Saturday, November 6, 2010

How to Approach Your Parents With Concerns About Their Driving Ability

How to Approach Your Parents with Concerns about Their Driving Ability

Initiating a dialogue about safe driving

If you have concerns about a family member's ability to drive, addressing them promptly could be a matter of life and death. It may be tempting to procrastinate -- to talk to him or her next week or before the first snowfall, for example — but think how you'd feel if the delay led to an automobile accident that resulted in a serious injury or death.

Considering the possible consequences should help you overcome your hesitation -- but that doesn't mean it will be easy. It's awkward and painful to have to inform older family members that they aren't capable of doing something as basic and essential as driving the car. For them, it's another humiliating reminder of their growing inability to take care of themselves and manage the tasks of daily life.

As difficult as it is, if you have reason to believe that your parent, spouse, or other family member could be dangerous behind the wheel, it's important to deal with the issue sooner rather than later -- because later could be too late.

Before you talk to someone about driving safety

It's a good idea to plan how you're going to approach the subject before bringing it up. Take time to consider how the situation looks from the driver's point of view and what driving means to him. In his book How to Say It to Seniors, geriatric expert David Solie points out that because elderly people face so many losses at this stage of life, they tend to rigidly control the few things they can. This struggle for control will almost certainly come into play where driving is concerned, because giving up the car keys could affect where they live, who they see, and what interests and activities they can pursue. To you, this decision is a simple matter of good sense and safety; for them, it represents the end of life as they've always known it.

Elizabeth Dugan, a geriatric researcher who wrote the book The Driving Dilemma, reports that a colleague stopped using his car for two weeks before talking to his elderly father about driving safety. His carless weeks gave him firsthand experience of the inconvenience and lack of mobility that his father was going to have to endure. You may not want to give up your car before your talk with your parents or other family members, but you should give some thought to the emotional and practical issues they'll face when they give up driving.

Preparing for the discussion also means approaching it with realistic expectations. If you assume that one discussion will neatly resolve the matter, you're bound to be disappointed. Given how charged the driving issue is, you need to think of this as a process that will take some adjustment and fine-tuning. Consider this a preliminary discussion only: a way to get the issue out on the table so it can be dealt with openly.

Finally, prepare for the discussion by considering your own role. Remember that it's not up to you to convince your parent or other family member to immediately cease driving, even if you think this is the best course of action. Unless the driver you're concerned about has dementia or is otherwise incapacitated (see below), it's best to respect his right to make decisions about his life -- with your input and support.

How to talk to someone about driving safety

Plan your discussion for a quiet time of day, when you and the driver you're concerned about is relaxed and rested and no one has any deadlines or commitments pending.

When you introduce the subject, try to avoid coming on too strong, or you'll set the discussion off on the wrong foot. You may feel a keen sense of urgency, but if you jump right in with, "You have to stop driving, Dad! You're going to kill someone!" he'll probably either get angry or tune you out.
Remember that if you've noticed that your father's driving has grown erratic and sloppy, he's probably aware of it, too. You can be most helpful at this point by helping him express and work through his own concerns.

A good way to do this is to initiate the discussion with a question. For instance, if you know that your father has received a traffic ticket, ask him about it, and then follow up with another question like, "How are you doing with your driving, Dad? Are you finding it a little difficult to manage?"

At this point, your father may respond by pointing out all the practical reasons he can't stop driving ("What about my weekly golf game?" or "Your mother's physical therapy appointments are clear across town!"). Without directly answering your question about his driving ability, he's already making the case for why he can't stop. This is valuable information because it provides a glimpse of his own internal struggle: He knows that he's having trouble driving safely but can't fathom how he and your mother will manage without a car.

Encourage your father to discuss his concerns without immediately jumping in with solutions ("I'm sure Jack or Stan will be happy to drive you to the golf course." "The bus goes right by the physical therapy office."). It's usually counterproductive to offer reassurances ("Don't worry, Dad, it will all work out fine."). Such responses may offer temporary comfort, but they won't help you or your parent or other family member explore the larger issues involved.

Instead, you can help your father express his fears by using "reflective listening," a technique Elizabeth Dugan recommends when talking about driving and other difficult issues with an elderly parent or other older adult. Reflective listening -- which essentially means rephrasing what the person has said -- conveys support and encouragement and helps the speaker gain insight about his experience.

To use reflective listening in the example above, you could say something like, "Dad, I know you're probably worried that giving up driving would mean you have to give up some of your usual activities." This type of response will encourage your father to keep talking about his worries and reflect upon them, which is an important step in working through major problems and transitions.

Driving down memory lane

When reflecting about driving and its role in the driver's life, don't be surprised if he or she begins to talk about the past. He may reminisce about his honeymoon road trip to the Grand Canyon or recall how he saved up money for his first car or taught you how to drive. Resist the temptation to interrupt and get him back on track. Instead, try to encourage the reminiscences by asking questions or even requesting to see photos. Sifting through memories will help your parent or other family member come to terms with this life transition as he reflects on the role driving has played in his life and gradually accept the fact that he'll soon have to give it up.

