“I don’t think Mom should drive anymore. I tell her, but she doesn’t listen to me!”
When I used to conduct palliative care home visits (read Post 1: What Exactly Does a Palliative Care Specialist Do?), family members would sometimes ask me to “convince” their loved one to agree to stop driving.
I would ask, “What are your concerns about their driving?”
Sometimes, I would hear, “Well, she’s getting older.” Age alone, without impairment, is not usually a reason I can use to justify attempting to significantly restrict another person’s independence.
However, sometimes family members do notice observable changes in a loved one’s driving.
“Oh my gosh, I don’t think my father-in-law should be driving at night. Last week, he kept crossing into the other lane, and it was nerve-wracking!”
“My wife didn’t used to get so anxious driving, but now she gets flustered and ends up confusing the exit signs on the highway.”
“This is Grandpa’s third fender bender in the past year! He crashed into another utility pole. I ask him each time what happened, but he can’t really explain.”
When we do become concerned about a loved one’s driving, we may feel unsure on how we could bring up our concerns. After all, telling another person that they should no longer have access to car keys because they lack the ability to drive (a huge contributor to independence!) could result in a very strong negative reaction, often driven by emotions rather than observations, facts, or statistics. The sensitivity of this topic may be akin to discussing moving a loved one out of their home because of worries that they may no longer be able to care for themself on their own (read Post 36: A Nursing Home for Dad? – Six Practical Steps to Making a Difficult Decision).
The following are seven approaches to helping a loved one “let go” of driving:
1. Start the conversation earlier on when you first start having concerns. It may be at this time when you start conversations earlier rather than later that you can discuss driving modifications rather than letting go of driving entirely. Driving modifications may include driving primarily during daylight hours, driving during traffic-light times (especially not during rush hour), driving primarily on local roads, and driving only to familiar places.
"The traffic on the highway is getting worse and worse, especially during rush hour. I feel like I have a harder time merging! What do you think?"
"I was reading about driving tips and strategies for helping people stay on the road as they get older. One of them was sticking to driving when there's light out and sticking to roads they're familiar with..."
2. Remain respectful of your loved one's pride and sense of independence. This would include being mindful of tone of voice and actual words said.
Think about how defensive, insulted, incredulous, or possibly angry you may feel if someone (family member or stranger) were to tell you that you were no longer capable of driving and demand that you start restricting your driving. At best, I might simply ignore this person, with surety that their comments did not apply to me.
Your loved one will only willingly let go of such a huge part of their life if they have buy-in. They have to believe themself that the risk of driving outweighs whatever driving means to them, whether it be personal independence, a means of maintaining some control in their life, a source of pride, or other.
Attempt to identify in your loved one what is most important about continuing to drive. Then, based on their overall values and what is most important to them, articulate potential motivators to make driving modifications or to let go of driving altogether.
"I know it's hard talking about putting a pause on driving. I'm only mentioning this because I know how important the kids' and grandkids' safety is for you. With how you feel now, with your reflexes and speed, do you think if Cara ran in front of the car that you could press the brakes in time?"
"I heard that if someone gets in an accident - even if they didn't cause the accident - things could be twisted around so that the other person's lawyer says, 'Well, this person has a dementia diagnosis or this person has a hearing loss diagnosis and wasn't wearing hearing aids,' and try to sue the person who didn't even cause the accident! That's potentially a lot of hard-earned money lost, even if it weren't fair."
3. Anchor the conversation on your observations (not your opinions) and focus on what is being gained rather than what is being taken away.
Use "I..." statements when talking about your observations, rather than "You..." statements that may sound accusatory.
"I've counted up the number of fender benders we've had with this car in the past year. I know you've never had an accident before, and in just one year, you've ran into a pole or mailbox three times. I think this means we might need to change how we're driving so you and I and the whole family can get peace of mind. Wouldn't want anyone to get hurt in another fender bender."
4. Make sure to have suggestions for realistic alternative modes of transportation if you are going to suggest completely letting go of driving.
Present the driving modifications or alternate modes of transportation as suggestions rather than edicts with phrasing such as "Could we try...?" or "How about...?"
"How about we drive together whenever you go to get your nails done or need to go to the store? You can drive, and I'll ride along. And if we're going to a new place like a new doctor's office, we can switch places."
"Could we try to go to the store, eat out, and hang out together on the weekends? I'd love to drive us around and we can spend time together. And during the week, you can keep busy with things to do around the house. You wouldn't have to stress about driving anywhere during the week."
"I can show you how to call for a ride on your phone like we do when we go on trips. How about we check that out?"
"I was thinking about asking the church to include you in their pick-ups. What do you think?"
5. Consider referring to an independent authority figure to weigh in on your loved one's driving.
"I've shared what I've noticed so far with the driving, and I've made some suggestions. It sounds like you don't exactly agree. How about this? Let's ask the expert! Let's ask your eye doctor."
6. Remember, the goal is to preserve your relationship with these conversations, not to "win" the argument at the cost of your relationship. It is highly likely that you will get pushback, and if so, consider pausing the conversation and saying you would like to circle back at another time. Life-altering decisions such as letting go of an activity one may have performed almost daily their entire adult life may require time (and multiple conversations) to process.
"Okay, I don't mean for us to get so upset over this. We can pause the conversation. I do feel strongly that we should work together to make changes with the driving and with how you get around, so I'll probably bring this up again some time in the future."
Patients with dementia may forget conversations and decisions already made, so family members may have to hold the “driving talk” multiple times. Sometimes, a loved one’s dementia, short term memory, and impulsivity may be so severe, and their driving so impaired, that family members have told me that they have done one or all of the following:
(Attempt the following approaches with care. As dementia expert Teepa Snow says, “Dementia does not mean dumb.” Maintaining trust and a relationship between patient and family/caregiver is important in the long term. Otherwise, in the future, the patient may have difficulty trusting their family member/caregiver to be “on their side” regarding medications, diet, or any other important aspect of their life.)
7. Take action, such as hide the car keys, disable the car, or move the car out of sight.
"Oh yeah, we don't keep the car keys in the house anymore. He's been misplacing things anyway and can't remember where anything is. We're still looking for his social security card."
"My brother has the car. We remind her the car's at the shop, and so far, she's been okay with that explanation."
Driving is an activity where impairment could hurt not just the driver, but also multiple people around them. It is a high stakes activity. I hope these approaches - with reminders to ourselves to maintain respect for our loved one's desire or need for independence, control, or pride - will make initiating these conversations a little bit easier.
The following are resources that might provide additional guidance on bringing up such a sensitive topic:
Youtube video: “Dementia and Driving”
Website written by the National Institute on Aging: "Safe Driving for Older Adults"
Website written by Warner Law Offices: “Dementia and Driving”
Website written by the National Institute on Aging: “Driving Safety and Alzheimer’s Disease”