November 01, 2016

Prolonging the Driving Experience and Adapting to Alternatives

By Edward W. Madeira Jr., Carolyn Rosenblatt

Once a person experiences the freedom of driving, it is difficult to think about giving it up. Even with some limitations, an older driver can continue to drive as long as the ability to do so continues. With good planning and proper evaluation, an older driver can prolong safe driving well into one’s eighties and beyond. In this article, we explore ways in which an older driver can strengthen driving skills, get a proper evaluation of driving safety, and find out whether she is still fit to drive using objective, rather than personal and subjective, measures. Finally, we look at other options besides driving so that a degree of independence in getting around can be sustained even when it is time to give up the keys.

Safety Versus Individual Freedom

Maintaining the personal independence and self-esteem that driving allows must be balanced with attention to personal and public safety. Age alone does not determine whether an individual should stop driving; rather, safety is about health and ability.

Due to the efforts of many, there are available methods to evaluate whether one is still a safe driver. For instance, the first “defensive driving” course was offered in 1979 by AARP. There are now many defensive driving courses for the mature driver, the best known being: AARP’s Driver Safety Program, the AAA Mature Driver Class, and the National Safety Council’s Defensive Driving Course. In addition, many local hospitals and health centers have similar courses (The Hartford. “You and Your Care: A Guide to Driving Wellness.”).

These comprehensive driving evaluations can determine whether one has maintained the skills and abilities to drive safely, what corrections are needed, and what steps or training could improve the individual’s driving skills.

Additionally, the American Occupational Therapy Association and the Association for Driver Rehabilitation Specialists have developed driving comprehensive evaluation programs that both allow clinical assessments of vision, cognition, motor performance and reaction time, as well as on-the-road evaluation.

The AMA’s Physician’s Guide devotes an entire chapter to the “Driver Rehabilitation Specialist (DRS).” DRSs often are occupational therapists with additional training in driver rehabilitation (Physician’s Guide, 41). A physician referral is frequently required and there is a cost for the assessment and rehabilitation services. There may also be a cost for any additional equipment for the vehicle.

There is also an educational program called CarFit created by the American Society on Aging, developed in collaboration with AAA, AARP, and the American Occupational Therapy Association. CarFit offers older drivers the opportunity to find their safest fit with their car (www.car-fit.org).

The results can vary from “continue” or “resume” driving to recommendations that limit or restrict driving, such as “no driving at night” or “it’s time to stop driving.” Recommendations frequently include modest modifications to the individual’s car, such as additional cushions to maintain a proper seating position, pedal extenders, a spinner knob to compensate for weakness in one arm, or hand controls to operate gas and brake pedals. It is important for the mature driver to drive a car that fits.

Each licensed driver is responsible to drive safely and appreciate the importance of both physical and cognitive health to safe driving. The critical factors of physical health include: vision, strength, flexibility, agility, and an understanding of the impact of medications. Critical factors of cognitive health include: memory, judgment, quick thinking, reaction time, and the ability to recognize one’s deterioration in driving skills and take steps to compensate.

The alarming statistics and predictions about dementia and Alzheimer’s Disease have been mentioned elsewhere. The Hartford’s chart, “Warning Signs for Drivers with Dementia” can be a source of information for families, caregivers, and physicians, and is available at www.thehartford.com/sites/thehartford/files/dementia-warning-signs.pdf. While signs of early dementia may not be an automatic reason to cease driving, the chance of an older loved one developing dementia may not be far ahead, and preparations should start promptly. According to the Alzheimer’s Association, by age eighty-five, the chance of having Alzheimer’s Disease is about one in three. The Physician’s Guide presents an excellent series of brochures, including “Safe Driving for a Lifetime,” prepared by The Hartford Center for Mature Market Excellence, from which we have borrowed extensively for ideas and occasional text.

Adapting to Alternatives

Once an older adult gets past the internal resistance to giving up the freedom of driving and comes to terms with realizing that it’s time, the elder has to look at just how to get around without that car. Without a doubt it is an adjustment: There is a sense of loss, even when logic says this is the right thing.

