Driving retirement is the transition from being an active driver to becoming an active passenger. Driving is a significant and very meaningful occupation. Many of us identify driving as the link to independence, to our identity and to supporting other key occupations. Losing driving as an occupation can feel devastating to our clients. We must be sensitive to the significant loss that this can pose to our clients.
It is also important to recognize that driving retirement can contribute to a number of adverse consequences. According to Chichuri, et al in 2016, driving retirement has been associated with:
- Decreased health-related quality of life,
- Increased likelihood of depression and social isolation,
- Reduced access to healthcare services and,
- Increased likelihood of placement in long-term-care.
Like retiring from a career, driving retirement should be a process. It should be carefully addressed from this perspective, and not approached as a ‘once and done’ conversation. Everyone involved in the process, both the driver and the family, will need support during this process, as well as choices for solutions for community mobility. This is an area where we as occupational therapists can really shine and is an extremely important role for the driver rehabilitation specialist to mentor both health care providers and the client and family.
As outlined in the Evidence-Based Consensus Statements for Driving and Community Mobility (2015), our role can be summed up as this: “If the client is determined to be unfit to drive, … provide intervention, planning or an appropriate referral to address transportation and community mobility options.”
The recommendation for driving retirement, as well as alternative community mobility options, should be based on the clients’ medical diagnosis, clinical assessment results, and guidelines provided in the Evidence-Based Consensus Statements for Driving and Community Mobility. Adhering to best practice guidelines will ensure we do not inadvertently restrict a client who may have potential to drive.
Driving retirement is primarily for those individuals who present with a progressive condition, such as dementia, or have maximized recovery and continue to present with significant deficits, as in the case of CVA with homonymous hemianopsia. For both of these situations, deficits make it unsafe for the client to continue as a driver.
Driving retirement, especially for individuals with dementia or other cognitive deficits, can be particularly challenging because cognitive deficits may affect the driver’s insight and reasoning. I have had situations in which I advised the client for driving retirement, and only a few moments later, the client did not remember the outcome. This client’s memory, as well as associated problems with insight and judgement require additional safety actions. Keys or the car itself need to be made unavailable to this client, or chances are they will attempt to drive in spite of the requirement for driving retirement.
Driving Retirement Conversation Tips
Conducting driving retirement conversations with clients and families may take some practice and finesse. It truly helps to practice how to deliver this message and to ‘find your words’ to ensure you show sensitivity and empathy, and that you are prepared for the various reactions you may encounter.
Consider the environment where you will have the driving retirement conversation. For safety reasons, this conversation should not be held in the car. You should have a private meeting area where you will not be disturbed and where the client can openly and freely ask questions and express emotions.
Furthermore, the driving retirement conversation should be held with the client and a support person. This message should be delivered in the presence of more than one person to provide support to the client and to help listen to clarify the outcome later as needed.
Depending on the client’s medical conditions, this conversation may be intended more for the family member who will be supporting the client in the days/weeks to come, than for the retiring driver. Always provide your phone number and contact information for any follow up questions that the client may have after the appointment.
When approaching these conversations make sure that you prepare in advance. Organize your facts, identify possible options and resources, and prepare yourself mentally to be fully present for the conversation. Here are some items to consider:
To organize your facts:
- Consider the medical diagnoses & medications.
- Use the Evidence-Based Consensus Statements to support your conclusions.
- Use the results of standardized assessments to clearly show the deficits prompting the recommendation of driving retirement.
- Have a clear understanding of your state’s licensing process and reporting process, so you can articulate any follow up steps to the client.
- Provide the recommendation for driving retirement in writing so that the client may have something written down to reference later.
- To identify possible options and resources:
- Consider the opportunity for rehabilitation, recovery, remediation, or adaptations of deficits. Again, the client’s medical diagnoses and maximized recovery will influence this possibility.
- Understand the client’s driving habits and routines. You should have gathered this information during the development of the occupational profile in the clinical interview. This information will help you identify possible options for community mobility to enable the client’s valued occupations.
- Help the client & family identify alternative modes of transportation.
- Refer to occupational therapy and other services to support driving retirement transition, which could include training for the client in how to use of community mobility options.
To prepare yourself to counsel your client and the family:
- Remember individual client needs; for example, someone with dementia should not be taught to use a new or different alternative mode of transportation. This would most likely not be successful due to limitations in new learning abilities, and will only confuse and frustrate the client.
- Encourage family, friends, and caregivers to be spontaneous with outings. Advise them to not just make trips out to be only about what has to get done. Suggest they plan outings for pleasure and for unstructured, leisurely trips as well.
- Encourage the client’s family and support system to set up their own routine of support. Being responsible for someone else can take a toll. Encourage caregivers to take breaks and work to address their own needs as well. Link them to community resources for caregivers, such as the local Alzheimer’s Association or senior adult support services.
- Counsel the client through the grief of losing a valued occupation. If you are not comfortable with your skills in this area, consider taking a continuing education course on empathetic listening or understanding the grief process. Build your skill sets in this area.
- Encourage the removal of temptation to drive or access to vehicles, especially for individuals with dementia. This could potentially be a safety issue, as mentioned earlier because cognitive deficits may affect the client’s memory, insight, and reasoning regarding driving retirement.
- Always remember: preparing a client for driving retirement is more than a one-time conversation.
Options and resources available to the client and family member to support driving retirement
There are many resources available to support driving retirement. These resources are valuable to the client, family, and to your OWN TRAINING. I especially recommend reviewing the Hartford’s At the Crossroads book or AARP’s We Need to Talk.
Remember to have care and compassion. Driving is a highly valued activity and many times the recommendation for driving retirement may come as a surprise to the client. Be patient, and don’t rush this conversation. Give the client time to respond and ask questions. Be prepared for a range of emotional responses from denial, to sadness, to anger, and even, on occasion, acceptance.
Chichuri, S., Mielenz, T.J., DiMaggio, C.J., Betz, M.E., DiGuiseppi, C., Jones, V.C., & Li, G. (2016). Driving cessation and health outcomes in older adults. Journal of American Geriatric Society, 64(2): 332-341.
Evidence-Based Consensus Statements for Driving and Community Mobility (2015) retrieved from https://www.aota.org/~/media/Corporate/Files/Practice/Aging/Driving/evidence-based-consensus-statements-driving-community-mobility.pdf