NEAL CONAN, HOST:
This is TALK OF THE NATION. I'm Neal Conan in Washington. For older drivers and their families, few decisions are more difficult than when or if to stop driving. For many, the car keys represent independence, and if they live alone or in areas with limited access to public transportation, a car makes an enormous difference.
While older Americans are generally safe drivers, that can change due to impaired vision, slower reflex or age-related illnesses like dementia. But giving up the keys can also lead to isolation and depression. Taking them away can disrupt families.
We want to hear from all sides of this conversation, older drivers and their kids. Tell us your story, 800-989-8255. Email us, firstname.lastname@example.org. You can also join the conversation on our website. Go to npr.org, and click on TALK OF THE NATION.
Let's begin with a caller, and Andrea(ph) is with us from Oakland.
CONAN: Hi, Andrea.
ANDREA: Well, my mom is 79, and we kind of broached the topic of at some point everybody stops driving. And so she knows it's in the air, but it's like the increasing she backs into poles, or she drives into, you know, like a ditch. And so it's now becoming increasingly apparent that if there's something unexpected or some increased event that she's really not safe anymore.
And I personally won't ride in a - I have to drive. I can't be a passenger in her car anymore. And so I don't know how many more little accidents. They're always property damage, no one's been hurt, but it's coming, and it's coming quicker than I think everybody recognized it would.
CONAN: And who's going to have to play the heavy?
ANDREA: Well, you know, my stepdad is kind of (unintelligible) does most of the driving. It'll probably be my sisters and I. She lives in a retirement community, but she's relatively active. She plays tennis, and it would be a big deal to, you know, have her rely on a shuttle or something like that. It would be a huge adjustment.
CONAN: And what about getting her doctor involved?
ANDREA: Well, you know, she sees pretty well, and so there's no - I mean, she has some arthritis and so some limited mobility, but overall she's physically pretty well. It's more - I think it's more of a cognitive disconnect that's starting to occur. And of course doctors don't always see that. So I don't know how we would get her doctor involved, to be honest.
CONAN: And have you and your siblings talked about it?
ANDREA: Yes, we all drive now when we go somewhere with Mom. We just feel safer, and she gets lost. She gets lots all the time and so if we kind of want to be somewhere on time, that's our - that's the guise is that oh we'll drive, you know, we'll pick you up. So I don't know if she even realizes that it's like we really don't want to ride with her anymore.
CONAN: And how soon do you think it's going to have to...
ANDREA: Oh, I would say, oh gosh, within the year is she continues to have these little fender-benders. You know, the garage is getting smaller and kind of all these things, so not too much longer. I don't want her to hurt someone else. I guess that's the biggest thing you have to step over is I wouldn't want Mom to inadvertently hurt someone else.
CONAN: Good luck with this, it's not going to be easy.
ANDREA: Thank you very much.
CONAN: Thanks for the call, Andrea.
CONAN: Elizabeth Dugan is an associate professor of gerontology at the University of Massachusetts, Boston and wrote the book "The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families." She joins us now from NPR member station WUMB in Boston. Nice to have you with us today.
ELIZABETH DUGAN: Hi, Neal, nice to be here.
CONAN: And I wonder, that story you just heard, that is not atypical in the least.
ANDREA: No, no, and Andrea's fortunate in some extent that the siblings are all on the same page. So there's not one person who's kind of in denial, but they all recognize a problem. I might recommend that she ask her mom, you know, at what point will you know you're no longer safe to drive and to put it into her mother's hands and say, you know, you see these problems accumulating, when will you know that it's time to hang up the keys and see if she has an end point in mind.
CONAN: And at least take the decision, maybe, out of - that's what nobody wants to do is to say I'm sorry, you can't drive anymore, give me the keys.
DUGAN: Right. That's so uncomfortable because you just think of all the things your parents have done for you, and then to turn around and have to be the heavy, as you said, or to try to impose your will on something that you may not be exactly certain when is it time to hang up the keys. If you can make it a shared decision, a partnership where you all have the same goal, you want the older person to be as active and to have as full a life as possible, but you also want that person to be safe and to not have the last chapter of their life marred by a terrible, tragic accident that could have been prevented.
If you're all in it together, then it makes talking about it and the solution a lot easier to deal with.
CONAN: Because it's not just - independence is important, but by taking away the keys, you're infantilizing them somehow.
