For most of us, driving represents freedom, control, and competence. Driving lets us go to the places we want or need to go. For many of us – even as we get older – driving is important economically. We drive to get to and from work, and sometimes as part of our jobs. Driving is important socially; it lets us stay connected to our communities and favorite activities.

Driving appears to be relatively easy, but in fact it is a complex skill. Our ability to drive safely is affected by changes in our physical and mental conditions. Many of these changes take place as we get older, though in different ways and at different times.

Research shows that age is not the sole predictor of driving ability and safety. But there is ample evidence to show that most of us experience age-related declines in our physical and mental abilities – declines that can signal a greater crash risk.

One key to safety is knowing when a driver is at increased risk – even if we ourselves are that driver. So we must know what signs to look for, and pay attention to them. We need to understand how our driving environment changes, and what we should do to respond to those changes. We can learn about community resources that can keep us driving safely longer or keep us connected to the activities in our lives if we must cut back or stop driving altogether.

Driving or riding a car is how most older adults get around. Most people 65 and older change how they drive as they age, choosing to drive only during daylight hours, for example, or limiting where they drive, or cutting back on how often they drive.

If you are a family member or friend of an older driver who wants to understand when and how such changes may be needed and how to keep your loved one or friend better connected to the people and activities that matter to him/her, you’ve come to the right place. This resource is intended to inform and broaden the discussion about older driver safety and mobility. In it, you will find:

• Information to help older drivers make informed decisions about their driving behavior, and
• Suggestions on how to begin conversation with an older driver about safety concerns.

These conversations don't happen often enough, and when they do, the older person fears – sometimes accurately – that someone is trying to take the car keys away. Unfortunately, discussions about continuing to drive often begin too late. And very often, families are asking the wrong questions.

The decision about driving for older adults is an emotionally charged issue, but it does not have to be that way.

As you age, your joints may get stiff, and your muscles may weaken. Arthritis, which is common among older adults, might affect your ability to drive. These changes can make it harder to turn your head to look back, turn the steering wheel quickly, or brake safely.

Safe driving tips:

• See your doctor if pain, stiffness, or arthritis seem to get in the way of your driving.
• If possible, drive a car with automatic transmission, power steering, power brakes, and large mirrors.
• Be physically active or exercise to keep and even improve your strength and flexibility.
• Think about getting hand controls for both the gas and brake pedals if you have leg problems.

Your eyesight can change as you get older. It might be harder to see people, things, and movement outside your direct line of sight. It may take longer to read street or traffic signs or even recognize familiar places. At night, you may have trouble seeing things clearly. Glare from oncoming headlights or street lights can be a problem. Depending on the time of the day, the sun might be blinding.

Eye diseases, such as glaucoma, cataracts, and macular degeneration, as well as some medicines, can also cause vision problems.

Safe driving tips:

• If you are 65 or older, see your eye doctor every year. Ask if there are ways to improve your eyesight.
• If you need glasses or contact lenses to see far away while driving, make sure your prescription is up-to-date and correct. Always wear them when you are driving.
• Cut back on or stop driving at night if you have trouble seeing in the dark. Try to avoid driving during sunrise and sunset, when the sun can be directly in your line of vision.

As you get older, your hearing can change, making it harder to notice horns, sirens, or even noises coming from your own car. Hearing loss can be a problem because these sounds warn you when you may need to pull over or get out of the way.

Safe driving tips:

• Have your hearing checked at least every 3 years after age 50.
• Discuss concerns you have about hearing with your doctor. There may be things that can help.
• Try to keep the inside of the car as quiet as possible while driving.

As you get older, your reflexes might get slower, and you might not react as quickly as you could in the past. You might find that you have a shorter attention span, making it harder to do two things at once. Stiff joints or weak muscles also can make it harder to move quickly. Loss of feeling or tingling in your fingers and feet can make it difficult to steer or use the foot pedals. Parkinson's disease or limitations following a stroke can make it no longer safe to drive.

Safe driving tips:

• Leave more space between you and the car in front of you.
• Start braking early when you need to stop.
• Avoid heavy traffic areas or rush-hour driving when you can.
• If you must drive on a fast-moving highway, drive in the right-hand lane. Traffic moves more slowly there, giving you more time to make safe driving decisions.

