By Michael A. Keys, MD

Dr. Keys is a geriatric psychiatrist, Adjunct Associate Clinical Professor of Psychiatry at the University of Cincinnati College of Medicine, and Director of The Senior Health Program at the Lindner Center of HOPE, Mason, Ohio.

My Aunt Bernie at age 88 is a remarkable and vital woman who prides her independence, but often doesn’t see or doggedly ignores her growing set of age-related limitations. Her vision isn’t what it once was because of macular degeneration. She isn’t quite as steady on her feet because of her arthritis and a painful hip. And her memory and cognitive abilities, while pretty well intact, have contributed to some flagrant miscues at the bridge table.

However, there was the issue of her driving. There had been a few traffic mishaps, and her own kids had become concerned — terrified is more the word — by her continued driving.  But she wouldn’t hear any of their suggestions that it was time to stop driving.  After all, she is an American and driving, by Aunt Bernie’s reckoning, is a god-given right. She wasn’t about to give that up. Then there was a fall in a parking lot walking into the grocery.  There was the day she searched the same parking lot for an hour trying to remember where she parked the car. Finally, on a traffic stop, she backed into a police car, not once, but twice. That was it for her driving. Her kids were relieved. Her good friend Martha dramatically proclaimed that life was now over if Bernie could no longer cart the two of them around in the old Buick.

As we get older, there are innate physical changes such as our cardiac, respiratory and immune system decline that makes it much harder to ward off illness. At an earlier age, a simple viral or urinary tract infection might produce discomfort and a set of symptoms, be easily treated and managed, and would run its course without much fanfare.  Now with the decline in immune defenses, a simple infection becomes an overwhelming fulminate illness that may be harder to treat, require hospitalization, and even be life threatening.

Aging is the most significant risk for intellectual and cognitive decline, with nearly 50% of those older than 85 showing cognitive impairment severe enough to warrant a diagnosis of dementia. Still many, well into their 80’s and 90’s show surprising cognitive abilities and stay mentally sharp.  But there are often holes and cognitive vulnerabilities that complicate day-to-day independent living.  Very few, if any, cognitively intact older adults appraise their memory as being as good as it once was.  One of the difficult issues in working with seniors with memory difficulties is that many lose the insight or ability to competently assess their own cognitive skills and see their intellectual and resulting functional weaknesses.  It’s often difficult to convince them of needed changes and solutions to help promote safe and vital day-to-day function.  This is often the defining difficult task for families and health care providers working to promote graceful change in a senior population.

Driving is still a regular topic of conversation and Aunt Bernie still thinks of her relinquishing of driving privileges as a travesty of justice. The Buick has been sold. But she and Martha regularly go shopping with her daughter once a week, have lunch, and it’s become a social event not to miss.  Even Martha seems contented. Bernie, living in a retirement community and taking full advantage of its amenities, is regularly out in the community van to the symphony, the flower show, and wherever.  It’s sometimes hard to find her at the apartment with her social calendar being what it is. Finally, she and Martha have given up the increased challenge and politics of bridge for the fast-paced life of Euchre. They have learned some tricks at the table, occasionally accused of cryptic communications, sometimes down right cheating.  They are tough to beat.