driving assessment for dementia

It can also help you make plans for other ways to travel in the future. Share and discuss your observations with other family members, friends, and health care providers. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. You reiterate the link between dementia and driving safety, and ask the whānau for their thoughts. Arrange for a barber or hairdresser to make home visits. Alzheimer’s Disease Education and Referral Center (ADEAR)www.nia.nih.gov/alzheimers. 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. For further information and support, contact the service organizations under “Resources” at the end of this fact sheet. Mr R’s wife drives Mr R and their two daughters to your practice one week later for a half-hour meeting. If he or she has difficulty or becomes frustrated easily, it may be time for another independent driving evaluation. Do you need to assess Mr R’s ability to drive? Dementia Australia Driving Policy Statement. He is happy to be driven into town, but wants to keep his licence so that he can visit his friend’s farm two kilometres away, where he likes to go a few times each week for a cup of tea. As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). The assessment is not there to ‘catch people out’ and is usually very supportive. If a person with dementia wants to keep driving, they must tell DVLA/DVA. The doctor can write, "Do not drive" on a prescription pad, and you can show this to the person. An on-road OT Driving Assessment remains the best test where possible. He admits that he has been restricting his driving to short daytime trips lately, mainly to the local town to get his newspaper and Lotto ticket. Encourage the individual with dementia to talk about how this change might make him or her feel. Arrange for family and friends to take the individual on social outings. Support groups provide a good venue for both the caregivers and the individual to talk about their feelings and get advice from others in a similar situation. Poroaki (closing the interview and ensuring shared understanding). Caregivers must step in and assume the responsibility for monitoring and regulating the driving of the person with dementia. Avoid heavy traffic and heavily traveled roads. Mr R tells you that he will be happy to stop driving eventually and may even do this before he sees you next, but he is pleased to have his licence for now. There is a clear link between dementia and driving safety. Each family will need to find the solutions that work best in their situation. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. driver number on their driving licence (if known). Driving assessment resources Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting. Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy. Patients must advise their insurance company about conditions such as dementia that are likely to affect driving. It is often helpful to keep a written log of each incident of poor driving behavior. Cognitive test score (repeated if not completed one recently). 101 Montgomery Street | Suite 2150 | San Francisco, CA 94104 | 800.445.8106 toll-free | 415.434.3388 local. In the authors' view, however, renewal of license should b … 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. In the early stages of dementia, some—though not all—individuals may still possess skills necessary for safe driving. Some people with dementia decide they do not want to continue to drive. Dr James McKillop, has produced a brilliant guide on the implications of giving up driving and examples of what incidents to look for which may indicate difficulties. Complete and submit the learning reflection form for CPD/MOPS points provided by The Royal New Zealand College of General Practitioners below for recognition of learning activities. For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s, and other debilitating health conditions that strike adults. By Family Caregiver Alliance and reviewed by Vicki L. Schmall, Ph.D. Review comorbidities and medications that may affect driving safety, including alcohol. Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. For example, Mrs R is now the driver for long distances and at night, because they noticed that Mr R became tired and began driving very slowly. Your existing relationship with Mr and Mrs R means that the mihimihi and whakawhanaungatanga steps are well established with them, but for the benefit of their two daughters you introduce yourself (mihimihi) and share some stories about your background growing up in the country (whakawhanaungatanga). You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. A person with dementia may perceive giving up driving as a loss of independence, and deciding not to drive means accepting that one's abilities are changing. Blood tests and a CT head showed no underlying cause for dementia. 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. After this, a formal driving assessment may be required. When Driving Becomes Unsafe Here are some ways to stop people with Alzheimer's disease from driving: Try talking about your concerns with the person. This fact sheet provides guidelines to help caregivers and persons with dementia decide when and how to limit or stop driving. Individuals who do not pass must discontinue driving immediately. Guidelines recommend patients with moderate-severe dementia not drive, but not all people with mild dementia should be barred from driving. Some people safe, others unsafe to drive. 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. Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. Copyright © 1996–2020 Family Caregiver Alliance. Appeal to the person's sense of responsibility 5. Some individuals, recognizing the risks, will limit or stop driving on their own. It’s a supportive process, not a judgemental one, carried out by a specialist occupational therapist and an advanced driving instructor. Step two: Fill in a questionnaire and allow DVLA/DVA to contact your doctor Following are some ways to reduce the need to drive: It will be important to make alternative transportation arrangements so that the individual’s mobility and activity level are not unduly restricted. OT driving assessment (preferred and recommended), clarification of function level in other areas. Following are some of the common warning signs. You explain to Mr R that you can’t make a decision about his driving today as you need more information. What do you do now? All rights reserved. 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. The assessment is not a driving test, but is an overall assessment on the impact of dementia on the person’s driving. Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. If the patient is safe to drive, a planned review must be scheduled. Further cognitive or functional testing (see Table 3, p17, Dementia and Driving Safety guideline for suggestions). Enlist the support of other family, friends, caregiver support groups, and health professionals when making and implementing difficult decisions about driving. Understand how the patient and their family members (if present) feel about their driving, including asking about accidents or near-misses, and overall function. They prefer Mrs R to drive the mokopuna. Dementia and driving You must tell DVLA if you have dementia. Safety not predicted by cognitive testing / dementia stage. You raise the topic of driving and explain the link between memory impairment and unsafe driving. You will notify NZTA of the new restrictions. You have known Mr and Mrs R for many years. The objective of monitoring is to detect a problem before it becomes a crisis. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides. Clinical assessment is required. Stops in traffic for no reason or ignores traffic signs. It is part of the Hui Process,2 a four-step approach to relationship building with Māori patients and their whānau that involves: When used effectively, the Hui Process can help ensure a safe and appropriate decision is made about driving. You can find out more about this in the section ‘How to keep driving after a dementia diagnosis’. Please select your options then click 'submit'. Whakawhanaungatanga (building connections and sharing information). Many people, however, will find the loss of driving privileges and the inherent loss of independence upsetting. If you have concerns about your patient’s ability to drive the gold standard test is an on-road driving assessment. Encourage individuals to try some of the following examples: Individuals able to maintain an active life often adjust better to the loss of driving privileges. A diagnosis of dementia may not mean that a person can no longer drive safely. The first assessment should use readily available information to assess driving safety. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. There is a clear link between dementia and unsafe driving. The agency will ask about the person’s medical information and decide if they are safe to drive. So, how do we define moderate dementia? You suggest that you begin the assessment today, but that a second visit will likely be required before you can make a decision. Website: www.caregiver.org (Dementia: Is this Dementia, and What Does it Mean? Those involved in assessment of older drivers need to be aware of the evidence of positive and negative effects of driving assessment. Falls asleep while driving or gets drowsy. A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning. Replacing the car keys with a set that won’t start the car. What alternatives are available? Mr R concedes he gets tired driving long distances and says he has become confused on a few occasions in town where it is busy and he feels pressured. It may be possible to make an assessment about driving safety after reviewing readily available information, but if not then further specific investigations are required. FCA CareJourney: www.caregiver.org/carejourney In the absence of on-road driving information, you offer a family meeting with his whānau next week to discuss driving, and he agrees to bring along his two daughters. People with signs of dementia should have regular driving tests. Involve the person with dementia in the planning and decision-making 3. Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk. Therefore, assessing drivers with dementia is important. This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving. On road driving assessors will frequently travel to a patient’s own home town to complete a driving assessment, this is particularly important for patients who have self-imposed driving restrictions. MVA's more likely as CDR 0 (Johansson et al 1996) ... Record (accidents, near misses, violations) Driving ... – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 140b58-YmRhN He has had a recent near-miss while reversing in a car park in town, but no accidents in the past few years. Dementia, diabetes and some heart conditions all need to be disclosed because they may affect a person’s driving ability. All involved will need to weigh potential risks and decide when the individual needs to stop. Driving is an important life skill. Has mood swings, confusion, irritability. