by Valerie Ward, MSW, CSW

In today's modern, mobile society, the automobile is the preferred mode of transportation for millions of people. Driving allows us to be independent and gives us a level freedom that is difficult to give up even when our driving becomes hazardous to ourselves and others on the road. If you drive, you can go where you want, when you want and you don't have to be dependent on others for assistance. As Mr. W., age 75, stated, "Driving allows me to be in control of my own destiny."

Our society has relied heavily on the automobile, maybe too much, because those now living in suburban homes made accessible by the automobile are now struggling to find alternate means of transportation when driving is no longer an option for them. In these communities, driving is not considered a luxury but rather a necessity of life and replacing the automobile with a suitable alternative presents a considerable challenge.

While many older adults with severe vision impairments will acknowledge that they no longer have the ability to drive safely and thus refrain from doing so, others continue to drive even when they are at risk. Losing the ability to drive can be a major life event, sometimes signifying yet another loss in the life of an older adult.

Mrs. C's Experience

Mrs. C., an 85-year-old woman who was legally blind due to glaucoma, was a proud woman who lived alone in a small city apartment where she had resided for 50 years. Despite her advanced age and medical problems, Mrs. C. had been able to care for herself with minimal assistance from others until her recent onset of vision loss. After a low vision examination, Mrs. C. was referred to me for short-term psychotherapy to reduce her depression associated with her deteriorating vision and ability to drive safely. Her family had reported to the low vision staff that Mrs. C. had recently experienced several near-accidents while driving but adamantly refused to surrender the keys to her car. Mrs. C. also vehemently denied that she was an unsafe driver or had had any near-accidents despite the presence of her frightened relatives during some of these incidents. She refused to realistically discuss the situation with her concerned relatives only resulting in increased family tensions.

During our sessions, Mrs. C. made the following statements which highlighted the significant impact that the loss of her ability to drive would have on her life.

"This is the beginning of the end for me! What more can be taken away from me? I don't have much time left in my life and I have already lost so much, my youth, my husband, my health! Why do I have to give up driving also? I have been driving since I was 15 years old and I have never had an accident."

"My family just wants to make all my decisions for me. I might as well be dead or in a nursing home."

In psychotherapy, Mrs. C. was eventually able to overcome her anger at her family in addition to her denial about her problems when driving and she reluctantly agreed to find another method of transportation. Her initial reactions to the loss were traumatic, however, and exacerbated her depression and anxiety about her future ability to care for herself independently. Leaving the wheel represented the end of her individual freedom and she desperately fought to avoid it.

Assessing the Risk of Older Drivers

As social workers, counselors, rehabilitation professionals, practitioners and family members, we should first conduct a detailed assessment of a person's ability to drive safely before we advise the individual to stop driving. Encourage the person to obtain the proper testing by qualified officials. Many older persons successfully drive safely into their 70s, 80s and 90s, so being 85 doesn't necessarily make a person an unsafe driver. As vision care professionals, we are concerned about those older persons with vision impairments who are unsafe and at risk drivers. In addition to your review of their eye and low vision assessments and functioning, here are some questions to consider for your discussion:
- Have they been involved in a car accident or multiple accidents?
- Are they able to see cars clearly when driving, use rear view mirrors, etc?
- Have they been ticketed for moving violations?
- When driving, are they getting lost more than usual? Is the 15-minute drive to the supermarket now taking an hour or more?
- Are they driving through stop signs, traffic lights, missing exits, not yielding the right of way?
- Are they driving too slowly, causing other drivers to honk their horns at them often?
- Do they get confused, overwhelmed, and fearful when driving?
- Are they able to drive safely at all times -- days, nights, in sunny or cloudy weather, for example?

If the person shares difficulties in one or more areas mentioned above, you should consider it of immediate concern and proceed to break the news that driving may no longer be an option.

Breaking the News

Breaking the news to a person who has become a risk when driving is not an easy task for professionals nor for family. Some individuals may accept their inability to drive and adjust to it accordingly, even considering the decision to no longer drive a relief. Hearing the news from a "professional" often eliminates the individual's burden of having to deny difficulties to those close to them and enables the person to retain his or her dignity. For many others though, the news is devastating and our ability to effectively communicate the message that driving is no longer an option and to provide the necessary assistance is crucial to their adjustment.

Tips for How to Break the News

1. Involve the doctors. If the driver's eye care doctor or other physician has issued recommendations against driving, get it in writing and have it available for your discussion.
2. Be truthful with the older persons with whom you discuss this. Talk about the nature of their eye condition and the consequences of their vision impairment. People have a right to know the truth and be respected no matter how difficult it may be for you to tell them.
3. Be compassionate, non-judgmental and acknowledge the individual's loss. Do not try to minimize it. Allow the person to express feelings and emotions, which may range among denial, anger, shame, resentment or depression.
4. Develop a list of your safety concerns and those of significant others and discuss the implications of continued driving. If the driver has loved ones, discuss how an accident would negatively impact friends and family.
5. Involve the family or significant others in the discussion if possible. Individuals will need the support and assistance of others if driving is no longer an option.
6. Offer your assistance in helping the person find alternate methods of transportation (via your local area agency on aging, for example) now that he or she will no longer be driving. Help the individual find other ways to travel to friends and continue activities for which the car had been necessary.
7. Don't ignore signs of ongoing emotional distress. Recognize the need for ongoing psychotherapy and discuss it. If such service is unavailable in your agency, refer the person to an appropriate organization.
8. Be patient and persistent. If the individual agrees to stop driving, commend this difficult decision. If you do not succeed the first time, try, try, again.



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