Grandma just got a ticket for driving too slow on the interstate.  Her car has dents and scratches that weren’t there before. And she got lost driving to the hairdresser she’s been going to for 20 years. Is it time to ask her to stop driving?

It’s tricky business, said Dr. Mark Wesselman, who treated many geriatric patients and veterans before recently joining the UCHealth team. He practices internal medicine at the UCHealth Primary Care Clinic – Chapel Hills in Colorado Springs.

Seniors’ driving is “an issue that comes up quite frequently,” Wesselman said.

Unlike some states, Colorado has no reporting requirement for doctors who suspect their patients might not be competent to drive any longer. There is, however, a form doctors (especially eye doctors) can fill out to report a concern to the state.

“Driving is such an important part of living and it is such an integral part of personal independence, it’s hard to take it away,” Wesselman acknowledged.

Age isn’t necessarily the catalyst, he added.

“I mean, teens are the worse drivers, statistically,” he said, “but seniors come in second. And seniors are more likely to be hurt in a car accident – fractures and head injuries, especially – or even killed. ’’

The National Highway and Transportation Safety Administration (NHRSB) reports that 18 percent of all auto accident fatalities are senior citizens age 65 and older.

What signs should indicate when it’s time for someone to stop driving?

“Cognition is probably the biggest issue – if your cognition is impaired, that’s pretty serious,” he said. “It becomes a bigger and bigger issue as more of us become older. Getting lost is one sign – and it’s a serious one.”

He defers to the NHTSA list of things to watch for:

• Getting lost on routes that should be familiar.
• Noticing new dents or scratches to the vehicle.
• Receiving a ticket for a driving violation.
• Experiencing a near-miss or crash recently.
• Being advised to limit/stop driving due to a health reason.
• Being overwhelmed by road signs and markings while driving.
• Taking any medication that might affect driving safely.
• Speeding or driving too slowly for no reason.
• Suffering from any illnesses that may affect driving skills.

“If your family and friends begin to comment on your driving ability, it’s time to take stock,” he added. Notice if you’re having trouble performing daily tasks, also, he said. Hand-eye coordination and reflexes should be good if you’re going to drive.

Some illnesses should preclude driving a car, he said.

“The big illness would be dementia – a lot of neurologic illnesses can impede our reflexes, diseases like Parkinson’s or epilepsy or multiple sclerosis,” Wesselman said, adding that poor heart health can affect oxygenation (and, thus, brain function). Some cardiac and pulmonary diseases can contribute to impairment and ability to operate a vehicle, too.

Some medications also make it dangerous to drive.

“Common medications can cause problems – sleeping and anxiety medications can impair ability to drive well,” he said. Anything that affects your alertness should be viewed with caution, even allergy medications like Benadryl.  Also, some blood pressure medications and diuretics can cause problems.

Read the cautions that come with any medication, he advised.

If an elderly driver doesn’t voluntarily give up the practice, what can be done?

In Colorado, the state does test drivers’ eyesight every five years after age 65. If you fail, only your eye doctor can get you a reprieve. But what if the problem isn’t just vision?

Well, you can have “the talk.”

“I’ve had some of my patients be in accidents when they shouldn’t be driving. We talked about it and they promised to curtail their driving, but …” he paused. “I even had to take away my own parents’ keys at one time.”

His father developed Parkinson’s disease in his 70s. After having an accident because he couldn’t brake fast enough while trying to avoid some pedestrians, his father admitted he needed to stop driving. Wesselman’s mother took over the driving duties until she, too, was no longer capable.

“It’s not easy, making that call,” he said. “There really isn’t a way to take the keys away, legally, and even if you do, they might have a spare tucked away somewhere, anyway. You can take away the driver’s license, but they might just drive without it. And you can’t take away the car without their permission. That’s theft.”

He can’t even count the times a family member has taken him aside and said, “Please tell Dad he can’t drive anymore. He won’t listen to us, but he’ll listen to you.”

Sometimes it works, sometimes not.

Some occupational therapists will test a patient to see if he or she should still be driving. That may reinforce the doctor’s opinion.

What are the options, then?

If a community has good public transportation, or the patient can afford to take a taxi or Uber, that helps, he said. Some non-profits offer free or reduced-price senior transportation. But often the burden of the driving then falls upon friends, children or other relatives. And it takes away the patient’s independence, which can be a hard blow for the patient to absorb.

This is not to say that all older patients need to stop driving, he said.

“Just being older doesn’t necessarily make you a bad driver,” Wesselman said. “Look at Paul Newman. He was a race car driver in his 70s and he was better than a lot of the younger guys. ’’

In fact, he agrees with this statement from the NHTSA:

“Getting older does not necessarily mean a person’s driving days are over. But it’s important to plan ahead and take steps to ensure the safety of your loved ones on the road.

“If you think you need to have a conversation with an older driver about his or her driving abilities, remember that many older drivers look at driving as a form of independence. Bringing up the subject of their driving abilities can make some drivers defensive. So, be prepared with your observations and questions, and—if necessary—provide possible transportation alternatives.”

NHTSA offers free material about how to recognize and discuss changes in your older loved one’s driving. Visit https://www.nhtsa.gov/road-safety/older-drivers#topic-older-driver-safety for more information. Other good sources of information, he said, include AARP and a website called Caring.com.

“You have to find the right way to approach the subject,” Wesselman said. “There’s no one-size-fits-all for taking away the car keys.”