Driving and dementia: a clinical update for mental health professionals: Table 1

Abstract

Most people with mild dementia can continue to drive, but dementia is progressive and many patients and clinicians will be faced with questions about driving safety in the course of their illness. Determining when this happens is a complex decision, with risks of personal and public safety needing to be weighed against individual patient benefits of driving in terms of autonomy, independence and well-being. Decisions need to make reference to cognitive abilities, as well as other factors including physical comorbidity, vision, mobility, insight and history of driving errors and accidents. Deciding to stop driving, or being required to stop driving is often difficult for patients to accept and can be a particularly problematic consequence of a dementia diagnosis. Legal frameworks help in decision-making but may not provide sufficient detail to advise individual patients. We review the current guidelines and evidence relating to driving and dementia to help clinicians answer questions about driving safety and to consider the full range of assessment tools available. INTRODUCTIONWe are becoming ever more dependent on driving; in 2014 81% of people aged 60-69 years and 62% of those over 70 years old in the UK held a full driving licence.

The impact of driving cessation for people with dementia – An integrative review

“…There are national resources available, specific to individual countries, designed to give advice and guidance to individuals with dementia about driving cessation and the legal processes involved. For example, within the UK, the main sources of information for individuals with dementia and caregivers about driving cessation are from the DVLA, Driving Mobility Centres and also the Alzheimer’s Society (Allan et al., 2016). Nevertheless, this review indicates that people with dementia need more support and direct intervention from healthcare professionals as opposed to simply being signposted and provided links to web based resources or other organisations (Carr et al., 2006; Carr & Ott, 2009).…”

Driving Cessation in Patients Attending a Young-Onset Dementia Clinic: A Retrospective Cohort Study

“…Impairment of certain cognitive domains such as praxis (visuospatial skills) in people with dementia affects driving ability and cessation. A recent guideline on driving and dementia says knowledge of key elements that increase driving risk will help clinicians to have an informed discussion with patients about whether or not it is sensible for them to continue driving [ 2 ]. More research and longitudinal studies are required to determine driving competences of YOD people using driving assessment tools and batteries of cognitive tests.…”

“…Driving is an important instrumental activity of daily living and the preferred mode of transport for many adults [ 1 ], requiring the coordinated engagement of multiple cognitive and motor processes, in particular visuospatial skills, executive function, memory, attention and motor skills. Dementia is associated with a progressive decline across a number of cognitive domains [ 2 ] including those that are critical for driving. Hence, it is not surprising that driving impairments are well known in those with dementia [ 2 , 3 , 4 , 5 ].…”

“…Dementia is associated with a progressive decline across a number of cognitive domains [ 2 ] including those that are critical for driving. Hence, it is not surprising that driving impairments are well known in those with dementia [ 2 , 3 , 4 , 5 ]. Most studies to date have focused on driving performance and driving cessation in later life and late-onset dementias [ 6 , 7 , 8 ].…”

Next steps after diagnosing dementia: interventions to help patients and families

“…34 People in the UK with any severity of dementia require that the Driver and Vehicle Licensing Agency (DVLA) and vehicle insurance company are informed, and it is the clinician’s professional responsibility to explain this. 35 If the person is obviously unfit to drive, they should be told this unequivocally and helped to surrender their licence immediately, or the clinician should inform the DVLA on their behalf if necessary. In other circumstances, it is best to reflect with the person on the benefits and risks of driving and to emphasise the legal requirement rather than express a personal opinion on their safety, especially as clinicians are generally poor at predicting this.…”