Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know about the issues involved with older adults driving and what to do when it is no longer safe for a loved one to drive. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001, and Jean Sniffin, RN.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007. She can be reached at infonvna@natickvna.org.

Many elders fear losing their independence if they give up their car keys; they don’t want to have to rely on others for tasks like grocery shopping, going to doctors’ appointments, visiting with a friend, or even going to the movies.

Caregiving MetroWest: So, when should you be worried about a parent or older loved one driving?
Boyko: Many factors must be taken into account when considering limiting a loved one’s driving. In fact, there are several important “signs” that a family member should look for: illness or injury; failing eyesight; degenerative conditions like dementia or Alzheimer`s; or hearing problems. Anyone experiencing such issues should not be driving. Another major factor to consider is whether your loved one has gotten into fender benders, more serious accidents or has received warnings from law enforcement.

Some other warning signs that insurance carrier The Hartford lists in its “We Need to Talk… Family Conversations with Older Drivers,” include driving at speeds that aren’t appropriate; increased agitation while driving; confusion at exits; tickets for moving violations; trouble navigating turns; not anticipating potentially dangerous situations; and more.

Other warning signs include drifting into other lanes of traffic; driving significantly slower than the speed limit; stopping abruptly without reason; and failing to obey road signs, signals and laws.

CGMW: How can vision problems, hearing issues, reduced reaction times and medications affect older drivers?
Boyko: Several normal conditions of aging contribute to an individual’s decreased ability to safely operate a motor vehicle. Vision problems, for example, create myriad issues for older drivers: lack of peripheral vision contributes to not being able to see other cars on the road, street signs or even traffic lights. Some experience an increased sensitivity to light, making it more difficult to see things as they are in normal daylight hours. Conversely, some have nighttime vision issues, which also pose a danger not only to the driver but to other drivers on the road, too.

Reduced reaction times also create a potentially dangerous situation, because drivers can’t gauge the proper amount of time to avoid an accident or injury.

People with chronic medical conditions like sleep disorders, impaired vision, arthritis, seizures or dementia, are at a higher risk of vehicular crashes.

As they say on their labels, some medications should not be used while operating a motor vehicle. Some combinations may be dangerous to use while driving, as well. Such medications can include narcotic pain pills, cough medicine, decongestants, antihistamines, some antidepressants and tranquilizers, according to AAA’s Senior Driving website.

RoadwiseRX is a tool on the AAA website that can help you understand how one’s medications can affect that individual’s driving.

CGMW: Are there other potential dangers for older drivers?
Boyko: The Hartford also says that drivers over the age of 75 are at higher risk for a collision each mile driven. In fact, “for older drivers, the rate of fatalities increases slightly after age 65 and significantly after age 75. This higher rate is due to the increased inability to withstand the physical trauma that often occurs with age.”

CGMW: How do you discuss driving issues or no longer driving with a parent or older loved one?
Boyko: It’s a tough conversation to have. Many older adults feel they’re giving up their independence along with their car keys. They fear that they will become increasingly dependent on others.

While some elders may realize that they should no longer be driving, they may also be resistant to limiting their driving for the reasons mentioned above. However, if you feel that a loved one is a danger to him/herself or others behind the wheel, the conversation is an important one.

Start by conducting research to identify viable alternatives to driving themselves; this way, you are armed with a potential solution to a problem that’s difficult to discuss. Take a short ride with your loved one. Pay attention to their reaction times and awareness of their surroundings. Ask them how they feel and whether or not they have their own concerns. An important consideration during the conversation is to communicate that the primary reason behind the conversation is to preserve your loved one’s own health and safety.

Talk to your loved one’s doctor to express your concerns; the doctor may have some practical tips for you as well as offer to help in the process.

CGMW: What strategies can you use if a parent or older loved one does not want to stop driving?
Boyko: If this is the case, you’ll have to take matters into your own hands, so to speak. Take away the car keys; cancel the car’s insurance and registration; or even taking the car itself away. While these strategies may not be optimal, they may save a life down the road.

In a 2008 “The New Old Age” blog, New York Times journalist Jane Gross wrote “And while it might seem extreme, many experts (and commenters on this blog) recommend filing an unsafe-driver report with your state motor-vehicles department if all else fails to persuade an elderly driver that the time has come to hand over the keys.”

CGMW: What transportation options are there if a parent or older loved one can no longer drive?
Boyko: In MetroWest, there are a number of transportation options for older adults:

•    MetroWest Regional Transit Authority (MWRTA) serves 15 towns in MetroWest with bus transportation options. The Authority also works with several area Councils on Aging by providing transportation to seniors and those who are disabled. For residents of Framingham and Natick, MWRTA offers the MetroWest RIDE. Residents of Ashland, Marlborough, Southborough and Wayland can take advantage of the Dial a Ride Service the MWRTA offers. Finally, the ADA Paratransit provides rides for individuals with disabilities.
•    Worcester Regional Transit Authority (WRTA) provides reduced fare paratransit services for elders and those who have disabilities in nearly 40 communities.
•   ITN Greater Boston is a membership-based non-profit organization that provides transportation for people over the age of 60 as well as those with vision impairment. It’s membership-based, and volunteers provide, according to the website, dignified “arm-through-arm, door-to-door” services.
•    The Massachusetts Health & Human Services website provides additional information on transportation options.
•    Caregiving MetroWest also provides detailed transportation options for the region on its Transportation page, or check for town specific options on the town pages from the clickable map of MetroWest.

CGMW: How do you deal with any anger, resentment or depression your parent or older loved one may be experiencing if they can no longer drive or if you have told them they shouldn’t be driving?
Boyko: Imagine your own children suggesting that you no longer drive; the roles are now reversed – your children are acting as the parents, and you become the child. Not such a great feeling.

Consider framing the initial conversation in a positive light rather than an attack on your loved one. Open up the conversation with a question like “How’s it going behind the wheel, Dad?” or “Are you still feeling comfortable driving?” This will spark a discussion that is led by your loved one – not you. An open-ended question leaves plenty of room for feedback and can set the stage for you to ease into the topic of taking away the car.

Show empathy. Allow your loved one to talk, and be sure to listen reflectively. Reflective listening, according to caring.com, “means rephrasing what the person has said – conveys support and encouragement and helps the speaker gain insight about his experience.”

Through reflective listening, you as the caregiver can help your loved one work through the difficulties in accepting this transition and can help to foster a sense of acceptance.