless than a senior who is being extra cautious not to loose that valued privilege and element of control over their life. Even the thought that they might drive has a lot of value to them. In the end both mom and dad had several events and agreed reluctantly to give up driving. Fortunately, for them we took them with us everywhere to ease the burden.

Loss of control over life when they are forced to give up health and mobility.

For those faced with having to move to a new care setting what ever it may be ( moving with a different relative, Assisted Living, Residential Care Home, Home Care, Hospice Care, Dementia Care, Alzheimer's or Memory Care)  they need to evaluate how much continuity of care and ability to maintain control they will have in that setting. That is a very difficult thing.  Indeed, finding the care team that can help but not sacrifice a seniors control over life is the things seniors value most.  It is not safety, cleanliness, pain control, but control over your own life that seniors worry about most.  That fear of loss of control and independence also is related to another feeling of abandonment.  if you can't do for your self and do need any level of assistance you are at risk of feeling abandoned.  I believe we all covet - Freedom, Independence, Right to choose and live.  If they want ice cream why can a doctor or care setting tell them they "can't" have ice cream because it is "bad" for their health when they choose their entire life to eat it.?  Or drive.  Of course, there is a wide scale upon which to balance Freedom and right to choose.  Each senior and family needs to exercise that right BEFORE THEY CHOOSE A CARE SETTING by meeting the actual care staff who will be "helping" them.   Choosing a care setting is choosing the amount of independence and freedom you will have for the rest of your life.  BE CLEAR, IT IS THE STAFF, ADMINISTRATOR, OWNER, of the new care setting or your family care giver who will assert a lot of control over your life when this move arises.  Choose the care team wisely.  Do not focus on the color of the sofa, or the physical plant, that is less likely to help or control you.

Give Seniors an equal playing field.

 My own opinion as a senior advocate and doctor on your mother case and not knowing all the details is that many people drive the wrong way on a one way street and I would prefer not to let a police officer hold your mom to a standard that was higher than for any other person. If a young, drunk driver, often times with no remorse or recognition of the event, drove on a one way street at night that would not result in a mandatory loss of the license. Of course if your mother had no insight to the problem and the danger of what happened and could not rationalize the limit setting plan and had a long string of events then I fully understand. I just like to discuss many options so that each family and continuity of care team can work within some social system to be fair and safe to all. Thanks, we can work together to help others. Your story and my story will start the string. Spread the word. By Shawn McGivney MD, RFA

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