Do you take any medicines that make you feel drowsy, lightheaded, or less alert than usual? Do medicines you take have a warning about driving? Many medications have side effects that can make driving unsafe. Pay attention to how these drugs may affect your driving.

Safe driving tips:

• Read medicine labels carefully. Look for any warnings.
• Make a list of all of your medicines, and talk with your doctor or pharmacist about how they can affect your driving.
• Don't drive if you feel lightheaded or drowsy.

In the very early stages of Alzheimer's disease or other types of dementia, some people are able to keep driving. But, as memory and decision-making skills get worse, they need to stop.

People with dementia often do not know they are having driving problems. Family and friends need to monitor the person's driving ability and take action as soon as they observe a potential problem, such as forgetting how to find familiar places like the grocery store or even their home. Work with the doctor to let the person know it's no longer safe to keep driving.

Good drivers are alert, think clearly, and make good decisions. When people with Alzheimer's disease are not able to do these things, they should stop driving. But some people may not want to stop driving or even think there is a problem.

As the caregiver, you must talk with the person about the need to stop driving. Do this in a caring way. Understand how unhappy the person may be to admit that he or she has reached this new stage.

Safety First

People with moderate to severe Alzheimer’s disease should never get behind the wheel. People with very mild Alzheimer’s may be able to drive safely in certain conditions. But as memory and decision-making skills worsen, they need to stop because a driver with dementia may not be able to react quickly when faced with a surprise on the road. Someone could get hurt or killed. If the person's reaction time or ability to focus slows, you must stop the person from driving.

Signs that the person should stop driving include:

• New dents and scratches on the car
• Taking a long time to do a simple errand and not being able to explain why, which may indicate the person got lost
• Two or more traffic tickets or increased car insurance premiums
• Comments from friends and neighbors about driving
• Speeding or sudden lane changes
• Confusing the brake and gas pedals
• Recommendations from a doctor to modify driving habits
• Other health issues that may affect driving ability, such as changes in vision, hearing, or mobility.

Some people with memory problems decide on their own not to drive, while others may deny they have a problem.

State laws vary regarding when a person with Alzheimer’s should stop driving. In some States, doctors are required to report to the State’s Department of Motor Vehicles whether a person has been diagnosed with Alzheimer’s or dementia. In others, anyone can report a potentially unsafe driver to the State. You may need to notify the person’s car insurance company, too.

It is a good idea to have the person’s driving skills assessed regularly by a professional. The American Occupational Therapy Association maintains a national database of driving specialists, or you can ask your State’s Department of Motor Vehicles or the person’s doctor to recommend someone who can test the person’s driving skills. Note that there may be fees associated with these types of assessments.

Department of Motor Vehicles staff may ask the person to retake a driving test. There are also a number of tools online that offer caregiver- or self-assessments.

When Driving Becomes Unsafe

Here are some ways to stop people with Alzheimer's disease from driving:

• Try talking about your concerns with the person.
• Take him or her to get a driving test.
• Ask the person's doctor to tell him or her to stop driving. The doctor can write, "Do not drive" on a prescription pad, and you can show this to the person.
• Hide the car keys, move the car, take out the distributor cap, or disconnect the battery.

Finding Other Transportation Options

If a person with Alzheimer's can no longer drive, find other ways that the person can travel on his or her own. Contact your local Area Agency on Aging or Eldercare Locator for information about transportation services in your area. These services may include free or low-cost buses, taxis, or carpools for older people. Some churches and community groups have volunteers who take older adults where they want to go. Family and friends are another great resource.

Are you worried about an older family member or friend driving? Sometimes, it can be hard for an older person to realize that he or she is no longer a safe driver. You might want to observe the person's driving skills.

If it's not possible to observe the older person driving, look out for these signs:

• Multiple vehicle crashes, "near misses," and/or new dents in the car
• Two or more traffic tickets or warnings within the last 2 years; increases in car insurance premiums because of driving issues
• Comments from neighbors or friends about driving
• Anxiety about driving at night
• Health issues that might affect driving ability, including problems with vision, hearing, and/or movement
• Complaints about the speed, sudden lane changes, or actions of other drivers
• Recommendations from a doctor to modify driving habits or quit driving entirely

The population of people age 65 and older is the fastest growing demographic in the United States. Many of these older adults will be drivers. Right now, there are more than 30 million licensed drivers age 65 or older.
People between ages 25 and 75 have relatively low crash involvement. After age 75, risk increases because motorists may have health conditions or take medications that negatively affect their driving abilities.
Drivers may be unaware of these changes or unwilling to admit challenges to themselves or others, including family members. In the case of people with cognitive impairments, like dementia, they may be unable to recognize poor performance.

