Switching lanes

For most of us, the ability to drive a car equals independence. However, as your parents age, physical and mental abilities may decline, affecting their skills behind the wheel of a vehicle. The changes might be so gradual that your parents are not aware they are no longer a safe driver — but you suspect it may be time to ask them for their car keys.

One of the most difficult conversations adult children can have with their parents is the suggestion that for everyone’s safety, it might be time to let someone else do the driving. Sometimes an independent evaluation saves strain on your relationship.

Washington University School of Medicine has partnered with The Rehabilitation Institute of St. Louis (TRISL) and Independent Drivers, LLC, to offer a driving assessment program called Driving Connections.

David Carr, MD, a Washington University physician whose areas of specialties include geriatric medicine and Alzheimer’s disease, serves as a consultant for Driving Connections. Dr. Carr offers some words of advice for adult children to help handle this delicate situation with their elderly parents.

“It’s important to have the discussion early, rather than when it becomes an emergency. As tough as it is to address the issue, it’s much easier to talk about things when you feel your parent is still OK to drive. The Hartford Insurance Company has a very helpful online booklet called We Need to Talk ( It’s a great way to get the conversation started.”

According to Dr. Carr, “The driving clinic’s occupational therapist Peggy Barco, (an instructor in the Program of Occupational Therapy at Washington University), and The Rehabilitation Institute of St. Louis staff therapist Kathy Dolan, have expertise in evaluations for medically impaired drivers.

Impairments that may affect driving include dementia, stroke, Parkinson’s disease, multiple sclerosis, head Injury, spinal cord Injury, glaucoma, macular degeneration, and amputation.”

The first part of the driving evaluation focuses on the human factors required for driving; including visual, cognitive, and motor functional abilities as part of the off-road testing. In addition, some written exam tests on the rules of the road along with traffic sign recognition tests are administered.

Dr. Carr states, “If the off-road results look promising, then we continue with the road performance test in real traffic conditions. The test is performed in a car with dual brakes.

In the research studies, up to two therapists may ride along during the 45-minute road evaluation. It’s a thorough course that starts in a parking lot and builds its way through more dense traffic and complex driving situations. We’ve studied the new road test, aptly named the Modified Washington University Road Test, and believe it to be a reliable and objective measure of driving safety and assessment.”

Dr. Carr points out that some patients fail the test the first time, due to anxiety or unfamiliarity of the course, and in these cases, it may be appropriate to be tested again or in an environment close to home.

There are other times when the driver can be trained on adaptive equipment in order to operate the vehicle safely, such as those patients that have had an amputation or disability from stroke or spinal cord injury. An example adaptive equipment could be a spinner knob on the steering wheel for turning or a left-foot accelerator in a patient with right sided weakness.

The driving assessment requires a physician referral and costs $290. The evaluations are typically not covered by insurance. However, there are times where research studies may cover this cost. Following the assessment, driving recommendations are provided to the driver, his or her family and doctor in a sensitive manner.

Driving Connections is located at 4444 Forest Park Ave. (near Barnes-Jewish Hospital). Free and convenient parking is available.

For more information, or to schedule an appointment, please call 314-286-1640 or visit the Driving Evaluation website.