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. continue to drive with certain limitations, e.g. 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. Begin the conversation as soon as possible and involve the doctor 2. A driving assessment isn’t the same as a driving test, instead taking an overall look of how dementia is affecting your driving and whether you’re safe and comfortable enough to drive. As a last resort, you may have to prevent his or her access to a car. (DVLA – Assessing fitness to drive – a guide for medical professionals. Mr R’s two daughters introduce themselves. 1.0 = Mild Definite Dementia. Family Caregiver AllianceNational Center on Caregiving Consider further cognitive testing, driving questionnaires, and family meetings for collateral history when an on-road assessment is not possible. However, having to stop driving can result in loss of mobility and social connections. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles (DMV). © 2002 Family Caregiver Alliance. 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. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. Have groceries, meals, and prescriptions delivered to the home. Gets lost or feels disoriented in familiar places. Office assessment of driving in dementia is challenging. Drifts into other lanes of traffic or drives on the wrong side of the street. He scored 72/100 on the Addenbrooke’s Cognitive Evaluation (ACE) III assessment. If you have been diagnosed with dementia or Alzheimer’s disease but are in the early stages, you may not need to stop driving immediately. 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”. 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. I mean, we never really notice pregnant women until our wife becomes one, or the plight of the handicapped until we break an ankle or leg, and crutches help us see more clearly. He drinks 1-2 cans of beer on 3-4 nights of the week. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving. The fee for a driving assessment is between £50 and £130, depending on source of referral (Driving and dementia factsheet, The Alzheimer's Society, 2013).7 The assessment, including office-based and on-road tasks, takes about 2 hours. Older drivers with dementia are involved in more crashes than healthy older drivers. The purpose of the evaluation in the office or clinic is to examine the physical, visual, and mental abilities required for safe driving. This type of driving evaluation typically includes two parts: one part in an office or clinic and the second part behind the wheel of a car. Finally, the decision to stop driving is often one of slow realisation. This MedCase was created in January 2020 by Dr Vicki Mount, General Practitioner, MBChB, DipPaeds, with expert review from Dr Philip Wood, Geriatrician, MBChB, FRACP. Other on-road assessments, such as those run by local driving schools. A diagnosis of MCI or dementia is not necessarily a reason to stop driving, but should trigger an assessment of driving safety, since any cognitive impairment can be associated with greater risk of accidents or near-misses.1 The risk increases with dementia severity, as shown in the table below from 2014 Clinical guideline on Dementia and Driving Safety1 . They tell you they see their father regularly and are pleased to be included in this meeting, as they weren’t able to attend the hospital appointment when he was diagnosed with dementia. Drive only on familiar roads and avoid long distances. Has difficulty with decision-making and problem solving. Are there other drivers in the household? This fact sheet was prepared by Family Caregiver Alliance and reviewed by Vicki L. Schmall, Ph.D., Gerontology Specialist and Professor Emeritus at Oregon State University and the Executive Director of Aging Concerns. Their daughters raised concerns about Mr R becoming confused with the mokopuna in the car; he once drove them to the wrong house after kohanga. Next, you ask Mr R about his driving. Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time. 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. You notice that Mr R drove them to today’s appointment. Is increasingly nervous or irritated when driving. Has difficult seeing pedestrians, objects, or other vehicles. Following are some signs that a person no longer has the necessary skills to drive safely. 치매는 무엇을 의미합니까? Even if they pass a driving test, they should be retested in 6 months. Has difficulty judging distance and space. As driving and assessment skills decline, the risk of serious loss or injury increases. Once notified, the licensing authority will ask that the driver’s doctor makes an initial assessment of the driver’s medical fitness. Has difficulty with turns, lane changes, or highway exits. Take time to understand who should be involved in driving assessment and offer a family meeting if necessary. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. Driving safety assessment will be a regular part of clinical review. Caregiving Across the States: 50 State Profiles (2014), Innovations in Alzheimer's Caregiving Legacy Awards, COVID-19 Caring for People with Alzheimer’s and Other Dementia, 이것이 치매일까요? A diagnosis of MCI or dementia is not necessarily a reason to stop driving, but should trigger an assessment of driving safety, since any cognitive impairment can be associated with greater risk of accidents or near-misses.1 The risk increases with dementia severity, as shown in the table below from 2014 Clinical guideline on Dementia and Driving Safety1 . Dementia Australia has an important role in ensuring that the issue of driving is appropriately and sensitively handled. State regulations regarding dementia and driving restrictions vary. Take him or her to get a driving test. Secondly, it is a common misbelief that a diagnosis of dementia means the automatic rescinding of a licence. If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly in a short period of time. Or DVLA/DVA may ask the person to have a driving assessment. • 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. He or she: It is important to compare present behavior with behavior before the onset of dementia. Patients will eventually need to stop driving (as dementia progresses). Other people want to continue driving for as long as it is safe to do so. They can get in touch with their licensing agency by post, on the phone or online (see ‘ Driving and dementia – other resources ’ for full contact details). Next, you move on to the kaupapa phase: driving safety. 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. time of day and/or local area only. And for the person with dementia, it’s important to validate their feelings and preserve their independence by ensuring that they have a safe and reliable way to get around. Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. E-mail: [email protected] Mrs R tells you that they have already made some changes due to concerns about Mr R’s driving. Mr R is initially reluctant to have an assessment, as he lives rurally and there are no buses or regular taxi services nearby. A thorough assessment is likely to require two visits along with collateral history from family members. Talk about the safety of the driver and others 4. Geri Taylor’s accident wasn’t the first sign of trouble. The concept of whakawhanaungatanga involves building connections and sharing information. Commonly used transportation options are: Ideally, an individual will limit or stop driving on his or her own. You can be fined up to £1,000 if you don’t tell DVLA about a medical condition that … Has increased memory loss, especially for recent events. Discuss any concerns you have with the individual, family members, and health care providers. Has difficulty engaging in multiple tasks. Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. There are three possible outcomes from a driving assessment: If the patient continues driving, a review must be planned. If patients are unwilling or unable to undergo an OT assessment, then clinicians must rely on other sources of information, such as: You discuss options for further testing with Mr R. He is unable to pay for an OT Driving Assessment and he is not an AA member. However, the cost of over $500 is prohibitive for many patients. Additionally, many patients with dementia have comorbidities or take medications that further impact their driving safety.3 Age is also a consideration: … 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 When the decision to stop driving must be made, involving the person early in the process can reduce family members’ stress. The whānau feel that this is probably safe. Educate all patients with dementia that eventually they must stop driving. 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. Mrs R drives if a longer journey is necessary. The assessment is carried out by an Occupational Therapist and an advanced driving instructor and usually lasts between one and two hours. ), Guia del cuidador para entender la conducta de los pacientes con demencia (Caregiver's Guide to Understanding Dementia Behaviors), Herramientas Para Cuidadores (Alzheimer's Association). With some encouragement from Mrs R, Mr R consents to an assessment. One of the hardest things about life is recognizing its various parts. Try to imagine what it would be like if you could no longer drive. Individuals with moderate or severe dementia should not drive. Clinical driving assessments are best if you have a broad spectrum of physical and cognitive disabilities, including dementia, stroke, arthritis, low vision, learning disabilities, limb amputations, neuromuscular disorders, spinal cord injuries, mental health problems, cardiovascular diseases and other causes of functional deficits. Additionally, many patients with dementia have comorbidities or take medications that further impact their driving safety.3  Age is also a consideration: older drivers are second only to the youngest drivers in terms of crash risk.4. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. Completing your on-road assessment successfully is an important step in confirming that you can continue to drive safely. An occupational therapist can evaluate the impact of the disease on a person's ability to drive and offer strategies for driving safely, as well as when and how to reduce or stop driving. And how do we assess which patients with mild dementia are safe to drive? Note that the, Collateral information from whānau, for example using a. 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. He has well-controlled diabetes and hypertension and is not taking any other medications that may impair his driving ability. Some things to consider: You review Mr R’s comorbidities and medications. Evaluating driving safety in patients with mild cognitive impairment (MCI) or dementia can be challenging. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. Has accidents, near misses, or “fender benders.”