At what age should you give up the car keys?

In January 2019, 97-year-old Prince Philip was involved in a car crash that overturned his Land Rover and injured two people—but the prince was back behind the wheel just two days later. He has since voluntarily given up his driver’s license. But the incident made many wonder: Why was he still driving at his age?

In the United States, people age 65 and older made up 19% of all licensed drivers in 2016. This age group also accounted for 18% of all traffic fatalities, according to the National Highway Traffic Safety Administration (NHTSA).

In the past decade, the number of people killed in crashes involving older drivers increased 18%—from 6,169 in 2007 to 7,256 in 2016. At the same time, the overall number of senior Americans is increasing. In 2016, more than 15% of the total US resident population was age 65 and older, which means more older drivers on the road.

Accordingly, consider whether your patients’ health status poses a danger to themselves or others on the road; likewise, be mindful of your own health and ability when you get behind the wheel.

Highway to the danger zone

“Despite public perception, older drivers do not pose a disproportionate threat on the roads,” according to information from the American Automobile Association (AAA). “On average, drivers in their mid- to late-80s have lower crash rates per mile driven than drivers in their early 20s and roughly half the crash rate of teenagers.”

The problem for older drivers is that they’re more fragile, with greater susceptibility to injury when a crash does occur. This is the reason for 60% to 95% of the higher death rates per mile driven in older drivers, the AAA reports.

There is no national or state age limit on drivers’ licenses, although many states have special requirements for older drivers, such as mandatory eye exams or in-person license renewal.

Can’t drive at 65?

You can simply tell older patients to stop driving or advise their adult children to take away their car keys—but the issue is more complicated than that.

“Keeping older adults off of the roads is not necessarily the best option: cessation of driving can contribute to social isolation, depression, and a variety of other health-related issues,” according to AAA.

“Physicians must balance dual responsibilities to promote the welfare and confidentiality of the individual patient, and to protect public safety,” according to the American Medical Association’s Code of Medical Ethics.

To that end, physicians are in a unique position to assess whether their patients’ physical and mental conditions affect their ability to drive safely. Plus, physicians “have a responsibility to do so in light of their professional obligation to protect public health and safety,” the Code of Ethic states.

What you can do

How do you make such an assessment? You can go with your experience and gut instincts, but you can also use the Clinician’s Guide to Assessing and Counseling Older Drivers, published by American Geriatrics Society and NHTSA.

According to the guide, physicians and other healthcare providers can assess and advise older adult drivers on their fitness to drive, recommend safe driving practices, refer older adults to driver rehabilitation specialists, advise or recommend driving restrictions and, if necessary, refer older adults to state licensing authorities.

The guide includes an algorithm, Plan for Older Drivers’ Safety, which involves these steps:

• Screen for red flags such as medical conditions, potentially driving-impairing medications, and recent adverse driving events or behaviors.
• Assess driving-related functional skills in older adults at increased risk of unsafe driving.
• Evaluate and treat the at-risk older driver for medical conditions and other causes that may be impairing functional skills related to driving, and intervene to:
  • Optimize the treatment of underlying medical and functional contributors to driving impairment within your scope of practice or that of another provider.
  • Refer older drivers with persistent deficits, when appropriate, to a driving rehabilitation specialist for further driving evaluation and/or training in use of adaptive equipment.
• Counsel older adults and their caregivers about potential driving cessation, and/or alternative transportation options.
• Reevaluate and follow-up with older adults tasked to adjust their driving to determine if they have made changes, and monitor those who stop driving for signs of depression and social isolation.

Put a plan in place

“It’s important to have open, respectful communication to establish that maintaining mobility and finding alternative means of transportation are key to retiring from driving. These discussions should occur long before there’s a crisis,” wrote Alice Pomidor, MD, MPH, editorial board chair of the Clinician’s Guide to Assessing and Counseling Older Drivers, and professor, Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL.

Americans—even older Americans—aren’t quick to give up driving, so adjusting to a life without this autonomy and convenience requires having a realistic mobility plan, Dr. Pomidor said.

Consider regional and local transportation resources that can help people get around without driving, or access ride-sharing apps like Uber or Lyft. Perhaps, someday, self-driving cars might be the answer to older Americans’ mobility needs, she added.

“Until then, following basic driving safety strategies and keeping as mentally and physically fit as possible is the best way to help us help ourselves to keep driving for longer,” she concluded.