Dear Carol: I read your column about a woman whose friend was getting lost when driving and she wondered about confronting her friend about possible dementia. I beg everyone that if people suspect that their older friends or family members are slipping mentally they pull their keys before something bad happens. I say this as the victim of a very old woman who should never have been driving. I was riding my bicycle in the bike lane when she hit me and dragged me half a block. She was driving a massive old vehicle and didn't even know I was there. I will forever live with the physical pain and limitations that remain, even after repeated surgeries for the injuries I sustained. Old drivers need to be pulled off the road. - SM

Dear SM: I am deeply sorry that you've had your life so terribly altered because of an older person who shouldn't have been driving. There is no question that if someone is showing physical or cognitive decline that impairs their driving, they should be tested, and if they are diagnosed with dementia, or indicate through testing that they are no longer able to drive safely for other reasons, they need to give up their keys.

I will take issue with using age as an exclusive guide, simply because far too many people are in situations similar to yours because of inexperienced drivers, drunk, drugged or overmedicated drivers, angry and overly aggressive drivers, and, of course, distracted drivers. Still, age is a risk factor that must be addressed.

Families and doctors who work with aging adults need to watch for signs that indicate that their loved ones or patients may no longer be able to drive safely. There could be any number of reasons. Older drivers may be taking medications that can cause confusion or poor judgment. Infections can cause older people to display dementia symptoms, as can thyroid issues, and myriad other conditions. If you are a concerned friend or family member, you should tell your friend or loved one about your worries and say that you'd like to go with them to see their doctor to sort things out. Meanwhile, ask that they don't drive and offer to provide transportation during this interim period.

Once this older adult has been seen by a doctor, even if he or she is cleared of dementia, and other potential issues are resolved, it may still be wise to ask the doctor to arrange for a road test with a physical therapist trained to evaluate drivers.

Meanwhile, families of older adults would do well to research alternative options for senior transportation in their community. Knowing that there are available options that will allow them to continue seeing friends, go shopping, and attend events can help ease their elder's feelings of lost independence that accompanies giving up driving.

My heartfelt sympathy for what happened to you, SM. Again, I agree with you that unsafe drivers need to stay off the road.