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Effects of medications
The use of multiple prescription drugs may cause drowsiness or anxiety, thus impairing driving skills.

	The Older Adult Driver (American Family Physician) includes a list of medication that may impair driving skills.
	Common medications can impair driving (WebMD)
	Drugs and human performance fact sheets (from NHTSA)

Brain impairments

	Incidence and prevalence of the major causes of adult-onset brain impairment in the U.S. (Caregiver.org)
	How dementia affects driving (CA DMV)
	Alzheimer's, Dementia & Driving (The Hartford)

Vision conditions
The eyes become slower to adapt to light and darkness, which can create sensitivity to bright sunlight and glare. The eyes also lose some ability to process light, which makes seeing at night harder. Depth perception and judging the speed of oncoming traffic also weaken.

	How is your vision? (from NHTSA)
	How vision conditions affect driving (CA DMV)

Loss of hearing

Should I be concerned about hearing loss? (AARP 55 Alive Driver Safety Program)

Physical fitness
Common health problems, like arthritis, can make it harder to drive by limiting people's ability to turn the head easily or move a foot from the accelerator to the brake.

	How is your physical fitness? (from NHTSA)
	Flexibility allows you to see what is happening on the road. Exercise can help to improve your range of motions. (SeniorDrivers.org)

Sleepiness
The use of multiple prescription drugs may cause drowsiness.

	Sleeping and driving don't mix. (SeniorDrivers.org)
	Drowsy driving and automobile crashes (from NHTSA)
	Danger Signals: How sleepy are you? (from AAA Foundation for Traffic Safety)

Attention and reaction time
Older drivers often find it difficult to react quickly as they process multiple images or sounds, such as when they're looking for street signs while monitoring traffic and talking with a passenger.

How is your attention and reaction time? (from NHTSA)

Senior
Few seniors plan for the time when they will be unable to drive, yet many will eventually face this decision. Most believe they will know when it is time to stop driving. However most seniors also know friends who continue driving and can no longer operate a vehicle safely.
Giving up the car keys is viewed by elders and those around them as a major event with significant implications regarding independence, self-sufficiency (especially in Los Angeles), and social responsibilities.
Many seniors face this dilemma:
"Do I continue to drive even when driving begins to pose real safety risks for myself and others?" 
Faced with this dilemma, some individuals stop driving, while others continue to drive.

Family
Giving up driving is a major event for an older person and a senior's loss of independence also has significant implications for his or her family.
Children are reluctant to discuss this emotional issue and may be concerned about hurting the senior's feeling. Some family members may also be afraid of losing the senior's affection or of retaliation.
Family members may be unprepared to provide the additional level of care and support needed by an increasingly dependent elder.
Many family members must face this decision:
"Do I continue to let a senior drive even when driving begins to pose real safety risks for him or her, other family members and the public?"
Some family members refuse to intervene but would not let their own young children ride with the senior driver.

Physicians
Physicians must balance their ethical responsibilities to patients and to the public. Their dilemma is illustrated in this Web page:
Medical Crossfire Debate: Should physicians report patients with medical conditions that make them unsafe drivers?
In December, 1999, the American Medical Association changed its ethical guidelines to let doctors notify the motor vehicle department in their states about patients with medical conditions that could make them unsafe drivers. This policy makes public safety a priority over the confidentiality of patients and does not have universal support among physicians.

Organizations
Most organizations providing services to seniors are aware of elders who can no longer drive safely but continue to do so and are placing themselves and the public at risk.
Like physicians, social workers attempt to balance their ethical responsibilities to clients and to the public. They are also very concerned that their organization not get a reputation for "turning in" seniors to the Department of Motor Vehicles, thus discouraging elders from seeking their services.

Elected Representatives
Elected representatives are caught between constituents clamoring for public safety through increased screenings of older drivers, and pressure from seniors and advocacy organizations fighting against age discrimination.
In several states, legislative attempts to add to the testing requirements for older drivers have met with successful opposition from senior groups (such as AARP and the Congress of California Seniors). Additional driving tests for the elderly continues to be a highly controversial topic.
An interesting comparison of the Driver Licensing Renewal Procedures for Older Drivers in the U.S. as of May 2004 can be found on the Insurance Institute for Highway Safety Web site.
Many renewal requirements now focus on health, not age, in determining whether people should be retested.

