Mobility changes and getting around

What health-related changes can affect my (or my loved one’s) ability to drive in older adulthood?

There is no set age for when someone should stop driving. However, as we grow older, we are more likely to experience physical changes in our body, such as our strength, endurance, flexibility and ability to move major joints of the body. These changes can affect our ability to operate a vehicle, such as turning the steering wheel, looking behind and pressing on the brake and gas pedals.

Changes in our thinking skills (cognition) can affect our ability to take in information in the driving environment and how quickly we process this information. These changes in our thinking patterns can increase the risk of an accident. Sensory-related problems such as decreased sharpness and clarity of objects (i.e. visual acuity) and declining contrast between objects and their backgrounds are also more likely to develop with age and can negatively affect our ability to drive.

When should I become concerned about my (or my loved one’s) ability to drive?

Deciding when a person is no longer fit to drive is difficult because some of us may not realize that our skills are declining. Some checklists have been developed for driving, which outline potential warning signs for the older driver, with questions like:

• 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 performance in other daily activities, such as medication use, cooking, shopping, or personal finances?

There is new research to support specialized tools which can identify drivers who may be a higher risk behind-the-wheel. For example, the Fitness to Drive Screening Measure is a free online tool that can help determine whether a driver requires a more formal assessment, which could include an evaluation by an occupational therapist. This tool guides you through several questions you or your loved one can answer. It also provides a list of local resources to help you make the next step.

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 an occupational therapist, to figure out the next steps.

Why is it important for me (or my older loved one) to access mobility options to participate in mycommunity?

Older adults who no longer drive may experience social isolation. Without a driver’s license, we are less likely to leave our houses and instead more likely to develop health problems including depressive symptoms and face earlier admission to long-term care. Social isolation and loneliness have also been linked to a higher risk of early death.

Research also shows that older adults will rely on public transit and other forms of transportation for upwards of five years after giving up driving. In older adulthood, the close relationship between our ability to get around the community, our health, and our social ties make planning ahead for driving retirement critical.

What are my options of getting around if I can no longer drive?

It’s important to have a ‘mobility plan’ in place 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 what you would like your driving retirement to look like is important. For example, if a loved one notices changes in your driving ability, how would you like them to approach the topic?

Start conversations about transit options 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 that allow you (or your loved one) to access the places you want and need to go. Include these considerations when planning ahead for where you plan or expect to live.

I am considering giving up my driver’s license – what now?

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

Here are some important questions you may find yourself asking:

• Who do I talk to about my 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 an occupational therapist. The occupational therapist can conduct fitness to drive screens, driver rehabilitation, recommend vehicle modifications to allow us to continue to drive safely, and plan for when we retire from driving (CAOT, 2009, pp. 1).

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

Healthcare professionals may ask us questions about our driving if they notice changes in our health, or we can simply tell them that we are concerned about our driving.

• How can an occupational therapist help me (or my loved one) when it comes to driving and community mobility in the context of everyday life?

Occupational therapists collaborate with people to help them participate in meaningful activities — including navigating our community using driving or alternative transportation. Being supported during the transition from being a driver to no longer having a license is critical because of consequences to our identity, health and our general lifestyle and wellbeing.

Occupational therapists are often involved in formally assessing individuals when their ability to drive is being questioned for medical reasons. Some 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 pen and paper answers, though sometimes computers and simulators are used.

The second part is the on-road test which 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 evaluation, which takes approximately one hour, is completed in light to moderate business traffic and on the highway and takes approximately one hour to complete. Most people go on to the on-road test as it is a functional test used to determine if a person is safe to drive. If it is determined that the driver is unsafe to drive, 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 consequences of these errors.*

Without my car, what are my options?

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 like shopping or visiting the doctor is only 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 for us 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 trains and buses have low floors, kneeling buses and ramps, making them accessible.
• A taxi 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 that are run by volunteers.
• Our friends or family may be able to offer rides. If we feel like a burden, we can consider doing something in exchange for the lift.

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