Gets lost or feels disoriented in familiar places. Some people with dementia decide they do not want to continue to drive. © 2002 Family Caregiver Alliance. It is often helpful to keep a written log of each incident of poor driving behavior. Because the progression of dementia varies from person to person, it is difficult to know at what point an individual can no longer drive safely. A study highlighted the negative consequences of stopping people with dementia from driving.w11 Stopping driving can limit access to family, friends, and services and is an independent risk factor for entry to a nursing home.w12 Traffic medicine has evolved significantly since the 1990s, with more emphasis on preserving mobility. Share and discuss your observations with other family members, friends, and health care providers. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. CDR and Driving. This MedCase was created in January 2020 by Dr Vicki Mount, General Practitioner, MBChB, DipPaeds, with expert review from Dr Philip Wood, Geriatrician, MBChB, FRACP. Geri Taylor’s accident wasn’t the first sign of trouble. With some encouragement from Mrs R, Mr R consents to an assessment. Mr R is initially reluctant to have an assessment, as he lives rurally and there are no buses or regular taxi services nearby. An occupational therapist can evaluate the impact of the disease on a person's ability to drive and offer strategies for driving safely, as well as when and how to reduce or stop driving. A thorough assessment is likely to require two visits along with collateral history from family members. Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting. Next, you move on to the kaupapa phase: driving safety. However, the cost of over $500 is prohibitive for many patients. The whānau feel that this is probably safe. You explain to Mr R that you can’t make a decision about his driving today as you need more information. The purpose of the evaluation in the office or clinic is to examine the physical, visual, and mental abilities required for safe driving. 2014 Clinical guideline on Dementia and Driving Safety, Addenbrooke’s Cognitive Evaluation (ACE) III assessment, functional impairment in some complex tasks, behavioural disinhibition – “risk-taking”. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. Every individual has the right to mobility. Avoid heavy traffic and heavily traveled roads. Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Understand how the patient and their family members (if present) feel about their driving, including asking about accidents or near-misses, and overall function. When an individual is diagnosed with dementia, one of the first concerns that families and caregivers face is whether or not that person should drive. If patients are unwilling or unable to undergo an OT assessment, then clinicians must rely on other sources of information, such as: You discuss options for further testing with Mr R. He is unable to pay for an OT Driving Assessment and he is not an AA member. You have known Mr and Mrs R for many years. Or DVLA/DVA may ask the person to have a driving assessment. You suggest that you begin the assessment today, but that a second visit will likely be required before you can make a decision. State regulations regarding dementia and driving restrictions vary. driver number on their driving licence (if known). Individuals who do not pass must discontinue driving immediately. Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin gradually to modify their driving. Try to imagine what it would be like if you could no longer drive. 1.0 = Mild Definite Dementia. Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. If a person with dementia wants to keep driving, they must tell DVLA/DVA. If the patient is safe to drive, a planned review must be scheduled. Confusion Over Colors, Words, or Road Rules. Even if they pass a driving test, they should be retested in 6 months. A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning. It is part of the Hui Process,2 a four-step approach to relationship building with Māori patients and their whānau that involves: When used effectively, the Hui Process can help ensure a safe and appropriate decision is made about driving. If there are any doubts about safety, the person with dementia should not be driving. Are there other drivers in the household? He is happy to be driven into town, but wants to keep his licence so that he can visit his friend’s farm two kilometres away, where he likes to go a few times each week for a cup of tea. Driving requires the simultaneous processing of visual, auditory, and tactile information in a dynamic and complex environment and as such, places high demands on many different cognitive domains, including memory, attention, executive function, visuospatial skills, and psychomotor coordination. Finally, the decision to stop driving is often one of slow realisation. If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly in a short period of time. Additionally, many patients with dementia have comorbidities or take medications that further impact their driving safety.3 Age is also a consideration: older drivers are second only to the youngest drivers in terms of crash risk.4. Whakawhanaungatanga (building connections and sharing information). Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. He has well-controlled diabetes and hypertension and is not taking any other medications that may impair his driving ability. Therefore, assessing drivers with dementia is important. There is a clear link between dementia and driving safety. They can get in touch with their licensing agency by post, on the phone or online (see ‘ Driving and dementia – other resources ’ for full contact details). When the decision to stop driving must be made, involving the person early in the process can reduce family members’ stress. And how do we assess which patients with mild dementia are safe to drive? For example, Mrs R is now the driver for long distances and at night, because they noticed that Mr R became tired and began driving very slowly. