Driving Us Crazy | Taking The Keys with Dr Joanne Bennett | Club Sandwich

Club Sandwich is recorded on Gadigal Land, home of the EORA Nation. We pay our respects to elders past and present. Always was, always will be.

Thank you so much for having me. It's my pleasure to be.

It is and it's really emotional for both sides and I think that's the thing that's really important to remember. It's emotional for the people having to initiate the conversation, but it is so emotional for the people who are having that conversation, had to. And for them to sort of think about that and think about what does life look like if I'm no longer driving is something that sparks a lot of frustration, anger, upset and sense of loss that is really important to consider when we have these conversations.

There are many, many stories and they're all across the spectrum. You'll have some people who are really self aware who go, yep, I know I'm no longer safe and I'm not able to continue to drive. And they will take active steps really early. And we call those the acceptors. But then you've got these people who are the reluctant one, take time, you know, they're in the middle, they'll listen to the conversation. But it can be a journey of a couple of years to kind of get them through that.

Yeah, a couple of years. And then you've got the real resisters at the other end. And it sounds like that's what EJ's experiencing with his family.

When I am dead, you know, in the coffin is the only time you're gonna get the keys from me. And that's a really challenging place. Like that's the hardest space to be in, both as the family, as the doctors, as the licensing agenc psychologist. You know, it's so challenging when they're at that really extreme end.

Absolutely. And that's the, that's that challenge. That balance that we're trying to always meet with, with this conversation is their sense of independence as well as that sense of community safety. And we're always walking a tight rope to make sure that we are balancing those two things. Cause there are negative consequences either way. You know, there's negative consequences for the individ in terms of, for their wellbeing, their cognitive health, their physical health, their social health. But there's obviously these really big community safety risks that we need to balance. And we've all heard those stories of an older person, you know, Sophie d' Alizio is the classic example of that.

Yeah, she's been hit twice. Once at a school.

And then the second time was crossing the road. And so both of those really extreme, awful situations. And that's just one example of something that unfolds many, many times over. And so it is a really genuine concern for everybody. And that's why we have to treat this tightrope in a really considered and careful way to make sure we make the decisions that balance those two things really well.

I suppose that's exactly right. So we know that when a person stops driving, there are a number of flow on effects from that. And it's a little bit of a chicken and the egg in terms of sometimes they stop driving because they're experiencing negative health impacts. And then sometimes the stopping driving exacerbates those. But it has an impact on in a variety of different ways. It's the cognitive impact. You know, we do see cognitive decline accelerate after they stop driving. We do see social isolation increase after they stop driving. It means because they're no longer getting out and doing activities with other people. We do see physical health decline. And mental health is the really big one. Research consistently shows that once they stop driving, they are twice as likely to get a diagnosis of depression. Their anxiety also increases and that actually lasts for a really long time. Long time. So it's not just that they have depression and then they get over it. Once they stop, they can have depression for four, five, six years. It can be a really long term negative impact.

We will get there. Yes, but yeah, no, that sense of loss is something that is really huge. And the research shows that again and again and again. These negative emotions that Older people experience when they stop driving that loss of independence, that loss of self identity is a really big one because often a license is a signal of capacity and capability. I am still a person who can contribute meaningfully to society. I can still take my grandkids to sport, I can still look after myself. And when they don't have that, it sort of has that negative impact on who am I if I no longer am able to contribute.

It's that sense of dependence that becomes on other people.

Yeah, exactly. And so when we think about the giving up the license, people often tend to focus on the really practical side and they go, oh, these are the things that we need to do to help you. But they forget the really emotional side. And that is so important. And as psychologists we've got this model called the dual process model of coping with bereavement and giving up your license is grief. It is a sense of loss that we go through a bereavement process for. And there are two sides to this process. You've got to deal with the loss oriented stresses as well as the restoration oriented stresses. So the loss oriented stresses around the emotions about what you're losing and you know, that sense of loss of independence, identity, that's freedom, that's the loss side. And there are stresses associated with that. And then there's the restoration side, which is what does my life look like after this change? How do I go through, you know, living a life that I still want to live even though I no longer have that license? And that comes with stress too. Thinking about the future, how we do things, creates stress. And so for older people, they're going through these. There's two sides of trying to cope with this loss and we tend to focus on the restoration. How do we get them still living? And we don't often focus enough on the emotional side, the loss side that they're experiencing and being there and listening and understanding and supporting them is so critical because we often go, it's for safety, you've just got to stop. Which can feel really dismissive for them of the emotional experience that they're having and often then makes them less likely to share and then work through those negative emotions that they're experiencing.

Yeah. No, for my mum, it was when my granddad was driving down the middle of the road opposite us that she went, okay, we're gonna need to do something here. And that's often too late in the sense that when you have that conversation, when a crash has occurred, it's really emotional for everybody, and it means that they don't have it in a rational way. And you don't have it in a rational way either.

Yeah. But emotions are heightened for everybody when you have it at those. And so we often recommend you have it earlier, even before you even think that there's going to be problems. I started having the conversations with my parents in their 60s.

