Straight Talk about Driving, Dementia and the Importance of Mobility
Dize, Virginia, Aging Today
Transportation allows older people to stay connected to family, friends and community, to stay engaged in daily and social activities, to get to medical appointments and to access services such as adult daycare and senior centers.
Such mobility can prevent isolation and even lead to improved physical or mental health. It can mean the difference between successfully aging in place and moving to a facility. Not surprisingly, transportation is one of the most frequent services family caregivers provide to their loved ones.
Transportation and mobility also are crucial for older adults with dementia. Having the freedom that mobility brings can preserve a good quality of life for this population. But family caregivers often agonize about the safety of their loved ones with dementia who are still driving. Taking away the car keys can be distressing - both during the process and in living with the end result.
The impact of not driving can be devastating: more tiian half of older non-drivers stay home on any given day because of lack of transportation options. A 2004 Surface Transportation Policy Project, "Aging Americans: Stranded Without Options," found that older non-drivers make 15% fewer trips to the doctor, 59% fewer shopping trips and visits to restaurants and other businesses, and 65% fewer trips for social, family and religious activities.
WHERE TO TURN FOR HELP WITH THE "DISCUSSION"
That doesn't mean it's safe to allow elders with dementia to drive. When considering what actions to take, family caregivers might consider the advice offered in Driving Transitions Education (www.nhtsa.gov/DOT/NHTSA/Traf fic9c20lnjuryo20Control/Articles/Asso ciated9e2oFiles/8i 1 1 52.pdf), which includes the following:
* Involve the older adult in the discussion;
* Focus on the older driver's functional capacity rather than age or disease; and
* Identify ways to ensure safety and driver remediation.
Before beginning any discussion about driving transitions, remember that age doesn't necessarily make someone a bad driver. Consider that there might be other workable options for elders besides giving up driving. Family caregivers should not try to approach the issue on tìieir own, but ask for help from others.
Contact the Department of Motor Vehicles for your state's specific requirements ,and to identify any available assistance. State drivers license renewal procedures vary, although it's common to be required to renew a driving license in person and to pass a vision test. Applicants' driving records are also checked to ensure there are no suspensions or revocations.
Twenty-seven states and the District of Columbia have additional requirements for older adults ranging from accelerated renewal cycles beginning at age 65 or 70 to vision and road tests (Insurance Institute for Highway Safety, www.iihs.org). Another resource is the family physician, who might be willing to discuss driver safety with the patient and make a recommendation.
The American Medical Association's 2010 release of a new "Physician's Guide to Assessing and Counseling Older Drivers" (www.ama-assn.org/ ama i/pub/upload/mm/433/older-driv ers-chapteri.pdf) encourages family doctors to include driver safety as a routine part of office visits for older patients. Having the driver assessed by a Driver Rehabilitation Specialist, typically an occupational therapist who has received special training on assessing and improving driving skills, is also useful, especially in the early stages of dementia. (Check out two recent publications of the National Center on Senior Transportation, "For the Aging Network" and "For the Mature Driver," at www.seniortransportation.net.)
MOBILITY PLANS ARE KEY
Unfortunately, family conversations about giving up driving too often take place after a near miss or car accident has occurred. Given the negative impact being unable to drive can have, family members should pay special attention to transportation and mobility issues as tliey plan for homecare and other supports. …