Checklist: Seniors and Driving

Know When to Put the Brakes On Elders Behind the Wheel

Telling seniors it may be time for them to stop driving can be one of the most difficult milestones in the caregiving process. Just as it does for teen-agers, driving represents freedom and independence for seniors ? the ability to visit friends, go to the movies and shop without having to rely on anyone else.

Because of the emotional nature of the issues involved, it is important to include seniors in the discussion rather than dictate a decision to them.

It is also useful to consult with family members, doctors and other health care professionals, and people the senior respects, such as clergy and friends. Seniors might get defensive and even angry when you broach the subject, but safety concerns demand you raise it nonetheless.

How does aging affect driving ability?

Safe driving demands the complex coordination of a host of skills. Many physical and mental changes that accompany aging can diminish the ability to drive. These include:

  • A slowdown in response time
  • A loss of clarity in vision and hearing
  • A loss of muscle strength and flexibility
  • Drowsiness caused by increased use of medications
  • A reduction in the ability to focus or concentrate
  • Lower tolerance for alcohol

None of these changes alone automatically means that seniors should not drive. But caregivers need to regularly evaluate a senior’s abilities and assess whether the person needs to alter driving habits or stop driving altogether.

A checklist on safe driving

Be on the look-out for telltale signs it might be time for a senior to stop driving. When they are behind the wheel, do they:

  • Drive at inappropriate speeds, either too fast or too slow?
  • Ask passengers to help check if it is clear to pass or turn?
  • Respond slowly to or not notice pedestrians, bicyclists and other drivers?
  • Ignore, disobey or misinterpret street signs and traffic lights?
  • Fail to judge distances between cars correctly?
  • Become easily frustrated and angry?
  • Appear drowsy, confused or frightened?
  • Have one or more near misses?
  • Drift across lane markings or bump into curbs?
  • Forget to use left- and right-turn indicators?
  • Forget to turn on headlights after dusk?
  • Ignore signs of mechanical problems with the car?
  • Have difficulty turning head, neck, shoulders or trunk while in traffic or parking?
  • Have too little strength to turn the wheel quickly in case of emergency?
  • Lose their way repeatedly?

If the answer to one or more of these questions is “yes,” you should explore whether medical issues are impacting their driving skills.

Medical issues to consider

Caregivers need to know:

  • Have seniors had their vision and hearing tested recently?
  • Have they had a physical examination within the past year to test reflexes and make sure they do not have illnesses that would impact their driving?
  • Are they taking medications or combinations of medications that might make them drowsy or confused?
  • Have they reduced or eliminated their intake of alcohol to compensate for lower tolerance?

Adapting to changes

Driving is not necessarily an all-or-nothing activity.
There are many ways for seniors to adjust their driving so they do not pose a danger to themselves or others. Among them are:

  • Avoiding nighttime driving
  • Driving only to familiar locations
  • Avoiding drives to places far away from home
  • Avoiding freeways and rush hour traffic
  • Leaving plenty of time to get somewhere
  • Foregoing driving alone

Other forms of transportation

You might encourage the senior to rely more on public transportation. This will reduce their time behind the wheel and help prepare them for when driving may no longer be an option. Many cities offer special discounts for seniors on buses and trains, and senior centers and community service agencies often provide special transportation alternatives for seniors.

How to get them to stop

If you feel strongly that a senior cannot drive safely, you have little choice but to get them to stop. If they agree without an argument, wonderful. If not, you have several options:

  • Stage an intervention. This approach, commonly used with substance abusers, involves confronting the senior as a group of concerned caregivers. The group should include family members, health care workers and anyone else respected by the senior. The intervention needs to be handled firmly but with compassion in order to break through the senior’s denial on the issue.
  • Contact the local Department of Motor Vehicles and report your concerns. Depending upon state regulations and the senior’s disabilities, it may be illegal for them to continue driving. The DMV may do no more than send a letter, but this may help convince the senior to stop.
  • Take the keys, disable the car or move it to a location beyond the senior’s control. Leaving the headlights on all night or disconnecting the battery are good ways to disable the car. But if the senior is likely to call AAA or a mechanic, you have no choice but to eliminate all access to the car. While these measures may seem extreme, they can save the lives of seniors, other drivers and pedestrians.

