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Now, the population of Americans over 65 is rapidly growing. And statistics tell us that 65 is the age when car accidents increase dramatically. The decision to quit driving can be a wrenching choice - not only for the elderly, but also for their families. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: Legally, you can drive as long as you can get in the car, turn on the ignition, and go. There are no state laws that say drivers of a certain age should give up their license. Dr. Marian Betz, an ER doctor at the University of Colorado Hospital, says it can be challenging to figure out when an older driver isn't safe on the road.

DR. MARIAN BETZ: What's so hard about this issue is that there's no one age when someone's unsafe; so certainly, there are 50 year olds who probably should be off the road, and there are 90-year-olds who might be fine.

NEIGHMOND: Many states require people over 70 to renew their license in person. Some require vision tests. A handful insists doctors alert authorities if they diagnose dementia, or other conditions that could impair driving.

But geriatric social worker Bunni Dybnis says it's typically family members who are the best judge of whether an older person's driving has deteriorated. They can start with the car itself.

BUNNI DYBNIS: You look at the car for dents; if you see traffic tickets; if you get that call from the hairdresser that they've been to every week and all of a sudden, they didn't show up, and you find out they got lost getting there.

NEIGHMOND: Then there's the tried-and-true test, says Dybnis.

DYBNIS: I see older children saying, "Well my mom's driving, and she only goes to the hairdresser and the market, and she's really fine. But I would never let my children drive with her, and I'm starting to get afraid to drive with her"; and gee, we're not willing to risk our own life or our children's, but maybe somebody else, and maybe our parents' lives. So that's a huge red flag.

NEIGHMOND: Doctors can also evaluate age-related problems in vision and hearing. Some can be remedied - cataracts removed, hearing aids added. Others are more serious - slow reflexes, lack of peripheral vision, memory problems. Take for example, the parents of Dan Nainan. Nainan is a really funny guy; a comedian who travels cross-country. But there was nothing funny about what recently happened to his 82-year-old dad.

DAN NAINAN: One day, I got a call. And he was in a parking lot. And I guess he had accelerated into a brick wall, and totaled his car.

NEIGHMOND: Motor vehicle authorities took his license away. But Nainan's 79-year-old mother was still on the road. So Nainan got in the car and took a ride with her. He discovered she couldn't stay in her lane, make a U-turn, or remember where she lived.

NAINAN: That's when I decided that if she were to drive, she'd either kill herself or somebody else, or both. And obviously, you know, being a good son, I didn't want that to happen.

NEIGHMOND: So Nainan contacted the state's motor vehicle department.

NAINAN: I said hey - you know - I want to report, you know, someone like, an old person who's like, driving really erratically and they're - it's really, really dangerous, you know; you'll have to get this person off the road. (LAUGHTER) And I mean, I feel kind of bad because I was turning in my own mother but, you know, I was doing it for her own good.

NEIGHMOND: The state requested Nainan's mother to come in for a driving test. Ultimately, her license was not renewed. Like Nainan, most people don't want to blow the whistle on their parents; which is why Dr. Marian Betz says it's best to have the conversation early - when you're in your 60s, and mentally healthy. She suggests an advance driving directive.

DYBNIS: Let's say Dad's memory is going, and he probably shouldn't be on the road anymore. If he had written down that he trusted his oldest son to help him make the decision, then maybe having that on a piece of paper will make it easier for the son to go to the dad and say look, you told me to take away your keys.

NEIGHMOND: And, if that happens, find an alternative. Hire a driver; drive yourself; investigate public services. Bottom line: Don't leave an older, non-driving adult feeling stuck or isolated.

Patti Neighmond, NPR News.

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