Independence Day...and When to Give t Up

If you know an aging independent-living senior, most likely his or her greatest concern is maintaining that INDEPENDENCE. In a perfect world, we would all be able to mentally and physically care for ourselves as we age. Unfortunately, especially with all the advances in medicine that prolong our lives, that is too often NOT the case.

Driving is probably the hallmark of independence. As long as we can find our keys to GET to the car, we feel a strong sense of freedom. Getting groceries, heading to a doctor's appointment, visiting a friend or attending church is simple, because we simply get in the car whenever we feel like it. No one wants to give up driving, but here are some issues to consider:
Hearing
Vision
Limited neck mobility
Slowed reflexes/stiff muscles in arms

If you have trouble hearing, you may not hear that siren or warning honk, or even the loud motorcycle approaching.
Decreased vision (think cataracts and macular degeneration)- well, this seems obvious, but you can see cars with pretty poor vision. However, you need to be able to read SIGNS, too, as well as see colors of lights.
Stiff neck? You can't turn your head to check your blind spots.
Slow or stiff muscles- you can't manuever your car quickly enough to react to sudden changes.

Please check out an earlier blog on Driving Safely while Aging Gracefully.
BOTTOM LINE: There are many options to driving yourself that do NOT involve giving up your independence. Please do NOT wait to give up or limit your driving until you've hurt your car, yourself or another person.

Driving Safely While Aging Gracefully

This week, I've been talking about seniors, driving and maintaining independence. This topic is incredibly difficult to bring up with family members and friends. What role should the primary care physician play in this situation? Well, frankly, I'm sure we need to be playing a far more active role than most of do. In fairness, often it is difficult to squeeze in all the pure medical issues that an elderly patient has into a routine office visit. Many seniors have multiple chronic issues (such as high blood pressure, high cholesterol, diabetes or thyroid disease) and simply addressing the ongoing concerns with these problems more than fills the appointment time.

However, I do think that at least addressing driving issues should be a routine part of annual physicals for our aging patients. There is a wonderful booklet, developed by the USAA Educational Foundation, AARP, and the National Highway Traffic Safety Administration, that outlines the physical effects of aging, as well as tips on coping with them so that people remain a safe driver as long as they can. The booklet is called "Driving Safely While Aging Gracefully" Take a look at this booklet, and print it out (in large print) for the senior you are concerned about. Additionally, if you have concerns about a family member's driving, let their physician know. A simple note with specific concerns ("Mom has had several fender-benders in the last year" or "I'm scared for my kids to ride with my father because he darts out into traffic, or drives 40 mph in a 65 mph fast lane") will help direct your parent's physician.

BOTTOM LINE: Don't wait for a serious accident to address issues with seniors driving, and PHYSICIANS- remember to ASK about driving and recommend the booklet Driving Safely While Aging Gracefully.

More on Senior Driving

How else can you talk with a parent or loved one about whether or not it is time to stop driving? Well, for many seniors, they have realized that they are not as comfortable driving as they used to be. Perhaps they have already self-limited their driving: no driving at night, or in the rain, or maybe no driving on busy highways any more. Often, they have narrowed it down to a weekly grocery trip, often doubling up with their same weekly trip to church. At this point, they are most likely spending more money on car insurance, car maintenance and gas then they would spend on a car service!

If they feel uncomfortable with "a stranger" and using public transportation, perhaps you could consider paying a responsible family member or friend to set aside a couple hours per week to run errands. Frankly, in this economy, there are many people happy to make an extra $100 per month for a couple hours work per week! Relying on friends and family members for favors is fine for the occasional event, but making a real business arrangement- even at a minimum wage plus gas type fee-helps all parties be more consistent and helps the senior feel more empowered (as opposed to feeling like a "charity case" or that they are imposing on someone to ask for a ride.)

BOTTOM LINE: Consider the financial bottom line as a legitimate talking point when deciding whether or not to stop driving.

Senior Independence

One of the most challenging issues with an aging family member is whether or not they should drive. As we age, most of have significant decreases in hearing and vision, as well as delayed reflexes. As I argued with my own father, if you complain that you can't see and you can't hear, why are you still driving? Of course, his answer was that if we took away the car, we were taking away his independence.

So, what can you do? First of all, I encourage people to start using public transportation BEFORE they "have to". Now, in many parts of the country, this is no big deal, but in others (such as Texas) we tend to rely on our own cars. Public transportation can be buses or trains, but don't forget about the cabs! Using a debit card (or a gift card- hint, hint) for a taxi service gives many people the independence they want to preserve without be limited by a set schedule or need to get to a specific bus stop or station. Often, regular clients form a working friendship with a specific driver, which creates the feeling of having a personal driver more than "having to take a cab".

BOTTOM LINE: Giving up driving does NOT have to mean giving up your independence!

Prevent Accidents: Hang up the Phone!

This week a perspective in the New England Journal of Medicine encouraged doctors to ask their patients about driving habits- and not simply about driving home after having wine with dinner. The issue here is all about texting or talking on cell phones while you are driving. Oh sure, you ONLY check your texts/emails when you are stopped at a light, right? Well, maybe if the traffic is really slow…What about simply talking on the phone- is that really a problem?

We know that driving while distracted by a phone conversation or texting is similar to driving while intoxicated. Both situations can cause you to react more slowly when an unexpected driving hazard emerges, or perhaps to never see the hazard until it’s too late. More and more studies are showing the dangers inherent with this distraction, and the hands-free phones do not appear to offer much (if any) improvement. There are more document accidents from talking on the phone than from texting, but this is likely due to the widespread use of cell phones (compared with texting.)

When teens are learning to drive, they are encouraged to put their phones in their backpacks or purses, and then place those items in the back seat. I believe we should all follow that advice. Move it to the trunk if you need to, but remove the temptation!
BOTTOM LINE: To quote a rude but accurate bumper sticker, “Shut up and DRIVE!”