Thursday, April 15, 2010

Aging, Dementia, and Driving. When to Turn in the Keys?

A new study by the American Academy of Neurology has issued guidelines to help determine when people with Alzeiher's Disease and Dementia should stop driving. “While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving,” said lead guideline author Donald J. Iverson, MD.

However, as Paul Span writes in the New York Times, these guidelines are not as clear cut as we would hope they would be. While the study states that those with Dementia will ultimate have to stop driving, it also cites many studies that show those with mild dementia can often still pass driivng tests.

So do we worry about drivers with dementia, or not?

The researchers recommend that caregivers and family members should "trust their instincts." If the person with Alzeheimer's Disease seems to be showing some of the warning signs that the study presents, then they should bring it up with the person's doctor.

Dementia isn't the only issue to think about with aging drivers. Weakened vision, hearing, and slower reaction speeds are all normal effects of aging in the healthiest people. By 2030 the US will have an estimated two-thirds more older drivers on the road than we do today. How do we prepare for this change?

One way to prepare is to re-test older drivers to refresh their skills and find those drivers who are no longer safe to drive. The AARP offers
an online driving course for older drivers. Taking this course can help older drivers refresh their knowledge and skills, as well as receive discounts on their car insurance rates.

The laws on retesting older drivers differ by state, but very few require seniors to take a road test. Some states require seniors to come into the DMV for an vision test, and others allow seniors to send in verified documentation of an eye exam.

And then what of the seniors who fail their tests are deemed unfit to drive? Limiting the use of a car can severely restrict older people's ability to get around, especially in rural or remote places. They can't necessarily negotiate a long walk, and
the limits of public transportation can be too cumbersome to bear. This means that basic means for living, such as visits to the doctor, grocery store, bank, etc are all limited by lack of transportation.

There are senior-specific public options that are meant to help seniors get around at a low cost. New York's federally-mandated Access-A-Ride is one option, but this program can be glitchy, with long waiting times.

With driving or public transportation, getting around for the older population seems to be troublesome either way. If we are going to be more stringent on limiting senior drivers, then we must couple this with expanding public transportation options that are both convenient and affordable.

1 comment:

  1. Driving is often a top concern for family members caring for someone with mild dementia. With the diagnosis of dementia, the day will come when it will no longer safe to drive. In the early stages, however, some people are capable of handling driving responsibilities, generally with agreed-upon limitations and family involvement.

    It is important that family caregivers discuss driving with their loved one soon after the diagnosis. Even if driving can continue safely for a short period of time, gradually transitioning a loved one from driver to passenger must begin. In time dementia will rob the driver of skills necessary for safe driving, as well as the insight to understand when driving is no longer safe. Family caregivers can help by becoming informed about the warning signs of unsafe driving, observing the driving of the person with dementia and being supportive by providing transportation. Balancing the need for independence and safety isn't easy, and such decisions can significantly impact family members and caregivers.

    For over 10 years we have conducted research with our partners, MIT AgeLab and the Boston University Alzheimer's Center, to develop resources that can help caregivers and other family members make informed and sensitive decisions about driving.
    Based upon our research we created the guidebook At the Crossroads: Family Conversations about Alzheimer's Disease, Dementia and Driving.  To download or order your free copy of At the Crossroads go to

    Beth Tracton-Bishop, PhD
    The Hartford