13 Patient Warnings on Safety for Driving with Dementia
Many people with dementia continue to drive following their diagnosis. Research suggests driving continues on average for a further two years. Now a multidisciplinary clinical team from the University of Newcastle in the U.K. have developed a pathway that brings together good clinical practice, appropriate management strategies and, in this case British legislation that they believe can easily be adapted to International legal requirements.
The pathway identifies 13 key pieces of information that can be learnt from questioning someone with dementia who drives. The information is not necessarily about a score based system, although answering yes to all the questions below would indicate that the driver is a serious danger to him/herself and others and needs to be urgently taken off the road now. They are:
- Do you have any concerns about your ability to drive?
- Have others voiced concerns to you about your ability to drive?
- Do you avoid driving in certain conditions e.g. at night, in busy traffic, in the rain?
- Do you feel you need to have someone in the car with you for familiar journeys?
- How far on average do you drive in a week?
- Do you take any medications that may make you less alert than usual?
- How often do you break the speed limit?
- Do you ever drive through red lights?
- Do you drive after drinking alcohol?
- Do you lose your temper easily with other road users?
- How often do you honk your horn, gesture or tailgate other drivers?
- Have you received any penalty notices for speeding/dangerous driving/other traffic violations in the last three years?
- Have you been involved in a traffic accident in the last three years? Who was at fault?
Because memory, executive functions and visuospatial functions and insight into deficits are affected by dementia the pathway offers questions for caregivers to answer too. The questions identify issues, some of which may be addressed to help keep people with dementia driving safely as well as people who need to stop driving now. It is not uncommon to hear of caregivers sitting besides a driver giving them instructions on where to go and when to stop, say, at traffic lights. We have also been contacted by worried relatives when a person refuses to stop driving. It is a significant problem.
The driving with dementia pathway provides a decision-making framework for how health professionals across a range of disciplines deal with patients with dementia who drive. The pathway information is downloadable from the team's Newcastle University website.
Iverson, D.J., Gronseth, G.S., Reger, M.A., Classen, S., Dubinsky, R.M., &
Rizzo, M. (2010). Practice parameter update: Evaluation and management of driving risk in
dementia. Neurology, 74, 1316-1324.
Driving and dementia: a clinical decision pathway
International Journal of Geriatric Psychiatry
Kirsty Carter, Sophie Monaghan, John O'Brien, Andrew Teodorczuk, Urs Mosimann and John-Paul Taylor
Article first published online :27 MAY 2014, DOI: 10.1002/gps.4132