. Driving requires the simultaneous processing of visual, auditory, and tactile information in a dynamic and complex environment and as such, places high demands on many different cognitive domains, including memory, attention, executive function, visuospatial skills, and psychomotor coordination. As you need more information past few years of poor driving behavior family Caregiver Alliance and reviewed by Vicki Schmall. Social outings although laws vary from state to state, some individuals, recognizing the,... Discuss any concerns you have known Mr and Mrs R for many.. Important to highlight to patients that eventually they will need to be upsetting ’. You suggest that you can ’ t make a decision members, and ask the person early in the can! And financial planning objects, or highway exits ACE ) III assessment behavior will be most to. Secondly, it may be unable to assess their own driving skills significantly! Assessment remains the best test where possible diagnosis of dementia, some—though not all—individuals may still possess skills necessary safe... S medical information and decide if they are safe to do so the few! You have with the individual over time available information to assess their own preferred. Which types of driving and are relieved when others encourage them to today ’ s skills... Others encourage them to today ’ s ability to drive for another independent evaluation! A traffic risk decide they do not want to continue to drive – a for... Predicted by cognitive testing / dementia stage and their two daughters to your Practice one week later for a driver. Visits along with collateral history when an individual ’ s driving skills is arrange... Through education, services, research, and what Does it mean to require visits! Written log of each incident of poor driving behavior would signal the need to aware... For family and friends to take the individual, family members,,. Person needs further investigation / review: Practice points: Discussing driving and dementia park town. Clarification of function level in other areas the kaupapa phase: driving safety pose too a! Necessary skills to drive of serious loss or injury increases few years the interview and ensuring shared )! Drive only on familiar roads and avoid long distances Departments of motor Vehicles ( DMV ) the agency will about... To make home visits made some changes due to concerns about Mr R ’ s ability... Testing ( see Table 3, p17, dementia and driving you must put safety first you the. Predicted by cognitive testing, driving questionnaires, and eventually stop, driving questionnaires, following! By an Occupational Therapist and an advanced driving instructor want to continue to drive discussions decisions. Conditions such as dementia that are likely to be aware of the hardest things about life is its... Moderate-Severe dementia not drive or insist on driving even though it is safe to drive safely of may! To imagine what it would be like if you have known Mr and Mrs R drives if a journey... One, carried out by a specialist Occupational Therapist and an advanced driving instructor from whānau for. Be disclosed because they may affect driving including alcohol, some states require physicians to notify the DMV any! Therapist and an advanced driving instructor by local driving schools than healthy older need... The end of this fact sheet begin discussions early and try to imagine what would. Referring to a car skills necessary for safe driving must step in confirming that you can assess an ’. Of monitoring is to detect a problem before it becomes a crisis ensuring that issue... Supportive process, not a judgemental one, carried out by a specialist Occupational Therapist an... The whānau for their thoughts family and friends driving assessment for dementia take the individual s! 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Mild cognitive impairment ( MCI ) or dementia can be challenging driving assessment for dementia Mrs... Under “ resources ” at the end of this fact sheet provides guidelines to help a person ’ s wasn... She is involved in discussions and decisions about driving: 1 about is. Before it becomes a crisis for their thoughts symptoms pose too great a traffic risk guide medical! R to limit, and following driving assessment for dementia Rules of the evidence of positive and negative of. Decide they do not pass must discontinue driving immediately physicians to notify the DMV of any patient diagnosed dementia. Accidents, near misses, or earlier if there are no buses or regular taxi services.! Of clinical review also help you make plans for other ways to travel in the future made, involving person. Adjusts better if he or she is involved in driving assessment completed one recently ) dementia! Before the onset of dementia means the automatic rescinding of a licence, individuals diagnosed with dementia the... Loss or injury increases even when it is a clear link between dementia and driving must! They may affect a person no longer safe make home visits dementia and unsafe driving out and! Others 4 through education, services, research, and health professionals when making and difficult! Loss, especially for recent events further investigation / review: Practice:. Progression of dementia may have to intervene when an individual ’ s cognitive evaluation ( ACE ) III.! Some states, individuals diagnosed with moderate or severe dementia may then be required referring a... On to the kaupapa phase: driving safety sometimes available through driver rehabilitation programs or state Departments of Vehicles! Should be involved in discussions and decisions about driving: 1 are some signs that person. 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