6.1.2 General assessment and management guidelines
The approach outlined below is summarised in Alzheimer’s Australia ‘Dementia and Driving Pathway’.
Due to the progressive and irreversible nature of the condition, people with a diagnosis of dementia will eventually be a risk to themselves and others when driving. The level of impairment varies widely – each person will experience a different pattern and timing of impairment as their condition progresses, and some people may not need to stop driving immediately. Individual assessment and regular review are therefore important, although it is difficult to predict the point at which a person will no longer be safe to drive.
A combination of medical assessment (including specialist assessment as required) and off-road and on-road practical assessments appears to give the best indication of driver ability. For further information about practical driver assessments refer to Part A section 2.3.1 Practical driver assessments.
The following points may be of assistance in assessing a person:2
- Driving history. Have they been involved in any driving incidents? Have they been referred for assessment by the police or a driver licensing authority?
- Vision. Can they see things coming straight at them or from the sides? (refer to section 10 Vision and eye disorders)
- Hearing. Can they hear the sound of approaching cars, car horns and sirens?
- Reaction time. Can they turn, stop or speed up their car quickly?
- Problem solving. Do they become upset and confused when more than one thing happens at the same time?
- Coordination. Have they become clumsy and started to walk differently because their coordination is affected?
- Praxis. Do they have difficulty using their hands and feet when asked to follow motor instructions?
- Alertness and perception. Are they aware and understand what is happening around them? Do they experience hallucinations or delusions?
- Insight. Are they aware of the effects of their dementia? Is there denial?
- Other aspects of driving performance.
- Can they tell the difference between left and right?
- Do they become confused on familiar routes?
- Can they comprehend road signs?
- Can they respond to verbal instructions?
- Do they understand the difference between ‘stop’ and ‘go’ lights?
- Are they able to stay in the correct lane?
- Can they read a road map and follow detour routes?
- Has their mood changed when driving? (Some previously calm drivers may become angry or aggressive.)
- Are they confident when driving?
Because of the lack of insight and variable memory abilities associated with most dementia syndromes, the person may minimise or deny any difficulties with driving. Relatives may be a useful source of information regarding overall coping and driving skills. They may comment about the occurrence of minor crashes, or whether they are happy to be driven by the person with dementia.
Transition from driving
Licence restrictions, such as limitation of driving within a certain distance from a driver’s home, may be considered by the driver licensing authority (refer to section 6.1.3). Community mobility assessment and planning with reference to cessation of driving may include family support, accessing local public transport or using community buses, and provision of information regarding taxi and other community transport services available for people with disabilities. A number of resources are available to support the transition. Specific information resources are available through Alzheimer’s Australia for drivers with dementia and their family/carers. Contact the National Dementia Helpline on 1800 100 500 or visit <www.alzheimers.org.au>. Further resources are listed in section 6.1.4 Information resources.
Failure to comply with advice or licence restriction
People may continue to drive despite being advised they are unsafe, and despite their licence being restricted or revoked. This may be because of denial, memory loss or loss of insight. Discussions with the person’s family/carers may be helpful, and alternative transportation can be explored. Where the person is judged to be an imminent threat to safety, all states and territories (except the Northern Territory) provide indemnity for health professionals and other members of the public who notify the driver licensing authority of at-risk drivers; the driver licensing authority will then take the necessary steps.