\n\tJudith Graham<\/span><\/p>\n

Lewis Morgenstern has made up his mind. When he turns 65 in four years, he\u2019s going to sign an advance directive for driving.<\/p>\n

The directive will say that when his children want him to stop getting behind the wheel, Morgenstern will follow their advice.<\/p>\n

\u201cI recognize that I might not be able to make the best decision about driving at a certain point, and I want to make it clear I trust my children to take over that responsibility,\u201d said Morgenstern, a professor of neurology, neurosurgery, and emergency medicine at the University of Michigan.<\/p>\n

His wife, 59, intends to sign a similar document at 65.<\/p>\n

Morgenstern has given a lot of thought to the often-divisive issue of when to stop driving. He co-authored a recent article<\/a> in the Journal of the American Geriatrics Society that found 61% of older adults with cognitive impairment continued to drive even though 36% of their caregivers were concerned about their performance.<\/p>\n

Many of these seniors probably adapted by exercising caution and drawing on extensive experience behind the wheel, Morgenstern said. But, he noted, \u201cthere is undoubtedly a group of people who are driving and shouldn\u2019t be because they\u2019re a risk to themselves and to others.\u201d<\/p>\n

Relatively few studies have looked at how many older adults with mild cognitive impairment or dementia continue to drive, and there aren\u2019t any national standards on when people should hand over the car keys. But the issue is a growing concern as the ranks of seniors in their 70s, 80s, and 90s \u2014 the age group most likely to have cognitive impairment \u2014 expand.<\/p>\n

Nearly 50 million people 65 and older held driver\u2019s licenses in 2021, a 38% increase from 2012, according to data compiled by the American Automobile Association. Almost 19 million were 75 or older, a rise of 31%. During this period, motor vehicle deaths for people 65 and older increased 34%, reaching 7,489 in 2021. The number of seniors injured in vehicle crashes that year exceeded 266,000.<\/p>\n

For the most part, older adults drive safely. They use seat belts more often, are intoxicated less often, and are less likely to speed than younger adults. Compared with younger and middle-aged adults, they\u2019re involved in fewer fatal car crashes each year. And they\u2019re more likely to restrict where and when they drive \u2014 following familiar routes, avoiding heavily trafficked streets, and not driving at night.<\/p>\n

Still, risks for older drivers rise with advancing age and the onset of medical conditions such as arthritis, glaucoma, and Parkinson\u2019s disease. And when crashes occur, seniors are more likely to be severely injured or die because they\u2019re more vulnerable physically.<\/p>\n

Cognitive impairment and dementia pose especially worrisome challenges because decision-making, attention, judgment, and risk assessment are compromised in people with these conditions.\u00a0<\/p>\n

\u201cThis is a big challenge when it comes to driving, because people don\u2019t react appropriately and self-regulate,\u201d said Emmy Betz, a professor of emergency medicine at the University of Colorado School of Medicine who has studied advance driving directives.<\/p>\n

This was the case for Morgenstern\u2019s beloved father-in-law, who developed moderate Alzheimer\u2019s disease in his 70s but remained convinced he was fit to drive. After he got badly lost one day, Morgenstern\u2019s mother-in-law took away the car keys, and \u201che didn\u2019t understand why. He was very unhappy,\u201d Morgenstern said.<\/p>\n

Morgenstern\u2019s interest in advance directives for driving, an option he recommends in his paper, springs from this experience.<\/p>\n

Several types of directives exist. One asks a person to name a family member or friend who will talk to them about whether it\u2019s safe to continue driving. AAA and the American Occupational Therapy Association have endorsed a directive<\/a> of this kind, which is not legally binding.<\/p>\n