Taking care of paid cargeivers

Paid caregivers come in many forms. They may be nurses, certified nurses’ assistants, home health aides, relatives, friends, neighbors, grandchildren, or others. They may work a few hours a day or week, or they may live-in. They may work days, nights, or around the clock. Whatever the arrangements you have made with them, paid caregivers are essential to the well-being of the seniors for whom they work. Often we assume that since they are paid, and since many of them are professionals in the field and/or have many years of experience, they do not experience stress and frustration. This, however, is far from the truth.

Caregiving can be a hard job and a stressful job, no matter who does it. Continuity and stability, however, are extremely important to seniors and to the people who care about them. Most older people find in difficult to bring strangers intotheir home and pay them to do the things they once could do independently. They need time to get to know and trust these caregivers, to teach them how they like things done, to learn to rely on them. Yet all too often these caregivers suffer burnout, quit, and then the senior must start over again with a new stranger.

How can you help prevent burnout in the caregivers that you hire? Here are some simple suggestions. While they won’t work for everybody, in most situations they will help a lot.

  • Make sure caregivers know the senior as a person. Encourage the senior to talk about himself. Tell caregivers about likes and dislikes, including food, music, noise, and smells. Encourage a dialogue between the senior and the caregivers about what the senior can realistically do for himself and where he needs assistance. Encourage the senior to share some of his history; about work, family, ethnic origins, and customs. If the senior cannot communicate this, have a family member or friend do it.
  • Treat caregivers with respect. Caregivers do a very important job, taking care of someone who is important to you and others. It is hard work and it is respectable work.
  • Help caregivers feel comfortable in the elder?s home. When providing caregiving in someone else’s home it is often difficult for caregivers to find a place that is “their own.” Provide a place where caregivers can keep a few personal belongings. Keep food on hand that they enjoy. Make provisions that allow them some privacy, especially if they are providing live-in care.
  • Make caregivers feel appreciated. Sometimes the seniors they are caring for can’t show appreciation. They may be unable to communicate, or they may be so angry or depressed about their need for help that they take it out on others. Then it is the family’s job to express that appreciation. Little tokens of appreciation go a long way. If you bring over a special treat for the senior, share some. Is it a special holiday? Remember the caregiver, too.
  • Keep caregivers informed. When there is information they should have, make sure they are kept in the loop. You are a caregiving team. Make sure paid caregivers feel like part of that team.
  • Paid caregivers need respite too. Be sure they know you are aware of their needs for rest, for sleep. Are they working around the clock? Does the senior keep them up at night? Do they have families of their own who need them? Lend a hand occasionally if you can? pick up a few items at the store, sit with the senior for an hour, or bring over a prepared dish or meal.
Paid caregivers are vitally important. When a senior or family member has searched for, interviewed, and hired somebody they like and trust to do a good job, it is in everybody’s best interest for that person to be satisfied with the job and working conditions, and to stay on for as long as needed. Many families tell stories about beloved caregivers who stayed with a dependent older person through many stages, including the end of the elder’s life, providing warmth and comfort and familiarity when it was needed the most. A little attention to the above suggestions can help make this a reality for the older people you care for.

Why is Setting Limits important

Setting limits means knowing when and how to say “no.” It means understanding your time and energy are limited resources, and people other than the care recipient, a spouse, children, close friends, also need and deserve your attention.

It means establishing a healthy and sustainable balance between caregiving and other aspects of your life, including work and recreation as well as family. And it means acknowledging that you must find others to help in your caregiving and that you also need some time for yourself to recharge.

Setting limits is a survival skill. Caregiving demands such a concentrated effort that those who don?t or can?t set limits are in danger of suffering from burnout or meltdown, anxiety and depression. Caregiving can quickly overwhelm the life of the caregiver, disrupting other relationships and making it difficult to pay attention to anything else.

What are some caregiving myths?

Examine these common myths and determine the ones you have incorporated into your beliefs:
  • If I set limits, I?m being selfish and aggressive.
  • If I set limits, other people will be angry with me.
  • I?m in good health, so I don?t need any time off from caregiving.
  • I have to do it all because nobody else volunteers or knows what needs to be done.
  • Even if someone else knows what to do, they can?t do as good a job as I can.
Only when we confront the distortions behind these notions can we begin to set the limits we need and deserve.