To go, we need to. 60 is young. It is young.

But it is starting to think about, what would a life look like? And having it early and often is a way that we don't just react after, you know, an incident has occurred and we're really emotional.

That's so true.

Yeah, so often the thing like, we can use sort of triggers. So there's sometimes triggers that we can use. So if there's been a change in health or a change in medication, that can be a good trigger to go, hey, mum or dad, how is this change maybe gonn impact on your driving? And getting them to start thinking about what does unsafe driving look like to them? You know, we've all seen unsafe driving. You know, we've gone, you idiot. On the road, when someone's done something really dangerous and getting them to think about what does unsafe driving look like to me? What would be the cues for me as a driver for when I'm no longer safe Is it when I'm having near misses? Is it when I'm finding I'm losing concentration or unable to control the steering wheel as well or not driving at

That's exactly right.

And that's one of those things that can also be. The conversation doesn't just have to be about stopping, it's about transitioning. And so if you focus on just the it's stop, this is the end. We've actually missed a whole opportunity gap in the middle there. When somebody is a parent who is still quite safe to drive, what are the self regulation strategies you can employ? Not driving at nighttime, driving shorter distances, doing more familiar routes. Or it can even be down to things like maybe we need to buy you a new car, a safer, newer vehicle that has all the bells and whistles that's too confangled with a computer

a simple car that might have, you know, the little warning signals that might have that automated brake, some of those inbuilt, they call them advanced driver assistance systems that can be able to support driving but not necessarily require all of the fang dangled things. And so they can be some of the conversations that can happen sort of earlier, getting them to think about self regulation, getting them to think about the transition, but also getting them to think about what does unsafe driving look like to me and where is my line? Because then you can come back to that later and go, hey mum, you remember when you said your line was X? I don't remember that. And we've passed that out.

But let's face it, that doesn't happen for everybody. Doesn't happen very often. And often for many older people the license gets taken and they weren't prepared

Because of a doctor. And so they go oh, I wasn't ready for this. And so that becomes that sense of loss is even greater for them, it's even higher because they've lost their agency in making that decision which makes it much harder for them, that sense of agency and control over making a decision. And so if you've at a point where somebody is unsafe and you are needing to start having that conversation, if you haven't already, making sure that you hear them is going to be important because their sense of agency in that conversation and getting them to come, you know, along the journey with you, they feel they've got some control in that decision and that's really supportive for them. But I do understand that there are times when they can't have control because they lack insight into their own driving ability. And they will be those resisters because they lack that insight.

That's right.

That's right.

Absolutely, absolutely. And doctors in this case are your best friend in terms of having the conversation with the person with the doctor present. So some people respond better to hearing feedback from family because they're like, oh, well, you've seen my driving. Other people respond better hearing it from a professional and. And being in the same room when that conversation happens. If Mum just goes by herself, what she tells the doctor might be very different to if you're there in the room with mum when they're having that conversation, if they let you go. And so the doctor can be a really useful resource, but you can contact the doctor even if they are not willing to let you go, you can let them know and you can inform the doctor who is able to support in making a medical assessment. And also you can also actually inform the licensing agencies. So every state and territory has a line, a helpline that you can report people who may be unsafe on the roads and so you can make that report and that can create an action for them to undergo a medical assessment if you feel that they're not going to go to the doctors themselves.

Yes.

your parent or they tend to sort of send, it depends. But they tend to write to them and say you, you're required to kind of undergo an assessment, a medical assessment to be able to continue to maintain your licence renewal, which will then trigger them going to the doctor. And so there are a couple of different ways that you can approach it.

That's right.

It's one of those things that if you take the keys and you go, I'm gonna take the keys from you, that creates so much anger, angst and interpersonal conflict that is so messy for both sides. And so you don't wanna be the person who takes the keys but you don't wanna be the person that lets them continuing to drive and then they end up in a crash and they hurt themselves or somebody else. And so if that's kind of a middle ground.

Dobbing them in that.

Yep.

Yeah.

Yeah. Suck at. What are you gonna do? That's right.

You have. And that puts you in a really challenging situation in the sense that you know, when they do the test it's one snapshot in time and so the assessor who is well trained to do that will do it at one point in time. There are additional kinds of tests that you can get them to do though. So you can do the, you know, the on road tests with Transport for New South Wales, for example, or you could do it with an occupational therapist. So an occupational therapist can do a driving assessment that is a lot more in depth than just the bit that they do on the road if they will do that. And it does come with an expense. So it's not a cheap test to do. So just being very transparent about that. It can cost about $800 to do but it is something that is really comprehensive because they do not just the on road part but they do a whole bunch of, you know, cognitive, physical, visual assess. And so they do a really holistic assessment around fitness to drive to be able to make a really well informed decision as opposed to just the 20, 30 minutes round the block on the road that might be done with an on road test.

Yeah.

Yeah, no, that's exactly right. And it is one of those things. Use the system. It is there to support you. And there are so many resources out there to be able to support you. The amount. If you Google older driver conversations, stopping driving conversations, the amount of resources you will get is sort of.

Yeah, exactly.

