(Reuters Health) - When Elizabeth Kennedy's 84-year-old father was diagnosed with Alzheimer's disease two years ago, she removed the car keys from his Johnstown, Pennsylvania home and his Volkswagen Passat from the driveway. Despite warnings from his four children and his doctor, any opportunity to get behind the wheel would have proven too tempting for Kennedy's newly widowed dad.
"He was convinced he was a perfectly good driver, and he took it like he was being attacked," she said. "My father didn't understand why we told him he couldn't drive anymore."
The car conversation often careens older drivers and families into conflict, aging experts say. Frequently, this discussion is dodged altogether- or addressed too late.
A recent telephone survey, sponsored by Home Instead Senior Care and conducted by a private public opinion research firm, polled 600 U.S. and Canadian residents 70 and older about driving.
Ninety five percent said they have not had a conversation about driving initiated by family or friends. Three quarters indicated that stopping driving would equate to the loss of independence. Almost 90 percent said they are dependent on their car. More than a quarter said if they could not drive, they would suffer depression.
"With someone like my father, a man very used to providing for his family and being strong, efficient and capable, it would always be hard," Kennedy said. Her sister helps their father with errands, and a hired caregiver comes once a week to take him where he wants to go. While his level of acceptance is increasing, he was angry for months.
"A license is not given with a lifetime contract," said Elin Schold Davis, coordinator of the Older Driver Initiative Project for the American Occupational Therapy Association, which collaborated with Home Instead to design the survey. She says many senior drivers worry about their abilities - and keep worries to themselves.
The project's community education program, "Let's Talk About Driving," helps families discuss how to limit or stop driving. The online resource includes a tool to assess driving capabilities (http://bit.ly/1rWQRuh).
According to the American Occupational Therapy Association, signs that older drivers may be unsafe include: heightened agitation, difficulty remaining in a lane, pedal confusion, stopping at green lights, getting lost in familiar locations, and delayed reaction time.
However, the appearance of one or two signs does not always necessitate stopping driving. The installation of a padded or smaller steering wheel, for example, could make maneuvering more manageable for a driver with arthritis. A seat lift can ameliorate the toll of aging on the spine, allowing a senior struggling to see over the dashboard to handle a car confidently. Blind spot indicators, backup cameras and GPS may lend a sense of situational awareness and comfort in navigating less familiar areas.
June McKoy, an associate professor in geriatrics at Northwestern University's Feinberg School of Medicine, urges families to address the issue with respect and empathy.
"Patients are often losing everything," McKoy said. "They are losing their hearing a little bit, their vision a little bit, their husband might be dead, their friends are dying, but they still have their car."
Research into alternate options is a must for families before broaching concerns, McKoy advises.
"We cannot pull this great freedom without having a plan," she said.
That plan should include offers to help get around; other options may include para-transit services and reduced fare programs. If a senior has friends who drive, carpooling is a practical and social option.
"Families must put on the table what they're willing to do and not do," McKoy said. Cabs are more affordable if a senior sells their car and no longer pays for insurance and gas. McKoy sometimes suggests giving the car to a teenage grandchild, for example, on the condition that the teen drives them on errands once a week.
"Ideally, if we have these conversations early, seniors are empowered in the planning," Schold Davis said. "The more families have conversations about driving earlier, the more it allows for the exploration of options and the comfort level with talking about some of the changes."
Let's Talk About Driving: North American Research Report 2016.