Who's going to tell Grandma she's unfit to drive?
An editorial in the Canadian Medical Association Journal this week emphasized the need to help seniors adapt when it's no longer safe for them to be behind the wheel. After the age of 75, it explained, the crash rate per kilometre surpasses that for teenage drivers. And by 2025, it noted, one in four Canadians will be 65 or older.
But breaking the news to Granny that she's a bad driver is an uncomfortable task, and even when handled with tact, the conversation can tear families apart and destroy a senior citizen's self-esteem.
"The hardest thing we do in our practice is actually dealing with driving issues," says Malcolm Man-Son-Hing, a geriatric doctor and an associate professor at the University of Ottawa's faculty of medicine. "You can tell somebody they have Alzheimer's. You can tell them they have cancer. But you tell them they can't drive any more and it's one of the most difficult things going."
He suggests that adult children first approach elderly parents about their concerns. In some cases, the senior citizens may even be relieved to give up driving, or share their family's concerns.
But cutting off someone's transportation is often interpreted as cutting off their engagement with life, says Michel Bédard, the Canada Research Chair in aging and health at Lakehead University. He advises that the bearer of bad news should be sensitive to the senior citizen's position and recommends that family members plan for alternative ways the elderly individual can get around.
Dr. Bédard says there is debate as to whether family physicians should be the ones to deliver the bad news, as it isn't a doctor's role to police a patient's driving ability.
Currently, physicians in Ontario may write a letter to the Ministry of Transportation, notifying the authorities of their concerns about a patient's ability to drive, he says. It is then up to the ministry to determine whether to assess the driver's ability or revoke a licence.
Doctors, however, need not tell the patient of their reports to the ministry in advance, he says. Although most do, the issue can destroy a long-time physician-patient relationship.
Even so, he advises, it's best for doctors to give some warning.
"It certainly is not a pleasant experience for people to receive a letter in the mail, telling them they can't drive."
Dr. Man-Son-Hing notes that in cases where family physicians and loved ones find it too difficult to confront elderly drivers, a geriatrician, such as himself, may be better suited to take the heat.
"We recognize somebody has to be the bad guy," he says. "It's better that we be the bad guy than the family member or the family physician who has an ongoing relationship with that person. And we, as geriatricians, only see them in consultation."
Likewise, if the senior is reluctant to address the issues, he advises that family members notify their family physician, who can then determine whether to contact the licensing authorities and whether to get a geriatrician involved.
Whatever the case, it's best when the news is not delivered alone, Dr. Man-Son-Hing says.
"Often hearing it from a doctor alone is not enough, but if the family is supporting the physician's position, it does carry a lot of weight," he says. "Some people will remain very angry, but at least they recognize that it's not the doctor ganging up on them."
Considering the fact that most people will be in the same situation eventually, it's an issue that everyone should think about for themselves well in advance, Dr. Bédard adds.
"Just like we do for retirement, think about planning for driving retirement, and making sure the decisions being made are consistent with maintaining quality of life when that happens."