DUGAN: Right, and look who picks up the rides. In most cases, it's family and friends. Most people don't all of the sudden when they stop driving hire a taxi or sign up for the senior ride. There just are insufficient resources available right now. So usually it's a family member who provides the rides.
So by being the heavy, you now sign up to have an extra job, and we're all busy enough as it is. So trying to manage this delicate dance between independence and public safety is really tough.
CONAN: David in Minneapolis sent us this email: When I had to have the conversation with my father regarding his driving, we agreed that if he could pass a written test and behind-the-wheel driver's license test administered by the DMV, we would wait two years to readdress the issue. That left the evaluation as to his ability to drive to a neutral third party that was also an expert.
Needless to say, after a month of consideration on his part, he conceded he would not be able to pass the test and willingly surrendered his keys. I should point out my folks lived in rural Wisconsin where there's no taxi or senior mobility service. So this was a decision that changed and saved lives.
And a lot of people would ask: Are there provisions in state laws - of course states administer these laws - to require older people to retake the test after a certain time?
DUGAN: It varies widely. So driving is regulated at the state level, and you see a range of approaches. There are two main policy approaches that are used. One concerns the license renewal, so how often do you come in to renew your license, what do you have to do? Do you have to pass some test? Is it a written test, a vision test, a road test?
And then the second component has to do with medical reporting procedures. Is it possible for physicians to submit reports for people who are too ill or have some impairment that threatens their driving fitness? And those two approaches are widely - the approach is just crazy across the country.
You see some states have very accelerated renewal cycles. Others, once you get your license, you're good for 10 or 15 years.
CONAN: Let's go next to Paul(ph), Paul is on the line with us from Orange Park in Florida.
PAUL: Yes, excellent program, very, very germane to the society we live in today where people are living longer. My dad lived alone for a number of years and had great coping skills. And one day he drove, simply drove off the side of a small country road he'd been driving on for 30 - more than 30 years into a creek.
And they took him to the hospital, and they wanted to check him out for symptoms of a concussion, and, you know, saw signs that he might be in early stages of dementia. And fortunately, my sister's an RN, and they asked her to come out and spend a few days with him, and he had days when he could do everything just fine and other days he couldn't figure out how to use a can opener.
What we did is we contacted the Pennsylvania, actually, state driver's license bureau and explained the situation to them, gave them the name of the primary care physician my dad used and, you know, suggested that he contact my dad and have him come in for a - just a checkup, you know. And so we kind of put the burden of, you know, telling him that he didn't think it would be safe for him to continue driving on the doctor, which the doctor, you know, willingly did.
And, you know, we were able to, you know, get his license revoked and, you know, state ID issued in place of it. And the car, actually, we actually asked our youngest brother to steal the car until the doctor's appointment, which worked out fine. But it's a nightmare.
I mean, the day that my two brothers and sister and I put my dad in a nursing home was one of the most difficult days of my life. You know, I felt like I was locking him up in prison, and that's exactly what he said: You're putting me in prison, you know.
And, you know, there is no easy way to deal with these kind of problems with your parents. You're going to suffer, you're going to cry, and, you know, watching somebody die of Alzheimer's is a slow, painful process. It took years for him to pass away. But you have to keep in mind that you have a responsibility to the public and to your parent to eliminate an unsafe situation.
And an unsafe situation exists when a man simply drives off the side of the road for no apparent reason, a road he'd been driving on for 30 years, like I said, and ended up, you know, at the bottom of the hill. But there's no easy way to do it. Contacting the state driver's license department is a good way to go because they probably, you know, are the best equipped to contact a physician.
And, you know, if you can get the physician to be the one to present the bad news, then the children, you know, have...
CONAN: Don't have to do it themselves.
CONAN: Paul, we're sorry for your loss.
PAUL: Thank you.
CONAN: I just wanted to ask Elizabeth Dugan, getting the state involved, well, the authorities are, well, the authorities.
DUGAN: Well, Paul, I thank you for sharing that, and it's so honest on so many levels, and that's exactly what people go through on this challenge. And fortunately your father survived that first crash. The risk of fatality with older drivers is much, much higher, so he was fortunate in that sense.
PAUL: Thank you. He didn't hit anybody. All he did was drive down the side of the hill and into a little stream.
DUGAN: Yeah, and, you know, I think this is rough now, but it'll be better in 15 or 20 years as we get the hang of dealing with our parents aging. So I'm optimistic as I look to the future, but this is as difficult as Paul has explained to us.
