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Independence is important, and having to surrender some of it — especially the freedom to drive — can be an emotional blow, no matter our age.
But a stroke can affect driving ability by killing or damaging brain cells and possibly causing long-term brain damage, which in turn can affect whether drivers have the coordination to get back behind the wheel after a stroke.
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Strokes are the fifth-leading cause of death in the U.S., according to the Centers for Disease Control and Prevention, but only about 10 to 20 percent of strokes are fatal. While strokes do happen to younger people, the odds increase with age. Nearly three-fourths of strokes occur in people older than 65.
The National Highway Traffic Safety Administration says most stroke survivors can return to independent, safe driving.
Drivers don’t automatically lose their license after a stroke. Regulations on that “vary from state to state,” says Lee H. Schwamm, M.D., director of the Massachusetts General Hospital Comprehensive Stroke Center, a professor of neurology at Harvard Medical School and a spokesperson for the American Stroke Association.
“Generally, physician-patient confidentiality rules discourage” reporting your stroke to driver’s license officials, he says. An exception would be “when it endangers public health,” such as if a school bus driver insists on returning to work and his or her doctor believes the driver isn’t ready yet.
A doctor can administer relatively simple tests to measure the stroke victim’s vision and responses, Schwamm says, “to tell you you’re not OK to drive if you don’t have vision off to the left or right side, or don’t have the coordination.” But the tests don’t tell you if you are ready to drive, he cautions.
Doug Carroll, who lives in Northern Virginia, had that in mind after a stroke on Christmas Day 2014 — a month after his 60th birthday. “It was a mild stroke, but that’s deceptive. It was not without consequences,” Carroll says.
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The stroke affected his coordination and reflexes. Even after three months of physical therapy, he didn’t feel confident enough to drive, nor did his physical therapist think he was ready. “Both my doctor and therapist told me I’d recover, so it wasn’t like I’d never be able to drive again. I didn’t go back to driving for six months,” Carroll says.
“While I very badly wanted to start driving, I didn’t want to rush it and have an accident that would disqualify me from driving — or cost me a lot of money or cause injury,” he says.
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Schwamm applauds Carroll’s approach. Some patients, he says, insist that they’re ready to drive again and are willing to accept the risk of being hurt in an accident. “I ask them, ‘What if a small child ran in front of you and was hit. Could you live with that?’ ”
Auto insurance is another issue. If you’ve had a stroke and then have a driving accident, are you in trouble with the insurer? “Your auto insurer is generally going to pay for the costs associated with your accident, unless your insurance policy had lapsed prior to the accident or you were found to have given fraudulent information to the insurer when initially applying for coverage,” says Michael Barry, head of media relations and public affairs at the Insurance Information Institute.
Many people who can’t drive or choose not to after a stroke — depending on where they live — have other options to preserve their independence. These include ride-hailing services such as Uber and Lyft, and in the not-so-distant future, self-driving cars.
“If you came from another planet and said, ‘What’s the ideal technology to let seniors get around,’ you’d say, ‘self-driving cars,’ ” says Ken Dychtwald, a gerontologist and founder of Age Wave, a California-based research and consulting firm.
In the short run, Dychtwald says, are Uber, Lyft and similar services that may emerge. Having an on-call vehicle and driver "that lets you get from here to there at not a big cost” could be “more logical” than paying for the upkeep on your own car, he says.
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Driver Safety Tips: Driving After a Stroke – AARP
