Driving and Dementia
Dr Gay Daniel, Rosemount Medical Practice, Aberdeen 2014
Background
•Driving and the independence it affords is frequently taken for granted.However it carries significant risks both to self and others.
•Many people with dementia can drive for some time after timely diagnosis.However it cannot be assumed and obviously may change as the diseaseprogresses.
•People with dementia often underestimate the impact of their condition ontheir driving skills.
•It is vital that the patient’s driving status is established sensitively early in thedisease process by asking both patient and family. For example the‘grandchild question’ – would you let the patient take your grandchild out inthe car?
•However it can be extremely difficult to assess driving ability in those withdementia due to variable presentation and rate of progression.
•Guidance from the Driving and Licensing Authority (DVLA) states that:
1) Any person who holds a valid driving license should inform the
DVLA when given the diagnosis of dementia
2) In early dementia, where sufficient skills are retained and
progression is slow, a license may be issued subject to annual review bythe DVLA.
Driving Assessment
•If a practical assessment of driving is required referral can be made byprimary or secondary care to the SMART Centre, Astley Ainslie Hospital,Edinburgh.
•Assessments are now only carried out in Edinburgh or Paisley
•The assessment by a doctor and occupational therapist can take up to 2.5hours, beginning with table top cognitive function tests, then a static carmock up, moving, if appropriate to a dual control car and road driving.
•The findings of the assessment are discussed at the close andrecommendations made in writing.
Audit
I carried out an audit of patients in our practice on the Dementia register to ascertain howmany had at least had a discussion about driving at some point in their medicalassessment.
Methods
Review of the paper and electronic notes of patients on Rosemount Medical Group’sDementia Register.
Results
Of 20 patients on our current dementia register 9 (45%) had had driving statusdocumented and discussed.
GP notes 3 patients
RCH letter 4 patients
PDSC letter 2 patients (Post Diagnostic Services Clinic)
Recommendations
•Driving status could be added to information required when referring patients withpossible dementia to ensure that the subject is raised early and avoid theassumption that others have covered the issue.
•Follow up by the multidisciplinary team regarding both driving status and compliancewith advice given is extremely important
•The University of Newcastle has produced some excellent work in this area (seealgorithm below) and has a useful online patient information leaflet ‘MemoryProblems and Driving’.
•This highlights the legal obligation to inform the DVLA & the importance of informingtheir insurance company. It also covers questions such as ‘how long can I continueto drive?’, advice about reducing risk when driving and helpful comments on thedecision to stop driving and what to so when that decision has been made.
References
Scottish Driving Assessment Service, Astley Ainslie Hospital, 133 Grange Loan,Edinburgh EH9 2HL
Driving and Dementia pack, Newcastle University 2013 www.ncl.ac.uk/driving-and-dementia
Driving and Dementia: www.alzheimers.org.uk