CONAN: We're talking about what happens when it's time to talk about hanging up the car keys. We want to hear from all sides of this conversation, older drivers and their children, 800-989-8255. Email email@example.com. Stay with us. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan. We're talking about older drivers and what happens when it's time to give up the car keys. It's important to remember, though, that teen drivers remain far more likely to be involved in a fatal crash compared with older drivers. That's based on miles driven.
The CDC reports that car accidents are the leading cause of death for U.S. teens, those between 16 and 19 years old. Any number of similar studies also tell us older drivers become increasingly likely to get into accidents once they reach 65. The rate goes up after 75 and 85 as well.
We want to hear from all sides of this conversation, about when to give up the car keys. Older drivers, their kids, tell us your story, 800-989-8255. Email firstname.lastname@example.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
Our guest is Elizabeth Dugan, she wrote the book "The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families." She's professor of gerontology at the University of Massachusetts, Boston. Canada approaches this issue in a more systematic way. In seven of 10 provinces, doctors are required to report concerns about a patient's ability to drive.
Ontario went a step further. Since 2006, they've paid doctors to warn any patients who may not be fit to drive. Dr. Donald Redelmeier is professor of medicine at the University of Toronto. He and his colleagues recently published a study in the New England Journal of Medicine that focused on Ontario and studied the effects of doctors' warnings to patients on the risk of serious car crashes. And Dr. Redelmeier joins us now from his office at the Sunnybrook Research Center in Toronto. Nice to have you with us today.
DONALD REDELMEIER: It's good to be here, Neal.
CONAN: And was there a drop in the accident rate among those who had been warned by their physicians?
REDELMEIER: Yeah, that was the main finding of our research, about a 40 to 50 percent reduction in subsequent - serious crashes, making these warnings way more effective than physician counseling about smoking cessation, exercise or weight loss.
CONAN: Do you have any information on what result there was? Did people give up their keys or drive more carefully?
REDELMEIER: I think that some of the results might reflect cessation of driving. Yet licenses were only suspended in about 10 to 30 percent of cases. Instead, the warnings might foster more adherence to effective medical treatments, as well as more mindfulness about basic road safety advice, like signaling turns, not speeding, yielding right away and so forth.
CONAN: And were there any significant statistical differences between men and women, rural, urban?
REDELMEIER: Yeah, we found that the warnings were particularly effective for elderly women of higher socioeconomic status who were living in rural regions, perhaps indicating a greater respect for the combination of physician and governmental authority.
CONAN: And does the doctor just warn the patient, or does the province get involved?
REDELMEIER: It's a combination of both things, very similar to the reporting of communicable infectious diseases like tuberculosis or meningitis. The physician has to both warn the patient, as well as notify the corresponding government agency.
CONAN: And what do they do?
REDELMEIER: They, you know, in most cases they send a rather threatening letter, which is a real blow to the patient's self-esteem, but they don't usually take away the person's license. They just take away their peace of mind.
CONAN: And you mentioned low self-esteem. There were some negative aspects, as well.
REDELMEIER: Yeah so that, you know, these warnings are never a joy to receive. So I mean in our study, we found they were followed by about a 25 percent increase in rates of depression amongst the patients, as well as about one in 10 individuals refused to go back and see that doctor ever again. They took their business elsewhere.
CONAN: So this is not necessarily a good business practice for physicians.
REDELMEIER: Well, it's - you know, I mean it's certainly different than in China. In China, in many regions, they just have a blanket prohibition against driving after the age of 70, no stigma, no surprise, and no initiative involved. Now, they make public transit free at age 60, and they build up a lot more alternatives in the community. Those sorts of policies would never fly in a democracy such as the United States or Canada.
CONAN: And as you look to the future, what do you expect is going to be the trend line in Canada?
REDELMEIER: Well, I think the analog is sort of the mandatory reporting of suspected child abuse, which is again a policy there's just no easy way to report that. And rates of adherence were very low in the '60s or '70s but very much now it's sort of a change. I would think that that sort of pattern is likely also to extend on to driving safety for the same rationale, that driving imposes risks on other people.
What's different now, though, isn't just the aging of the population but also the convenience of modern motor vehicles with automatic transmissions and power steering and electronic seats. It's so much easier to drive a car now than it was, say, 30 or 40 years ago. In the olden days, seniors just gave up driving; it was too exhausting, and the problem used to just solve itself.
