Decision Aid Helps Older Adults Plan for When They Need to Stop Driving

When should an adult who has physical or mental health conditions that interfere with road safety give up driving and the convenience and autonomy that comes with it?

Based on the results of a clinical trial that included more than 300 older adults, researchers hope to empower older drivers and their families to make that assessment and plan ahead for when the time comes to hang up their keys.

The study found that using an online decision-making aid decreased a person’s internal conflict about making the choice to stop driving, while also increasing their knowledge about whether to continue, stop, or modify their driving.

Why Driving Becomes Unsafe

Marian Betz, MD, MPH, a professor in the department of epidemiology at the Colorado School of Public Health and the lead author of the study, told Verywell that the tool is not just for older drivers.

“There’s no age at which someone becomes unsafe or needs to stop. It’s really important to avoid kind of ageist assumptions,” said Betz.

While Betz’s study focused on older adults, she said that many conditions can affect driving safety at any age—for example, vision and hearing problems, or any condition that can slow reflexes.

Decision aids are used to help patients and providers make choices about health needs like end-of-life care and cancer therapies. The aids are also useful in situations where there are a few options that could work for someone depending on their preferences and needs.

“The tool tries to walk people through thinking about their options, their preferences, their needs, and then to make the decision that feels right to them,” said Betz.

The Study

To see how the decision aid worked, Betz and colleagues did a clinical trial with more than 300 older adults.

All the participants were over the age of 70, fluent in English, drove at least weekly, and had at least one medical condition that could potentially become a reason to stop driving. None of the adults were cognitively impaired.

The participants were randomized into two groups; one group used the online driving decision aid created by Healthwise. It included information on driving and age, various options for driving, the driver’s feelings, the driver’s decision, and a summary.

The aid gives two end-point options: to stop driving or keep driving. Each decision is presented with its respective risks and benefits.

The other group, which served as a control, viewed a webpage about driving in older age created by the National Institute on Aging.

What the Results Showed

The main outcome the researchers were looking for was any change in the participant’s decisional conflict scale, which measured their personal perceptions of uncertainty or ambivalence in making a choice.

The researchers found that the group that used the driving decision aid had a 24% greater reduction in decision conflict than the control group.

These participants also had more knowledge of the concepts presented to them—about 89% for the decision aid group compared to 80% for the control group.

About 87% of the participants who used the decision aid said they would recommend it to someone in a similar situation.

However, the authors of the study noted that in the end, most of the people in the trial chose to continue driving. The researchers plan to keep following the participants for two more years.

Is It Time to Hang Up Your Keys?

While most cars on the road today have backup cameras and GPS navigation that help drivers who have minor impairments, these safety features don’t replace defensive driving skills.

Betz said the driving decision aid is just one tool to help people figure out if they’re no longer safe to be on the road—a realization that’s not always obvious or easy to face.

“There are going to be cases where someone’s going to need input from an expert like an occupational therapist or driving specialists,” said Betz. “They may need a lot of discussion with their family or primary care doctor.”

Betz added that some people may need another person to step in and tell them they can’t drive safely anymore. For example, if a person’s decision-making has become impaired by dementia or memory loss.

That said, the decision aid is meant to be used by people who have reached that point. It’s designed to help them gauge when it’ll be time for them to stop or limit their driving—for example, they might only drive during the day and in areas that they know well.

Empowering People to Choose

According to Betz, what’s key is that no matter how old they are and what their circumstances may be, people usually want to make the decision on whether to keep driving for themselves.

A decision aid can help them prepare to make changes and learn about the options they’ll have when they stop driving, like grocery or meal delivery services, public transportation, taxis, or ride-sharing apps like Uber and Lyft.

“It’s really important that people not become isolated at home—both for their needs in terms of food or medical care, but also emotionally,” said Betz. “It’s really important that people can still be connected to others.”

Anne E. Dickerson, PhD, the director of the Research for Older Adult Driver Initiative (ROADI) at East Carolina University, told Verywell that some of the changes that affect driving are progressive and can easily creep up on a person.

“It’s a whole array of when does somebody recognize it’s time to stop driving,” said Dickerson. “Some people have to stop in their fifties and some people can drive in their nineties.”

Dickerson added that the speed at which people process information and react to a situation slows down with age, as does their reaction time.

For example, a person might be fine when driving on familiar roads, but if construction blocks their usual route, they might get lost. That kind of incident might be the first clue that something’s wrong.

Seeking Support

People don’t have to make these choices alone. For example, Dickerson said that occupational therapists are beginning to include driving evaluations in their work to help people decide if they need to stop driving or change how they drive.

Some occupational therapists are actually driving rehabilitation specialists. Not only do they understand vehicles and the rules of driving, but they can also perform a clinical evaluation of a person’s driving skills. In some cases, they may be the ones to convince the person it’s time to stop driving.

Planning Ahead

Dickerson and her colleagues created a website with information on assessing driving skills as well as ways to connect with experts. The site also offers suggestions on practical matters like how to transition from driving to using public transportation or making arrangements with family and friends.

Dickerson said that getting strategies in place as a person’s medical condition worsens needs to be done sooner, not later. It’s best to give a person who is approaching the transition to not driving the chance to try out services like a taxi or Uber before they start relying on them.

“We are about keeping you on the road as long as we can,” said Dickerson. “But if you can’t, let’s work out a plan so that you can stay engaged in your community.”