Many family members and caregivers wonder what to do when they think a loved one’s driving skills have diminished. Or, they may not know how to assess one’s driving abilities. They may dread approaching an older adult to discuss the need to modify driving habits or stop driving.

Older adults and their loved ones and caregivers should take a realistic, ongoing inventory of the driver’s skills and openly discuss them. Family members need to remember that many older drivers view driving as a form of independence. Bringing up the subject can make some people defensive, angry, hurt, or withdrawn. Be prepared with observations and questions, listen with an open mind, and be ready to offer transportation alternatives.
You may need to talk with an older driver if you answer “yes” to any of the following questions.

• Does he or she get lost on routes that should be familiar?
• Have you noticed new dents, scratches, or other damage to his or her vehicle?
• Has he or she been warned or ticketed by a police officer for poor driving?
• Has he or she experienced a close call or crash recently?
• Has a doctor advised him or her to limit or stop driving for health reasons?
• Is he or she overwhelmed by road signs, signals, markings, or other things while driving?
• Does he or she take any medication that might affect the capacity to drive safely?
• Does he or she stop inappropriately or drive too slowly, preventing the safe flow of traffic?
• Does he or she suffer from Alzheimer’s disease, dementia, glaucoma, cataracts, arthritis, Parkinson’s disease, diabetes, or another condition that may affect driving skills?

If you need to start a conversation about driving safety, it is important to be caring, respectful, and non-confrontational. Show genuine concern and understanding, and offer alternatives that will not injure the older driver’s self-respect and sense of independence. You might also consider riding with an older driver to observe, encouraging a vision and hearing evaluation, or suggesting a driving safety class. You and/or the older driver can also discuss concerns with a physician, who may have recommendations.

The good news is that, depending on the severity of the problem, older drivers may be able to adjust their driving habits to increase safety. For example, they may limit driving to daylight hours and good weather, or avoid highways and high-traffic areas.

We all age differently. For this reason, there is no way to set one age when everyone should stop driving. So, how do you know if you should stop? To help decide, ask yourself:

• Do other drivers often honk at me?
• Have I had some accidents, even if they were only "fender benders"?
• Do I get lost, even on roads I know?
• Do cars or people walking seem to appear out of nowhere?
• Do I get distracted while driving?
• Have family, friends, or my doctor said they're worried about my driving?
• Am I driving less these days because I'm not as sure about my driving as I used to be?
• Do I have trouble staying in my lane?
• Do I have trouble moving my foot between the gas and the brake pedals, or do I sometimes confuse the two?
• Have I been pulled over by a police officer about my driving?

If you answered "yes" to any of these questions, it may be time to talk with your doctor about driving or have a driving assessment.

You may have gotten your driver’s license the day you turned 16. By the time you retire, you could have driven daily for more than half a century. But for some people, there comes a time in the aging process when driving becomes dangerous.

“On the whole, older drivers are safe,” says Dr. Marian Betz, an expert in healthy aging at the University of Colorado, Anschutz Medical Campus. “They tend to drive slower than younger drivers and have a lot of experience.”

But some health conditions common with aging may make it riskier to get behind the wheel. Stiffer joints and weaker muscles can make it harder to steer or brake safely. Eye diseases and some medications can cause vision problems. Hearing loss can blunt the sounds of horns or sirens. And cognitive changes, even mild ones, may impair quick decisions behind the wheel.

Deciding to stop driving can be emotionally challenging for older adults, says Betz. “Many people see their car as a marker of independence. Giving up the privilege of driving can feel like a real loss.”

People often depend on cars to get them to and from the activities they enjoy. Or to see the people they care about. So stopping driving can lead to isolation. That’s why it’s important to have a plan for alternative transportation.

“We don’t want older adults isolated and shut in,” Betz says. “We want people to be emotionally and socially connected, as well as be able to get out and exercise.”

Feeling disconnected can lead to poorer health. Studies have shown that loneliness and social isolation are linked to higher risks for some health problems. These include heart disease, depression, and cognitive decline.

