Driving while aging: How can she make her mother give up the keys?

Dolores Munson, 85, got tired last winter of waiting behind a police car that had made a traffic stop about a mile from her home. She swerved into the next lane to pass, but couldn't help looking to see who had gotten in trouble. "I was nosy," the Stratford, N.J., woman said. Distracted, Munson slammed into the front of the police car hard enough to break an axle on her white VW Passat. The cruiser was unharmed.

This might be good news, Joan Smeraski thought when she got the call from her mother's Jitterbug. Maybe the police would make her mother stop driving. Smeraski had been trying for months to take the keys away, but her mother wanted the freedom that only your own car can give.

Smeraski's hopes were dashed. The police didn't even ticket Munson. Her insurance company was also understanding and helpful. So was the body shop. Smeraski asked her mother's doctor to write a note telling Munson, who has "mild to moderate cognitive decline," not to drive. She put it on her mother's refrigerator.

Munson is still driving.

"If you live to be my age, you will see," she said in June as she sat in her favorite chair, the one with a view of the gloriously green backyard she won't leave to live closer to Smeraski. "You're in the house all the time. You sit in a chair and sometimes you wonder why you're living. You can't do anything. You can't go anywhere.  …"

"Sometimes you need a change of scenery."

Smeraski and her brother and sister wondered if they might be liable if their mother hurt someone. They talked about going above their mother's head to the New Jersey Motor Vehicle Commission but haven't been able to take that step.

Thousands of families are all too familiar with scenarios like this, which will grow more common as car-loving baby boomers reach old age. Especially for people who live in suburban and rural areas, driving is not only a psychological marker of independence, but also a skill that allows seniors to stay in their homes and avoid asking for — or paying for — help. Feeling trapped in a house is depressing for people of any age, and it can make health problems worse. Adult children don't want to make their parents miserable, but they also fear accidents. Figuring out when — and how — to stop an elder from driving is one of the toughest challenges families face, and it's made even tougher by the fact that they often don't get much support.

Deciding what to do about older drivers who are faltering is touchy for everybody. People age differently, which makes it challenging for lawmakers and insurers to create effective, nondiscriminatory rules. Police have less power than you'd think. Families are likely to find their most powerful allies in doctors and driving evaluators who are trained to test older or disabled drivers.

State laws vary widely. Regular vision tests and a requirement that drivers renew licenses in person seem best at reducing fatal accidents, but only for the oldest drivers. Experts say many older drivers decide on their own to stop night and highway driving when they have trouble with vision or response times.

Despite a growing senior population, fatality rates for older drivers have dropped in recent years, likely because cars are safer and seniors are in better health. Almost 6,000 drivers 70 and older died in traffic accidents in 1997 compared with 4,300 in 2015, said Jessica Cicchino, vice president of research for the Insurance Institute for Highway Safety. But seniors still have higher rates of fatal accidents than most other age groups, in part because they are more fragile. When they're in crashes, drivers who are 80 or older are four times more likely than middle-aged drivers to die, she said.

Older drivers don't drive as much as younger drivers, so their per-capita crash rates are low. However, the rate of crashes per mile is twice as high for people 80 and older as it is for those 35 to 54. The risk of being in a crash where someone dies starts to rise around 70.

Smeraski and her siblings probably wouldn't need to worry about being sued unless their mother had been declared incapacitated by a court, said Cherry Hill elder lawyer Jerry Rothkoff. "Legally, I do not believe the child is under any special legal duty to prevent the parent from driving," he said. "However, there clearly is a moral obligation."

It's not as easy as taking the keys or moving the car. Experts say they know of cases where seniors ordered new keys, bought new cars, or accused an adult child of stealing the car.

Doctors in Pennsylvania are required to report to the state patients they think shouldn't be driving. New Jersey has that rule only for people with a short list of conditions that cause convulsions, seizures, loss of consciousness, or certain motor-coordination problems. Anyone, though, can report dangerous drivers in any state and trigger an investigation. Pennsylvania's Department of Motor Vehicles gets 35,000 such reports a year.

Police can't just yank a license, much as they might want to. Michael Chitwood, superintendent of Upper Darby police, said his officers recently dealt with a woman in her early 90s who hit something and drove away. When they found her, she said: "You know I thought I hit something, but I wasn't sure." The officers reported her to the DMV but didn't have the power to stop her from driving immediately. "Local municipalities should have more power because we deal with the here and now," Chitwood said. The department tries to track down family members and hopes they'll stop the person from driving.

The Laurel Springs Police Department, which handled Munson's accident, did not respond to requests for comment.

Mike Fergus, a program manager for the International Association of Chiefs of Police, said many departments could use more training to help older people use their cars safely — many don't ever adjust seats and mirrors when they buy a new car — and to recognize when drivers have dementia or other problems that could affect their driving.

