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. Please select your options then click 'submit'. Following are some signs that a person no longer has the necessary skills to drive safely. Confusion Over Colors, Words, or Road Rules. 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. 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. You have known Mr and Mrs R for many years. It is important to highlight to patients that eventually they will need to stop driving altogether. Drifts into other lanes of traffic or drives on the wrong side of the street. 1.0 = Mild Definite Dementia. 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. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. When the decision to stop driving must be made, involving the person early in the process can reduce family members’ stress. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. While it is important to maintain respect for the individual’s feelings, you must put safety first. Dementia Australia has an important role in ensuring that the issue of driving is appropriately and sensitively handled. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. Copyright © 1996–2020 Family Caregiver Alliance. 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”. The assessment is carried out by an Occupational Therapist and an advanced driving instructor and usually lasts between one and two hours. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. Replacing the car keys with a set that won’t start the car. He scored 72/100 on the Addenbrooke’s Cognitive Evaluation (ACE) III assessment. Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin gradually to modify their driving. Gets lost or feels disoriented in familiar places. 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. The purpose of the evaluation in the office or clinic is to examine the physical, visual, and mental abilities required for safe driving. ), 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). A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning. 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. Are there other drivers in the household? It’s a supportive process, not a judgemental one, carried out by a specialist occupational therapist and an advanced driving instructor. FCA CareJourney: www.caregiver.org/carejourney Has difficulty engaging in multiple tasks. 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. And how do we assess which patients with mild dementia are safe to drive? Have groceries, meals, and prescriptions delivered to the home. 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. (DVLA – Assessing fitness to drive – a guide for medical professionals. 101 Montgomery Street | Suite 2150 | San Francisco, CA 94104 | 800.445.8106 toll-free | 415.434.3388 local. For further information and support, contact the service organizations under “Resources” at the end of this fact sheet. 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. Caregivers must step in and assume the responsibility for monitoring and regulating the driving of the person with dementia. Dementia and driving You must tell DVLA if you have dementia. Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. What is the practical impact of losing a driving licence? Talk about the safety of the driver and others 4. Has increased memory loss, especially for recent events. The concept of whakawhanaungatanga involves building connections and sharing information. Try to imagine what it would be like if you could no longer drive. Involve the person with dementia in the planning and decision-making 3. 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). Cognitive test score (repeated if not completed one recently). 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. 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. In the early stages of dementia, some—though not all—individuals may still possess skills necessary for safe driving. Falls asleep while driving or gets drowsy. One of the best ways to identify unsafe drivers, according to the guidelines, is a standard test called the Clinical Dementia Rating (CDR) scale. However, the cost of over $500 is prohibitive for many patients. The objective of monitoring is to detect a problem before it becomes a crisis. There are three possible outcomes from a driving assessment: If the patient continues driving, a review must be planned. A thorough assessment is likely to require two visits along with collateral history from family members. 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. If a person with dementia wants to keep driving, they must tell DVLA/DVA. Other on-road assessments, such as those run by local driving schools. An on-road OT Driving Assessment remains the best test where possible. With some encouragement from Mrs R, Mr R consents to an assessment. E-mail: [email protected] Share and discuss your observations with other family members, friends, and health care providers. CDR and Driving. However, having to stop driving can result in loss of mobility and social connections. Is increasingly nervous or irritated when driving. Each family will need to find the solutions that work best in their situation. So, how do we define moderate dementia? It is often helpful to keep a written log of each incident of poor driving behavior. 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. 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? • 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. You explain to Mr R that you can’t make a decision about his driving today as you need more information. The first assessment should use readily available information to assess driving safety. All rights reserved. Mrs R drives if a longer journey is necessary. 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. Some people with dementia decide they do not want to continue to drive. You can find out more about this in the section ‘How to keep driving after a dementia diagnosis’. Mr R’s two daughters introduce themselves. 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. As driving and assessment skills decline, the risk of serious loss or injury increases. You can be fined up to £1,000 if you don’t tell DVLA about a medical condition that … State regulations regarding dementia and driving restrictions vary. 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. What do you do now? 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. Some methods to do that include: Balancing safety with respect for an individual’s desire to drive can be difficult and emotionally trying. Has difficult seeing pedestrians, objects, or other vehicles. A comprehensive driving evaluation can determine whether you can continue to drive safely for the time being. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. You notice that Mr R drove them to today’s appointment. 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. 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. You raise the topic of driving and explain the link between memory impairment and unsafe driving. You suggest that you begin the assessment today, but that a second visit will likely be required before you can make a decision. Driving is an important life skill. This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving. Has difficulty with decision-making and problem solving. (415) 434-3388 | (800) 445-8106 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. Once notified, the licensing authority will ask that the driver’s doctor makes an initial assessment of the driver’s medical fitness. Encourage the individual with dementia to talk about how this change might make him or her feel. In the authors' view, however, renewal of license should b … 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. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. Driving safety assessment will be a regular part of clinical review. Appeal to the person's sense of responsibility 5. Has difficulty judging distance and space. driver number on their driving licence (if known). 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. 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. He has had a recent near-miss while reversing in a car park in town, but no accidents in the past few years. 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. Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. There is a clear link between dementia and unsafe driving. Next, you move on to the kaupapa phase: driving safety. You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. continue to drive with certain limitations, e.g. Those involved in assessment of older drivers need to be aware of the evidence of positive and negative effects of driving assessment. 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 . 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). 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. 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. 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. Commonly used transportation options are: Ideally, an individual will limit or stop driving on his or her own. © 2002 Family Caregiver Alliance. Begin the conversation as soon as possible and involve the doctor 2. Some things to consider: You review Mr R’s comorbidities and medications. Consider referring to a secondary care team for specific driving assessment. Family Caregiver AllianceNational Center on Caregiving Stops in traffic for no reason or ignores traffic signs. It can also help you make plans for other ways to travel in the future. Alzheimer’s Disease Education and Referral Center (ADEAR)www.nia.nih.gov/alzheimers. 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. Dementia Australia Driving Policy Statement. Therefore, assessing drivers with dementia is important. People with dementia are especially likely to minimize the complexity of driving and overestimate their abilities. 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. Individuals with moderate or severe dementia should not drive. Discuss any concerns you have with the individual, family members, and health care providers. Person needs further investigation / review: Practice points: Discussing driving and dementia. Enlist the support of other family, friends, caregiver support groups, and health professionals when making and implementing difficult decisions about driving. One of the hardest things about life is recognizing its various parts. Has mood swings, confusion, irritability. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. 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. 치매는 무엇을 의미합니까? Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time. Educate all patients with dementia that eventually they must stop driving. He has well-controlled diabetes and hypertension and is not taking any other medications that may impair his driving ability. 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