CONAN: Donald Redelmeier, thanks very much for your time today.
REDELMEIER: Thanks for your interest in our research, Neal.
CONAN: Dr. Redelmeier, professor of medicine at the University of Toronto. His study "Physicians' Warnings for Unfit Drivers and the Risk of Trauma from Road Crashes" can be found in the September 27th issue of the New England Journal of Medicine. He joined us from his office there in Toronto.
And Elizabeth Dugan, in Boston, as he points out, our population is aging rapidly. This is going to become more and more of a problem.
DUGAN: It will. In less than a decade, we should - sorry, by 2030 we can expect the number of older drivers to double. So it's a problem that we're aware of now and we'll be even more aware of in the near term.
CONAN: And the kinds of solutions or approaches that he's talking about in Canada, as you said, it's all different; every single state in the United States seems to be different.
DUGAN: Right, and I think it's important to keep in mind that there is no magic policy, that we don't have a test yet that will determine who's safe or not or perfectly predict who's at risk. We don't have perfect adherence when someone does have to stop driving. So we need to think at multiple levels if we're really going to solve this problem.
Older drivers have to be comfortable and alert that there'll be a time when they may have to stop driving. Their family members have to be willing to talk about it. Their doctors have to be trained to assess and evaluate it. There should be referral patterns to occupational therapists who specialize in driving rehab, and we need policies uniformly at some level that will - we know that in-person renewal reduces fatalities for the oldest drivers, and yet we still have 14 states that don't require it.
So there's a number of changes that need to occur at every level of society.
CONAN: Let's get another caller in. This is Dale(ph), Dale's on the line from Iowa City.
DALE: Hello, thank you for taking my call. My heart goes out to the previous caller. My father also has Alzheimer's, and so after he was diagnosed, of course we had begun to see signs of dementia and those related problems, and he was having problems driving, just basic executive decisioning, having a lot of problems with that.
And when we started talking to mom, it probably took another year, year and a half to two years before he did stop driving. And that was very difficult. My mother really hasn't driven in about 15 years because they sort of have that traditional marriage where the guy drives and that sort of thing, and so she's taken over the driving, drives less often. So they're not getting out as much.
But she really doesn't have the practice required to be a good driver either. So myself and my siblings do what we can. I live two hours away, so that's difficult.
CONAN: And yeah, that's difficult. I understand, Elizabeth Dugan, you had a patient who lived even further away from a parent, and what advice did you have for her?
DUGAN: Yeah, this is really a tough case when you're geographically some distance away from an older person, and so what I recommend is the person walk around the car when they visit and see if there's accumulating dents and scrapes and that kind of thing.
And for this woman who was concerned, her father was a retired professor and very intelligent, successful and accomplished person. And like most professors, we think we know everything, so he wasn't very open to her help and meddling. But I gave her a three-point plan to tackle this, and the first was to talk about it. So to put it on the table that there is likely to be a day when he's not safe to drive. Has he thought about how he wants that to go and when he'll know he's not safe to drive?
Second, to get an assessment, so find out if this is a fixable problem. So with cognitive impairment it's not, but perhaps it's cataracts or medication or something with a vehicle that could be modified. So get a formal assessment. Occupational therapy has a subspecialty or special training in driving rehabilitation, and that's a great resource and not too expensive to get. So get a formal assessment and see if it's at all possible to remediate the skills that are causing the problem.
And the third is to plan for alternatives. So with cognitive impairment, it's not fixable, but in other cases it is. And for the person who has cease driving at that point or in the very near term, plan for the alternatives. So this caller is so fortunate that his mother is willing and able to pick up the driving responsibilities. And so, in that case, I would encourage her to take a driving class or to...
DALE: I think so.
DUGAN: ...do something to build her confidence as she, you know, takes more and more of the driving responsibility because this is a change for her as well. And so working out the alternatives can help the person to see that even though they are suffering this tough loss and transition that no one wants, that they can get through it and they can still have a full quality of life and do the things that are valuable to them.
DALE: Thank you very much.
CONAN: Dale, thanks very much, and I'm sorry for your situation.
DALE: Well, thank you.
CONAN: Here's an email from - this is Peter(ph) in Utah: In hindsight, we waited too long to take my father's keys away. We did not want to see the signs. It was not until he crashed the car into a fence that we were shocked into a sober appraisal of what was really happening. You do not always notice a slow decline.
Let's go next to Charles(ph), and Charles is with us from Fort Thomas in Kentucky.
