Wednesday, February 07, 2007

Impaired Driving


One of the most difficult things the team on our Geriatric Assessment Unit has to do is to advise a patient that they are too impaired to drive. Cars are necessary in our society and owning a car is an essential vehicle for independent living. Many of the elderly recognize when their mental and physical skills are deteriorating. They will take the initiative to stop night driving, highway driving and driving in rush hour traffic. Others take only familiar routes to the grocery store, bank, church or doctor’s office, but may get lost if there is a detour. When someone has had a good driving record, perhaps no accidents for 40 or more years, they cannot believe they may have a problem. There are poor drivers in every age category, but what makes a good driver become a risk to the point where their license needs to be revoked by a physician?

One of my recent patients had been experiencing memory and judgment problems that were noticeable to her family for about three years. She came into hospital with a broken hip from a fall she suffered when she could not see a step in a store. In hospital, her routines were changed and her impairments became even more noticeable. She was given a full psychology work up a couple of months after her surgery (anaesthetics and pain medications can cause temporary delirium and cognitive impairment). On the basis of her test results, the doctor contacted the Ministry of Transportation to have her license revoked. The patient could not comprehend why this was necessary and she paid $500.00 for a re-test at a driving assessment centre. She failed her written and road test, missing red lights on the practice course and showing great difficulty in judging distances. I visited her at home the next week and because of her dementia, she still did have insight into her problems. She was still driving to do her errands because her family had not taken the keys or the car away.

For every person we identify on our unit, there are probably twenty more that are driving regularly with significant impairments. I followed the car above for a few blocks and watched as the elderly lady narrowly missed sideswiping several cars parked on the road. She stopped at green lights and seemed unsure of where she was going, demonstrating the classic symptoms of dementia.

Yesterday, in spite of cold temperatures, I had to go to a car wash remove the salt from my vehicle and to dislodge the ice in my wheel wells. It was so cold, the water froze on contact with the metal and the entire vehicle was covered in a layer of hard ice. I drove off quickly because of the line up and my view through the windshield was much distorted. I imagined that this would be how some people perceive their environment when vision deteriorates and the brain ages.

Driving with any impairment, whether it is icy windows, alcohol, drugs (even legal ones), fatigue, distraction of any kind, illness or dementia, is something we all need to avoid. And families need to communicate their concern in a loving way when they see an elder showing dangerous signs of decline.

9 comments:

  1. You are so right--giving up the privilege of driving is one of the hardest transitions for anyone, especially our senior citizens.
    In a prior job, I was liaison to our Department of Transportation and its medical advisory comittee that ruled on such cases. People were always irate--how dare you take away my right to drive. That's it--people think it is a right, not a privilege.

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  2. Ruth, we have faced this in our family. It's very saddening for our elders. Two years afer my Dad's sroke, he insisted he could drive safely, but being wheel-chair bound for so long, he soon forgot his desire. So sad. But I am very saddened to hear your older lady patient paid $500 for a re-test...when she might have needed he money? My husband's younger sister took the car keys away from her Dad and sold his car...a very wise move on her part but he adjusted to that decision very well, I think.

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  3. One of the toughest things we ever had to do was to tell my Dad that he could no longer drive. He'd been driving since age 13 and it was painful for him. He slid into a depression and said it was just one more piece of his life that he had to hand over. I know it was the right thing for us to do but it still makes my heart ache 5 years later.

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  4. Taking away the car keys is one of those "you no longer know what is best for you and others" moments that we'll all face. Because I'll have no one to do that for me, I suppose at some point, husband and I will just have to decide to sell the cars and move to a retirement center where they will cart us around safely. It's such a sticky wicket, but one that is necessary to keep everyone safe.

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  5. KGMom- I know it would (will) upset me to give up my license. I am sure you have some interesting stories to tell about your previous job.

    Mary- It is sad to see a parent decline, but so important to be there for them. As far as the $500, this lady showed impairment in handling money. She was so vulnerable, but when we talked to her family, they would not intervene.

    Lynne- Our elders need to have a role in their families and community, and as they become more dependent, depression is common. The reversal of parent-child roles is very difficult, as you know.

    Jayne- Some people never contemplate the eventuality of change and then they resist the inevitable. I know very capable 90 year olds who drive well. I wish that for you!

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  6. Um...somewhat unrelated to the post itself but I really like the pic that you used for this post. It was very effective :)

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  7. Thanks Becka, Your crazy mother tried to drive home with that view. I did pull over and de-ice the window. I took the picture when I was stopped!

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  8. Ruth - working on the Geriatric Assessment Unit with you has taught me that we have so much power over our vulnerable patients, and it would be easy to abuse that power in making crucial decisions about people's lives, such as when to recommend to a physician that a person should have their driver's license revoked. I see some staff members on the unit making "snap judgments" about patients and sharing those judgments with other staff members before they have even met the patient. The best we can do is try to keep our biases in check, be mindful of them, and strive to obtain evidence through testing and interviewing with family members and friends regarding a patient's capability to complete any task, whether it be driving or taking medications or living independently in the community safely.

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  9. Jim- Welcome! and thank you for your insightful comments. I think we need to think of ourselves in the patient's place and treat them like we would want to be treated...fairly and compassionately. Your caring attitude is a good example to the rest of us.

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