Advising the older patient about driving retirement

For most older adults, driving cessation is inevitable. Yet, medical professionals often find the topic difficult to discuss with older patients. Because there is not a specific age at which people should stop driving, the clinician needs to trust older driver’s physical and cognitive assessments and concerns communicated by family members or caregivers. The clinician’s responsibility to public safety can seemingly conflict with maintaining patient trust, autonomy, and self-esteem. However, public safety aligns with patient safety, and that should be a key concern for medical professionals.

The Perspective of the Older Adult

A recent survey found that older adults agreed that physicians and family members should help make driving decisions. In fact, older drivers cite input from these two groups as their most common reasons for driving cessation. Studies also indicate that patients want discussions about fitness for driving in the healthcare setting—either by a physician, nurse, or other member of the clinical team. In addition, older drivers report that they would consider a driving evaluation if recommended by their physician.[1] One study showed a 45 percent reduction in the annual rate of crash injury in medically unfit drivers after they received warnings from their physician. The benefits of clinician intervention to both patient care and public safety are verifiable.[2]

Consider if driving retirement is not well managed, older adults can suffer negative physical and emotional consequences, which include increased isolation and lack of control. For example, five recent studies indicate that driving cessation nearly doubles the risk of greater depressive symptoms in older adults.[3]

The clinician can serve as an advocate for the patient, offering a well-planned and compassionate discussion that offers options, alleviates stress, and results in solutions amenable to the drivers and those individuals supporting the older driver.

Start the Conversation Early

A clinician can initiate a discussion about driving before cessation is required. Medical professionals can “plant the seed” about safe driving in an older adult’s mind years before the onset of any problems. Ask simple questions, such as “did you drive here today,” and “are you having any challenges driving that we could address today?” Making driving a routine topic in an older patients’ annual wellness visits paves the way for later discussions about safe driving and cessation. This type of discussion eases discomfort and surprise later when “giving up the keys” becomes a possibility.

Medical professionals can recommend tools to support the older driver in decision-making for driving reduction or cessation. The ChORUS Older Driver Transportation Planning Tool provides a roadmap to allow for safe driving as long as possible and to plan transportation options as the capacity for safely driving diminishes. Using this tool, individuals identify their transportation needs, explore options in their communities, and establish alternate plans so they are prepared when they must give up their keys.

Another valuable tool is the Driver Planning Agreement (DPA ), sometimes referred to as an advanced driving directive. This form, analogous to those related to end-of-life care, facilitates discussing and planning driver retirement. This directive can be reviewed and signed by the older adult and the individuals who help ensure their safety.

Prepare for the “Giving up the Keys” Conversation

Medical professionals should be caring, respectful, and non-threatening during this discussion, offering understanding and concern for the driver’s situation. At the same time, medical professionals should seek to maintain the patient’s independence and self-esteem. Following are steps clinicians who meet with older drivers can take to assure positive outcomes.

  • Ask the patient to bring a family member or caregiver who can provide additional information about the driver’s current situation and who can receive from the clinician up-to-date health information. (Remember: by law, medical professionals cannot share medical information without a patient’s permission unless the caregiver has a medical power of attorney or the older patient has signed a HIPAA release.)
  • Provide resources related to older adult driving safety and retirement. The ChORUS Older Driver Resources Handout includes websites where individuals can start the process. This handout can also be tailored to include specific resources in your community.
  • Become familiar with transportation options in your community and ask patients' family members or caregivers to do the same. Options can include public transportation; rides from family or friends; ride-hailing services, such as Uber or Lyft; city or county sponsored free vans; volunteer organizations; and more. Given a clinician’s limited time for appointments, this task can be recommended to family members and caregivers.
  • Write the patient a “Do Not Drive” prescription to provide a tangible reminder of your recommendation.
  • Explain to the older patient and family members or caregivers that medical professionals in some states may be required to report patients whom they consider unsafe. If the clinician needs to report, they should inform the older adult about documents that the older adult may receive from the licensing agency.
Addressing the Resistant Older Patient

If the older patient is resistant to becoming a retired driver, a clinician can counsel concerned family members, including providing information on safe driving assistance programs and licensing laws. Instruct family members and caregivers to visit the ChORUS website and My State Info for more information. Each state has a process for reporting a potentially unsafe driver to its licensing office or Department of Motor Vehicles. Law enforcement officers and physicians represent the majority of those submitting reports, but concerned family members and citizens can also submit reports.

If a state agency finds a complaint reasonable and credible, it may ask the reported driver to submit additional information. The information helps determine if a screening or assessment is justified. Some states keep the person submitting the report anonymously, but others do not.

Next Steps

After having the discussion with the patient, medical professionals should:

  1. Prepare and submit a report to the state licensing agency if required. Visit My State Info to identify reporting requirements and state points of contact.
  2. Document the discussion in the patient’s medical record.
  3. If the older adult has agreed to driver retirement, follow up during future visits to check for adverse effects, such as depression, decreased cognitive abilities, or other negative results.

[1] Betz, M. E., Scott, K., Jones, J., & Diguiseppi, C. (2016). "Are you still driving?" Metasynthesis of patient preferences for communication with health care providers. Traffic Injury Prevention, 17(4), 367–373.

[2] Redelmeier, D. A., Yarnell, C. J., Thiruchelvam, D., & Tibshirani, R. J. (2012). Physicians' warnings for unfit drivers and the risk of trauma from road crashes. The New England Journal of Medicine, 367(13), 1228–1236.

[3] Chihuri, S., Mielenz, T. J., DiMaggio, C. J., Betz, M. E., DiGuiseppi, C., Jones, V. C., & Li, G. (2016). Driving Cessation and Health Outcomes in Older Adults. Journal of the American Geriatrics Society, 64(2), 332–341.