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 disease progresses.

• People with dementia often underestimate the impact of their condition on their driving skills.

• It is vital that the patient’s driving status is established sensitively early in the disease process by asking both patient and family. For example the ‘grandchild question’ – would you let the patient take your grandchild out in the car?

• However it can be extremely difficult to assess driving ability in those with dementia 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 dementia2) In early dementia, where sufficient skills are retained and

progression is slow, a license may be issued subject to annual review by the DVLA.

Driving Assessment

• If a practical assessment of driving is required referral can be made by primary 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 2.5 hours, beginning with table top cognitive function tests, then a static car mock up, moving, if appropriate to a dual control car and road driving.

• The findings of the assessment are discussed at the close and recommendations made in writing.

AuditI carried out an audit of patients in our practice on the Dementia register to ascertain how many had at least had a discussion about driving at some point in their medical assessment.

MethodsReview of the paper and electronic notes of patients on Rosemount Medical Group’s Dementia Register.

ResultsOf 20 patients on our current dementia register 9 (45%) had had driving status documented and discussed.

GP notes 3 patientsRCH letter 4 patientsPDSC letter 2 patients (Post Diagnostic Services Clinic)

Recommendations• Driving status could be added to information required when referring patients with

possible dementia to ensure that the subject is raised early and avoid the assumption that others have covered the issue.

• Follow up by the multidisciplinary team regarding both driving status and compliance with advice given is extremely important

• The University of Newcastle has produced some excellent work in this area (see algorithm below) and has a useful online patient information leaflet ‘Memory Problems and Driving’.

• This highlights the legal obligation to inform the DVLA & the importance of informing their insurance company. It also covers questions such as ‘how long can I continue to drive?’, advice about reducing risk when driving and helpful comments on the decision to stop driving and what to so when that decision has been made.

ReferencesScottish Driving Assessment Service, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh EH9 2HLDriving and Dementia pack, Newcastle University 2013 www.ncl.ac.uk/driving-and-dementia

Driving and Dementia: www.alzheimers.org.uk