Driving and Memory loss
26 March 2014
Dr John Carmody is a Senior Staff Specialist Neurologist at Wollongong Hospital, NSW, Australia. He is Head of the Neurology Department, Clinical Theme Leader for Neuroscience and Mental Health at the Illawarra Health and Medical Research Institute, and is a member of the local Human Research Ethics Committee. In terms of clinical research, Dr Carmody is nearing completion of his PhD studies at the University of Wollongong. This work involves the development and testing of a new decision aid booklet which has been designed specifically for drivers with dementia. It is hoped that this booklet will assist people with dementia plan for retirement from driving in Australia and New Zealand. It is anticipated that the booklet will be made available free-of-charge from mid-2014.
John why did you decide to research Driving and Memory Loss?
I found it hard to know what to say to my patients and harder still to know what to say to carers when addressing the issue of memory loss in the hospital setting. The existing guides were not user-friendly.
John many people who have memory loss have no formal diagnosis, how can they stay safe on the roads?
A greater awareness of memory loss and dementia in our community would go a long way in addressing this issue. An important starting point is arranging an appointment to see your GP.
John what is the best way for families or care givers to address a person's driving if they think it is risky?
There are a variety of measures which could be considered. I would favour contacting their GP, local dementia carer group, Alzheimers Australia 1800 100 500 or Alzheimers NZ 0800 004 001 for advice. At times, families are afraid to raise the issue with the driver. It may be best to let the doctor be the ‘bad guy/girl'.
John, what level of memory loss is it ok to drive? And how does someone know if they are safe to drive?
Some people with early/mild dementia are safe to drive. As dementia is gradually progressive, it is very difficult to accurately determine when someone has become unsafe to drive. Early discussion and planning are important strategies. Retirement from driving is easier when planned rather than forced. Review by a GP or specialist every 6 months is wise.
Dr Petra Hoggarth, what is your experience in this field?
I'm a clinical psychologist and did a PhD investigating factors that predict driving ability in healthy older adults and adults with mild cognitive impairment and Alzheimer's dementia. I currently work at Psychiatric Service for the Elderly at the Canterbury DHB. I work in a day hospital and the geriatric psychiatric inpatient ward where I do therapy for mental disorder. I have an interest in the diagnosis of dementia and do the odd neuropsychological assessment when a complicated case arises (such as a younger-age person, or when a rarer form of dementia is suspected). I've written two published articles specifically for NZ GPs about how to detect unsafe driving in their older patients with a focus on the detection of cognitive impairment:
http://nzbri.org/research/publications/papers/0722.pdf 2013 paper in the NZ Medical Journal
http://nzbri.org/research/publications/papers/0549.pdf 2011 paper in the Australasian Journal on Ageing
It can be a challenge for a General Practitioner to act to stop a person driving. Yet, it is their responsibility. What advice do you have for them?
In regards to the effect of cognitive impairment on driving, once the necessary steps of diagnosis are completed New Zealand GPs have the option of referring for a specialist on-road driving assessment (which for most of NZ is paid for privately by the patient). If the patient fails this the assessor will generally have the hard task of breaking the news. If the decision is made without a specialist assessment then breaking the news can be a hard task. My advice is to remember that driving is a privilege, not a right, and that failing to discuss the issue leaves the patient at a much higher risk of a crash and resultant injury or death than in a non-cognitively impaired older driver. Then there are passengers and other road users to think of also. GPs only need to advise the NZ Transport Agency of the decision if they are concerned that the patient will continue driving against advice. My second piece of advice is to start talking about driving cessation as soon as a dementia diagnosis is given. All drivers with dementia will need to stop driving at some point, and so being clear about this at the beginning and encouraging the patient to think of alternative methods of transportation when that time comes is important. It would be best to involve family in this discussion also.
Dr John Carmody
The responsibility for issuing and revoking driver licences in Australia lies with the local Driver Licensing Authority (DLA). In the Northern Territory and South Australia, health practitioners are obliged to report all unsafe drivers to their DLA. However, in other states and territories, there is no such obligation. A valuable resource for Australian GPs (and all health professionals) is the Austroads Fitness to Drive Guidelines 2012.