Caregivers must step in and assume the responsibility for monitoring and regulating the driving of the person with dementia. He has well-controlled diabetes and hypertension and is not taking any other medications that may impair his driving ability. Person needs further investigation / review: Practice points: Discussing driving and dementia. Review comorbidities and medications that may affect driving safety, including alcohol. The agency will ask about the person’s medical information and decide if they are safe to drive. You have known Mr and Mrs R for many years. Has difficulty with decision-making and problem solving. What is the practical impact of losing a driving licence? Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. What alternatives are available? A diagnosis of MCI or dementia is not necessarily a reason to stop driving, but should trigger an assessment of driving safety, since any cognitive impairment can be associated with greater risk of accidents or near-misses.1 The risk increases with dementia severity, as shown in the table below from 2014 Clinical guideline on Dementia and Driving Safety1 . Has accidents, near misses, or “fender benders.”. Your existing relationship with Mr and Mrs R means that the mihimihi and whakawhanaungatanga steps are well established with them, but for the benefit of their two daughters you introduce yourself (mihimihi) and share some stories about your background growing up in the country (whakawhanaungatanga). The objective of monitoring is to detect a problem before it becomes a crisis. They prefer Mrs R to drive the mokopuna. Have groceries, meals, and prescriptions delivered to the home. 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. Some methods to do that include: Balancing safety with respect for an individual’s desire to drive can be difficult and emotionally trying. © 2002 Family Caregiver Alliance. Enlist the support of other family, friends, caregiver support groups, and health professionals when making and implementing difficult decisions about driving. Further cognitive or functional testing (see Table 3, p17, Dementia and Driving Safety guideline for suggestions). You agree to review driving safety in 6 months, or earlier if there are any new concerns. Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. You reiterate the link between dementia and driving safety, and ask the whānau for their thoughts. It is often helpful to keep a written log of each incident of poor driving behavior. If you have been diagnosed with dementia or Alzheimer’s disease but are in the early stages, you may not need to stop driving immediately. Mr R is initially reluctant to have an assessment, as he lives rurally and there are no buses or regular taxi services nearby. And for the person with dementia, it’s important to validate their feelings and preserve their independence by ensuring that they have a safe and reliable way to get around. E-mail: [email protected] The assessment is not there to ‘catch people out’ and is usually very supportive. You explain to Mr R that you can’t make a decision about his driving today as you need more information. Ask the person's doctor to tell him or her to stop driving. 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. Complete and submit the learning reflection form for CPD/MOPS points provided by The Royal New Zealand College of General Practitioners below for recognition of learning activities. Finally, the decision to stop driving is often one of slow realisation. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. 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. Take him or her to get a driving test. Has increased memory loss, especially for recent events. If a person with dementia wants to keep driving, they must tell DVLA/DVA. If you have concerns about your patient’s ability to drive the gold standard test is an on-road driving assessment. Has difficulty with turns, lane changes, or highway exits. Avoid heavy traffic and heavily traveled roads. Confusion Over Colors, Words, or Road Rules. Following are some signs that a person no longer has the necessary skills to drive safely. You notice that Mr R drove them to today’s appointment. Some people safe, others unsafe to drive. 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. Driving as a means to this mobility should not be challenged if drivers have the functional ability to do so without risking the safety of their passengers, other road users and pedestrians, and themselves. People with dementia are especially likely to minimize the complexity of driving and overestimate their abilities. When Driving Becomes Unsafe Here are some ways to stop people with Alzheimer's disease from driving: Try talking about your concerns with the person. Driving evaluation At the earliest stages, a person with Alzheimer's disease may begin to have difficulty with complex tasks such as 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”. continue to drive with certain limitations, e.g. Other people want to continue driving for as long as it is safe to do so. A driving assessment isn’t the same as a driving test, instead taking an overall look of how dementia is affecting your driving and whether you’re safe and comfortable enough to drive. Once notified, the licensing authority will ask that the driver’s doctor makes an initial assessment of the driver’s medical fitness. Some people with dementia decide they do not want to continue to drive. Encourage the individual with dementia to talk about how this change might make him or her feel. Mr R has hyperlipidaemia, type II diabetes, and hypertension, which are adequately controlled on his regular medications: atorvastatin 40mg nocte, metformin 1000mg twice daily, and losartan 50mg. Dementia and driving You must tell DVLA if you have dementia. 