Steering to safety
New ways needed to assess who should be behind the wheel and for how long
HELEN HENDERSON
- Toronto Star - August 1, 2004
Should anyone over the age of 65 be behind the wheel of a car?
This month a Kingston neuropsychologist published some numbers that shocked a public already hypersensitive to reports of seniors involved in motor vehicle accidents.
Based on his recent study published in the Canadian Journal Of Psychiatry, Robert Hopkins estimated there are at least 45,000 drivers with dementia on Ontario roads today. He also forecast that number would increase to nearly 100,000 by 2028, emphasized that the system for detecting drivers with dementia is inadequate and called for better ways to assess older drivers.
Anyone unnerved by Hopkins' report will be glad to know a nationwide group of researchers is already on the case. Led by researchers at the University of Ottawa, they're looking at everything connected with driving and seniors — from the effectiveness of training programs to possible licence restrictions.
But one thing has been clear from the start: The issue is not age. The issue is physical and mental ability and how to measure it accurately.
The Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE) wants to develop a scientific screening process that will allow doctors to identify older drivers with physical or cognitive problems that should prevent them from driving.
The group, which gets its main funding from the Canadian Institutes of Health Research, aims to "improve the health, safety and quality of life of Canada's older drivers." In so doing, it will be building on a number of existing, carefully thought-out guidelines to help families and doctors address the issue.
"It's a huge undertaking," says Dr. Anna Byszewski, an Ottawa geriatrician and a member of CanDRIVE. "But the scientific approach is key."
Byszewski also chairs the Mini Task Force on Driving, a joint effort by the Dementia Network of Ottawa-Carleton and the regional Geriatric Assessment Program. The group's website offers a driving and dementia tool kit to help doctors counsel patients and their families.
The idea stemmed from the questions Byszewski found she was fielding regularly from family physicians looking for help. It offers strategies for addressing the issue without jeopardizing the doctor-patient relationship.
Researchers agree that assessing the physical and mental abilities of an aging baby-boom generation is clearly going to be difficult.
Statistics from the Canada Safety Council and the Insurance Bureau of Canada show that:
* So-called "young seniors," aged 55 to 70 are among the safest drivers on the road. But somewhere in the early 70s, a correlation begins to emerge between age and health conditions that can affect driving.
* These conditions include reduced vision, particularly at night, decreased depth perception, decreased range and speed of motion, and changes in decision-making abilities.
* Most drivers over 65 drive only a few times a week for shopping, health care appointments and social get-togethers. The majority of their trips are short and the total distance per day averages 11 to 17 kilometres. They avoid busy highways as well as rush-hour and night driving.
* Still, over the years, road fatalities have dropped significantly in all age groups except 65 and over. Based on kilometres driven, older drivers have more collisions than any other age group.
And what about the dementia issue?
The driving and dementia website notes that research in both Canada and the U.S. confirms that people with Alzheimer's who continue to drive are involved in more accidents than other drivers.
One U.S. study compared 30 drivers diagnosed with Alzheimer's with 20 healthy control subjects of the same age over a five-year span. It showed that the people with Alzheimer's were involved in five times more crashes than the control group.
Still, Byszewski and others caution that numbers don't tell the whole story.
Hopkins' extrapolations, for example, may indicate the number of people with dementia who have drivers' licences but they do not tell us the number of people with dementia who are actually driving, Byszewski says.
Nor do they take into account the stage of the condition individuals are at, adds Lynn Moore, director of public policy for the Alzheimer Society of Ontario.
While Moore emphasizes that Ontario must recognize and prepare for a steep increase in the percentage of people with dementia as baby-boomers age and modern medicine improves the outlook for their physical health, she also emphasizes that dementia is a progressive illness.
"Not everyone who has been diagnosed is at the same stage," Moore says. "There are so many myths and stereotypes about dementia. In fact, it's no different from something like cataracts in that there's a slow progression from the initial symptoms."
One of the main goals of the five-year CanDRIVE research program is to find accurate ways of measuring the extent to which physical and mental conditions affect the ability to drive.
Until their report is in, Canadians will have to rely primarily on the judgement of families and family doctors. It's a difficult assignment.
As the Alzheimer Canada website puts it: "The loss of freedom to come and go as one pleases can have a devastating effect on a person. The person with Alzheimer Disease may have been the only driver in the household. Also, many communities lack alternative forms of transportation; and, where alternative transportation is available, it may be expensive or inconvenient."
Both Alzheimer Canada and the driving and dementia tool kit have many good suggestions. Among them:
If a person has a diagnosis of dementia but is still able to drive, they suggest planning ahead by looking at the most important areas in which driving plays a role — for example, getting to medical appointments, shopping or meeting friends.
Once those have been identified, take a look at alternatives such as public transit, services offered by community organizations or transportation organized by family and friends.
Throughout the course of the disease, they recommend driving ability be closely monitored. When the time comes for a decision to be made, they suggest looking into local driving assessment facilities and enlisting the help of a trusted adviser or doctor.
The Alzheimer Society says: "It might be helpful to soften the presentation by blaming the person's vision, reduced mobility, or other `acceptable conditions.'
"Some caregivers may be surprised to find the person relieved to relinquish the responsibility of driving. Others will find the person depressed or angered. Regardless of the reaction of the person with the disease, once the decision is made, it must be firm and non-negotiable."
What can you do if someone with dementia still refuses to stop driving?
"Try parking the car out of sight, perhaps in a neighbour's garage or driveway," the Alzheimer Society suggests.
"This may lessen the person's frustration at seeing the car but being unable to drive it."
It also suggests hiding the car keys or asking a mechanic to install a "kill switch" to prevent the car from being started.
In the long run, the society cautions, "remember that preventing the person ... is an act of kindness and concern. You may feel guilty, but better this than feeling responsible should the person have an accident."
For more information, check http://www.candrive.ca, http://www.safety- council.org, http://www.alzheimer.ca (type "drive" in the Search box and it will take you to ethical guidelines on driving), http://www.rgapottawa.com/dementia, the site for the mini task force on driving for the Dementia Network of Ottawa-Carleton. (The site was developed with the financial help of Pfizer Canada.)
