Dr. Marian Betz on How to Talk With an Older Adult About Stopping Driving

CU Anschutz Medical Campus

Excerpts from our conversation with Dr. Marian Betz, an NIH-funded expert on healthy aging at the University of Colorado, Anschutz Medical Campus.

NIHNiH: Why is the idea of stopping driving frightening for many older adults?

Betz: Many people really link driving with independence and their identity. So the transition to not driving can be emotionally really hard for people. It can feel like giving up an important part of their adulthood.

Also, people worry about feeling more isolated. Many older adults are still engaged in community activities that are important to them. So people are going to need a strategy for the activities they really want to stay connected with, even when they're not driving.

Another thing we hear over and over again is that older adults don't want to be a burden on other people. They don't want to feel like a burden to their families, or friends, or whoever it is they’ll need to rely on. But that's true in other parts of aging, too: It's hard to ask for help, if you're used to being independent.

NIHNiH: What are some tips for families who want to start talking with an older adult about stopping driving, to address some of these fears?

Betz: There are a couple of key points. What we hear from older adults and family members is first just acknowledge that this is a hard decision. And whenever possible, families should let older adults make the decision themselves, to support their independence.

Ideally, these conversations should happen over time. Imagine if someone told you: You can't drive as of tomorrow. That would be shocking. You need time to prepare, to adjust to it both emotionally and practically.

So, start talking about it ahead of time, especially if someone is developing a chronic disease that's probably going to progress. Starting early saying, something like, "you know, Mom, the nerve problems in your feet from the diabetes are getting worse. At some point, you know, you might need to stop driving.”

That also makes it not about blaming the person for their behavior. It’s about linking it to a specific medical problem. That can help take away some of the stigma.

There are some people who are not going to want to engage in those discussions no matter what. But for a lot of people, I think that gentle introduction of these topics over time can kind of plant the seed. It can give them time to kind of to adjust to the coming changes.

NIHNiH: Are there additional difficulties in having these conversations if a loved one has dementia?

Betz: Dementia is one of the things we really worry about in terms of driving. Sometimes people with cognitiveRelated to the ability to think, learn, and remember. impairment, when they're in the middle of driving, can forget things like where they're going or how to do things like turn left. These things require some cognitive skills.

Dementia is probably the most complex situation in terms of talking about stopping driving. The difference is that there comes a point when the older person can't make the decision themselves anymore.

If someone just has physical limitations, we really encourage them to decide for themselves. When someone has real memory and thinking problems, family members might need to step in. And that's different for everybody in terms of the timing, the signs, and so forth.

It’s helpful for families to know the resources that they can reach out to—like primary care doctors, physical therapists, occupational therapists—to get support. And if an older family member really doesn't want to listen or can’t engage, sometimes a medical evaluation, having someone else saying “it's time to stop driving” can then help families not be the bad guys.