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    Older Drivers: The Car Key Decision

    As the number of older drivers increases as the population ages, the question arises more often: When should the car keys be taken away to ensure the safety of older drivers -- and others on the road?

    When It's Time to Quit

    If an older driver's declining skills are beyond help, the best solution is helping family and friends convince the drivers to hang up their keys for safety's sake. While some older drivers relinquish their driving privileges on their own, most need to be persuaded to stop driving by a relative or doctor.

    To get a driver off the road, police officers, doctors, social workers, and family members can file a hazardous driver report (in some states, anonymously) with the state Department of Motor Vehicles. The DMV is then, in effect, the "bad guy." When they revoke a license, most people will comply, if bitterly, according to Nancy Wexler, MA, MFCC, a founding member of the National Association of Professional Geriatric Care Managers, which helps families arrange for long-term care and other services.

    Doctors, for their part, would prefer to limit their involvement to patient counseling. Despite a proposal of its Council on Ethical and Judicial Affairs stating that the reporting of impaired drivers is an "ethical obligation" of a physician, representatives to the American Medical Association twice rejected that position at the urging of many medical societies, including the American Academy of Ophthalmology.

    "We were concerned that patients with potentially blinding diseases would not seek the medical care they might need to halt progression of vision loss once they learned their physician was obligated to turn them in to the DMV," says Craig H. Kliger, MD, a representative of the ophthalmology academy to the AMA. The AMA eventually adopted language that made it "ethically acceptable and desirable" to report an impaired driver, but not mandatory -- except where required by law.

    But if the DMV is not involved, or the driver's doctor is unsuccessful in convincing the patient, more creative solutions are needed. Wexler recalls a man in his 80s suffering from dementia who refused to stop driving. Finally, the family asked a distant relative who was a police officer to come to the house and tell the man that his insurance had lapsed and his car was going to be removed. The man agreed to stop driving and instead of being angry with his family, called his son to complain about what the police had done. "If the person respects authority, this can work," says Wexler.

    Mr C is finally off the road, too. His son came to visit and told his father he couldn't drive any longer. Oddly, Mr. C seemed relieved, says Gauthier, the retirement community's assistant manager. "He says, 'Well, my doctor kind of said I shouldn't be driving. ... ' " And he had been thinking about giving his car to his grandson, anyway.

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    Reviewed on July 17, 2003

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