In the American society, driving a car remains the method of choice for meeting transportation needs and this applies to older adults as well. As we age, the potential increases to develop cognitive impairments that can negatively affect driving safety. There is no universal method to assess an older persons driving ability and regulations for addressing driving concerns vary dramatically from state to state.
For many older drivers, maintaining their driving independence is central to their overall independence and allows them to remain in their current home and community. Losing this ability is often a major factor facilitating a transition to a less independent environment (assisted living, moving in with family members, etc.)
Drivers with Dementia have “at least a 2 fold greater risk of crashes compared with cognitively intact older adults … and the risk of a crash for the drier with Alzheimer’s disease appears to increase with the duration of driving after disease onset.” In addition, studies have shown that drivers with “mild dementia” were able to pass a formal road test.
The initial assessment of at-risk driving behavior can be initiated by asking questions of caregivers. These may include:
- Has the patient had any motor vehicle crashes?
- Has the patient had any near misses?
- Has the patient had any tickets?
- Has the patient been pulled over by police?
- Have you noticed a change in the patient’s driving behaviors?
- Has the patient had difficulty staying in a lane?
- Does the patient have difficulty following the rules of the road?
- Do other drivers honk at the patient?
- Are there scratches on the vehicle?
- Has the patient gotten lost in familiar areas?
- Is the patient vigilant in scanning for vehicles/pedestrians?
It is important that clinicians and health professionals understand both their legal and ethical responsibility to report concerns regarding older drives to their respective State’s Department of Motor Vehicles.
It is typical for clinicians and/or family members to suggest to an older driver that they drive with a “co-pilot,” but there is little data to validate the effect that this has on driving ability. Another commonly used tool is to recommend limiting driving times, distances, night driving, etc. Many times, older drives have already begun to self-limit their driving.
“The American Medical Association’s Code of Medical Ethics on impaired drivers and their physicians states, ‘in situations where clear evidence of substantial driving impairment implies a strong threat to patient and public safety, and where the physician’s advice to discontinue driving privileges is ignored, it is desirable and ethical to notify the [DMV].”
There are many resources available to assist clinicians, family and caregivers in addressing this issue with an older driver. Many of these are listed on our website under the “Resources” tab then by clicking “Industry Resources.”