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.