August 8, 2003
Last month's tragic accident in which an 86-year-old driver plowed his car through a crowded pedestrian mall in Santa Monica, California, killing 10, threw into the spotlight once again the issue of the safety of older drivers. Of particular concern are those with Alzheimer's disease and related forms of mental decline that can impair judgment, attention and the processing of information essential to good driving.
The American Medical Association and the National Highway Traffic Safety Administration recently issued in-depth guidelines that doctors can use to assess and instruct seniors on driving safety. Among their top medical concerns for those behind the wheel was dementia, the most common form of which is Alzheimer's. Medications, failing eyesight, and declining muscle function were also cited as concerns for older drivers.
Driving safety is an issue for any older driver. Per mile driven, the accident rate is nine times higher for those 85 and older, compared to younger drivers aged 25 to 69. If someone has failing cognition due to early Alzheimer's or other forms of mental decline, the likelihood of a car crash is much greater.
Yet imposing driving restrictions can be hard for anyone to accept. Driving affords older people a coveted sense of independence and connection to the wider community at large. Taking away a license can be devastating to self-esteem and make life more difficult for seniors and family members both.
Alzheimer's of Special Concern
Alzheimer's disease is of particular concern, the AMA notes, because patients may be unaware of their progressive mental decline and the threats they pose on the road. Unlike someone who has a condition such as failing eyesight or arthritis, for example, who often cuts down on his or her own driving voluntarily, a patient with Alzheimer's may stay behind the wheel longer and drastically misjudge their ability to continue driving.
In the case of Alzheimer's, it often falls on caregivers to assess the driver and enforce a driving ban. It is particularly important that family members look for any signs of mental decline in loved ones and discuss concerns with a physician.
Family members and doctors also need to counsel the patient to prepare him or her for stopping driving and get them to accept a "no driving" status.
Among the group's recommendations:
Some drivers in the early stages of Alzheimer's may be competent to drive, even if they have been diagnosed with dementia. The decision whether to impose a driving ban should depend on a careful assessment of a driver's ability. If a driver poses a threat to himself or others, a ban must be imposed.
Detailed Assessment. Family members should provide the doctor with detailed information about any problems relating to driving as well as memory, judgment, attention and visual and spatial abilities. When appropriate, patients should be included in decisions about current or future driving restrictions.
Ongoing Testing. Doctors should perform thorough and regular exams to assess the patient's skills and abilities and conform to state and local restrictions and laws. A driver rehab specialist can conduct an on-road driving test of an older person with impaired mental functions to assess his or her abilities to continue driving.
Transportation Alternatives. Physicians and family members should plan early for those with progressive dementia to use public transport and alternative transportation options, such as buses, taxis, trains, senior shuttles, and rides from family and friends. Your local Area Agency on Aging may also be able to help. [See the alzinfo.org Meta-Search function to find help in your area.]
For more on Alzheimer's and driving safety visit www.ALZinfo.org.
By Toby Bilanow, Medical Writer for www.ALZinfo.org. The Alzheimer’s Information Site. Reviewed by Samuel E. Gandy, M.D., Ph.D., Chairman of the Scientific Advisory Board, Fisher Center for Alzheimer's Research Foundation.