Most people can tell you about getting their driver’s license — who taught them to drive, what they were asked to do on their road test, and whether they passed the first time. This rite of passage usually remains vivid as an eagerly anticipated, if nerve-wracking, event.
But there is another rite of passage, much less eagerly anticipated, at the other end of life. It is the moment when you can no longer drive, when your body or your mind are no longer reliable enough to safely control a potentially lethal vehicle that weighs between one and three tons. Some people manage this transition by gradually reducing the range and times of driving — driving only in the neighborhood, driving only in daylight and in good weather, then finally relinquishing the keys. Others resist any alterations, denying that their abilities have changed, refusing to listen to the concerns of their families.
How dangerous are older drivers? According to AAA, seniors are safe drivers compared to other age groups, since they usually wear seat belts, observe speed limits and are less likely to drink and drive. However, age-related fragility makes them more likely to be injured or killed in a crash. They drive less after dark, avoid rush hour and bad weather, but they still have the highest crash rate of death per mile driven.
Northampton resident Hy Edelstein, who is 92, remembers the car he got when he married Sally. Sixty-eight years later, they are still married. That car was a two-seater Plymouth with a rumble seat. Later, they had station wagons with back seats that flipped down. He remembers driving out to Chesterfield to swim and putting their infant daughter on a blanket in the back. (No car seats for babies back then.) It was a dusty road, he says, and when they got home and took the baby out, there was her silhouette in dust on the blanket.
That was then. Now he has given up his keys. What does that feel like? He replies with a loud roar: “Rrrraaafff! I hate it.” Then he adds, “A little snarling doesn’t hurt, but it’s terrible. Suddenly you’re in prison, limited in ways I never imagined.”
Among the losses that inevitably come with aging, giving up driving is one of the most dreaded, especially for those who live in places where public transportation is spotty, at best. Says Sally Edelstein, 90, who also gave up her keys after being sidelined with back pain from a herniated disk, “It has changed our lives terribly. We are dependent on friends.” But because they still live in the house where they raised their children, they are within walking distance of town.
Carol Edelstein, their daughter, was instrumental in helping her parents make the difficult decision about driving. She lives in town and can often, but not always, help them get where they need to go. When her mother was in rehab after back surgery, she and her two brothers and her husband, Robin, were convinced that their father shouldn’t be driving. They physically kept the keys to the car, making the argument that they didn’t want him driving while Sally was out of commission. Then they enlisted the help of his doctor, who spoke to him about giving up driving, but he was not convinced. The doctor then suggested a program at Mercy Hospital that assesses people’s ability to drive safely. The program requires a prescription from a doctor, but because it is not a medical necessity, the $442 charge is not covered by insurance. As the program’s website says, it is “self-pay.”
After the assessment, Edelstein was told he was an unusually good driver given his age, but that he had deficits due to limited range of motion and reaction time, and that his scores would predictably decline whether rapidly or gradually, as happens to all of us as we age. They recommended he voluntarily give up his keys. If he did want to continue driving, he should re-take the official driving test and get adaptive equipment for the car, including larger side mirrors that make it easier to see behind you, good for people with limited neck mobility.
Carol Edelstein describes the program as very well done, a three-hour assessment that measures reading, reaction time, mental acuteness. The person administering it was “skilled, kind, a lovely person,” she says. “Hy was skeptical at first. He thought it was a set-up. But he came out believing that it was a very thorough test.” He agreed to give up his keys. Then, says Carol Edelstein, he either forgot or had a change of heart. Another series of struggles ensued, but since then he has gradually accepted the new conditions. Hy and Sally Edelstein have discovered new ways of getting around, including rides from family, friends, hired drivers, taxis, or sometimes walking with canes or rollator — a wheeled walker.
Despite Hy’s roar of protest, the process of making this change went relatively smoothly in the Edelstein household. But that is not always the case. Local geriatric care manager Janet Bunce describes some of the strategies she suggests to concerned family members when they see that an elder’s driving skills have declined significantly. Often the elder is not aware of this decline or refuses to acknowledge it. Start with the least disruptive idea around driving, she advises, maybe suggesting that “the family is worried.” Sometimes that’s all that’s needed for the elder driver to realize that it’s time. But often there is resistance. So then the conversation needs to get more specific: “Wouldn’t it be awful” if something happened to hurt someone. When she’s in on the conversation, she tries to keep the stance of the good cop, letting the family be the bad cop.