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. 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. An on-road OT Driving Assessment remains the best test where possible. Guidelines recommend patients with moderate-severe dementia not drive, but not all people with mild dementia should be barred from driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Take time to understand who should be involved in driving assessment and offer a family meeting if necessary. However, the cost of over $500 is prohibitive for many patients. Has difficulty engaging in multiple tasks. 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. Blood tests and a CT head showed no underlying cause for dementia. Therefore, assessing drivers with dementia is important. Other on-road assessments, such as those run by local driving schools. A diagnosis of MCI or dementia is not necessarily a reason to stop driving, but should trigger an assessment of driving safety, since any cognitive impairment can be associated with greater risk of accidents or near-misses.1 The risk increases with dementia severity, as shown in the table below from 2014 Clinical guideline on Dementia and Driving Safety1 . Mr R’s wife drives Mr R and their two daughters to your practice one week later for a half-hour meeting. (DVLA – Assessing fitness to drive – a guide for medical professionals. Individuals who do not pass must discontinue driving immediately. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles (DMV). In closing, you congratulate Mr R on a successful driving career. Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. 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. There is a clear link between dementia and driving safety. Driving is an important life skill. Has mood swings, confusion, irritability. Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin gradually to modify their driving. Mrs R drives if a longer journey is necessary. If there are any doubts about safety, the person with dementia should not be driving. Geri Taylor’s accident wasn’t the first sign of trouble. While it is important to maintain respect for the individual’s feelings, you must put safety first. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. Safety not predicted by cognitive testing / dementia stage. Poroaki (closing the interview and ensuring shared understanding). Note that the, Collateral information from whānau, for example using a. Website: www.caregiver.org Understand how the patient and their family members (if present) feel about their driving, including asking about accidents or near-misses, and overall function. In the authors' view, however, renewal of license should b … If your loved one does not want you getting involved in their driving, get help from their health care provider, lawyer, or other family members. Educate all patients with dementia that eventually they must stop driving. Cognitive test score (repeated if not completed one recently). 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. A comprehensive driving evaluation can determine whether you can continue to drive safely for the time being. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Some individuals, recognizing the risks, will limit or stop driving on their own. CDR and Driving. Individuals with moderate or severe dementia should not drive. Mr R tells you that he will be happy to stop driving eventually and may even do this before he sees you next, but he is pleased to have his licence for now. Appeal to the person's sense of responsibility 5. Do you need to assess Mr R’s ability to drive? 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. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. It’s a supportive process, not a judgemental one, carried out by a specialist occupational therapist and an advanced driving instructor. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. A thorough assessment is likely to require two visits along with collateral history from family members. There is a clear link between dementia and unsafe driving. 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. You suggest that you begin the assessment today, but that a second visit will likely be required before you can make a decision. The first assessment should use readily available information to assess driving safety. You raise the topic of driving and explain the link between memory impairment and unsafe driving. Family Caregiver AllianceNational Center on Caregiving He has had a recent near-miss while reversing in a car park in town, but no accidents in the past few years. It is important to highlight to patients that eventually they will need to stop driving altogether. 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. Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers. Invite friends and family over for regular visits. Dementia Australia has an important role in ensuring that the issue of driving is appropriately and sensitively handled. Secondly, it is a common misbelief that a diagnosis of dementia means the automatic rescinding of a licence. Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting. 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. Older drivers with dementia are involved in more crashes than healthy older drivers. 