Car keys are a sign of independence, and who wants to part with that? But with age comes increased risk behind the wheel, so it’s important for families to decide together when a senior loved one may need to find alternative forms of transportation.
The risk of a driver being in a fatal car crash increases per mile after the age of 75 and sharply rises after 80, according to the American Automobile Association (AAA). In fact, the latest data from 2021 found that 7,489 drivers 65 and older were killed in car accidents, making up 17% of all traffic fatalities, according to the National Highway Traffic Safety Administration.
“Crashes are more likely to be fatal for adults aged 70 and older because they are more easily injured and suffer more medical complications,” explains Marlena del Hierro, a gerontologist based in New York City.
Here, the nine signs experts say caregivers should be on the lookout for when attempting to decide if it’s time for a senior to stop driving.
1. Declining health
There are various medical conditions that can decrease a person’s ability to drive safely. For example, arthritis can affect a person’s ability to move and notice obstacles when switching lanes or backing out of a parking spot. Dementia can also decrease a person’s ability to obey the laws of the road and increase the likelihood of getting lost or disoriented behind the wheel.
If you’re getting concerned, schedule an appointment for your senior and a trusted physician, and call ahead of time to let the doctor know what you’re worried about, recommends Jody Gastfriend, a licensed independent clinical social worker in Boston. When you attend the appointment, you can discuss whether your senior is considered healthy enough to drive safely. You’ll do well to ensure that the conversation feels like it involves them and makes them feel like their thoughts were heard.
2. Noticeable side effects from medications
According to AAA research, up to 97% of older drivers reported being on at least one medication — and while some medications don’t affect older adults’ ability to drive, “many drivers are taking one or more potentially impairing medications before getting behind the wheel.”
The fact of the matter is that some medications (from sleep medicines to antihistamines and even certain antidepressants) can have side effects, such as drowsiness, which could make it unsafe for a senior to drive.
3. A problematic recent driving record
Any recent accidents or fender benders, tickets or close calls with mailboxes can be warning signs that your loved one’s driving abilities are not what they should be — even if it was “just” a one-time occurrence.
4. Concerning answers to 20 questions
The National Highway Traffic Safety Administration (NHTSA) provides a list of 20 warning signs that an older driver may no longer be safe behind the wheel. Dr. Scott Kaiser, a board-certified family physician and geriatrician at Providence Saint John’s Health Center, says he often refers patients or their caregivers to this tool.
“I encourage people to ask these 20 questions [and] to use them as a starting point for an honest self-assessment,” he says.
5. Recent damage to the car’s exterior
Look for any new dents or scrapes on the car, as this can show that there is trouble when driving, says Dr. Douglas Scharre, director of the Division of Cognitive Neurology at the Ohio State University Wexner Medical Center in Columbus, Ohio. When a loved one is aware of recent damage to the car, they’re able to quickly have time-sensitive conversations about it.
Donna Naylor, who spent 13 years as a caregiver for her elderly parents and has transitioned to now providing care for her in-laws, agrees that this sign led to a larger discovery.
“I’d keep an eye out if they side-swiped the garage, knocked mirrors off when entering the garage or anything like that,” she says. “During one of our conversations, [my] mother ultimately made the decision to turn over her keys when she admitted she mistook the gas pedal for the brake — twice — running a red light and almost hitting someone.”
6. Observable differences in your loved one’s driving
Observation of your loved one’s abilities is one of the better ways to evaluate if it is time to have a discussion, so arrange to be in the car or a nearby vehicle while your loved one is driving. Keep an eye out for errors with signaling, difficulty turning, driving at inappropriate speeds (too fast or too slow), increased agitation or irritation, failure to stop at a stop sign or red light, issues staying in their lane and delayed response to unanticipated situations. Naylor says she also used this time of “passive observation” to check in on her parents’ confidence behind the wheel.
7. Curious mileage
Make a point of looking at the car’s mileage before they leave for typical activities and monitor where it’s at when they get back.
“If the mileage is longer than the short trips they’re taking, it could mean they’re getting lost,” Scharre says.
8. Discomfort with children in the car
It’s incredibly important to trust your gut and in order to help make that feeling crystal clear, Kaiser asks patients and families a curveball question: “Would you feel comfortable having children in the car?”
“Of course, nobody wants to be unsafe or harm anyone by getting behind the wheel,” Kaiser says. “If the answer is ‘no,’ that says it all.”
After all, if your loved one wouldn’t want to put children at risk, it’s time to avoid putting others at risk, as well.
9. Compromised vision
Dr. Leigh Plowman, an optometry specialist from Victoria, Australia, says caregivers must remember that eyesight critical to driving safely, and it’s not just about meeting the minimum vision limit.
“If you have any questions about a loved one driving, make sure you have their eyes examined,” says Plowman. “During an eye examination, optometrists monitor not just the eyes, but gain an insight on how seniors see and interact with the world.”
One of the ways they can do this is by performing a peripheral vision or visual field test.
“This test requires concentration to see lights on a screen and can identify ‘gaps’ in our peripheral vision,” Plowman says. “The visual field test also gives insight into reaction times and concentration, [which are] two critical components to driving.”
Getting a second opinion
For those who need an outside opinion on the matter, Scharre recommends that loved ones look into local centers that offer testing for elderly drivers, such as the Ohio State University Wexner Medical Center’s Occupational Therapy Driver Rehabilitation Program. These programs provide driving evaluation and skill development services for older drivers, including those with early-onset dementia, Alzheimer’s disease or Parkinson’s disease.
As AAA notes, the tests typically fall within two categories: driving skills evaluations and clinical driving assessments. For the driving skills evaluation, state-licensed and trained driving instructors perform an in-car assessment of a senior’s driving ability. The instructor will also offer recommendations if specific specialized training could be useful to improve skills and help reduce risks. This type of evaluation does not identify or deal with underlying related medical causes that could be impacting test results. Instead, it is meant to give a “snapshot” of someone’s current skills and typically costs $100 to $200.
With clinical driving assessments, trained specialists examine the driver for the “true level and cause of a decline in driving health.” They do this by taking into account not only a senior’s driving skills but also their overall medical history that could be impacting them on the road. Typically performed by Occupational Therapist Driving Rehabilitation Specialists (OT-DRSs), this type of assessment includes a treatment or intervention plan and can cost between $200 to $400+, according to AAA.