Many seniors are gradually facing various kinds of losses in their lives and the loss of individual freedom to drive is one more. Adapt they do, but not without discomfort. There is the awkwardness of having to use a transportation service that involves others. You must wait. There are adjustments to one’s schedule. You have to plan ahead and accommodate others rather than just getting in your own vehicle and going where you want.

Despite all of this, people do adapt. Elders across the country take advantage of various forms of transportation other than their own cars and they get used to it safely. The success of adapting to giving up driving depends on one’s attitude toward acceptance of change and the services available.

Although alternates to driving are often less than ideal or sometimes non-existent, the ability to suggest a plan that meets the standards can often be the “carrot” that tips the persuasion scale of voluntarily agreeing “It’s time!”

The Physician’s Guide explains, “When faced with the choice of driving unsafely or losing mobility, many risk their safety by continuing to drive.” Alternatives to driving need to be made available to older drivers in order to satiate their need for mobility.

Existing forms of transportation clearly need to be optimized for use by older persons. Polling has shown that after driving, the most frequent alternative was ride-sharing, which led many to feel overly dependent upon others (Physician’s Guide, 191).

Public transportation, where available, was the alternate of choice for about 5 percent of responders, conditioned with concerns about unavailable destinations, accessibility problems and fear of crime. Less than 5 percent looked to taxis as their alternate of choice. Transportation programs specifically designed for the elderly, such as senior shuttles and vans, have been developed in many communities (Physician’s Guide, 191).

A creative model described in the ABA Manual is the Independent Transportation Network of America, also known as ITN America (www.itnamerica.org/). This company runs on an affiliate basis throughout the country, in such locations like the Lehigh Valley, the Greater Boston area, Las Vegas Valley, Twin Cities, etc. (www.itnamerica.org/find-your-affiliate). Others are described in the Supplemental Transportation Programs for Seniors (June 2001) prepared by the Beverly Foundation for the AAA Foundation for Safety.

As with other aspects of elder driving issues, there have been, and continue to be, multiple, basically consistent efforts to provide alternatives to driving one’s own car. Again, The Hartford, in its series of brochures, provides guidance starting with suggestions as to how to encourage the older adult to plan for and use alternative transportation. One frequently persuasive consideration is the annual cost savings if the car were sold compared against available alternatives in one’s neighborhood, such as taxis and car services.

Previously, the importance in the family discussion about stopping driving is to include a workable alternative. In The Hartford’s brochure “We Need to Talk: Family Conversations with Older Drivers,” a transportation cost worksheet is provided. Emphasis is placed on easing the transition from driver to passenger over time (i.e., driving shorter distances on familiar roads; avoiding difficult, unprotected left turns; and avoiding driving at night, in heavy traffic hours, or bad weather).

The National Center on Senior Transportation is a Washington-based agency, administered by Easter Seals, Inc. working through a cooperative agreement with the Federal Transit Administration of the U.S. Department of Transportation, with guidance from the Administration on Aging of the Department of Health and Human Services. This agency focuses on the importance of including taxis in the family of senior transportation services with programs throughout the country that are directed at making taxis more available, accessible, and affordable.

In Knoxville, Tennessee, for example, the Knox County Community Action Committee Office on Aging offered, through the Taxicab “Senior Friendly” Project, multistep training and certification to volunteer taxi drivers to become “Senior Friendly.” This project allows for the better service of seniors in the area, ensuring “potential customers that they are in the hands of professional drivers who have the rider’s safety first and foremost in their minds” (www.seniortransportation.net/Portals/0/Cache/Pages/Resources/Knoxville%20-%20Senior%20Friendly% 20Taxi%20Certification%20Project%20Handbook.pdf).

Increased affordability has resulted in many areas for Taxi Voucher programs. As an example, in Olathe, Kansas, the city sells booklets of vouchers at a 79 percent discount to eligible older adults and people with disabilities who can use the vouchers for taxi services. Another example is a cab company in Arlington, Virginia, which offers books of coupon for rides for older riders, promoting this service as “Give the Gift of Mobility” (www.aarp.org/content/dam/aarp/livable-communities/learn/transportation/taxis-for-senior-transportation-aarp.pdf).