As the discussion progresses, ask him directly what he thinks he should do about driving. You may want to help him jot down some of the pros and cons of the alternatives he faces. This approach can help someone realize that there are actually some benefits to not driving (tremendous savings on auto insurance, car maintenance, and gasoline, for example). It also may help focus him on the stark consequences -- such as a fatal accident -- that could result from maintaining the status quo.

Depending on how everyone is feeling, this might be a good point to put the discussion on temporary hold. Agree to meet again in a couple of days, after you've all had a chance to reflect on the various options. (You might want to set a specific time to meet to ensure that it happens.)

Of course, there's no telling how the discussion will unfold, since that will have a lot to do with factors unique to your family's situation. But the discussion is much more likely to be productive and positive if you approach it with a genuine desire to learn more about your family member's experiences, ideas, and concerns.

Next steps: what to do before someone gives up driving

Identify the problem.If your parent or other family member acknowledges that he's having difficulty driving, find out the specific problems. Make appointments with his physician and eye doctor, and be sure to ask about medication, side effects, and drug interactions. It's possible that the problem can be remedied with a change in medication or a stronger pair of glasses. Make sure his car is suited to his needs and physical abilities, and ask his doctor if assistive devices might help address driving difficulties.

Discuss interim measures, if possible.Once you determine the source of the problem, you can decide what to do next. His physician might suggest that he limit driving to daylight hours or essential errands. If he's going to continue to drive at all, it's a good idea for him to brush up on his driving skills and the traffic laws by taking a senior driving refresher course. AARP, AAA, and commercial driving schools all offer such courses. Agree to revisit the decision every few months to see how it's going.

Help explore other transportation options: whether or not your parent or other family member has to give up the car keys immediately, it's a good idea to help him become familiar with other transportation options. Take the bus with him if he's apprehensive and help him find out more about local senior transportation services. Encourage him to carpool with friends.

Take a break if your parent or other family member refuses to address the issue of driving safety. He may become angry when you try to talk about driving or refuse to discuss it, so it's a good idea to temporarily drop the issue. There's no point in engaging in a battle -- it will only make him more resistant. Give the matter some time, and then bring it up again in a week or so. You may find that he's become more receptive to discussing the matter over time, as he grows used to the idea and realize that the risks of continuing to drive outweigh the benefits.

If you're convinced that your parent, spouse, or other family member poses an immediate risk to himself or others, be prepared to take action, whether he's receptive or not. If he agrees, go with him to talk the matter over with his physician. You can also request permission from him to talk to his physician yourself. (Under patient privacy laws, a physician can't disclose information about a patient's health without written permission from the patient, unless the person requesting the information has power of attorney.) If the physician shares your concern, she may be willing to talk to him herself. If this doesn't work, you can contact your local Department of Motor Vehicles (DMV) and, if possible, anonymously issue a safety complaint.

The DMV routinely gives older drivers driving and written tests as a requirement for license renewal. If a driver fails such tests, his license can be suspended or revoked. In some cases, the DMV puts restrictions on an elderly person's license, forbidding him to drive after dark or on the highway, usually because of vision problems. If the DMV receives a complaint about an elderly driver, either from a private citizen, a police officer, or a physician, the driver will be asked to submit to a medical evaluation. Depending on the results of that evaluation and further investigation and evaluation by the DMV, the elderly driver's license could be restricted, suspended, or revoked.

Dementia. If your parent or other family member has dementia, the driving issue is even more urgent. The effects and progress of dementia can be subtle, but they can also have a corrosive effect on decision making and good judgment. A person with dementia may believe that he can drive safely and insist on doing so, no matter how badly impaired he is. For these reasons, if the person you're concerned about is diagnosed with dementia, he should receive a driving safety evaluation from the DMV. Some people with mild dementia can continue to drive, but if dementia is moderate to severe, the individual should stop driving altogether.

Be there. Wherever your parents or other family members are on the driving continuum -- whether they're still driving, driving with restrictions, or must give up driving altogether -- you can play a valuable role. Most elderly people dread giving up their car because they fear that it will cut them off from their community and activities they enjoy. Your loving, active participation in their lives will reassure them that ceasing to drive doesn't have to sentence them to isolation and boredom. Make it a habit to check in on them often, just to chat or share some news. Offer to drive them to the activities they enjoy when you can -- or help find someone who can. Include them in family outings, like your children's school events or a day at the beach. Encourage them to try taking the bus on their next trip to the pharmacy, or to walk, if it isn't too far away, and offer to go with them if you can. Urge them to ask for rides from friends and to reciprocate themselves. Help them develop new routines and interests that don't require driving, like gardening, walking, or swimming at the local pool. Your support and involvement in their lives will make giving up the car a far less lonely and frightening prospect.

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