Senior driver information
Topics include renewing your driver's license, preparing for exams, and driving tests.

Medical Conditions and Traffic Safety
The DMV provides guidelines for physical and mental conditions such as dementia, diabetes, loss of consciousness and vision problems.

Another DMV Web page addresses these questions:
* What can DMV do about a person who may be unable to drive safely due to a physical or mental condition or disorder?
* What types of medical conditions can affect a person's ability to drive safely?
* How does DMV find out about persons who may be unsafe to drive due to a physical or mental condition or disorder?
* How do I let DMV know about a family member, relative or acquaintance whom I believe may no longer be a safe driver?
* What types of conditions must a physician report to DMV?

How to Refer an Unsafe Driver
If you are concerned for the safety of a family member, friend, or other person who can no longer drive safely, you may write to your local Driver Safety Office or the address given below. You should provide the person's name as shown on the license, birth date, driver license number (if known) and current address, and explain what you observed that led you to believe the person is an unsafe driver. The letter must be signed; however, you may request that your name be kept confidential.
Write your letter to:
Department of Motor Vehicles
Driver Safety Actions Unit M/S J234
P.O. Box 942890
Sacramento, CA 94290-0001
DMV will contact the person for a reexamination and, if necessary, administer a driving test to determine whether or not the person is safe to drive. The person may be issued a restricted license. It is possible that the person's driving privilege may be revoked as a safety measure, not only for the safety of that individual but also for the safety of the rest of the driving public.
For more details, please see the DMV Web page.
The list of DMV Driver Safety Offices in California can also be found on the DMV Web site.

Confidentiality of Reporter
Anonymous reports will not be considered. However, you can ask to keep your name confidential and DMV will not tell the person who made the report. 
According to Vehicle Code §1808.5, all records received by DMV, which report a physical or mental condition are confidential and cannot be made public:
"Except as provided in Section 22511.58, all records of the department relating to the physical or mental condition of any person, and convictions of any offense involving the use or possession of controlled substances under Division 10 (commencing with Section 11000) of the Health and Safety Code not arising from circumstances involving a motor vehicle, are confidential and not open to public inspection."

Reexamination Process
The reexamination process may include an interview, a written test and a driving test.
DMV may send the person a form (DS 326: Driver Medical Evaluation) and a notice to call a Driver Safety office for a DMV reexamination. The physician treating the person must complete the medical form. It is important for the person to come in for his or her DMV appointment and bring the completed medical form, otherwise his or her driving privilege will be suspended.
A detailed description and a copy of the Driver Medical Evaluation Form can be obtained on-line.
Starting January 2001, a driving test will be given to any person when a:
*Physician reports the person has lapses of consciousness.
*Traffic officer requests a DMV review and the officer believes the driver is incapable of operating a vehicle safely.
*Relative makes a good-faith report to DMV stating the driver cannot safely operate a vehicle.

DMV Guidelines for Taking Action
This DMV Web page provides comprehensive guidelines for evaluating and taking action against the driving privilege of drivers with physical or mental conditions or disabilities that may impair the ability to drive.
Some of the requirements considered are:
* Physical requirements
* Sensory functions
* Mental requirements
* Emotional stability
* Knowledge requirements
* Physical limitations/restrictions
* Physical or mental condition and history
* Aggravating factors
* Treatment
* Nexus of physical or mental condition to driving
* Determination of compensating factors
* Driver understanding and awareness
This Web page also reviews DMV options and your hearing rights. 

DMV Options
A determination may be made that no condition exists which warrants an action against the driving privilege. The department may also find that a condition exists which warrants:
*Reexamination on a specified date (Calendar Reexamination)
*Medical Probation I: driver must comply with medical regimen and report any changes to the department
*Medical Probation II: annual medical reports required to be submitted to the department on specified dates
*Limited Term Licenses: license issued by the field office for one to two years which requires the driver to return to the department for reevaluation and/or testing
*Restrictions
*Suspension
*Revocation: The hearing officer may revoke the person's driving privilege if he or she does not do well on the written test or it is clear that the person does not have the skills needed for safe driving. For this reason, DMV suggests that someone accompany the person to the interview. The loss of license will be a traumatic event. Support and resources should be made immediately available to help the senior during this crisis.

