If you begin to see that the senior is having more difficulties than before, be on the alert for changes that make driving unsafe. If you notice any of the warning signs listed below, it is time to reassess the risk of the senior’s driving.

• Problems on the road. Abrupt lane changes, braking, or acceleration. Failing to use the turn signal, or keeping the signal on without changing lanes. Drifting into other lanes. Driving on the wrong side of the road or on the shoulder.
• Trouble with reflexes. Trouble reading signs or navigating directions to get somewhere. Range-of-motion issues (looking over the shoulder, moving the hands or feet). Trouble moving from the gas to the brake pedal, or confusing the two pedals. Slow reaction to changes in the driving environment.
• Increased anxiety and anger in the car. Feeling more nervous or fearful while driving or feeling exhausted after driving. Frustration or anger at other drivers but oblivious to the frustration of other drivers - not understanding why they are honking. Reluctance from friends or relatives to be in the car when the senior is driving.
• Trouble with memory or handling change. Getting lost more often. Missing highway exits or backing up after missing an exit. Trouble paying attention to signals, road signs, pavement markings, or pedestrians.
• Close calls and increased citations. More frequent "close calls" (i.e., almost crashing), or dents and scrapes on the car or on fences, mailboxes, garage doors, and curbs. Increased traffic tickets or "warnings" by traffic or law enforcement officers.

A professional driving assessment can aid in the decision-making process. Three driving assessment programs in metro Atlanta all requiring a physician referral are listed below. The assessment lasts approximately three hours; the cost is around $500; and insurance will generally not pay for the assessment.

1. Emory Center for Rehabilitative Medicine - Phone: 404-712-5527
2. DeKalb Medical Center Outpatient Rehab - Phone: 404-501-5749
3. Shepherd Center Driving Clinic - Phone: 404-350-7760

Adjusting to life without a car may be difficult at first. Hopefully, you have assisted the senior to find ways to continue his or her routine activities. Many seniors have difficulty asking family and friends for rides while others may have a problem accepting offers of rides. Be pro-active and work with them to make it comfortable for all. For example, it may be easier to adjust if the senior keeps the car and have others drive it. That way the car will feel more comfortable and familiar and decrease the sense of loss.

Emphasize that money saved on car insurance, maintenance, registration, and gasoline is one of the advantages of giving up the car and leaves him or her able to pay for alternative transportation if it becomes necessary.

If you have to talk to an older family member or friend about not driving, approach the issue with sensitivity. A driver’s license signifies more than the ability to drive a car; it is a symbol of freedom and self-sufficiency. Understandably, driving is not a privilege that anyone wants to relinquish. Some older drivers may be aware of their faltering ability, but still be reluctant to give up driving completely. Some seniors may forget that they aren’t supposed to drive. If that is the case, it is even more important to remove the car or the keys to make it impossible to drive. Before you ask a family member to significantly restrict or stop driving, do your homework.

• Get the facts. Observe your relative's driving, and look for patterns of warning signs of future problems.
• Observe the older driver behind the wheel over time. Has the driver expressed personal concerns about driving safety? Is the older driver limiting where and when he or she drives?
• Discuss your concerns with a doctor. Determine what information you need to provide, given your relative's medical condition. Some doctors may take an active role in assessing a driver's skills and rendering an opinion; others will refer a concerned patient to a driving specialist for a comprehensive driving assessment.
• Investigate the alternatives for helping older drivers adjust to driving limitations. Consider how to satisfy social and transportation needs when the older adult curtails or ceases driving. Relatives may need to set aside time to provide rides. In addition, think about increasing the frequency of visits, outings, phone calls, and e-mails. Help the older driver calculate the current amount of money that he or she is spending on transportation.
• Be Supportive. The transition from driver to passenger is not always easy or smooth. Your support and understanding is necessary before, during and after driving changes are made.
• Be patient. Expect to have several conversations to achieve a balance between safety and independence. Don't be dissuaded by initial negative reactions. During each conversation, share your genuine safety concerns and desire to protect the driver's best interests.

Sometimes an older driver has to be stopped from driving. It might be very difficult for you to make this call. However, their safety and the safety of others must come first. An unsafe driver can seriously injure or kill themselves or others. If no amount of rational discussion has convinced the senior to hand over the car keys, then you may make a report to the Department of Motor Vehicles or recruit the family physician to write a prescription to stop driving. In some cases there is a need to take further actions such as taking away the car keys, selling or disabling the car, and enlisting the local police to explain the importance of safe driving and the legal implications of unsafe driving.

My father-in-law still drives, but only during the day. He avoids rush hour and days when it rains; he knows that I am keeping an eye on his driving. My father is now only driving within a few miles of his house to familiar places like the gym, drug store and grocery store. He is aware that he has memory issues and I think the time will come when he will stop driving because the fear of getting lost will be so great. It is difficult to know when is the right time to tell a loved one that he or she must stop driving, but as caring adult children it is our duty to figure it out.