It is important to note that transportation options vary from community to community. One such neighborhood service is Island Connections’ “Neighbors Helping Neighbors” (http://islconnections.org/transportation-services-we-offer). This program looks to provide free transportation for seniors and people with disabilities within the community of Mount Desert Island, Maine, and its surrounding islands.

Other examples of neighborhood services include: the East Side Neighborhood Services in Minneapolis, Minnesota (www.esns.org/SeniorTransportation), Pawcatuck Neighborhood Center Senior Transportation Program in Connecticut (www.the-pnc.org/senior_transportation. shtml), and Neighborhood House in Portland, Oregon (www.nhpdx.org/WhatWeDo/seniors.html).

To find transportation services in your area, visit: Eldercare (www.eldercare.gov), a free service of the U.S. Administration of Aging, or the National Center on Senior Transportation (www.seniortransportation.net).

Alice’s Story

Alice is a ninety-three year old who has lived independently and driven her own car until recently. She decided after two years of urgings by her family to move to a seniors’ community near her daughter’s home. At the same time, she also decided without urging, that she did not want to drive in the large city where her daughter lives, even though she raised her children in the area and is generally familiar with directions and locations. Moving day came and her family drove her to the new residence in her car. It was parked in the building’s garage and had remained there just in case. She plans to sell the car.

The seniors’ community provides a van service three times a week. It will take residents to doctor’s appointments and errands in the area. It goes to a shopping center and large grocery store weekly on a set schedule, as well as to the movie theater on a certain day and time, which allows for seeing a matinee. Alice is not entirely pleased with it, but will go on outings and to the stores on scheduled days. She relies on her daughter for getting to and from some of the doctors and dentist appointments. As she has many such appointments, she does not want to burden her daughter, who is employed. So, she asked her son to help her find a driver. Through an online resource she used for a part-time caregiver in the past, he connected her with a young caregiver who will drive her wherever she wants to go, without requiring a minimum visit of four hours. The caregiver, a young mother, gets some limited work hours, which is exactly what she wants, and Alice gets freedom to go where she pleases on her own schedule.

Alice has solved the transportation problem successfully. She uses a combination of three resources to maintain her independence. First, she uses the provided van service. This kind of senior van is available in many communities, though the services based in the community generally charge a small fee and is typically offered by a nonprofit organization with volunteer drivers. In her case, there is no charge, as it is a part of her benefit of living at the senior’s residence. Second, she relies on family. Her daughter can sometimes take her to her appointments, but not always. Third, Alice hired a caregiver for a reasonable hourly rate to pick her up, take her to other appointments and social events on days or times that the seniors’ van is not available. Some of her activities are on the other two days of the week, or after 4 p.m., the limit of van service or at times she wants to go somewhere.

Summary

Driving, while legally a privilege granted by the state, is viewed by millions of American drivers as a right—one necessary to live a productive life. As we age, we may not be able to determine subjectively whether we are safe to maintain driving. Many excellent resources are available to evaluate driving. We can sometimes prolong our ability to drive with safety courses and minor adaptations on the vehicle. However, there nearly always comes a time when we must give up the keys. That is often precipitated by the development of cognitive and physical impairments. When that occurs, it is best to plan ahead for alternative transportation sources. Some people successfully use public transportation services. Others find reduced cost taxis while others use community van transport services. Where these options do not exist, family is the resource an elder must depend upon, though this is not always the best solution.

Regardless, finding and using a combination of resources can be a successful way to keep a senior engaged in the community and connected to enjoyable and necessary activity.

Edward W. Madeira Jr.

Edward W. Madeira Jr. is chair emeritus and senior counsel at Pepper Hamilton LLP in Philadelphia. Long active in efforts to improve the justice system and address the court funding crisis, Madeira is known, in part, for his work on behalf of the ABA’s Task Force on Preservation of the Justice System, Standing Committee on Judicial Independence, and Standing Committee on Federal Judicial Improvements.

Carolyn Rosenblatt

Carolyn Rosenblatt has more than forty-five years of experience in her combined professions of nursing and legal practice. She is the cofounder of AgingParents.com and AgingInvestor.com, and she is the author of both The Family Guide to Aging Parents and The American Bar Association publication Working with Aging Clients: A Guide for Lawyers, Business, and Financial Professionals.