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Yesterday I was pulling into a parking space when an elderly man driving a large truck started to back up. I could see that if he kept backing up he would soon hit my car and I gave a friendly toot on the horn to let him know I was there. He never acknowledged my presence, but just kept accelerating toward my car. I hurriedly shifted to get out of his way while continuing to toot my horn. Soon, a pedestrian stepped out behind me so that I could not back up any farther at which point I leaned on my horn and watched helplessly as the elderly man with the big truck backed right up into the bumper of my little Toyota. Finally, satisfied that he had sufficient room to pull forward, he drove off. He never heard my horn, he never looked in the rearview mirror, and he never felt the impact of my bumper. Was I flabbergasted? Not really.

Driving privileges in the elderly are a growing concern in the U.S., where 15 million drivers are over the age of 65. In the year 2020, that number will grow to 50 million over the age of 65. A driver’s license means freedom from the limitations of an aging body and continued independence in society. Maintaining the driving privilege is not merely a convenience, but in many parts of the country (especially here in rural New England), it is a necessity. How do we know when it is really time for our elderly parent to stop?

However, in the absence of certain medical problems, advanced age does not lead to poor driving skills. Older adults who do need to stop driving frequently have the following health problems: Dementia, diabetes, vision impairment and mobility impairment. In addition, certain medications affect the safe operation of an automobile, especially those that result in sedation.

Many elderly self-impose restrictions on their driving: Driving only in daylight, in good weather, in light traffic and on familiar roads. Yet, other aged individuals (especially those with memory problems) fail to recognize when their driving is impaired, or they recognize it, but see no way to really avoid driving.

Many states are changing the laws regarding the driving privilege, making license renewals more strenuous or physician reporting of certain medical conditions mandatory. In Massachusetts, the burden of responsibility still lies with the driver. The physician provides guidance to the patient and the family and documents the advice, and the ultimate responsibility remains with the operator of the vehicle.

If in doubt about driver safety, driver refresher courses are offered through AAA, AARP and an occupational therapy referral via your local hospital or physician. Most elderly don’t need big government to tell them when to relinquish the driving privilege. With the guidance of family and their local doctors, they know when it is time.

Dr. Deborah Gelinas is the neurologist at Nashoba Valley Medical Center. She comes from a 20-year practice in San Francisco where she was the clinical director of an internationally recognized ALS/MDA center and a Memory Center. She has published books for newly diagnosed patients with neurological disease as well as a host of articles and book chapters. Dr. Gelinas moved back to Massachusetts to be near her mother and five sisters.

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