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Driving
Background
Driving
a motor vehicle is a complex activity that requires quick
reactions; the ability to divide and maintain attention
(for example, watching traffic light and pedestrians
while keeping one's foot on the gas pedal or brake);
good judgment; an understanding and ability to recall
the rules of the road; the ability to find a destination;
and adequate eyesight and hearing. Driving also represents
freedom, independence and mobility. Although driving
is a privilege, some people view it as a right.
Alzheimer's disease and related dementias cause changes that affect
a person's ability to drive a motor vehicle safely. However,
a diagnosis of Alzheimer's disease does not automatically
mean that a person is incapable of driving. Some people
may be capable of driving safely for some time after
the diagnosis, depending on the timing of the diagnosis
and the rate the disease progresses. However, eventually
a person with Alzheimer's disease must stop driving, as
it will no longer be safe. There is currently no nationwide
standardized testing to determine when someone with Alzheimer's disease is unable to drive a motor vehicle safely.
The
issues
For
people with Alzheimer's disease:
Loss
of independence, freedom and mobility: Recognizing
and admitting the loss of abilities needed to drive
is difficult for some people, while others freely give
up their licence. The loss of freedom to come and go
as one pleases can have a devastating effect on a person.
The person with Alzheimer's disease may have been the
only driver in the household. Also, many communities
lack alternative forms of transportation; and, where
alternative transportation is available, it may be
expensive or inconvenient.
For
family members and caregivers:
Determining
when driving is no longer safe: When a person is
unable to recognize or admit that driving abilities
have been lost, family members and caregivers often
have to address the issue. Their concerns may include
the risk to the person, the risk to the public and
the risk of liability in the event of an automobile
accident.
Within
families, there may be disagreement about when the person
with Alzheimer's disease should stop driving. Some family
members may believe that the person should stop driving
immediately upon diagnosis. Others may be inclined to
overlook some risky driving behaviour in favour of maintaining
the person's sense of independence.
Family
members and caregivers often find it difficult to suggest
that the person with Alzheimer's disease stop driving.
They may fear that bringing attention to the person's
loss of abilities and the need to stop driving may create
difficulties in the relationship.
For
doctors:
Determining
when driving is no longer safe: Doctors are often
approached to assist people with Alzheimer's disease
and their families in determining if a person can continue
to drive. However, doctors:
- see
people for a limited time during visits, not when they
are behind the wheel;
- may
not have proper training to assess driving abilities;
- must
rely on information from individuals and family members
that may not always be objective or reliable;
- may
be concerned that telling people they must stop driving
could harm the doctor/patient relationship.
Doctors
are bound by law, in some provinces, and by professional
ethics, to report medical conditions that could impair
a person's ability to drive. They also may be held liable
if a person in their care who has Alzheimer's disease is
involved in an auto accident and they have not reported
the person's driving problems to provincial licensing
authorities.
Preferred
choices
When
driving is recognized as dangerous:
- Stop
driving immediately
Driving
must be stopped immediately if safety is at risk.
Signs that a person's driving abilities are declining
include: slow response times, traffic violations,
collisions, taking too much time to reach a destination
or not reaching the destination at all.
When
the person is still able to drive:
- Plan
ahead
Plan
ahead for the time when driving must stop. This includes
talking with the person with Alzheimer's disease to
find out when driving is needed most and why. For
example, is it used for keeping medical appointments,
shopping, entertainment, meeting with friends, or
perhaps as a form of escape or relaxation? Once the
needs have been identified, there should be a discussion
of alternatives, such as public transit, services
provided by community organizations, and transportation
organized by family members and friends.
- Driving
assessment
Look
into the availability of testing to assess the person's
driving abilities. This could be a driving simulation
test and/or a road test conducted by someone with
experience in assessing drivers with cognitive problems.
If
this type of driving assessment is not available,
enlist the help of a doctor to determine if and when
the person is no longer able to drive. The doctor
may ask the person and family members questions about:
- driving
patterns (when and where the person drives);
- any
differences noticed in driving skills;
- any
unsafe or abnormal driving behaviour;
- traffic
tickets (for going too slow, too fast, improper
turns, failing to stop);
- crashes,
fender benders or near-misses;
- instances
where the driver has been lost;
- how
comfortable the person or family members feel about
the person's driving abilities.
- Ongoing
monitoring
Throughout
the course of the disease, the person's driving ability
needs to be monitored by the individual, family members,
a doctor or other health-care professional, and appropriate
actions taken.
When
conflict arises
Reactions
to driving restrictions may vary from immediate acceptance
to strong resistance. Some people will recognize their
failing abilities and limit their driving or stop driving
on their own. Others will accept the decision more readily
if it is discussed openly in a trusting environment.
As well, the decision may be more acceptable if someone
whom the person believes to be objective presents the
information.
Some
people may refuse to accept losing their driving privilege
or simply forget that they are no longer able to drive.
In these instances, family members should request that
doctors or other members of the health-care team help
them raise the issue. However, these discussions should
not interfere with the provision of health care or support.
This may happen if the person with Alzheimer's disease
becomes angry with the doctor and fails to return for
future appointments.
If
open discussion of the issue does not result in acceptance
of the loss of driving privilege, then it may be necessary
to use other means to prevent the person from driving,
such as removing the keys to the vehicle.
For
people with Alzheimer's disease and their families, determining
when driving is unsafe can be stressful. Talking to health-care
professionals, or individuals and families in similar
situations can provide information and support.
In
closing...
The
lives of people with Alzheimer's disease should be as free
and fulfilling as possible, but a totally risk-free life
is not possible. Throughout the course of the disease,
driving skills and abilities must be monitored. However,
risks should never be assumed without an individual assessment
and should not be exaggerated in order to remove driving
privileges earlier than necessary. It must be recognized,
as well, that people with Alzheimer's disease who drive
when not competent to do so create an unacceptable risk
for themselves and others in the community.
Restricting
or stopping driving may threaten a person's independence
and sense of freedom. Therefore, how and when to insist
that a person stop driving is a difficult issue for people
with Alzheimer's disease, family members, doctors and other
members of the health-care team. Public discussion of
this issue will become crucial as more and more people
are diagnosed with Alzheimer's disease in Canada.
Contact
your local Alzheimer Society for
information about provincial regulations for reporting
potentially unfit drivers and the availability of driving
assessment programs in your province.
Resources:
- Determining
Medical Fitness to Drive: A Guide for Physicians.
Canadian Medical Association, May, 2000. (Addendum added
February 1, 2005.)
- Driving
and Dementia Toolkit. The Dementia Network of
Ottawa Carleton, 2001.
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