Driving and Getting Around in Later Life

• Have I ever become lost while driving?
• Do other drivers often honk at me?

Caregivers have their own questions to consider:

• Do you feel uncomfortable driving with the person?
• Is a ‘co-pilot’ needed to alert the driver to potentially dangerous events or driving styles?
• Has there been a decline in the ability to do other daily activities, such as medication use, cooking, or personal finances?

The Fitness to Drive Screening Measure is a free online questionnaire to determine whether a driver requires a more formal assessment, and provides a list of resources to consider.

Our loved ones, especially adult children, can usually notice when driving changes become concerning. In such cases, we should consult a healthcare professional, such as a family physician or occupational therapist, to figure out the next steps.

“I’ll be the first to admit that I rarely used public transit prior to this point. To me, the acronym TTC (Toronto Transit Commission), used to mean ‘Take The Car.’ But after giving up my vehicle and selling it, I became more dependent on the TTC. It took me years to actually start getting used to the idea of commuting. I had to become familiar with the routes, arrange fare money and use problem solving skills when things didn’t go as planned.It wasn’t simply the idea of commuting that took some time to adapt to; my social network took a hit as well. Slowly but surely, most of my friends disappeared because I couldn’t visit them on my own. And unfortunately, they didn’t want to come and pick me up because I lived further away. Giving up driving impacted other meaningful activities I used to engage in, such as picking up my daughter from work. Her shift typically ended at 1.a.m. and I used to enjoy picking her up, chatting about her day and getting us home safely.”

-Paul Lea

Older adults who no longer drive are more likely to experience social isolation. Without a driver’s licence, we are less likely to leave our houses, which makes us more likely to develop health problems and face earlier admission to long-term care.

Research shows that older adults often rely on public transit and other forms of transportation for upwards of five years after giving up driving. The close relationship between our health and our social ties make planning for transportation critical. It’s important to have a ‘mobility plan’ in place for the future before we experience a medical-related change that affects our driving. According to research, those who plan ahead report a higher quality of life after they stop driving than those who do not.

Starting early conversations about how you would like your retirement from driving to look is important. For example, if a loved one notices changes in your driving ability, how would you want them to approach the topic with you?

Start conversations about transit options other than your car with your family members or your health team. Ask for a referral to see an occupational therapist, as they can look at your activity schedule and suggest practical and affordable transportation alternatives. Include transportation considerations when planning where you expect to live so you can be sure you can get around without a car.

“Despite the many cons of not having a car, I realized there were an equal number of pros – the main one being finances. I used to spend nearly $2,000 on car insurance alone. But when you don’t have a car, you don’t need insurance. And there are also the maintenance and gas costs. It saved me a ton of money and that I could use for other activities. Another advantage is the added physical exercise. I live with diabetes, so walking is very important. On a typical summer day, I walk between 5 and 10 kilometers. Back when I drove, I would often take the car even to visit the nearby corner store.

Despite losing contact with some of my friends, taking transit lets me connect with people in meaningful ways. I can pick up a conversation with someone at the bus stop and talk to them about my stroke and experience living with dementia. It gives me a chance to do what I love doing: break the stigma about a condition that impacts many Canadians. I hope you take away at least two things from my story: you’re not alone and there’s definitely life after driving!”

-Paul Lea

Hanging up the keys can often feel like losing part of our independence. Worrying about how to get around and carry out our everyday tasks is normal. But there are alternative options.

First, we may not need to give up driving completely. Perhaps we could drive shorter distances or change when and where we are driving. It is important to speak to a healthcare professional and get their recommendations.

There are many alternatives to driving, for example:

• Walking and cycling are good ways to get regular exercise.
• Many public transit options have low floors, kneeling buses, and ramps, making them more accessible.
• A taxi or rideshare (like Uber) could be a cost-effective way to get around if we only use our car a few times a week.
• There are community transportation options run by volunteers.
• Our friends or family may be able to offer rides. If we feel like a burden, we can offer to do something in exchange for the lift, like watching our grandkids or making a batch of our famous brownies. 

Giving up driving saves money. We no longer have to pay for gas, servicing, or car insurance; freeing up a significant amount of money each month. It also frees us from the stress of driving in busy traffic. Being a passenger allows us to let someone else do the hard work while we read a book or take in the scenery. Using alternative transportation allows us to meet people in our community and to get more exercise than if we were to rely on our car.

• Who do I talk to about concerns related to my (or my loved one’s) driving?

We can talk to our primary care team and/or family physician about our concerns. Physicians can provide information and resources for the next steps. We can also seek support from an occupational therapist directly, or ask our physician to refer us to one. The occupational therapist can conduct fitness to drive tests, driver rehabilitation, recommend vehicle modifications to allow us to continue to drive safely, and help plan for when we retire from driving (CAOT, 2009, pp. 1).

• How do I bring up this topic with a healthcare professional?

You are your own best advocate! Healthcare professionals may ask questions about our driving if they notice changes in our health, but we can broach the subject anytime, especially if we are concerned. 

Occupational therapists collaborate to help people participate in meaningful activities — including getting to those activities with comfortable transportation. Being supported during the transition from being a driver to no longer having a licence is critical because of the potential consequences to our health, identity, and wellbeing.

Occupational therapists are often involved in assessing individuals when their ability to drive is being questioned for medical reasons. Some drivers will be required to undergo a comprehensive driving evaluation (CDE), which is usually made up of two parts. The first, completed by an occupational therapist, is a clinical evaluation that assesses the driver’s abilities and impairments. It takes approximately two hours and typically involves completing assessments using pen and paper, though sometimes computers and simulators are used.

The second part involves seeing how you do while you are driving. The driving portion is completed in a vehicle with a dual brake and any necessary adaptive driving equipment. A driving instructor completes the evaluation with the occupational therapist.

The on-road portion, which takes approximately one hour, is usually completed in light to moderate traffic. If it’s determined that there are concerns about behind-the-wheel abilities, the clinical evaluation is reviewed to see whether the person would benefit from driving lessons. Lessons are only recommended if the driver shows insight into the errors made and that they will help with improving driving skills.

Transportation is crucially important to our health as we age, and meeting with an occupational therapist can help us transition through these life changes.