Dr. Jauhar is a cardiologist in New York who writes frequently about medical care and public health.
When my father was declining from Alzheimer’s disease, my family often talked about when we should make him stop driving.
Of all his children, I held out the longest, hoping to preserve his freedom even as we gradually decreased the distance we would let him drive. One day, while driving on a busy street, he asked his caregiver which was the gas pedal and which was the brake. Not long after, he hit a neighbor’s car while backing out of the driveway. That was when we put his old Audi up for sale.
Over the course of those years, I don’t remember my father’s doctors ever asking about his ability to drive, let alone advising him to stop. Being a doctor myself, this did not come as a surprise. Few of us have the time or inclination in a brief office visit to wade into a fraught subject like when a patient should stop driving. Many doctors are also wary of breaching patient confidentiality by reporting impaired drivers to state authorities.
Yet doctors are perhaps uniquely qualified to address this issue. We treat many common conditions that affect the ability to drive, including seizures, heart arrhythmias, eye diseases and dementia. We are privy to our patients’ abilities and to medications that may affect their driving. Our patients also tend to follow our advice on matters of health and lifestyle.
For all these reasons, states should make it mandatory for doctors to report medically impaired drivers to the Department of Motor Vehicles, while at the same time providing legal protections to those who do. A final determination regarding fitness to drive would be made by the state. Society cannot leave a matter that so affects public health to family judgment.
Of course, revoking someone’s driving privileges is no small matter. In most of America, driving is essential for mobility and independence. The ability to drive gives us access to work, friends, recreation and many other things that make our lives worth living. Taking away this privilege can worsen the isolation that medically or cognitively impaired patients already struggle with.
Don’t click on this link: https://www.nytimes.com/2024/11/04/opinion/dementia-driving.html !!! - It’s the hated New York Times! They’ll ask for money! I list the link to cite my source, not to get anyone to click on it - God forbid! The above is all one gets for free.
I can go along with the doctor’s suggestions. My father in law drove way too long before my wife took his keys away. He hit a guard rail due to poor attention and got lost going to the barber shop, a place he drove to every 2 to 3 weeks for years. Fortunately, no one was injured. I wonder if doctors should be required to do some sort of testing to check for lucidity.
Doctors CAN write a letter to the DMV in most states recommending a license revocation. Doc’s generally won’t do it because of HIPAA violations and won’t consider it unless contacted by family member. They generally are not in a position to suggest someone’s license be revoked even after many 5-10 minute sessions with the patient. Even a long time patient. You would be surprised to find out how lucid an Alzheimer’s sufferer can be for short periods of time. A patient that cannot remember what they had for breakfast 20 minutes before can memorize the 6 digit door access code in a secure medical unit and head out the door and into the parking lot. This is from personal experience with a family member as well as my wife’s professional experience working in elder care.
The problem the family members have is their reluctance to “be the adult” when it comes to taking away the keys of an elderly family member so they plead with the doctor, who cannot or refuses to intervene in this messy problem. The family has always seen the elderly family member as an authority figure that they are not willing to contest so they want someone else to deal with it.
The next problem is to pursue a legal path to be appointed that elder’s guardian. That takes a court order. The judge is concerned about greedy family members wanting to pillage Mom’s finances more than stop her from driving. Mom is concerned about that, too! Unless confronted with overwhelming evidence, the judge will tend to side with the elder. My dangerous driving, but completely lucid (no Alzheimer’s), mother would prevail in a court of law. An Alzheimer’s patient could appear lucid for just long enough to also prevail. Now the problem is doubled because the family member can cut off all ties to the family that tried to take away their rights.
This is a complicated issue. While I trust my doctor, I don’t want him having the power over my driver’s license without due process. The real responsibility lies with the family. Step up, be the adult. That is how my father got grandpa to give up his car. It is how I got mom to give up her car.
A couple of months ago, a former co-worker died, but she had been in a specialized care facility for a few years prior to her passing. What had led to her being placed in that facility was an incident where she thought that she was driving a mile or two to a friend’s house in the same city, but she actually wound-up in a rural town about 90 miles away, after driving for several hours in the wrong direction.
The cops in that rural town found her on the side of the road–very confused–and they rightfully had her evaluated at the closest ER. The doctors there realized that she was suffering from dementia, and that began the process of her being placed in a nursing home that specialized in caring for folks with Alzheimer’s and other forms of dementia.
Dementia doesn’t suddenly come on overnight, and if her own M.D. had seen the signs, she could have been placed in a safe environment much sooner. The only good news is she didn’t have any accidents and didn’t injure/kill anybody while she drove dementedly.
My Mother loved to drive and had a semi lead foot even into her early 80’s. The local YMCA to do water aerobics almost every morning.To church to sing in the Choir. To her hair dressers about 15 miles west of Rochester (NY) in the country side. She delivered “Meals On Wheels” once a week.
