I dread the day I must broach this question with my parents, yet, if they (and I) live long enough, it is inevitable. Changes in physical, cognitive, functional and/or sensory health (usually a combination) will eventually require most of us to retire from driving for personal and public safety reasons.

The pathway to driving retirement is not always clearly marked. Older adults, their family members, and the professionals who serve them, often disagree on a reasonable course of action. Some elders self-limit and do give up driving readily when they realize their ability has diminished, but others resist until safety risks become extreme and society must intervene. Assistive devices and compensating strategies can extend safe driving years for many older adults, but one type of impairment cannot be corrected--cognitive decline due to Alzheimer's disease or other dementing illnesses.

The challenge for families and professionals alike is knowing when a high-risk driver is no longer safe behind the wheel. Individualized assessment and intervention is key, as there is no general rule that applies to all situations, and expert advice on the warning signs of an at-risk driver are hard to come by.

In interviews with stakeholders in the area of aging, driving and dementia (Perkinson et al, in press, The Gerontologist) we heard quite a bit about the need for better education in this area.

Family members expressed frustration that health professionals, particularly physicians, are not better trained to recognize and manage driving-related issues. Health professionals expressed uncertainty about what to look for and the extent of their responsibility. Inconsistent state laws and local enforcement add to the confusion for all involved.

The bottom line is, we all share in the responsibility to monitor and intervene when an individual's fitness-to-drive is in question, and each of us brings a unique and valuable perspective to the table.

We look to physicians to diagnose and treat dementia and other conditions of aging. Physicians, in turn, look to other professionals for input and/or ongoing participation in patient care. Occupational therapists, for example, trained in driving-related assessment to render an objective, data-driven opinion on impairment and safety; psychologists to test for aging-related deficits and counsel to combat depression and isolation when its necessary to give up the keys; social workers to help develop alternative transportation plans. Finally, all this input and direction comes back to the family for day-to-day implementation and support in helping a loved one transition to life-after-driving.

Each of us will eventually confront the dilemma of the at-risk older driver, either with an aging client or family member, or, as we age, in our own declining abilities. We will have to weigh personal relationships and make tough decisions that ensure public safety--sometimes acting for the greater good and against our own self-interest and convenience.

I'm still confident in my parents' ability to drive safety but remain watchful for "red flags." I will be there for them when its their time to retire from driving, helping to ease their transition and find other ways of "getting around." Although no one can't prevent the sense of loss that accompanies giving up the keys, we must all do our part to ensure that the process protects the dignity and emotional well-being of our elders, and leads to an equally accessible and fulfilling life-after-driving.

I am pleased and honored to contribute to the "Getting Around" website and encourage you to explore its ample resources. Whether you're a healthcare provider, an older driver or a family member concerned about a loved one's driving ability, you'll find on these pages tools you can use and information worth sharing.

Tom Meuser, PhD
Director of Education & Rural Outreach
Alzheimer's Disease Research Center
Washington University School of Medicine, St. Louis
E-mail: meusert@abraxas.wustl.edu
Website: http://alzheimer.wustl.edu/adrc2/default.htm