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. All rights reserved. This MedCase discusses driving assessment for a patient with mild dementia using the 2014 Clinical guideline on Dementia and Driving Safety1  and the Hui Process,2 a four-step approach to building relationships with Māori patients and whānau. In the early stages of dementia, some—though not all—individuals may still possess skills necessary for safe driving. MVA's more likely as CDR 0 (Johansson et al 1996) ... Record (accidents, near misses, violations) Driving ... – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 140b58-YmRhN 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. It can also help you make plans for other ways to travel in the future. 101 Montgomery Street | Suite 2150 | San Francisco, CA 94104 | 800.445.8106 toll-free | 415.434.3388 local. Copyright © 1996–2020 Family Caregiver Alliance. Clinical assessment is required. Every individual has the right to mobility. However, having to stop driving can result in loss of mobility and social connections. Driving safety assessment will be a regular part of clinical review. Has difficult seeing pedestrians, objects, or other vehicles. 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 Or DVLA/DVA may ask the person to have a driving assessment. Even if they pass a driving test, they should be retested in 6 months. Are there other drivers in the household? Mr R is a retired fisherman who now works part-time as a handyman at the primary school, where Mrs R works part-time as a teacher aide. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving. Drifts into other lanes of traffic or drives on the wrong side of the street. You can find out more about this in the section ‘How to keep driving after a dementia diagnosis’. Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. The Occupational Therapy (OT) Driving Assessment remains the most rigorous and reliable test of driving safety, and it is the only test that allows clinical input from referrers to inform the OT decision. Those involved in assessment of older drivers need to be aware of the evidence of positive and negative effects of driving assessment. You will notify NZTA of the new restrictions. 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. Whakawhanaungatanga (building connections and sharing information). Some things to consider: You review Mr R’s comorbidities and medications. You reach agreement on a plan for Mr R to limit driving to within 5 kilometres from home, during the daytime. Arrange for family and friends to take the individual on social outings. If he or she has difficulty or becomes frustrated easily, it may be time for another independent driving evaluation. This fact sheet provides guidelines to help caregivers and persons with dementia decide when and how to limit or stop driving. Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. He scored 72/100 on the Addenbrooke’s Cognitive Evaluation (ACE) III assessment. This fact sheet was prepared by Family Caregiver Alliance and reviewed by Vicki L. Schmall, Ph.D., Gerontology Specialist and Professor Emeritus at Oregon State University and the Executive Director of Aging Concerns. Share and discuss your observations with other family members, friends, and health care providers. Drive only on familiar roads and avoid long distances. 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? Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy. Consider referring to a secondary care team for specific driving assessment. Each family will need to find the solutions that work best in their situation. Next, you ask Mr R about his driving. When the decision to stop driving must be made, involving the person early in the process can reduce family members’ stress. The assessment is not a driving test, but is an overall assessment on the impact of dementia on the person’s driving. The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. People with signs of dementia should have regular driving tests. By Family Caregiver Alliance and reviewed by Vicki L. Schmall, Ph.D. 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. A diagnosis of dementia may not mean that a person can no longer drive safely. The concept of whakawhanaungatanga involves building connections and sharing information. Commonly used transportation options are: Ideally, an individual will limit or stop driving on his or her own. Many patients with MCI or mild dementia will be safe to drive, but cognitive test scores are not useful predictors in these groups and thorough clinical assessment is required. The doctor can write, "Do not drive" on a prescription pad, and you can show this to the person. Stops in traffic for no reason or ignores traffic signs. And how do we assess which patients with mild dementia are safe to drive? I mean, we never really notice pregnant women until our wife becomes one, or the plight of the handicapped until we break an ankle or leg, and crutches help us see more clearly. This type of driving evaluation typically includes two parts: one part in an office or clinic and the second part behind the wheel of a car. Gets lost or feels disoriented in familiar places. All involved will need to weigh potential risks and decide when the individual needs to stop. The whānau feel that this is probably safe. So, how do we define moderate dementia? 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. You can also estimate an individual’s potential for a traffic accident by taking the person along as a passenger and asking him or her to co-pilot. 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. Patients will eventually need to stop driving (as dementia progresses). Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk. Is less alert to things happening around him or her. Mr R’s two daughters introduce themselves. … Talk about the safety of the driver and others 4. Support groups provide a good venue for both the caregivers and the individual to talk about their feelings and get advice from others in a similar situation. • 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. Completing your on-road assessment successfully is an important step in confirming that you can continue to drive safely. What do you do now? It may be possible to make an assessment about driving safety after reviewing readily available information, but if not then further specific investigations are required. To help a person with decisions about driving: 1. 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. 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). Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time. Avoid driving at night and in bad weather. As a last resort, you may have to prevent his or her access to a car. Office assessment of driving in dementia is challenging. 1.0 = Mild Definite Dementia. Driving assessment resources Replacing the car keys with a set that won’t start the car. Dementia, diabetes and some heart conditions all need to be disclosed because they may affect a person’s driving ability. (415) 434-3388 | (800) 445-8106 Has difficulty judging distance and space. Some investigators, therefore, have proposed that a diagnosis of dementia (DAT or other type) should lead to the automatic revocation of a driver's license. Please select your options then click 'submit'. After this, a formal driving assessment may be required. 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 tell you they see their father regularly and are pleased to be included in this meeting, as they weren’t able to attend the hospital appointment when he was diagnosed with dementia. Discuss any concerns you have with the individual, family members, and health care providers. Making the transition from driver to passenger over time can help ease the adjustment. If the patient is safe to drive, a planned review must be scheduled. Arrange for a barber or hairdresser to make home visits. Evaluating driving safety in patients with mild cognitive impairment (MCI) or dementia can be challenging. This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving. Following are some ways to reduce the need to drive: It will be important to make alternative transportation arrangements so that the individual’s mobility and activity level are not unduly restricted. He drinks 1-2 cans of beer on 3-4 nights of the week. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. Alzheimer’s Disease Education and Referral Center (ADEAR)www.nia.nih.gov/alzheimers. driver number on their driving licence (if known). 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. A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning. For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s, and other debilitating health conditions that strike adults. One of the hardest things about life is recognizing its various parts. Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. The purpose of the evaluation in the office or clinic is to examine the physical, visual, and mental abilities required for safe driving. State regulations regarding dementia and driving restrictions vary. He or she: It is important to compare present behavior with behavior before the onset of dementia. ), Guia del cuidador para entender la conducta de los pacientes con demencia (Caregiver's Guide to Understanding Dementia Behaviors), Herramientas Para Cuidadores (Alzheimer's Association). Falls asleep while driving or gets drowsy. Patients must advise their insurance company about conditions such as dementia that are likely to affect driving. The American Occupational Therapy Association has a national database of driving specialists. Their daughters raised concerns about Mr R becoming confused with the mokopuna in the car; he once drove them to the wrong house after kohanga. Dementia Australia Driving Policy Statement. With some encouragement from Mrs R, Mr R consents to an assessment. Try to imagine what it would be like if you could no longer drive. You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. (Dementia: Is this Dementia, and What Does it Mean? The assessment is carried out by an Occupational Therapist and an advanced driving instructor and usually lasts between one and two hours. time of day and/or local area only. As driving and assessment skills decline, the risk of serious loss or injury increases. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. For further information and support, contact the service organizations under “Resources” at the end of this fact sheet. FCA CareJourney: www.caregiver.org/carejourney A person with dementia may perceive giving up driving as a loss of independence, and deciding not to drive means accepting that one's abilities are changing. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. Explain to patients and their families that: The NZTA guidelines specify that patients with dementia should not drive “where cognitive impairments may affect an individual’s ability to drive safely”.2 This decision is straightforward in cases of moderate or severe dementia, when driving must be stopped, but is more difficult in cases of mild dementia or MCI, as safety cannot be inferred from cognitive test results or dementia stage. Additionally, many patients with dementia have comorbidities or take medications that further impact their driving safety.3 Age is also a consideration: … Dr James McKillop, has produced a brilliant guide on the implications of giving up driving and examples of what incidents to look for which may indicate difficulties. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. 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