It’s perhaps one of the most difficult conversations to be had with an older adult: Whether it’s your aging parent, your spouse or another loved one or friend, asking them to scale back or stop their driving altogether strikes at the heart of the fear that so many of us have about getting older: losing our independence and autonomy. It’s a major life transition for anyone who has depended on a car to carry out his or her daily routines and sources of pleasure. A recent review of the literature on driving cessation noted that giving up the car keys is significantly related to such mental health outcomes as depression, anxiety, stress, and distress. It’s akin to experiencing a loss and going through the process of mourning and grief. Thus, preparation for this eventuality needs to be thoughtful and allow time for adjustment, in addition to developing workarounds and solutions for new transportation options so your loved one can maintain some sense of autonomy. There is also the concern that the person will become less physically active and more isolated, which can lead to health problems. While the decision to stop driving is necessarily one involving personal autonomy and safety (of both the person and the larger community) no one wants it to come at the expense of the physical or mental health of the person asked to turn over the keys. And while age alone is not a reason to ask someone to stop driving, older adults are more likely to experience problems on the road or medical conditions that get in the way of proper driving behaviors.

Before you ask someone to stop driving, it’s useful to understand what may be the signs that such a request is warranted. According to the Driver Cognitive Assessment Center, there are two areas of concern when it comes to considering driving cessation: driving skills and medical conditions. Regarding driving skills, you should be on the lookout for such signs as unexplained dents/scrapes on the car, driving too fast or slow, ignoring traffic rules, confusing the gas pedal and the brake, and showing fear or confusion while driving, especially in familiar places. The medical conditions that should concern you include such diagnoses as dementia, neurologic diseases (Parkinson’s, ALS), sleep apnea, and cognitive impairment. In fact, problems with driving can be some of the early clues that a person is suffering from dementia.

There are both in-office tests as well as formal and informal road tests that can help you determine one’s precise skill level and deficits and how likely they are to cause an accident. You can always just hop in the car with the person for a short ride, say to the store, to observe how they do on the road. There are a number of online resources to help you find driver-ed courses specifically for older adults, driver evaluation programs (often run by occupational therapists), technology that may help improve safety on the road, and other sorts of support. The New York State Dept of Motor Vehicles has a good list of resources on its website (none of which are exclusive to NY) that help you get the lay of the land when it comes to considering senior driving. Some states have specific laws or requirements to assess or reassess the skills of older drivers (click here to find out what your state requires) and some clinicians are now using technology in their offices to evaluate the potential safety concerns for older drivers. For example, technology developed by Florida Atlantic University, called “Fit2Drive” can predict, in office, an older driver’s ability to pass an on-road test. This technology demonstrated an accuracy rate of over 90% in its predictions as to who would pass a road test, and it provides sound, objective data that can help determine whether someone should continue to be on the road. To find out more about this technology, buckle your seat belt and click here

Given our aging population and dependence on automobiles, we are heading down the road to a major problem in the United States, for which we are not adequately prepared. While some car manufacturers are trying to develop technology to rethink the design and safety of a car to be driven by an older driver, the reality of most of these innovations is a long way off. We do already have some data that suggests drivers are not paying sufficient attention in the car when vehicles have driver-assist technology such as lane-departure warnings or automatic emergency braking. For the moment then that means that family members and other loved ones need to gently but firmly raise the possibility of driving cessation when concerns or signs arise. But as we said at the start, these conversations need to be cognizant of the distress that may be caused by handing over the keys while at the same time reflecting safety concerns. It’s a delicate but necessary balancing act.