When It’s Time to Reassess Driving Safety: A Care Manager’s Perspective

For many older adults, driving is more than a way to get from place to place — it’s independence, freedom, and dignity. But what happens when safety becomes a concern?

As a Care Manager, I make it my business to know the resources that support our aging population. Recently, I met with the owners of Drive Rx, located in the Cummings Center in Beverly, Massachusetts. Drive Rx is a specialized service dedicated to assessing the driving safety of people with disabilities caused by aging, illness, or developmental conditions.

The business was founded by occupational therapists Amanda Holt and Renee Antuono, who together bring 15 years of experience evaluating and treating patients with cognitive and/or physical challenges that affect daily function. They saw a growing need for a dedicated service to evaluate — and when possible, support — safe driving in people who may require adaptive equipment or specific safety considerations.

How Drive Rx Works

With a doctor’s order for evaluation and a medical history in hand, Amanda and Renee perform a comprehensive, 90-minute in-office assessment that measures:

• Visual acuity, eye movements/scanning patterns, and visual perceptual/processing abilities

• Motor planning, coordination and reaction time

• Strength, range of motion and mobility

• Cognitive functions

If needed, they can also provide training in the use of adaptive driving equipment. For some clients, an on-the-road test is recommended. Results and recommendations are shared with the patient the same day, along with their family (when appropriate), the referring physician, and — if required — the Registry of Motor Vehicles.

An assessment like this costs well under $1,000 — a modest investment when you consider it could prevent a serious accident and save lives.

Why an Objective Evaluation Matters

For healthcare practitioners, telling an older adult that it’s time to give up the keys is one of the hardest conversations we have. For family members, it’s often worse. The dynamics between a parent and adult child rarely make for a productive or peaceful discussion on this topic — and it can easily damage trust.

That’s why I often advise families to let the primary care physician address the concern. But even doctors don’t always have the tools to make a truly informed decision. A service like Driver Rx is to driving what an orthopedist is to a broken bone — a specialist with the right training, tools, and time to make an evidence-based determination.

Signs It May Be Time for an Assessment

Not every medical issue means a person should stop driving, but there are certain changes that should prompt an evaluation:

• Noticeable cognitive decline or a change in ability to complete complex daily activities, such as financial management, medication management, or cooking

• Frequent falls or balance problems

• Slower reaction times or difficulty handling complex traffic situations, such as merging, taking unprotected turns, or managing 4-way stops.

• Any “close calls” or driving incidents, including minor accidents, unexplained damage to their car, taking longer to get places, or getting lost or confused while driving 

• If someone confuses the gas for the brake or stops in traffic for no apparent reason, these are serious safety concerns and indicate that an individual should stop driving immediately and be evaluated

The goal is not to take away independence unnecessarily — but to measure safety objectively, using proven criteria.

Balancing Safety and Quality of Life

In our culture, driving represents autonomy. And while questioning someone’s driving ability solely based on age is a form of ageism, many age-related conditions can make driving dangerous. The challenge is balancing safety with dignity.

If a loved one must stop driving, the Massachusetts RMV will issue a free state identification card when a license is surrendered — avoiding the costly and complicated process of replacing an expired license later. From there, exploring alternative transportation options can help preserve connection, routine, and freedom of movement.

Final Thoughts

If you’re worried about a loved one’s driving, don’t try to navigate the conversation alone. Engage an expert, get objective results, and when in doubt, limit driving until a thorough assessment is complete.

Our job — whether as family members, healthcare providers, or care managers — is to ensure safety, preserve peace of mind, and maintain quality of life for as long as possible. Services like Drive Rx make that possible.