When is the Time to Take Away the Car Keys From Your Parents or Grandparents:
A Personal and Professional Dilemma
|
As the baby boomers are now reaching middle age, many have found themselves taking care of their parents at home. The original baby boomers have grown up and are now grandparents. These baby boomers are children of the Vietnam Era, Kent State, Woodstock, peace marches, President Kennedy, Martin Luther King, the Beatles, the Rolling Stones and love, peace, and happiness. I am among this generation.
 |
As a group, we are now facing personal and family challenges that were never thought about years ago. As our parents and our grandparents age, we are watching the aging process affect their muscles, bones and joints, senses of hearing, smell, and sight, and the mind as well. These aging loved ones are more dependent on medications to function properly than in their youth and their doctors’ appointments continue to increase. Many of these needed medications help a patient to survive and to maintain health, but may cause side effects. If this aging population is lucky, they may be able to have their independence to enjoy a productive life as they enter their retirement or “golden” years.
|
Those people who are not as fortunate will have their independence affected in many ways like being homebound. They may have their mobility affected by being in a wheelchair. They may not be able to drive. They may need hearing aids. Their glasses or contact lenses may not provide 20/20 corrected vision. They may be diabetic, hypertensive, have osteoporosis, be confused, be suffering from Alzheimer’s, or have had a stroke or a heart attack. They may be suffering from physical or mental limitations if they have survived a stroke or a heart attack. They may be in chronic pain. They may have needed surgical procedures for a pacemaker, a catheter, or a knee or hip replacement.
Most have had cataract surgery or are in need of cataract surgery. Many will suffer from age-related macular degeneration or glaucoma. The numerous problems encountered have medical, financial/economic, social, personal, and family ramifications. The scope of the multiple problems that are encountered on a day-to-day basis may affect the health of the caregiver. I know this personally from first-hand experience. I have seen these aging patients in my optometric practice for 20 years. I am also the staff optometrist at many nursing homes. In addition, I care for my 88 year old father at home who is a retired optometrist.
One common problem that many ECPs have encountered is driving problems among the elderly population. It becomes a more profound problem when that elderly person is your parent or grandparent. You are now put in the position of becoming the “parent of the parent.” How do you say to your mother or father that they cannot drive any longer? As an eye care professional, how and when do you become involved with this decision in order to protect the public? It is not easy to maintain your professional standards when the patient is a loved one, yet it is mandatory.
These decisions place you and the patient, or the parent or grandparent, in positions of conflict that have never existed before. The loss of independence for an elderly person is enormous. Their acceptance of that loss is slow to arrive. As the caregiver to an elderly parent or grandparent, you must now drive the affected party to all of their appointments. This includes lunches, meetings, social events, and the now more numerous doctors’ appointments. If you are working, this can affect your job. If you have children, it will affect the time you can spend with your children. The sacrifice is huge. But the alternative to do nothing and to let a risky patient, parent, or grandparent drive can have life-threatening and financial consequences. Whose name is the car in? Who pays for the insurance? Who is liable in the case of an accident? What about the harm they may do themselves or others?
Taking a pre-emptive action may prevent you or your loved one from having a picture of an accident on the front page of the newspaper for a situation that will affect all parties and many families forever. And I can promise you that most people will not give up the car keys quietly. Doctors, lawyers, and other family members may need to intercede. It can become complicated. In Pennsylvania, licensed physicians and optometrists play a vital role in ensuring the safety of the roadways. Pennsylvania has required by law that physicians and optometrists report to the Pennsylvania Department of Transportation those drivers under their care whose driving skills may be affected by a medically related condition or a visual disability.
An excellent website, www.mdsupport.org/library/drivingrequirements.html, provides a list of vision screening and standards for a license to drive for every state. Pennsylvania requirements are as follows:
“Vision is screened only at original licensure (unless drivers are randomly selected for random reexamination). Applicants who fail to meet the 20/40 acuity standard are referred to their eye care specialist, who must complete a form which the applicants bring back to the licensing center. A person who must wear corrective lenses to meet the standard is restricted to driving with corrective lenses. Individuals with visual acuity poorer than 20/40 with both eyes may drive with a daylight-only restriction if one of the following conditions is met: (1) the combined vision has been corrected to 20/60 or better; (2) the combined vision is less than 20/60 but at least 20/70 , and recommendation is obtained from a licensed optometrist or licensed physician who has equipment to properly evaluate visual acuity; (3) the combined vision is less than 20/70 but at least 20/100 , and recommendation is obtained from a licensed optometrist or licensed physician who has equipment to properly evaluate visual acuity. Drivers licensed under the third condition must pass a driving test, may not drive on freeways, may be limited to driving within a specific geographic area, and may have the license suspended if involved in one at-fault crash or receives two violations during a 1-year period. Telescopic lenses may not be used to meet the standards. The horizontal visual field requirement is at least 120 degrees (combined) in the horizontal meridian, excepting the normal blind spots. A person may be adequately sighted in one eye and still meet the requirements, however, the license will be restricted to vehicles with outside mirrors that provide a view of the highway for a distance of 200 feet to the rear.”
The American Medical Association (www.ama-assn.org) has a good resource called the “Physician’s Guide to Assessing and Counseling Older Drivers.” The guidebook has plenty of information about assessing a patient’s driving ability. The guide includes medications and medical conditions that impair mobility, vision, hearing, reflexes and judgment, tips on having the conversation with patients and caregivers, advice on how to avoid isolation and dependence when driving is no longer sensible or safe, discussion of a doctor’s ethical responsibilities, and state-by-state guidelines for reporting drivers to the state department of motor vehicles, which has the ultimate say in who remains on the road.
The lessons of the guidebook include the great difficulties physicians and ECPs have at this sensitive moment, and how much easier it would be if the decision did not involve them. Physicians and ECPs must wrestle with laws that vary by state on a variety of issues including, how elderly drivers are assessed differently than younger ones, whether it is mandatory or optional for doctors and ECPs to report their concerns, how doctors and ECPs are supposed to go about it and strike the right balance between confidentiality and safety, and whether they risk legal liability if they alert the state authorities or if they keep silent and an accident occurs.
In short, they provide some guidelines to assist the ECP with this moral, ethical and professional decision making process. This is a topic that will have potentially profound ramifications for all involved regardless of what decision is made or not made. However, with these guidelines the ECP will hopefully make the decision that is best for all concerned.
|
