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Dementia and Driving
There is an increased crash rate per miles driven for all drivers 70 years or older in comparison with middle-aged drivers. Older drivers with dementia have seven times higher risk of causing at-fault crashes than non-demented drivers. It is attributed to greater impairment of road skills and their unsafe driving behaviors.
Studies have been conducted to better understand the effects of Alzheimer’s on driving. Most of the studies were conducted at the Alzheimer’s Disease Research Center at Washington University in St. Louis, Missouri. One study conducted in 19971 demonstrated that poor driving performance increases with increased dementia severity and validates the use of an in-car, on-the-road evaluation test to assess driving skills in dementia. Another study provides longitudinal evidence
for a decline in driving performance over time, primarily in early-stage Dementia of Alzheimer type, and supports the need not only for driving assessments, but also for reevaluation of individuals with very mild and mild Dementia of Alzheimer type2.
A third study conducted in 20003 indicates that actual crashes do not necessarily occur more frequently in drivers with dementia compared to non-demented elderly drivers, suggesting that the diagnosis of dementia should not be the sole justification for suspending driving privileges.
A diagnosis of dementia is not, on its own, a sufficient reason to take away driving privileges. A significant number of drivers with dementia are found to be competent to drive in the early stages of their illness. Therefore, the determining factor in withdrawing driving privileges should be the individual’s driving ability. When the individual poses a serious risk to self or others, driving privileges must be withheld.
Physicians can address the issue of driving safety with demented patients and their families. When appropriate, patients will be included in decisions about current or future driving restrictions and cessation; otherwise, physicians and families must decide in the best interest s of the patient whose decision-making capacity is impaired.
Physicians can perform a focused medical assessment that includes history of driving difficulty from a family member or caregiver and an evaluation of cognitive abilities, including memory, attention, judgement, and visual abilities. Physicians also need to perform serial assessment in drivers with dementia as the disease is progressive over time.
If an individual with dementia has impaired driving ability, and the individual would still like to continue driving, a formal assessment of driving skills should be administered by both physician and a driver rehabilitation specialist. A driver rehabilitation specialist is needed to perform on-road driving assessment. A
driver rehabilitation specialist is an occupational therapist who has received additional training for driving assessment and rehabilitation. The assessment will lead to specific recommendations, consistent with state laws and regulations, as to whether the individual is safe to drive.
Physicians can also influence patients with dementia to plan early for eventual cessation of driving privileges by developing alternative transportation options as they ultimately become unsafe to drive. Family members and caregivers can coordinate these efforts and seek assistance as needed from their local area agency on aging.
Cognitive changes can happen so slowly that the drivers are not even aware that their driving safety is at risk. In this case, a family member or caregiver play a very important role in watching out for the early warning signs in regards to unsafe driving. In order to do that, he or she should go for a ride with the patient if he or she has the chance and look for the warning signs such as failure to yield the right of way, not staying in his or her lane and making poor driving decisions etc. Family members should do this every once in a while to keep track of the patient’s driving and should also communicate with each other about their loved one’s driving behavior.
If family members are concerned about their loved one’s driving, they should talk to their loved one at appropriate time. They can make an agreement about
driving and create a transportation plan. They should also encourage a visit to the doctor so that the doctor can also help in driving assessment and counseling.
When it’s time to stop driving, they have to show that their loved one has their support by offering help willingly and by being a good listener.
Myo M. Aung, MD
Geriatric Medicine and Continuing Care Department
The Permanente Medical Group, Inc.
Santa Clara, CA
References
(1) Hunt, Linda A., et al. Archive of Neurology 54: 707-712, 1997.
(2) Janet M. Duchek, Janet M., et al. Journal of the American Geriatric Society
[51:1342–1347, 2003.
(3) Carr, D.B., et al. Journal of the American Geriatric Society 48: 18-22, 2000.]
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