She was developing memory problems but she handled it pretty well. And then…her youngest son (my youngest brother) died unexpectedly in 2017. (I am the oldest of 4 boys). Her mild dementia started to accelerate.
I got a call from my Dad. (I live in NC) Mom had headed out to her hair dresser that she had driven to a hundred times before. An hour and a half later she showed back and was crying. She told my Dad she had gotten lost but made her way back home. She hung up her keys on the hook next to the door and she never drove again!
That surprised my Dad and me, we thought it might be a problem taking the keys. (My Dad died in 2018 and my Mom in 2022.)
Yeah been there. Someone reported my dad at 87 at the time. Dont know who exactly. But at any rate he was forced to go take the road test again to keep his license. Never having taken the test before we went out driving to cover the finer points of the test and scoring.
Yeah he passed. The hardest part was having to back into an alley about ten feet wide with snow banks on both sides. So if the dmv passes you, and insurance has no issues, get off my back as they say. Watch out for nosey neighbors.
I’m more worried about teenage drivers than medically impaired drivers. I’m also more worried about adults who are drug and alcohol addicts.
Medically impaired drivers, assuming they are matured and aren’t alcohol and drug addicts, usually develop sharper driving skills. But this depends on the nature of the disability.
I know a few disabled persons who I thought initially should never be allowed to drive and they are licensed much longer than I am and rock up much more miles on their vehicles than I do and they drive incredibly safe.
I personally hear of intoxicated and being a male human cause more accidents than anything else.
We better start choosing our gender more wisely now
As they say lies and statistics. Of course older drivers are more likely to die due to reduced organ performance, brittle bones, and so on. That’s why broken hips from falls can result in death where it wouldn’t have the same consequences fir a teenager.
So the only reason for higher injury and death rate is aged bodies, not decrease in driving competence? So why do so many folks have stories of problems getting the keys away from their aging parents? Why do I see my neighbor getting lost because he can’t remember how to drive home?
The lack of competence that I observe with some middle-aged drivers makes me wonder what they will be like in a few more years. One day last week, I was driving through the local county park, and as I approached an entrance/exit of a parking lot, I observed a car that was stopped at the exit, waiting for traffic to clear, apparently. I saw the middle-aged woman driver look in my direction, as well as in the other direction.
Then, she looked again in my direction, and proceeded to pull out directly in front of me, in order to make a left turn. I estimate that I was less than 10 car lengths away when she decided to make a left turn across my path.
The speed limit in the park is 25 mph, so that helped me to avoid a collision, and I guess that I must still have good reflexes, because I was able to avoid T-boning her car, but I really have to wonder whether that woman was in full possession of her mental faculties.
I had an ex with a vision problem. She was going blind in both eyes. Her doctor knew she would need to stop driving soon and waited to hear from her on how she was feeling.
Her family tried taking away her license 10 year prior and she would not give it up because that would take away her independence.
One day when she went in for her regular eye exam, she said to her Dr. “ I don’t want to drive anymore because I feel unsafe .”
At that time , her vision situation wasn’t at the alarming mark just yet but the doctor knew she would soon be troubled by her eye condition.
“
The Dr. responded “ I agree with you. If you feel like you’re pushing yourself rather than otherwise , then I believe both you and I are on the same page where safety is concern.”
She then voluntarily turned herself in.
This is why doctors are not quick to report patients with visual issues. The patient will oftentimes know when it’s time for them to retire from driving.
As someone who had to deal with “Medically Impaired Parents” and is reaching “That Age” myself, I think that doctors absolutely should advise, report and are indemnified against reporting all “Medically Impaired Patients”.
We routinely test for Impaired Vision but a 3 minute Mini-Cog test for Cognitive Impairment is impossible? Not saying that the Mini-Cog test is definitive but like the Vision test, both should require a referral to and require approval from a qualified professional before renewing a drivers license.
Furthermore, we have no hesitancy to suspend or revoke the license of a DUI driving Impaired (Alcoholism & Drug Addiction are also Medical problems) but we can’t do the same with someone who is otherwise Medically Impaired?
Of course the first responsibility is on the person impaired but guess what, THEY’RE IMPAIRED!
Do you actually a rational decision from someone who’s not completely rational?
Next, we have Family and Caregivers which have been very effective in strategies to “Take away the keys” (Mom’s Chrysler LeBaron spent 5 years parked on the curb which kept her happy but nobody told her that her keys were actually for a long gone 1962 Chevy II).
“Won’t start? Must be a problem with the Fusion Reactor, I’ll have the mechanic look at it ASAP!”
But in the end and as a very last resort, it’s the Government and the Court’s responsibility to do what’s necessary to protect us from us.
Your Freedom to do, “Whatever you damned well want to do” is balanced between my Great Aunt’s Freedom to “Drive through the front of the Tire Shop” when mistaking the brake pedal for the accelerator.