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving. Mr R concedes he gets tired driving long distances and says he has become confused on a few occasions in town where it is busy and he feels pressured. Has difficulty judging distance and space. Avoid driving at night and in bad weather. Caregiving Across the States: 50 State Profiles (2014), Innovations in Alzheimer's Caregiving Legacy Awards, COVID-19 Caring for People with Alzheimer’s and Other Dementia, 이것이 치매일까요? If you have concerns about your patient’s ability to drive the gold standard test is an on-road driving assessment. In the absence of on-road driving information, you offer a family meeting with his whānau next week to discuss driving, and he agrees to bring along his two daughters. • in early dementia, when sufficient skills are retained and progression is slow, a licence may be issued subject to annual review A formal driving assessment may be necessary. FCA CareJourney: www.caregiver.org/carejourney A driving co-pilot is not a recognised safe practice for reducing safety risk in dementia An occupational therapy on-road driving test is accepted as a ‘gold standard’ assessment Neuropsychological results generally do not sufficiently or consistently correlate with on-road driving performance Mrs R tells you that they have already made some changes due to concerns about Mr R’s driving. Following are some of the common warning signs. They prefer Mrs R to drive the mokopuna. On road driving assessors will frequently travel to a patient’s own home town to complete a driving assessment, this is particularly important for patients who have self-imposed driving restrictions. Completing your on-road assessment successfully is an important step in confirming that you can continue to drive safely. You can find out more about this in the section ‘How to keep driving after a dementia diagnosis’. Has accidents, near misses, or “fender benders.”. Additionally, many patients with dementia have comorbidities or take medications that further impact their driving safety.3 Age is also a consideration: … Has increased memory loss, especially for recent events. Have groceries, meals, and prescriptions delivered to the home. You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. The assessment is carried out by an Occupational Therapist and an advanced driving instructor and usually lasts between one and two hours. However, having to stop driving can result in loss of mobility and social connections. He drinks 1-2 cans of beer on 3-4 nights of the week. If the individual is reluctant to talk about driving, ask the individual’s physician or care manager to bring up the subject of driving during health care visits. Once notified, the licensing authority will ask that the driver’s doctor makes an initial assessment of the driver’s medical fitness. The fee for a driving assessment is between £50 and £130, depending on source of referral (Driving and dementia factsheet, The Alzheimer's Society, 2013).7 The assessment, including office-based and on-road tasks, takes about 2 hours. The objective of monitoring is to detect a problem before it becomes a crisis. Encourage individuals to try some of the following examples: Individuals able to maintain an active life often adjust better to the loss of driving privileges. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. Consider further cognitive testing, driving questionnaires, and family meetings for collateral history when an on-road assessment is not possible. He or she: It is important to compare present behavior with behavior before the onset of dementia. Clinical driving assessments are best if you have a broad spectrum of physical and cognitive disabilities, including dementia, stroke, arthritis, low vision, learning disabilities, limb amputations, neuromuscular disorders, spinal cord injuries, mental health problems, cardiovascular diseases and other causes of functional deficits. Has difficulty engaging in multiple tasks. Office assessment of driving in dementia is challenging. You reiterate the link between dementia and driving safety, and ask the whānau for their thoughts. He admits that he has been restricting his driving to short daytime trips lately, mainly to the local town to get his newspaper and Lotto ticket. In the early stages of dementia, some—though not all—individuals may still possess skills necessary for safe driving. Further cognitive or functional testing (see Table 3, p17, Dementia and Driving Safety guideline for suggestions). The agency will ask about the person’s medical information and decide if they are safe to drive. 101 Montgomery Street | Suite 2150 | San Francisco, CA 94104 | 800.445.8106 toll-free | 415.434.3388 local. What alternatives are available? Driving is an important life skill. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. Dementia can impact on both the mobility and safety of drivers, and the impact of formal assessment of driving is unknown in terms of either mobility or safety. An on-road OT Driving Assessment remains the best test where possible. Blood tests and a CT head showed no underlying cause for dementia. Although family and caregivers can watch for signs of unsafe driving, a proactive strategy would be to get a comprehensive driving evaluation by an occupational therapy driving rehabilitation specialist. Patients will eventually need to stop driving (as dementia progresses). Poroaki (closing the interview and ensuring shared understanding). You explain that you understand the significant consequences of being unable to drive, but that you are required by law to ensure that Mr R is safe on the road. Family Caregiver AllianceNational Center on Caregiving Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk. 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