There are many alternatives to driving. Some areas provide free or low-cost bus or taxi services for older adults. Some communities offer a carpool service, or scheduled trips to stores or the doctor. Rideshare service may also be an option. Your local Area Agency on Aging can help you find services. Call 1-800-677-1116 or go to eldercare.acl.gov to learn more.

Betz and her colleagues are currently testing an online tool to help older adults and their families make decisions about driving.

“We’re not telling people ‘you need to stop,’” explains Betz. But they hope to make people feel comfortable and empowered when they do decide to stop driving. “That makes such a decision more likely to stick,” Betz says.

Options for getting things done without leaving the house have also boomed recently. Grocery delivery, telehealth visits, and online social hours can reduce the need to drive every day.

Online options can’t—and shouldn’t—replace everything, says Betz. “But some of these things are good solutions for people to reduce their need to drive.”

If you’re wondering whether it may be time for you or someone else to stop driving, see the Wise Choices box for questions to ask.

Is It Time to Stop Driving?

If you answer “yes” to any of the below questions, it may be time to consider stopping driving:

• Do other drivers often honk at you?
• Have you had some accidents, even if they were only “fender benders?”
• Do you get lost, even on roads you know?
• Do cars or people walking seem to appear out of nowhere?
• Do you get distracted while driving?
• Has anyone told you they’re worried about your driving?
• Do you have trouble staying in your lane?
• Do you have trouble moving your foot between the gas and the brake pedals, or sometimes confuse the two?

Are you worried you won't be able to do the things you want and need to do if you stop driving? Many people have this concern, but there may be more ways to get around than you think. For example, some areas provide free or low-cost bus or taxi services for older people. Some communities offer a carpool service or scheduled trips to the grocery store, mall, or doctor's office. Religious and civic groups sometimes have volunteers who will drive you where you want to go.

Your local Area Agency on Aging can help you find services in your area. Call 1-800-677-1116, or go to https://eldercare.acl.gov to find your nearest Area Agency on Aging.

You can also think about using a car or ride-sharing service. Sound pricey? Don't forget—it costs a lot to own a car. If you don't have to make car payments or pay for insurance, maintenance, gas, oil, or other car expenses, then you may be able to afford to take taxis or other transportation. You can also buy gas for friends or family members who give you rides.

Before you leave home:

• Plan to drive on streets you know.
• Only drive to places that are easy to get to and close to home.
• Avoid risky spots like ramps and left turns.
• Add extra time for travel if you must drive when conditions are poor.
• Limit how much you drive at night.
• Don't drive when you are stressed or tired.

While you are driving:

• Always wear your seat belt and make sure your passengers wear their seat belts, too.
• Wear your glasses and/or hearing aid, if you use them.
• Stay off your cell phone.
• Avoid distractions such as eating, listening to the radio, or chatting.
• Use your window defrosters to keep both the front and back windows clear.

Maybe you already know that driving at night, on the highway, or in bad weather is a problem for you. Some older drivers also have problems when yielding the right of way, turning (especially making left turns), changing lanes, passing, and using expressway ramps.

Safe driving tips:

• Have your driving skills checked by a driving rehabilitation specialist, occupational therapist, or other trained professional.
• Take a defensive driving course. Some car insurance companies may lower your bill when you pass this type of class. Organizations like AARP, American Automobile Association (AAA), or your car insurance company can help you find a class near you.
• When in doubt, don't go out. Bad weather like rain, ice, or snow can make it hard for anyone to drive. Try to wait until the weather is better, or use buses, taxis, or other transportation services.
• Avoid areas where driving can be a problem. For example, choose a route that avoids highways or other high-speed roadways. Or, find a way to go that requires few or no left turns.
• Ask your doctor if any of your health problems or medications might make it unsafe for you to drive. Together, you can make a plan to help you keep driving and decide when it is no longer safe to drive.

Before you leave home:

• Plan to drive on streets you know.
• Only drive to places that are easy to get to and close to home.
• Avoid risky spots like ramps and left turns.
• Add extra time for travel if you must drive when conditions are poor.
• Limit how much you drive at night.
• Don't drive when you are stressed or tired.

While you are driving:

• Always wear your seat belt and make sure your passengers wear their seat belts, too.
• Wear your glasses and/or hearing aid, if you use them.
• Stay off your cell phone.
• Avoid distractions such as eating, listening to the radio, or chatting.
• Use your window defrosters to keep both the front and back windows clear.