Memory Loss - Dementia & Driving
Information
Driving represents independence, integrity, confidence, also providing a means to access necessary services, social interaction with friends, family and community. Loss of driving privilege can result in isolation, distress, lowering in self esteem and can contribute to other social and health disadvantages.
Today’s seniors are living longer, are healthier, are more apt to travel, and demand services and independence. As the population continues to age, older drivers apparent over involvement in crashes encourages considerable interest in what research and interventions are needed to improve the safety of older drivers.
The following is a guide for anyone directly or indirectly involved with someone experiencing age related memory difficulties or has a diagnosis of dementia, and the issue of driving may be a concern.
This information is intended to provide advice, support, guidance and create awareness around dementia and driving. It is also intended to encourage conversations, debates and communication on the subject and thereby contribute to progress in this area of driving and road safety.
Unfortunately, the approach to driving and dementia is more reactive than proactive.
Most information about dementia warns against driving but does not describe how individuals and caregivers can determine when to stop.
Southern Mobility Assessment & Tuition Specialists is committed to providing ways to enhance quality of life concerning the issues of driving since independence and mobility are essential to maintaining quality of life. Discontinuing driving can be deeply emotional and controversial for an individual. A reactive response is not always acting in the best interest of the person with dementia.
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Monitoring / Limiting / Discontinuing
A comprehensive Driving Plan for A. MONITORING, B. LIMITING and C. DISCONTINUING driving needs introduction to maximise independence and minimise risk.
A. Monitoring
- Caregivers often must assume most of the responsibility for monitoring and regulating
the person with dementia.
- Create opportunities to observe the person with mild dementia when driving
- Keep a written record of observed driving behaviours
- Share opinions with the person with dementia (if possible), other family members, GP.
- Families need to consider circumstances and decide a course of action. This may involve developing a driving plan, involving health care professionals (e.g. G P, Occupational Therapists, Consultants), driving advisors, support groups, close friends.
B. Limiting
- The most effective approach to limit or stop driving involves progressive steps and a combination of strategies that suits the needs of the family. For persons with dementia driving is best reduced over time rather than all at once, where possible.
- Unlike changes common in later life e.g. a decrease in reaction times, fatigue, etc. older adults who do not have dementia are often able to assess and regulate their own driving. For those with dementia an individuals capacity to assess his or her abilities may diminish.
- At the early stages of dementia, having established the person is driving safely, consider and eventually implement self imposed driving restrictions. Involve the person with dementia in open conversations and decisions regarding their driving. This may help the transition to ceasing driving in the future. Some of these restrictions may include:
- Driving on familiar routes
- Shorter journeys
- Avoiding night driving
- Avoiding rush hour
- Avoiding driving in bad weather
- Avoiding complicated busy junctions where possible
- Some caregivers act as co-pilots. Supervised driving is sometimes recommended/suitable whereby a passenger provides company, security, or gives directions. But where the passenger has to give instructions on “how to drive” this strategy is not a safe option. In hazardous situations there is rarely enough time for the passenger to foresee the danger and give instructions and for the driver to respond quickly enough to avoid an accident. ( Do not mistake supervision for instruction).
- Having discussed and agreed these restrictions, involve others in doing some of the driving to ease the transition from driver to passenger.
- Begin to avail of public transport more regularly. Friends, neighbours, relatives can offer to drive to social/religious events, appointments etc.
- While caregivers decide ways to reduce the need to drive, it is important to remember the social benefits the person with dementia derives from interacting with others. Plan well and avoid allowing one person to arrange/decide the strategies. Consult support groups, health care professionals, etc. Share concerns and explore options.
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C. Discontinuing
Taking away car keys, licence, selling the car should be a last resort. Such actions are abrupt, extreme, disrespectful and punitive.
Once a person has stopped driving a decision must be made as to whether taking the keys, licence and car away will help the person adjust or simply make the adjustment more difficult. By keeping the keys, licence and car often helps an individual maintain a sense of dignity.
Another recommendation which suits some families, would be that a member of the family uses the car and the person with dementia travels as a passenger in their familiar vehicle thereby getting used to letting go of driving independently.