Exactly. So there's a lot of resources that are really available for you. So use those, use the systems that are there and go in prepared, go into those conversations prepared, knowing what it is that you're wanting to say to them. And that can help kind of take some of that edge off. If you do it reactionally, it tends to fall apart more than if you do it.

Yeah. So the website that we're creating is called Thriving Without Driving and we're doing this with the support of the act government and it really is about trying to balance those two sides. Like I said, most of the resources tend to focus on the public transport, how we help them get around side, and they tend to forget that, helping them navigate the emotional side. So the Thriving Without Dr. Website has a series of activities and exercises to be able to support them through navigating both sides of that loss, as well as them being able to support families in terms of how they can have the conversation, but also how they can look after themselves. So you raise a really interesting point around there. Often that sense of burden for the person who has said, you need to stop driving, so I'm going to drive you everywhere.

Hi. Nice to meet you.

It's like, oh.

Yeah. And maybe because of that sense of guilt that you have, too. So that feeling of guilt to go. I told them they can't drive anymore, so I've got to do all of this is really heavy. And that sense of burden actually goes both ways. It's felt by the person, you know, who has to take them around now, but it's also felt by them a lot of the time. They actually don't like asking for the help.

They don't want to be a burden. Especially when they recognise that you've got your own kids that you're trying to juggle. You are the sandwich generation and you're trying to do all of this juggling and working and all the rest of it. I don't want to ask you to do this.

Yeah, so there's a whole range of different things that you can do. And again, if you have the opportunity to doing those early, while they are still driving actually really helps. We had an older man say to us during our workshops that I've just gotta train. It's like training for the footy. I spent my whole life training for the footy. Now I've gotta train for stopping driving. So I'm gonna get out there and I'm gonna try this and this and this. And I'm gonna make sure that I'm fully prepared in my training and I'm ready and I'm ready to go.

It was awesome. And so it's great if you can do that, it's great if you can train and train with them and for them, but in a way that actually allows them to maintain their own sense of independence. So one of the things we often overcompensate and we say, I'm going to take you everywhere, but actually reduces that ability for them to have their own independence. So things like you've mentioned, you know, Ubers and taxis are great. You can actually get through a lot of my aged care packages, taxi vouchers and services. A lot of the states and territories offer concession rates for taxis. And so it's really important to take a look into what is available in terms of the taxi support. There is obviously Ubers as well. And Uber hasn't just released at the end of last year, Uber Senior, which is where they've actually got a version of the app that increases font size. It allows to be connected to your, you know, family members account so that they can organize things for you, allows a family member to track their Ubers, you know, all of those things that are really, you know, supportive to make it an easier transition and journey for them. And also comes with vehicles, because one of the challenges sometimes in Uber is you go, yep, I'm getting an Uber. And they turn up and they've got a tiny little car, but you've got a walker that you've got to try to get into the car.

And so Uber Senior will sort of make sure you get kind of the right, right vehicles that you need. And so there's thinking kind of through that and that allows you to do that, you know, direct transport. But there's a whole bunch of community transport options that are available, so I really urge everybody to look into in their local area. There's a whole host of community organisations that will have a variety of community buses. In certain areas, they've actually got on demand public transport that you can get that will come kind of and pick them up from their house and take them along certain public transport, add it

I think it's a, in certain generations that's more heightened than in others. So in older generations where the man used to be the primary driver, that is something that is really noticeable in men because they're used to doing that and they're like, well, how am I gonna get my. For my grandfather it was, how am I gonna get my wife around if I'm not driving anymore? Because my grandmother never drove. And so the loss of his license actually meant the loss of hers too. And so for him it was really, really emotional from that perspective. And so, yes, but as we actually move through the generations, that's becoming less and that difference is less and less pronounced because women were driving themselves a lot more. And also we have women who tend to be living in more alone nowadays than men. And so that loss of licence can still create a really emotional trigger for them. So the research sort of shows that for both men and women, it does have that negative implications.

Absolutely. Grandparents and grandkids spending time together, we know that that's so beneficial for both of them. And often we find that older people, they haven't used a bus or a train or a light rail in a really long time. And grandkids, they use buses, they use trains, they use light rail, and they can be a great opportunity for them to be able to spend time with their, with their grandparents and teach them at the same time and go along with them to activities because they often feel like I'm the one who has to do it. Actually we can ask our kids to show them and that gives them an opportunity to bond with one another. And it means, you know, they're great with technology, they can show them how to use the apps and they can be a support as well.

You're not alone. No. And I think one of the things that's really important to remember is when they're giving up their licence, when they're stopping driving, we want them to thrive, we want them to continue to live well. And we're so focused on needing to do all of the practical stuff that we sometimes forget, actually. They just want to go to the pub with their friends and making sure that we give time and space for them to be able to do, do those activities. And we can get home deliveries and all of those other things in source, but give them space to really continue to live well. And that's going to be the key to a really successful transition. Because if they feel that they are living well and they're getting to live a life that brings them joy, then that will bring you joy and ease the pain of that transition.

You can. Indeed.

Thank you so much for having me.

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