Often, she says, the elder can be persuaded to talk to a doctor — if the doctor is willing to talk. Insurance companies, she explains, can blame and even sue a doctor if their patient has an accident. If the elder is willing, there are assessments such as the one the Edelsteins used at Mercy Hospital, and there is the driving test administered by the Registry of Motor Vehicles. Private driving schools will also make assessments.
Other agencies offer chances to improve and assess driving skills. Northampton Senior Social Worker Michele Dihlman says that AARP offers a weeklong classroom refresher course on driving, focusing on what’s changing as people age. AAA helps family members learn how to talk about this difficult subject, stressing open, respectful communication. She also recommends an online program offered by the Registry of Motor Vehicles for older drivers on how to self-determine their driving skills. In addition, the registry offers free presentations for older drivers as well as disability plates and placards.
Meanwhile, new programs are emerging to help people stay in their homes as they age, despite living without cars. One of these is Northampton Neighbors, a nonprofit organization that provides volunteer services for people over 55. These include practical assistance: transportation, service referrals, as well as social, cultural and educational activities. Membership is free. Katharine Baker, president of the organization’s board, says around half of all Northampton Neighbors’ volunteer services involve transportation for members who are unable to drive, either temporarily or permanently. Volunteers take members to medical appointments, the hairdresser, grocery shopping, to religious services, to visit friends — whatever they need. A similar organization is being formed in Amherst.
Diane Porcella, Northampton Neighbors’ administrator, says that there are a number of opportunities in the area for people to get around. PVTA is “pretty great,” she says, offering reduced senior fares on ordinary buses plus a paratransit service for people with disabilities who can’t use the regular buses. There is also a PVTA senior van service, which provides door-to-door service weekdays in the daytime. Other possibilities include Uber and Lyft and several taxi services.
What Northampton Neighbors offers is a flexible service using trained and vetted volunteers. “What’s especially good about this,” says Porcella, is the possibility for interaction, conversation, the human contact. “There’s the benefit beyond getting from point A to point B.”
Northampton Neighbors member Sharon Frost has already experienced many of these benefits. “In February,” she says, “my neurologist told me I should stop driving due to a chronic progressive condition. I was flabbergasted. All the ‘how will I do’ thoughts rushed in. I was 70, living alone in a housing complex and already feeling isolated. My three attentive grown children live scattered down the Eastern Seaboard from Washington, D.C., to Florida. I couldn’t imagine car fare for all the incidental trips life requires. Then I joined Northampton Neighbors.” A Florence resident, she needed to get to a weekly appointment in Hadley, but found cabs and Uber to be prohibitive. Northampton Neighbors got her to her appointments, and provided drivers with whom she enjoys riding. Because the conversations are so enjoyable, she says, “I sometimes regret reaching my destination. They’ve solved much of my isolation problem.”
Meanwhile, Dihlman says, the Northampton Senior Center is in the third year of offering a transportation service for doctors’ appointments and trips to the Hadley malls. It costs $1 each way. There are also volunteers who provide individual transportation to out-of-town hospitals, where the driver will wait and then go to the pharmacy, if needed. There is a charge for this ranging from $25 to $40. In addition, Cooley Dickinson Hospital now has a free shuttle to Mass. General Hospital in Boston. Gogograndparent.com offers connections to Lyft and Uber for people without cell phones. In addition, area senior centers can provide information about specific transportation opportunities in their communities.
It’s an unhappy fact that there are drivers of every age who should not be on the road. If a member of the community believes someone is driving unsafely, the concerned person can request an Unsafe Driver Investigation from the registry. The registry will administer a competency road test. If a person fails, they can be retested; if they fail again they must surrender their license. But as all of these options show, leaving the car behind is not the end of the world. There are alternatives, some of them opening up new and surprising opportunities.
Here is a partial list of transportation services and useful information about driving laws:
■Registry of Motor Vehicles online page on Older Drivers
Information on self-rating tools offered by AAA and AARP, resources for caregivers and much other information, including how to report a medically impaired driver.
Mass.gov.
■Mercy Hospital Driver Advisement Program
Assessment of drivers by occupational therapist; not covered by insurance, self-pay, $442. Mercycares.com; 413-748-6880
■Northampton Neighbors
Free membership includes access to volunteer drivers.
northamptonneighbors.org
■gogograndparents.com
Connections to Lyft and Uber for people without cell phones.
■Nolo.com
Summary of Massachusetts driving laws for seniors and older drivers.
■Local senior centers
Information about transportation possibilities in individual communities.