Who’s Driving Who?
recent NY Times Ethicist piece “Nursing Home Pitfalls,” raises crucial issues in
the area of geriatric ethics.” How far
should we go in order to protect a person with dementia from herself and others?
As a geriatrician I am regularly asked by family members and loved ones what to
do about a variety of problems that are usually only seen in persons with
dementia. One of the most troubling conundrums is in the area of driving
The evaluation starts when a new patient arrives with a loved one for an
initial evaluation. The presence of the loved one is my first clue that there
may already be a problem with memory. When, despite my best efforts to direct my
questions to the patient, the loved one answers, I realize that memory and other
functions related to overall intellect are going to be an issue.
As I ask the patient to move into the exam room so my assistant can
prepare her for a physical exam, the loved one motions for me to allow a few
private moments without the patient in the room. “She keeps asking me the
same questions over and over again. Her
car is covered in dents. Should she still be driving and how do I get her to
stop?” The fact that the loved one asked
this question leads me to believe that the answer is “No.”
There are companies that will perform a
driving test that can be helpful, IF the patient will allow herself to be examined. If not… it is more difficult. Even if they have still retained the skills of driving, being able to safely navigate to their destination and home may be diminished as the dementia progresses. Sometimes removing any cues for driving such as the keys or the car sitting in the driveway will help. We know of one man who was no longer a safe driver being adamant about continuing to drive whenever the topic was discussed. The family removed the car to get it “fixed” and in a few days driving was forgotten. Taking away the keys and removing the car seems drastic but
can be life and face saving.
In addition to cognitive abilities, sensory and motor function need to be assessed also. Vision and hearing losses make driving more risky. Slowed reflexes and weakened motor function also pose safety issues. Medications should be monitored for side effects that could hamper driving such as dizziness caused by low blood pressure. Once an elder says he or she is cutting down (no nights, no bad weather, no highways, no left turns, not too far), a thorough evaluation of driving skills is in order.
Having some plans in place for how the elder will get around is important as the transition occurs. Public transportation may no longer be a safe alternative but elder rides provided by some social service agencies and family/friend support can fill the gap. Proactively, when seniors are contemplating downsizing, moving to warming climates, or moving to be near family, the availability of needed services within walking distance, delivery services, and public tranportion should be factored into the decision.