Finally, the decision to stop driving is often one of slow realisation. Falls asleep while driving or gets drowsy. Mr R is a 73 year old Māori man who comes with his wife to discuss a recent diagnosis of dementia made by the DHB memory clinic. You suggest that you begin the assessment today, but that a second visit will likely be required before you can make a decision. Has difficulty with decision-making and problem solving. Mr R’s two daughters introduce themselves. 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. State regulations regarding dementia and driving restrictions vary. You reiterate the link between dementia and driving safety, and ask the whānau for their thoughts. 치매는 무엇을 의미합니까? What is the practical impact of losing a driving licence? 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. As a last resort, you may have to prevent his or her access to a car. 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. driver number on their driving licence (if known). There are three possible outcomes from a driving assessment: If the patient continues driving, a review must be planned. Note that the, Collateral information from whānau, for example using a. 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”. 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. 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. It is important to highlight to patients that eventually they will need to stop driving altogether. All rights reserved. All involved will need to weigh potential risks and decide when the individual needs to stop. Additionally, many patients with dementia have comorbidities or take medications that further impact their driving safety.3 Age is also a consideration: … Has accidents, near misses, or “fender benders.”. The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. 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. Or DVLA/DVA may ask the person to have a driving assessment. 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. Some people safe, others unsafe to drive. It can also help you make plans for other ways to travel in the future. Once notified, the licensing authority will ask that the driver’s doctor makes an initial assessment of the driver’s medical fitness. 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. • 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. The whānau feel that this is probably safe. 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 Making the transition from driver to passenger over time can help ease the adjustment. Involve the person with dementia in the planning and decision-making 3. 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. 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. If there are any doubts about safety, the person with dementia should not be driving. Therefore, assessing drivers with dementia is important. While it is important to maintain respect for the individual’s feelings, you must put safety first. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Has increased memory loss, especially for recent events. Encourage the individual with dementia to talk about how this change might make him or her feel. Individuals with moderate or severe dementia should not drive. Family Care Navigator: www.caregiver.org/family-care-navigator. Please select your options then click 'submit'. 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. Commonly used transportation options are: Ideally, an individual will limit or stop driving on his or her own. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. He drinks 1-2 cans of beer on 3-4 nights of the week. Begin the conversation as soon as possible and involve the doctor 2. You have known Mr and Mrs R for many years. OT driving assessment (preferred and recommended), clarification of function level in other areas. Drifts into other lanes of traffic or drives on the wrong side of the street. As driving and assessment skills decline, the risk of serious loss or injury increases. Are there other drivers in the household? Mr R’s wife drives Mr R and their two daughters to your practice one week later for a half-hour meeting. (Dementia: Is this Dementia, and What Does it Mean? In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. 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. Alzheimer’s Disease Education and Referral Center (ADEAR)www.nia.nih.gov/alzheimers. Try to imagine what it would be like if you could no longer drive. 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