When It's Time To Hang Up the Keys

It's a conversation perhaps even more inevitable than talking with your kids about the birds and the bees. When your parent — or in-law, grandparent or sibling — is driving dangerously, someone has got to talk with him or her about the possibility of hanging up the car keys for good. And it's better if that discussion comes in the form of advice from someone he or she knows rather than in an order from the state motor vehicle department.

But it may not be an easy thing. "In America, being without wheels means being 'without go' — you can't go to the beauty parlor, or church, or to meet with your friends, and you have to have someone come and pick you up for the simplest appointment," said Dr. Philip Hessburg, president of the Detroit Institute of Ophthalmology, in Grosse Pointe, Michigan. Hessburg often makes medical determinations that older patients no longer can drive. "That's devastating. And the rate of depression in these people is extraordinarily high."

So it's crucial to be sensitive. "Most of all, you've got to try and understand how incredibly difficult it is for a parent to give up driving — then find a solution that takes everything into account," said Marion Somers, an elder-care practitioner and author.

Self-Determination Is the Best Option
The optimum course is for an older person to begin planning for his own "retirement" from driving far in advance, just as he may have plotted his departure from the workforce years before. "Self-limiting" driving is one way to approach the issue gradually, and, done effectively, it can buy years' more independence for many aging motorists. Similarly, it's best if senior drivers make their own decisions about when to leave the wheel completely behind.

"If you're smart, you'll decide when you need to give up driving — you won't have the kids come in and wrestle the keys from you," said Nancy Stegeman, a Michigan-based instructor in the AARP driver-improvement course.

To a surprising — and reassuring — extent, recent research suggests that more seniors are limiting their own driving without prompting by loved ones or others in their lives. Fewer than 1 percent of older drivers in three states, who were interviewed by the Insurance Institute for Highway Safety in 2006 and 2007, said that they'd been advised by family, friends or a doctor to give up driving.

How To Approach "The Conversation"
But all too often, there's still the need for "the conversation", forced by things that already are occurring when your senior gets behind the wheel. The top 10 warning signs include frequent near-accidents, dents or scrapes on the vehicle or the mailbox or the sides of the garage door, difficulty for the senior to see the sides of the road when looking straight ahead, and a recent spate of traffic tickets or warnings, according to the AARP.

"You really need to work with the whole family and problem-solve how this can be done," said Anne Dickerson, a specialist in geriatric occupational therapy at East Carolina University.

Keep the conversation between "adults," not "child and parent," Somers advised. Use the term "I" to describe how you perceive the situation rather than "you," which can be interpreted as accusatory. Remind the senior about his responsibility to others. "Say to Mom or Dad, 'You don't want to be the person who runs into someone and kills the innocent,'" advises Dickerson. "That tends to work."

At the same time, don't necessarily blow off any opposition. "If a senior is obstinate and still sharp of mind, they could still be OK to drive," Dickerson said. "It's the person who has beginning dementia that shouldn't." And perhaps there are other issues that actually underlie poor driving and can be addressed first, including deterioration in the senses, contra-indicated medicine, physical pain or even addiction.

If necessary, tell the person with the onset of dementia that the vehicle just isn't available or doesn't work anymore. Then actually disable the car by removing the battery cable or distributor cap. "I'm not one for saying that you should be lying to your family member," Dickerson said. "But it is a last resort in a very difficult situation."

Watch out for Falling Baggage
The conversation often is toughest with an elderly person who still has most of his faculties — just not enough to drive safely. Sometimes those talks often don't go smoothly due to factors that may be unrelated to driving per se.

"It's a very anxious and often guilt-ridden situation," said Elizabeth Dugan, a geriatric-medicine specialist at the University of Massachusetts Medical School. "For some families, it's a breeze: Mom has cataracts or macular degeneration and can't see. But with other families, it can be very complicated, including baggage from decades and decades of dysfunctional relationships, which can get greatly exaggerated in this instance."

If indeed it gets down to a confrontation, family members may want to get some help. The senior may be more willing to listen to an authority figure, especially one who he trusts deeply. And it's always good for a son or daughter or niece to be able to deflect blame.

"It's difficult for the family to do it and be the bad guy," Dickerson said. "It's much better to have someone else say, 'You can't drive anymore,' and then you can say, 'Isn't [that person] awful?'"

Leading candidates for the dirty work might be a family friend, a pastor or a physician. "Have [the doctor] write the prescription saying they can't drive anymore and, if necessary, remind [the older person] and show them," advised Dickerson.

Once the inevitable occurs and a senior driver does agree to hang up the keys — or they are hung up for him — there are a couple of important housekeeping matters. Turn in license plates and get a receipt for returned plates, since old ones can be used for stolen cars. And notify the insurance company and the state motor vehicles department that the senior no longer is driving.

Beginning a New Life
Then, an entirely new phase of adjustment begins for the elderly former motorist. It's important, geriatric experts said, that the individual doesn't regard the lack of driving as the end of a lifestyle. So you should put just as much care and effort into helping to mitigate the negative effects of the decision.

Most seniors will still want to have as much mobility and independence as possible. Their new transportation plan can have a variety of elements. Somers provided her father with a three-wheeled adult bicycle with a cart in the back to carry groceries, for example. Map out a monthly "transportation budget" with the senior; seed it with the proceeds from selling his car. Encourage him by pointing out that it likely will turn out to be much less expensive overall for him to rely on transportation rather than his own vehicle.

"If you figure out what you invest in a car on a yearly basis, by comparison you could take a lot of taxis, ride a lot of buses and even pay friends for lots of rides — and still have money left in your pocket at the end of the year," noted Jack Stegeman, an AARP driving-improvement instructor.

Many churches, senior centers, other nonprofit groups and communities provide ride services to the elderly. If the senior is part of a socially active group, such as a poker club or a golf foursome, you may be able to arrange for his friends to lend regular rides. And increasingly, local merchants such as supermarkets are bringing back home delivery as well — a real boon to non-driving seniors.

If none of those solutions are viable or complete, there is conventional mass transit, of course — which, unfortunately, remains largely senior-unfriendly in many parts of America. You also can hire home-care agencies. Right at Home, for example, is one of many outfits that drive seniors around as part of its regular elderly-assistance services.

"After a couple of weeks, many times those clients will go, 'Why didn't I do this before?'" said Allen Hager, president of the Omaha-based franchiser. "They've been frightened while driving, as it turns out, and a bit overwhelmed."

This rite of passage is only going to get more difficult with boomers. On average, they may remain better drivers, for longer, than the current generation of seniors because they may have developed better cognitive reserves. But when the inevitable decline comes, they probably won't go quietly.

"Unless there is some work done to establish what the criteria might be, I don't think you're going to see an awful lot of people who are in the boomer age group simply sit idly by while some law without any scientific backing denies them their independence," says Dr. Hessburg. "I don't think they're going to take it."

Below are links to all of the installments in this series.

What Should We Do About Grandma's Driving?
Aging Drivers: Intersections Are Danger Zones
How To Improve Seniors' Driving Skills
Better Cars, Equipment Assist Senior Drivers
When It's Time To Hang Up the Keys
Florida Paves the Way for Senior Drivers

Dale Buss is a journalist and author based near Detroit.