Alice Pomidor, a Florida State University geriatrician, brings up the subject of driving with her patients over age 75 by asking a simple question: "How did you get here today?"
As the editor of a newly revised American Geriatrics Society guide for medical clinicians on older people and driving, Pomidor understands why many doctors don't initiate the driving talk. For one thing, they don't have much time and older patients often have many serious medical problems. For another, many people don't take kindly to the suggestion that it's time to start thinking about giving up the keys.
"People highly value their relationships with their patients," she said, "and they don't like to discuss things that are going to make their patients very angry or unlikely to come back."
Doctors can actually help many patients stay on the road awhile longer, Pomidor said. If a patient tells her that she's stopped driving at night, Pomidor can order a vision check. Maybe the patient needs new glasses, or treatment for cataracts or macular degeneration. Physical therapy might help someone with arthritis who's having trouble gripping the steering wheel or turning his head to see. Extra-wide side mirrors and a spinner knob on the steering wheel can also help. Medications affect alertness; perhaps a dosage can be adjusted.
Some people can keep driving if they're willing to accept some limitations, such as staying off highways or driving only during the day.
But some should not drive at all — and don't want to hear it.
"These are the group of people who tell you, 'I will stop driving when you take the keys from my cold dead fingers,' " she said. They see driving as their last scrap of independence or the sole reason they can stay in a suburban house. "They see stopping driving as the first step down the line to the nursing home," Pomidor said. Some will drive even without a license.
Pomidor recommends tips from the American Geriatrics Society Health in Aging Foundation. Here are her ideas for managing cognitively impaired drivers who won't stop driving (bear in mind that some people with dementia may have more trouble with judgment than memory):