"When the Time Comes..."

It was one of the hardest things I had ever done.

My 83 year old father in law had recently spent a week with us,  recovering from a near fatal heart attack that landed him in Intensive Care. I drove him home, with the idea I would attend his first visit with his local GP. Dad was weak, and had been struggling with some minor confusion issues, so he needed help sorting out his meds and health advice.

What we did not discuss before the appointment was that his driving also had to come up in the conversation. Dad had, for some years, been experiencing an erosion in driving skills. Poor eyesight, fatigue, and the natural loss of reaction time that comes to us all as we age had made their mark. Several years before, he had jauntily informed my husband that "when the time comes...", all he had to do was tell Dad it was time to hang up the keys, and that would be that. No muss, no fuss.

It sounded so simple, so logical. And one day after driving friends to and from the golf course, Dad backed up his car while one of his friends was still getting out of it, knocking the man unconscious. The local police investigated but all that was required of Dad was a written driver's test...and he resumed driving. He failed to connect the dots on this occasion and we children were unsuccessful in getting him to address the issue of when he would stop driving. There were objections: Dad was well beyond being able to wait for, and clamber into, a bus. Taxis were an option but he hated the lack of spontaneity involved, and even more, felt he would lose self respect and dignity if he gave up the keys. One issue had raised others...without the car, it seemed obvious that a move closer to children, and transit options, and a more manageable home was suddenly something we should consider. But Dad wasn't ready for all of that. Wary of conflict and upset, we backed off.

At the time we were shocked the authorities allowed Dad to continue driving. We were even more shocked when we realized that prior to the larger heart attack (not his first) Dad had been experiencing random blackouts. In spite of that, his GP had made no move to suspend Dad's driving privileges. And Dad, increasingly driven by an irrational fear that revealing any loss of ability would lead to an assisted living situation, kept quiet. This fear would dominate his final years, and cause Dad to refuse to make any of the changes that were necessary to keeping him safe and comfortable in his own home for as long as possible: the years of playing possum had begun.

In the doctor's office, and after the general questions and queries had been dealt with, I raised the topic of driving. Dad was terribly upset, I was too, but turned to him and said I was haunted by an incident in Toronto:

 "...when 42-year-old Beth Kidnie was killed after Pilar Hicks, 84, ran a red light at Bloor St. W. and Markland Dr. and kept driving, dragging Kidnie's body for several kilometres before realizing what she had done.

Hicks, who had passed three transportation ministry road and written tests before the accident and received a clean bill of health from her doctor a few months before the accident, was convicted of criminal negligence causing death and had her licence taken away"

If I remember that story correctly, Mrs. Hicks actually drove home without ever realizing what she had done, which was continue to drive whilst the screaming Beth hammered on the side of the car before finally being dragged under it. Mrs. Hicks was remorseful, but confused; wounded by the agitation around her.

I explained to my father in law that while I felt his crashing and killing himself was a fate we could both probably deal with, I did not want his final years marred by living with the aftermath of having killed someone else, possibly a mother or child. He began to cry, but agreed that was right. And the doctor said that if she allowed him to drive when she knew he was having blackouts, she would lose her license to practice. That helped Dad face the fact that his actions did indeed involve other people. This gave him a dignified reason to give up the keys.

And that is what we need to give our elderly citizens: 
a dignified reason to give up the keys.

We have a lower limit on age of drivers, and we need an upper one. Indeed we should always have had one. If Dad and all his cohorts knew in advance that they would cease to hold licenses at 75, it would be accepted as a matter of course, something to plan for. And they would be in the same boat, not left to self regulate between their loss of skills and fear of shame. Alternate modes of transportation would become acceptable and more numerous.

We would be preventing, rather than reacting to, the fact that older drivers, per driver mile, experience the highest proportion of accidents, injury and death of any demographic.

Unfortunately, Dad's story involved more tragedy. Having lost the keys, he put a great deal of pressure on his wife to continue driving. Like Dad, she was reluctant in any case to give up the keys. And in spite of demonstrably poor driving skills, and being nearly blinded by cataracts, neither her GP nor her children ever moved to get her off the road. Finally (at 84), and after several frightening incidents, she confused the brake with the gas pedal and crashed the car, mercifully without injuring or killing anyone else. Recovering in the trauma unit, she angrily blamed the crash on a recent oil change, and remained determined to get back on the road. The accident set off a train of tragic events; she lost that critical bit of mobility that she needed to live alone, and had to enter assisted living, completely unprepared, in a strange city where her adult children lived, immediately after release from the hospital. She lost much more than her license in the crash. It was a brutally difficult, and abrupt, transition for her.

My own parents are now in their mid '70's. After my father in law's experiences, I asked them to consider when and how they would approach the issue. While still roadworthy, their driving skills were definitely eroding. They became instantly angry and defensive, and cut the discussion short, saying they will deal with the situation, "when the time comes". They have never since referred to the topic.

It's a common reaction. When this topic arises among the elderly of my acquaintance, I hear one of two stories. The first is: "Oh, but we only drive around our little neighbourhood, not in the big city". This story is code for "I am completely incapable of quick reactions to surprises in traffic, and I know it, but I am convinced that the route between my house and the grocery store is completely proof to those surprises." This of course, is potentially a fatal mistake.

The second story is: "Oh my, I just bumped into old Mrs. Smith. Why, she's 92 and still drives to the cottage/Vegas/the big city and back all by herself! Just goes to show you!" This story, which my own parents love to tell me, translates as "Don't ask me to stop driving! I just can't face that issue". They artfully "forget" that the Mrs. Smiths of the world are a) running terrible risks and b) the exception, not the rule.

These experiences, and the now common and eerily similar experiences of my 50 year old peers, have caused me to think long and hard on this topic. I have decided for myself, and have told my husband and children, that I will stop driving no later than age 75. 

If you are driving at 75, you are lucky, but if you are driving at 80, you are taking cavalier risks with the lives of others.

It is worth noting that the pre-boomer generation (now in their 70's and 80's) are living much longer than their parents did. That means they are living without a roadmap to this newer, longer old age. I think the image of what their own parents were doing at the end of their lives has left them with an unexamined belief that they should be doing exactly the same things, forgetting that their parents just before they passed were members of a much younger age bracket. They have no idea that while the aging slope is fairly gentle between 60 and 75, it is precipitous as you approach and pass 80.

And I think many, like my in-laws, begin a habit of concealing the effects of aging out of fear of losing autonomy and a voice in decision making.

I do not think the boomer generation (of which I am technically a member), now poised to hit the road in huge and increasingly greying numbers, will make better choices. In fact, I think it probable that the sense of entitlement that generation is famous for will preclude wise and pre-emptive decisions related to aging and the attendant change in abilities.

And so we are left to ponder. How can we give our older drivers dignified reasons to give up driving? Can we change legislation and change a cultural norm? It is such an upsetting issue. What can we use as a guide?

I suspect it would be helpful here to borrow a little cultural wisdom from the Buddhist tradition, which suggests that a good life strategy is to pursue one's own happiness, but only insofar as it does not compromise the happiness of others.

That is an excellent maxim to take into old age, a place in which one must adjust to changing horizons, and increasingly take a team-based approach to planning for and making important life decisions.

In the end, it is not about diminishment, and being Less-Than; it is about living the life you have fully, and joyfully, with a clear view to keeping tragedy at bay. There is no shame in facing, resolutely and with grace and humour, the challenges of aging, including giving up driving.

Update January 2012:
Great resource for aging drivers
http://www.bcaaroadsafety.com/drivers/older-drivers/