No-Fee Identification Card
The driver license is often a person's primary means of identification. Its loss often means the person will not have a handy form of photo identification for check cashing purposes, qualifications for services, etc. DMV understands that a person needs some form of identification. So If a senior's driving privilege has been revoked because he or she is no longer able to drive safely, or he or she develops a physical or mental condition which interferes with his or her driving performance and voluntarily surrenders the driver license, then DMV will exchange a valid driver license for an identification card (ID) free of charge, as long as the license has not expired.

Prevention, Choosing Safe Alternatives, Rehabilitation and Assistive Devices

	AARP 55 Alive Driver Safety Program The nation's first and largest classroom driver improvement course specially designed for motorists age 50 and older. It is intended to help older drivers improve their skills while teaching them to avoid accidents and traffic violations. Find a class near you!
	Driving Safely From California DMV
	Safety tips on a variety of subjects From the AAA Foundation for traffic safety
	The Association for Driver Rehabilitation Specialists offers helpful fact sheets covering several types of disabilities, how they affect driving skills and possible remedies including assistive devices: Aging and driving Driving after a limb amputation Driving after a spinal cord injury Driving after a stroke Driving after a traumatic brain injury Driving and Alzheimer's / Dementia Driving and cerebral palsy Driving with multiple sclerosis Driving with rheumatoid arthritis The Association Web site Directory can help you find a specialist near you.

Independence and self-esteem

Access to family and friends

Employment and income

Access to trusted medical care

Ability to shop including grocery shopping and prescriptions

Access to personal care

Social and cultural activities

Religious expression.

The local Multipurpose Senior Center (MSC)
is the primary source of assistance for seniors and their families. Our "Find a Senior Center Web page" can help you find an MSC near you.
The MSC Care Manager can help you with:

	Local transportation and transit programs for seniors,
	Applying for the various benefits, which a senior may be entitled to receive,
	Social activities, trips, classes, fitness, grocery shopping, assistance/escort for medical appointments, nutrition sites near you, meals-on-wheels and much more...
	Professional advice and support for the senior's family.

Specialized Resources
are available to help a senior remain independent in his or her own home. 

Local clergy
Seniors who are actively involved with a religious institution can find support from the congregation to keep this important component in their life.

Delivery Services
Increasingly groceries and prescriptions can be delivered to a senior's home and you can explore this option.

Get a prescription from the doctor that states "no driving"
Show this to your relative when s/he insists on getting behind the wheel.

Distract the person
When your family member insists on driving, try to get his or her attention focused on something else. For example, one wife would say to her husband, "I was just fixing a bowl of your favorite ice cream. Let's eat it first." Another wife would say, "We can't drive now. The car needs to be repaired."

Control access to car keys
Do not leave car keys in view of your family member. Give him or her a different, but similar-looking set of keys or have a locksmith file the part of the key that turns the ignition. The person can still enter the car, but will not be able to start it. Some people, however, may become frustrated and angry when "the keys won't work."

Disable the car
A car mechanic can show you how to quickly disable a car - remove the distributor cap or battery or unplug the starter wire - so it won't run and what to do to get it to operate again. Another option is to have a "kill wire" installed. It prevents the car from starting unless a switch is thrown. If your family member lives alone, this may not be a good option. As one family said:
"We knew how important Dad's car was to him. I had never seen him cry so hard as the day we told him he could no longer drive. He finally agreed not to drive, but wanted to keep his car in his driveway. Since we did not know if he would remember that he was not to drive, as a precaution, we made his car inoperable. What we did not count on is that a week later he would call a mechanic to repair the car."

Move the car
For some people, seeing the car is what triggers the desire to drive. Try parking the car where your family member does not see it but where you can get easy access.

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