Breaking the myths

  • Setting limits is a gift to yourself and others. You can give nothing of yourself when you have nothing left to give. Exhausting yourself through non-stop caregiving helps neither you nor your care recipient.
  • Setting limits does not mean a lack of love or caring. On the contrary, whatever you do to conserve your energy and preserve your strength will enhance rather than detract from your caregiving skills. In that sense, setting limits is the ultimate act of love for your care recipient.
  • If you?re in good health, you want to keep it. If your health is fragile, you want to stabilize it. Studies show caregivers are at greater risk of illness, injury and emotional collapse. Taking practical steps to reduce your caregiving load will help prevent your health from deteriorating. Recognizing the need for time to be with a spouse, friends, children or alone is a sign of strength, not weakness.
  • Others can?t do everything exactly the way you do, but they will do it in their own way. This does not mean that a poor substitute will suffice. It is important for you to settle on the qualities you consider most important in a paid caregiver and those open for compromise. Even if seniors complain at first, they may come to appreciate another?s approach for a change.
  • Other people might be very willing to help but don?t want to intrude. Or perhaps they don?t realize how much you feel you need help. If you are the primary caregiver, it is part of your job to communicate your needs to other family members and friends who could take over some tasks or to seek out professional caregivers should resources permit.

Tips for caregivers on setting limits

Setting limits is a skill. Some people are naturals at it. Others have to learn. These tips can help:
  • Begin setting limits early so it becomes a natural part of your caregiving rather then a reaction to a crisis, either yours or someone else?s. Setting limits early also helps prevent the care recipient from harboring the unrealistic notion that your life is only about caregiving.
  • Assess realistically what you can and cannot do and make every effort to stick to your plan. If you don?t, you may start to experience anger and resentment ? toward the senior, the situation and everyone else who is not helping enough. You must stop this cycle at the outset.
  • Clearly communicate with the care recipient. Stay focused and speak in a relaxed and compassionate manner. Explain your decision and gently acknowledge any concerns and fears the senior expresses. If the senior protests and the conversation turns heated, take a break and return to the discussion later when you are both calmer.
  • Don?t lay blame on the senior for exhausting you, but don?t back down or apologize for taking steps to help yourself either. And don?t make promises you can?t keep about what you will do for them down the line.
  • Sit down with other family members and friends and determine how much time everyone else is willing to invest. Let go of the idea you are the only competent person involved. Others frequently want to pitch in but may feel they are in the way and don?t know how to volunteer. Set up a caregiving schedule and have others sign up in advance for shifts.
  • Guilt has no place in caregiving. It helps no one, least of all the person in your care. Ignore anyone who attempts to make you feel guilty about setting limits to your caregiving activities.
  • If you are nervous, practice setting limits through mental rehearsal and role-playing. Work through the process with yourself and others before approaching your care recipient. What will you say? How will you say it? How will you respond if the other person becomes angry? Think through the possibilities ? and then initiate the conversation.
  • If you find setting limits impossible, you might need to discuss matters with a therapist to help you discover why. Otherwise, you are far more likely to find your responsibilities leaving you ill, emotionally spent or suffering from caregiver burnout.

Facts on Caregiving

Among working caregivers, more than half have made at least some work-related changes to accommodate the demands of care-giving

  •         Modifying work schedule
  •         Going in to work late
  •         Leaving work early
  •         Taking time off during the day
o       26% have had to take a leave of absence due to care-giving responsibilities
o       30 % have had to give up work entirely
o       15 % took early retirement
  • If the work of caregivers had to be replaced by paid home care staff, the estimated   cost would be $45-$94 billion per year
  • Because care-giving is such an emotionally draining experience, caregivers experience depression at 3 times the rate of others in their own age group, and they are more likely to become physically ill themselves
  •  Female caregivers are more likely to suffer from anxiety, depression, and other symptoms associated with emotional stress
  • A study of elderly spousal caregivers (age 66-96) found that caregivers who experience mental or emotional strain have a 63% higher risk of dying than non-caregivers
  • 31% of those caring for persons 65+ describe their own physical health as ?fair to poor?
  • Studies show that among caregivers, an estimated 46%-59% are clinically depressed
  • Approximately 49% of female caregivers and 31% of male caregivers experience depression as a result of caregiving

Support groups for caregivers

When people suffer hardships, sharing the pain almost always helps. A support group is a gathering of individuals to explore a common cause or problem. Members of the group discuss their experiences, exchange information and provide encouragement and friendship. They also offer shoulders to lean on when times are tough and allow each other to express anger, frustration, resentment and other troubling emotions.