CHARLES: Hello. Neal?
CHARLES: I wanted to be a representative of those that are being discussed, but are absent from this wonderful program. I have ceased to drive, and I've taken my transportation issues to public transportation, buses, and I'm up to walking 20, 25 miles a week. And I - I'm having a hard time understanding why there aren't more people like me who are saying, yes, there's cognitive impairment. I'll hope for the best and prepare for the worst.
And there are some freedoms that are involved in taking the initiative away from the children who obviously are extremely stressed and not dealing with the problem very well or soon enough. So I just took that problem away from my children.
CONAN: I wonder, Elizabeth Dugan, are there - this is certainly a subset.
DUGAN: Right. And what a guest, that you had the insight into taking control of the situation, making the change, finding alternatives. And - but just your increase in walking alone will be a positive benefit to your health and your safety. So this is a great example of a success, someone who took a look at the situation and decided for himself, you know, this is the time to make the change and to not put the family through, you know, what can be a wrenching conversation and difficult transition.
CONAN: And, Charles, I wonder, do you have a way to get a ride when you need one?
CHARLES: Yes. I occasionally rent a car to go to my son's university where he's going to school, and I take the other son with me. And, actually, one of them made a joke recently when we were waiting for the bus to go get groceries. He went along with me, which was so sweet. And I said, I've taken that problem away from you. You won't have to worry about being with me when I become a dangerous driver. And he said, you've always been a dangerous driver, Dad.
CONAN: Well, Charles, I hope you walk safely.
CHARLES: I am. I will. And there are many social and practical benefits from taking a chance and going out there and removing that difficulty from somebody who doesn't need to be stressed out.
CONAN: Thanks very much for the phone call.
CHARLES: You're welcome. Thank you, Neal. Thank you, Elizabeth.
CONAN: We're talking about older drivers and their families and the decision about when to take away or give up the keys. You're listening to TALK OF THE NATION from NPR News.
And let me reintroduce our guest: Elizabeth Dugan, associate professor of gerontology at the McCormack Graduate School at the University of Massachusetts Boston, author of "The Driving Dilemma: The Complete Resource Guide for Older Drivers and Their Families." And just mentioned, perhaps older drivers or non-drivers unrepresented in this program or underrepresented.
This from Jill(ph) in Lynchburg, Virginia: Children aren't the only ones that must deal with taking the keys away. I also addressed this with my husband, who's older than me and whose driving had reached the point of being unsafe. It was incredibly difficult as he refused to admit he could no longer drive safely. It didn't help that I could still drive safely. I was advised to take out the distributor of his car so he couldn't start it, but that only put a bandage on the situation. After much agony and tears over weeks of trying to help him see what the rest of us saw, he finally gave me the keys. I dread having to deal with this with my parents.
So this is a situation that goes on and on. Let's go next to - this is Deborah(ph), Deborah with us from the Bay Area in California.
DEBORAH: Yes. I'm loving the show. I am actually taking a three-and-a-half-hour drive up to my elderly parents. They're in their late 80s, and the driving is something we've been talking about for several years. My father has expressed how that will take his independence away. It's time to take it away, and I appreciate the people that suggested letting the DMV do it because that was my idea. And I approached my mother on the subject the other day, and she is willing to go and take a written and driving test. And now, in a couple of hours, I am hoping my father will agree to the same thing.
But on your comment with checking with the doctors, I would like to give a little word of warning to people. I started noticing some things in my parents about two and a half, three years ago. And at that time, I started going to the doctor with them, and what I noticed was none of their doctors - the first doctor that I met with was very surprised that I was there and he said, you have very great parents and there was no need for you to come. My father has no short-term memory, and my mother is in the process cognitively of losing her short-term memory, and she's also very confused.
Now if a doctor can't see that and I wasn't there with them, they'd still be doing their doctor visits on their own, not taking the medications they're supposed to be taking because they couldn't remember by the time they walked out of his office.
CONAN: Well, Deborah, good luck with the talk.
DEBORAH: Bye. Thank you.
CONAN: Drive safely yourself, OK? Our thanks as well to Elizabeth Dugan up there in Boston at member station WUMB. Thanks very much.
DUGAN: Thank you, Neal.
CONAN: Coming up, we'll talk with a former CIA thief, Douglas Groat, about breaking into embassies and stealing secret codes. Stay with us. It's the TALK OF THE NATION from NPR News.