By Dr. Beth Hodges
A license to drive is a main source of independence to many Americans. Losing it can range from an inconvenience to loss of the ability to continue to maintain a separate household. Here are some steps you can take to help your early dementia patients and their families determine if it's still safe to drive.
What to Ask Patients and Caregivers
When a provider suspects or simply wants to ensure that driving in an early dementia patient is still safe, it is a good idea to elicit feedback from the patient and caregiver. Have there been any recent auto accidents? Has the patient gotten lost on the road recently? Ask the caregiver if he or she has noticed any driving issues, such as missed traffic signs or agitation while driving. Is the patient driving at the appropriate speed?
Some occupational therapists can offer driving evaluations if there is a truly borderline case. Be aware, however, that this is usually not a covered service by insurance and may require out-of-pocket payment.
I frequently enlist my office staff to observe a patient arriving or leaving the office. My receptionists have an excellent view of our parking lot and are quick to let me know if they see a patient driving erratically.
How the DMV Can Help
If the family is on board with the removal of driving privileges but the patient is not, you can write a brief letter to the Raleigh office of the Department of Motor Vehicles stating that the patient is felt to not be safe to drive, and why. The DMV will then issue a document to the patient by mail, stating that a medical form needs to be filled out by the Primary Care Provider. They do not tell the patient that there has been a report of them as being unsafe to drive. If the patient does not bring the forms to the PCP to be completed, he or she will automatically lose their license in 60 days. The form requires the PCP to mail or fax directly from their office, so if you prefer, the patient will never know exactly what you wrote. Of course, I recommend honesty with the patient and family whenever possible.
If the family is on board, you can circumvent this process by having them take the keys or disable the vehicle. A mechanic can add a “kill switch” which has to be tripped prior to the vehicle starting.
Some families are surprisingly resistant to this conversation, either because of not being able to understand Grandpa’s limitations or out of fear or dread of how making Grandpa more dependent on them will change their own existence.
The Importance of Being Proactive
Unfortunately, I have a dozen tragic but true stories about dementia patients and traffic accidents that I can share with families to help them understand the dangers. It is not fun to be “the bad guy” in these conversations, but remember that most of our dementia patients would not want to be responsible for the death or injury of another, and it only takes one second for something horrific to happen. So be proactive. Who knows, it might be your own family you save.
Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.