No two families dealing with dementia resolve transport issues identically. Families and circumstances differ. Where family members differ in opinions, to enable everyone to reach consensus an outside professional opinion may be sought to resolve difficult issues e.g. solicitors, G P, social worker, occupational therapist, support groups.
Another way of avoiding difficult situations arising is to discuss the reality of the situation at the early stages when the person with dementia can make an objective decision.
It is the opinion of Southern Mobility Assessment & Tuition Specialists that neuropsychological tests, cognitive and perceptual table top tests, the Mini Mental State Examination, Static Simulator tests all provide us with valuable information to help guide decisions. However these tests are not always accurate enough to determine cessation or continuation of driving.
A combination of one or more of these tests including an on-road evaluation, is currently the most comprehensive way forward.
Good interdisciplinary management should therefore ensure that people with dementia and carers are provided with timely and informed advice and explanation about driving including the necessary procedures and support to adjust to driving changes and/or cessation.
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Warning Signs For Drivers
The following is a list of warning signs a carer, driver or family member may notice if there is a concern for an individuals driving.
Be vigilant in your observations and decisions and do not over react to common driving errors. Do not mistake these warning signs for an individuals habitual style of driving. Note if there is a change in frequency or severity of these warning signs, and if so do not neglect any deterioration. Be discrete in your observations as driving errors will increase if one is feeling under scrutiny.
INCORRECT SIGNALING ( Signaling left when turning right, or signaling right when turning left, failing to use indicator, or forgetting to switch off after use ).
CONFUSION BETWEEN WIPERS AND INDICATORS:
MOVING INTO INCORRECT LANES:
CONFUSED AS TO WHICH LANE TO USE ON FAMILIAR ROUTES.
PARKING INAPPROPRIATELY:
BUMPING KERBS:
SCRAPES OR DENTS ON CAR, EXTERIOR MIRRORS DAMAGED:
NEAR MISSES:
CAR ACCIDENT:
GETTING LOST IN FAMILIAR PLACES:
CONFUSION BETWEEN ACCELERATOR AND BRAKE:
DRIVING AT INAPPROPRIATE SPEEDS:
(Either too fast or too slow for traffic or road situations)
DELAYED REACTION TO TRAFFIC/ROAD CONDITIONS:
CONFUSION AT ROUNDABOUTS:
(stopping and giving right of way to vehicles on left or delayed moving off despite no vehicles approaching)
CONFUSION AT JUNCTIONS:
(delayed moving off despite no vehicles approaching or giving right of way to vehicles on minor road)
INCORRECT USE OF CLUTCH:
(gears grating or engine cuts out moving off)
INCORRECT USE OF GEARS:
(changing incorrectly 2nd to 5th , 5th to 2nd ,5th to reverse, moving off in 3rd ,changing for no reason)
BEHAVIOUR:
(impulsive and not prepared to wait at junctions, roundabouts or red traffic lights. Aggressive towards other road users)
ATTENTION:
(unable to activate secondary controls, windows, check mirrors without causing steering to lose course. Unable to attend to driving task because of off road distractions, mobile phone, radio etc.)
SPATIAL AWARENESS:
( unable to judge distances between parked and oncoming vehicles, turning left too wide, turning right on incorrect side of road, traveling on incorrect side of road on bends and corners)
STOPPING IN TRAFFIC FOR NO REASON:
USE OF HANDBRAKE / PARK BRAKE:
( Failing to secure handbrake when parked, applying handbrake unnecessarily while on the move, rolling back on hills and forgetting to use handbrake).
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Frequently Asked Questions
Q. If I observe any of the warning signs in someone’s driving does it mean they have dementia?
A. No, noticing a deterioration in someone’s driving skills certainly does not guarantee a diagnosis. Other factors have to be taken into consideration.
Q. At what point should someone’s driving be assessed, prior to or after diagnosis?
A. As soon as "driving warning signs" cause concern.
Q. Are the driving skills the first or last to deteriorate for someone with dementia?
A, Individuals differ. Driving warning signs may be the first signs prior to any diagnosis and for others that may have a diagnosis of dementia they may continue to drive without driving deficits.
