Elderly and driving By Melissa Hendrickson Auburn University Primary Care Nurse Practitioner Student

Dementia Brain disorder leading to loss of brain function. Most types are degenerative Cannot be reversed Most common type is Alzheimer’s disease

Evaluating Driving Behaviors Independent driving evaluation with the Department of Motor Vehicles (DMV). Evaluation of driving ability from family members. Self evaluation of driving skills.

Detecting unsafe drivers: Warning signs Almost crashing, with frequent “close calls” Finding dents & scrapes on the car, on fences, mailboxes, garage doors, curbs, etc. Getting lost, especially in familiar locations Having trouble seeing or following traffic signals, road signs, & pavement markings Responding more slowly to unexpected situations or having trouble moving their foot from the gas to the brake pedal; confusing the two peddles. Misjudging gaps in traffic at intersections & on highway entrances & exits Experiencing road rage or causing other drivers to honk or complain Easily becoming distracted or having difficulty concentrating while driving Having a hard time turning around to check the rearview while backing up or changing lanes Receiving multiple traffic tickets or “warnings” from law enforcement officers

Does having dementia mean I can’t drive? Some people with dementia can drive safely for a time. A dementia diagnosis should not automatically lead to restricted driving. Caregivers and family can help identify a developing problem because they are familiar with their loved ones behaviors and can identify a change.

Healthcare providers role Clinicians caring for patients with dementia should work with family members to identify those patients with cognitive impairment who may be at a higher risk for unsafe driving, without unnecessarily restricting those who are safe drivers (AAN, 2010). Elements of the driving history and additional cognitive testing are considered along with Mini-mental state examination (MMSE) scores, the prediction of unsafe driving practices are more accurate. For patients with dementia, MMSE scores <24 may be considered useful for identifying patients at increased risk for unsfe driving. Because there is no test or historical feature that accurately quantifies driving risk, clinicians can make only qualitative estimates of driving risk.

Algorithm: Evaluating Driving Risk

GA Department of driver safety (DDS) Those over 59 years of age are eligible to obtain a short term, 5 year license. This is due to the vision screening requirement for those 64 years of age and older. Minimal acceptable vision is 20/60 in one eye with or without corrective lenses. (Senior drivers, 2014)

“We need to talk” Carefully select the person who will initiate the discussion and have others reinforce decisions about driving. Older adults typically prefer to speak confidentially about driving safety with someone they trust. Expect strong emotions. Nearly one-fourth of older adults report feeling sad or depressed as a result of the conversation. Negative reactions are often more about the message than the messenger. Do not postpone the conversation because of fear or guilt and be prepared to have several conversations to achieve your goal. It is more important to avoid accidents or death than to avoid unpleasant topics. When driving is placed within the larger context of other safety concerns, it may take the personal edge off the conversation. Use news reports to inform, not scare, older persons.

Driving is not an “all or nothing” activity Avoid driving at night and, if possible, at dawn or dusk. Drive only to familiar locations. Avoid driving to places far away from home. Avoid expressways and rush hour traffic. Leave in plenty of time to get where they are going. Don’t drive alone. Encourage other forms of transportation.

Examples: “I’m glad that you’ve cut down on night driving. I would never want you to drive when you’re not comfortable or feel that it’s too risky.” “Have you asked your doctor about the effects of your new medication on your driving?” “That was a close call yesterday. I worry about your safety on the road.” “I’m worried about your getting lost.”

Resources AARP driver safety We need to talk program – AARP Driving safely while aging gracefully

References AARP American academy of neurology AAA Senior drivers. (2014). GA Department of Drivers Safety. Retrieved from Family caregiver alliance.