Above all, successful support groups ? also called self-help groups ? create an environment where people grappling with difficult issues feel understood and accepted by those in similar circumstances. As a caregiver you may need a support group, especially if you feel isolated, believe your situation is unique and think no one around you understands what you are going through.Support groups can offer caregivers:

Encouragement. Caregiving is a demanding task that can drain your emotional, physical and spiritual energy. Support groups provide a safe place to recharge your batteries.
Information. Support group members can glean ideas and suggestions from others in the trenches. Other caregivers are often the best source for helpful tips about community resources, medical developments, support services and other key issues.
Emotional support. Sometimes caregivers simply need to vent. Support groups provide a space to unload pent-up frustrations while others in similar circumstances empathize and counsel without judgment.

What should you look for in a support group?

Support groups cover a broad spectrum. Some may be only for people taking care of someone with a particular illness, such as Alzheimer?s, Parkinson?s or cancer. Others may be for anyone caring for a parent or anyone involved in long-distance caregiving.Some support groups are open-ended, with new people joining periodically. Others continue for a defined length of time ? 10 weeks or six months, for example ? and don?t admit new members after the first or second week. Some groups schedule regular lectures or presentations on topics of mutual interest. Others are less structured, with members offering the floor to those who request it.

Think about the kind of group you would prefer. You may need to check out several before settling on one that suits your purposes. To find out about support groups in your area, inquire at community centers, fraternal associations and religious organizations. Hospitals and nonprofit agencies associated with specific diseases or conditions also sponsor them. Check local Web sites, newspapers? community listings, classified ads or bulletin boards for privately organized support groups.

As you evaluate a support group, consider these qualities:

Comfort. Support groups are about relationships. Do you feel at ease with the people? Are they welcoming? Are smiles and hugs freely available? Or do you feel as though you?ve stepped into an refrigerator?
Convenience. Does the group meet at a time and place convenient to you? How far are you willing to drive? If you?re a morning person, does the group meet early enough in the evening for you to get home without falling asleep at the wheel?
Confidentiality. Does everything discussed stay within the group, or does information leak out? If you don?t feel safe, you?re likely to clam up ? which would defeat the purpose of joining.
Sometimes professionals ? social workers, therapists and nurses ? run support groups. Sometimes one group member takes charge, or leadership responsibilities rotate among the participants. All approaches have their advantages, but a designated leader can help keep the group productive and moving forward.Leading a support group is an emotional, draining and challenging task. A support group facilitator should show:

Empathy. An ability to sympathize deeply with others is a prerequisite. An empathetic leader will make people feel welcome and draw out even the most reluctant group member.
Poise. Those who feel comfortable in front of groups, articulate their feelings well and demonstrate grace under pressure can help sustain a group?s spirit in times of crisis.
Enthusiasm. People often share their darkest emotions and fears in support groups. Leaders who firmly believe in the goals and mission of the group will be the most successful in encouraging participants to speak openly. A sense of humor helps, too.
 Focus. A good leader will have a sense of what members are feeling, where the group needs to go and how to guide discussions to get there.

Starting your own support group

If you can?t find a group to meet your needs, start one yourself. It?s not as difficult as it sounds. People who perceive a gap and are determined to fill it make the best support group founders. To organize a support group:
 Start with a mission. Maybe you want to focus on serving caregivers taking care of people with dementia or caregivers coping with difficult family relationships. If you need a particular kind of support group, undoubtedly others do, too.
Locate others. When you have defined your target group, enlist the aid of doctors or hospitals to help you find other caregivers grappling with the same issues. Give the health care professionals your name and phone number and have them share that information with others in similar situations.
 Advertise. Let the community know that the support group is available. Post notices on community bulletin boards. Many newspapers publish public service announcements free. Or try low-cost classifieds.
Find a meeting place. Churches, synagogues and other religious establishments often open their doors to support groups. So do hospitals, libraries and corporate conference rooms. Make sure the meeting place is accessible to all. If necessary, negotiate a price for renting the facility.
Decide whether to enlist a professional to lead the group. The leader could be a health care professional from a local agency, a therapist or someone with support group and caregiving experience.