Auto insurance companies might be among the first to see an uptick in claims that signals declining driving ability. But even The Hartford, which produces useful educational materials on older drivers, sidestepped a question about whether insurers could do more to identify problem older drivers. Family members are usually the first to notice a problem, said Jodi Olshevski, a gerontologist who is executive director of the Hartford Center for Mature Market Excellence. If seniors won't listen, family members can take them for a special driving test. "We really think that comprehensive driving evaluations are the best way to go," she said. The company will even pay for evaluations if an insured driver was injured in an accident.

Michael Barry, a spokesman for the Insurance Information Institute, an industry group, said age is a factor in setting insurance rates, but companies weight it differently. Accidents typically make rates go up. Insurers can decide not to renew policies for drivers with particularly bad records, but they do it with "great reluctance" because "they want more customers," he said. "They don't want to send them away."

"I think auto insurers would be reluctant to assume the role that the state motor vehicle department currently serves" in assessing a driver's safety, he added.

Baby boomers could spare their children this nightmare by planning for old age and infirmity. "Most all of us are going to outlive our ability to drive by six or seven years," said Alice Pomidor, a Florida State University geriatrician who edited the new edition of the American Geriatrics Society's 300-page guide for medical personnel on senior driving.

Both AAA and The Hartford have advance-directive forms that let drivers designate someone they trust to tell them when it's time to give up the keys. Olshevski conceded that elders with dementia might not keep their end of the agreement, but that's not the point. The forms give caregivers confidence. "Knowing that they had the conversation and that the person agreed to it is empowering for them," she said.

Smeraski and her mother, however, didn't have that talk.

Munson still wants to take a drive when she feels like it. She takes occasional local trips, to the drugstore or the ice cream shop. Her favorite ice cream is about 18 miles away. She says it's a "straight run."

Munson has shown several warning signs that her driving is questionable. She's gotten lost, most recently for two hours after she took a "shortcut" to a relative's house. She banged into the police car. She's having trouble parking and backing out of the garage. Other drivers honk at her a lot — "especially men," she said. "The men get so irritated" — often because she wanders out of her lane. She has fallen, which is a risk factor for driving problems. People outside the family have started to notice. "I hold my breath every time she backs out of the driveway,"  Smeraski said a neighbor told her.

Munson says she's not someone who particularly loves driving. She says she'd quit now, "if I had a chauffeur." But she also doesn't want to pay for more help. "I don't throw my money around," she said. "That's why I have some."

Smeraski has tried hiding the keys, but her mother finds them. More recently, she and other family members as well as her mother's paid caregiver have made a point of taking Munson on outings. Smeraski took her mother's car to the mechanic for maintenance and cleaning and parked it in the garage, where it has mostly stayed put. She noticed that Munson has seemed less interested in driving in the last month. She drove only twice and seemed to have lost some confidence about going out at all. Smeraski is hopeful that the driving problem will soon resolve itself. She is relieved that her mother — and other people on the road — is safer. She's also sad that an era is ending.

Licensing rules in N.J., Pa.

Some states impose extra rules on older drivers. They may have to renew their licenses more often; renew in person; or pass extra vision, written, and road tests.  New Jersey and Pennsylvania generally treat drivers of all ages the same. In-person renewals and vision tests are the only steps proven to reduce traffic fatalities among older drivers, and then only for those 85 and older. A recent study found that insurance claims declined after Illinois required drivers over 75 to take a driving test when they renew their licenses.

New Jersey drivers must renew their licenses every four years, although most can renew by mail every other time. Vision tests are required only at the time of initial licensing or if a driver is asked by the Motor Vehicle Commission's Medical Review Unit to get one. That unit screens reports about questionable drivers from doctors, police officers, courts, social workers, and family members. Doctors are required to report patients who have had convulsions, seizures, or loss of consciousness or certain motor-coordination problems. The unit had 4,159 new cases in 2016, said Mairin Bellack, a spokesperson for the commission. That year, 686 licenses were suspended for medical reasons. Licenses may also be restricted.

Bellack said the American Medical Association's 1999 ethical guidelines held doctors ethically responsible for notifying their state licensing department about patients they believe are unsafe drivers.

In Pennsylvania, people over 45 can be chosen randomly to take an eye exam although the notices — there are 1,900 a month — are more likely to go to senior drivers. Drivers of all ages renew every four years and do not have to go in person. Doctors are required to report many medical conditions, including dementia, that could impair a patient's ability to safely operate a motor vehicle. Police, family, and friends can also report people they think are dangerous drivers. People must include their names in the report, but they will not be disclosed to the driver. The state gets 35,000 such reports a year. Half are about drivers under age 65. About 10,000 of the reported drivers lose their driving privileges because of medical impairments, and 21 percent get driving restrictions, such as only being allowed to drive during the day.

Laura Krol, manager of the state's driver safety division, said the state tries to balance public safety with aging drivers' need for independence. "We want to keep our drivers behind the wheel," she said, "as long as they can safely operate a vehicle."