" There is still a lack of information and understanding around what is required by people who have a diagnosis of dementia and who hold a driver’s licence. "
Mandatory reporting should be considered to ease confusion around driving and dementia

Mandatory reporting for health professionals to transport licensing authorities for conditions including dementia should be considered to ease confusion around the legal and licensing requirements when it comes to driving and dementia, a new discussion paper has found.

The discussion paper, Driving and Dementia, released by Alzheimer’s Australia NSW, has found that there is still a lack of information and understanding around what is required by people who have a diagnosis of dementia and who hold a driver’s licence, little clarity around the role of doctors in this area and a lack of information and support regarding alternative transport options.driving-and-dementia-cover

Alzheimer’s Australia NSW CEO The Hon. John Watkins AM said these all combine to make what is already a very difficult time in people’s lives more confusing, stressful and challenging.

“Driving, for many, represents freedom, independence and, for some, plays an important role in the formation of their identity,” Mr Watkins said.

“As people age, driving is often critically important to health care, personal happiness and social involvement. Carers and people living with dementia tell us that giving up a driver’s licence is one of the most challenging aspects of the dementia experience.

“To have the possibility of having your driver’s licence taken away, particularly after you’ve been given the devastating news that you have a diagnosis of dementia, can make an already highly stressful situation worse.  The confusion and lack of information about what is legally required by the person with dementia once they have been given the diagnosis and the lack of information and support regarding alternative transport options for people who have given up their licence, or had it revoked,  can then pile on more stress, uncertainty and confusion.

“Currently, in NSW, once dementia has been diagnosed, a driver has a responsibility to inform the Roads and Maritime Service and their insurer of their diagnosis, but many drivers are not aware of these requirements.

“We need to make this process smoother. We need clearer guidelines and information about just what is required by a person with dementia who holds a driver’s licence once they have been given a diagnosis of dementia and, importantly, we need a much clearer understanding of just what alternative transport options are available to a person who no longer holds a licence.

“The rights and needs of the person with dementia must also be considered in this. Many can continue to drive, albeit with some conditions, and with an annual assessment.

“But access to alternative forms of transport in order to be able to travel to things like medical appointments, the local shops, social gatherings, all those ‘every day’ activities that we all take for granted, is also critical for people with dementia to remain connected with their community.”

With the ageing of the Australian community, this issue is going to become more significant. In 2014, there were approximately 142,000 licence holders in NSW over the age of 80 and approximately 50,000 over the age of 85. It is not known how many of these older drivers had a diagnosis of dementia, but research suggests that the incidence of dementia increases significantly with age.

Mr Watkins said the lack of clarity around driving and dementia means medical professionals continue to be placed in a difficult position.

“At the moment, it is not mandatory in NSW for doctors to report that a patient has dementia to the Roads and Maritime Service (RMS),” he said.

“They only do so if they are concerned that a person with dementia is driving when they should not be. This can place them in a difficult position and can be seen by their patient as the cause, if their licence is revoked, which can impact on their on-going relationship with their patient.

“If reporting is made mandatory, if removes the need for this discretion and takes it out of the hands of the physician.”

Key recommendations from the discussion paper:

  • Consider mandatory reporting for health professionals to the RMS for conditions that are likely to affect public safety;
  • Improve the guidelines for medical professionals to support their role in the transition from driver to non-driver;
  • The NSW RMS to develop a Driving and Dementia information pack for doctors in NSW to issue to patients with dementia at the time of diagnosis. This should include material highlighting the need to consider ceasing driving, the need to check their insurance liabilities and the need to disclose a diagnosis of dementia to the RMS. This material should also be made available to Aged Care Assessment Teams (ACATs), Dementia Advisors and other health professionals;
  • Introduce policies that subsidise the issue of cost and accessibility of on-road driving assessments in order to make the service timely and affordable for people with dementia;
  • Improve the process of driving cessation by streamlining communication between doctors, the RMS and occupational therapists who undertake on-road assessments for drivers with dementia;

A full copy of the discussion paper, along with the full list of recommendations, can be found at https://nsw.fightdementia.org.au/nsw/research.

A copy of a fact sheet with information on driving and dementia is available here.fact-sheet-driving-and-dementia_page-1

There is an estimated 115,000 people with dementia in NSW, which is expected to grow to 272,000 by 2050[1].

[1] Alzheimer’s Australia NSW and Deloitte Access Economics, August 2014

 Posted: November 9th, 2016
Discussion

Jeff said:

My wife, Wendy, drove for a little after she was diagnosed with dementia and I didn't realise how much driving skill she had lost until I rode with her. She demonstrated that she had no idea of the speed she was driving at, which was quite high, she had no conception of depth which made it very difficult to park and she had no judgment of distance which had her braking at the very last moment and narrowly missing other vehicles. It was the most horrendous ride I have ever experienced. After this experience I then drove her to whatever destination she required and she never drove again. When it was time for her licence to be renewed it was my decision under enduring guardianship to have her licence cancelled.

AbrarAhmad said:

Let me briefly tell you that there are multiple forms of dementia - alzheimer’s disease being the most common one that accounts for 40 to 75% of dementia cases and is the sixth leading cause of death in United States. Additionally, dementia and its types have common signs with some variations. Let’s start with the most common signs of dementia most commonly seen in patients at the early stages of the disease. They start experiencing subtle memory loss, mood instability such as immediate occurrences of maniac (laugh) and depression (sadness) episodes, and have trouble with listening and explaining things to other people, communicational obstructions to be exact. They also segregate their selves from social gatherings and unions, face difficulty in performing daily chores and also experience muscle impairment. Additionally, some people fail to converse with other people because they fail to keep up the pace and comparatively take longer to process the coming words and repeat the same question over and over again. Most of the cases showed that, dementia patients start segregating their selves and start living alone because they could not keep up with the lives of normal people. They just are not up for the adaptation to change. In one of the form of dementia, which is Lewy Body dementia, probable signs appear to be sleeplessness. Patients experience insomnia which leads to mood swings. It has been seen that they fail to keep tracks of roads and lose their tracking skills as well. In case of Alzheimer’s, a patient the most common signs are memory loss and forgetfulness. In some cases, it has been observed that people with Alzheimer’s segregate their selves from others. Additionally, they experience complete memory loss and trouble understanding visual images and spatial relationships, lack the judgement skill and a complete withdrawal from work or social activities. One most commonly observed is the forgetfulness and inability to retrace steps. There is another type of dementia called Parkinson’s characterized as uncontrollable movement of body parts such a shaking limbs and fingers. It has been observed that patients experience writing and speech changes, their ability to respond fails badly and they lose posture and balance. One of the common sign is bradykinesia characterized as slow body movement. One thing to keep in mind before labelling someone as a dementia patient is that forgetfulness and memory loss do no really mean a person has dementia because memory loss and forgetfulness are a normal parts of aging. But if any severity has been observed in these signs, a patient definitely requires a professional advice and consultation. There is no cookie approach to cure dementia but if you observe such changings or signs in your loved ones do not take it for granted before it gets too late. Reference: http://bit.ly/2e5hYgU

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