Q. Having observed the warning signs in someone’s driving should they stop or restrict their driving?
A. Have the driving assessed and if the difficulties are serious, it may require a temporary cessation. Further investigation may reveal other circumstances which may be corrected and the person may be able to return driving.
Q. What is an on-road assessment?
A. An on-road assessment is not a pass or fail driving test. Its aim is to look at a persons physical, visual, cognitive and perceptual ability to drive a motor vehicle in safety and comfort. One may be successful on an on-road assessment and may not be driving at driving test standard.
For further information go to Driving Assessments.
Q. I noticed my father recently demonstrating increased aggression towards other road users and is inclined to drive above the speed limits. Should he have an assessment?
A. Not necessarily. Firstly discuss your observations with your father. A change in driving behaviour may have other underlying implications. Maintain your observations, check the warning list for other signs and check all other possibilities and if still unsure seek a second opinion.
Q. My mother is always a very careful driver but last week I noticed her miss a red traffic light. Should she have an assessment?
A. Not necessarily. It may be human error. Speak to her about it. Does she have an underlying medical condition ? Reoccurrence or other warning signs may require further investigation.
Q. My Dad is now in his late sixties and still thinks and acts like an immature racer. Would it correct his attitude if he were to be threatened with an assessment?
A. No. This could lead to a communication, or cooperation breakdown. An assessment should never be a threat but perceived as a supportive course of action acting in the best interests of everyone involved.
Q. My mother is learning to drive and is in her fifties. She demonstrates some of the warning signs. Should she be assessed?
A. Not necessarily. Some of the warning signs are common when someone is beginning to drive. However if there is no improvement over a period of time with plenty practice, seek advice from her driving instructor or a specialist driving assessor.
Q. My mother is having a driving assessment shortly and is very nervous about the whole procedure. Is it possible to have a friend or relative of her choice travel with her on the assessment as reassurance and support?
A. Yes, where it is in her best interests certainly. Discuss this with the driving advisor and arrive at a suitable arrangement.
Q. We live in a rural area. My husband has recently been diagnosed with dementia. Isn’t this driving assessment only an issue for busy towns and cities?
A. No, this issue with driving and any driving skills deficits should be monitored, regardless of geographical area.
Q.Our family including my father wishes to have his driving assessed as a result of recent ongoing short term memory difficulties. Who should we contact? Will his car insurance increase because of same? Will it prevent him renewing his licence?
A. Contact your G.P. for a referral. His car insurance should not be affected. Providing it is decided his safety to drive has not been affected renewal of licence is possible.
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Quotes And Short Stories
“Our children talked to her about possibly not driving. They don’t know it, but she cried that night. Driving is extremely important to her. I don’t want to strip her of her dignity.“
Husband whose wife has dementia
“Take advantage of the time during the early stages to discuss options for when the person must limit and eventually stop driving. Where the subject causes conflict, try to involve as many as possible and share the responsibilities, decisions etc. There is no easy answer.“
Advice from Carer
“There was a big meeting all about my driving. They’re making a big fuss. I’m very comfortable on the road. I’m driving longer than they’ve been alive. I never had an accident. A load of fuss about nothing.“
Driver diagnosed with Alzheimer’s
“Mum was passive and secretive about Dad's driving and avoided the subject so as not to upset him. We approached his G. P. who arranged for a comprehensive driving assessment and this whole issue was finally resolved.“
Daughter, whose father was diagnosed with Alzheimer's
“This illness is destroying me, if they take my driving I have nothing left, it will not be worth carrying on.“
A lady diagnosed with Alzheimer’s quotes, prior to her driving assessment
“My father was diagnosed with Dementia. We avoided the subject of driving while at the back of our minds we should have done something. The neighbours knew something was not right but were unsure how to approach us. Looking back now it seems everyone wanted to say something but what, to who, how, and no one wanted to strip him of the last few comforts he had left. Stopping his driving was the beginning of the end but had to be done. Don’t be passive and ignore the obvious, seek help. The guilt of organising cessation of his driving I can live with. If the situation had gone the opposite way and someone was fatally or seriously injured I would not be able to forgive myself.“
Son whose father has dementia
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