Identifying Unsafe Resident Drivers
As the influx of the baby boomer generation enters the senior living community environment, many will bring their vehicles with them. Warning signs can occur when some of those drivers begin to exhibit signs of early dementia. A diagnosis of dementia does not always mean that the resident is immediately incapable of driving, but cautionary measures should be taken to monitor if and when the time comes that driving is no longer safe.
Provider's must be very careful not to overlook any of the signs of unsafe driving while still respecting the autonomy and lifestyle of the resident. Since dementia can cause loss of memory, limited concentration and sight problems, some signs to look for include:
- Difficulty following simple directions or problem solving – do they become upset and confused when more than one thing happens at the same time?
- Not alert or always aware of what is happening around them;
- No longer able to tell the difference between left and right, or stop and go lights;
- Moodiness with driving – e.g. becomes aggressive or easily angered;
- Getting lost or frequently missing a formerly familiar exit;
- Getting the gas and brake pedals mixed up;
- Having fender benders that cannot be recalled;
- Any visual changes, such as an inability to see the road markers, night driving issues, inability to recognize someone across the street or see traffic signs or lights.
Other physical signs that can impair a resident's driving ability include:
- Stiffness of joints causing inability to raise arms or look back over the shoulder;
- Pain in extremities and/or weakness;
- Impaired coordination (e.g. becoming clumsy and/or walking differently); and
- Dangerously slowed reaction time (e.g. can't turn, stop or speed-up their car quickly when needed).
In addition, medications can have several side effects, which could affect the resident's driving abilities, such as: dizziness, blurred vision, nausea, nervousness, possible jitteriness, lethargy, inability to focus and/or pay attention. Sometimes these medications are temporary or can be changed to ones with less adverse effects, but often they cannot, which poses a danger when driving.
Providers should educate and train their staff to observe and report any sign of compromised driving ability by residents. Unsafe driving is a serious risk, not only to the resident, but to everyone in their path. When caregivers and family members become alert to warning signs, actions must be taken to urge the resident to surrender his or her keys:
- Talk to the resident about your concerns. Be respectful and give specific examples of what has been observed or occurred that has made him or her unsafe to drive.
- Ask family members and trusted friends that share your concerns to join you in the discussion, so it's not perceived as nagging or just being picked on.
- Offer alternative modes of transportation so the resident doesn't have to give-up going to places they enjoy or feel they need to visit.
Some residents will recognize their declining ability and will respond by accepting the fact that they can no longer drive safely and turn in their keys. Others may feel their independence threatened and will resist or refuse to stop driving. For them, it is important to involve a more trusted authority, their physician.
Most residents respect their physician's advice, so it is important that the decision to stop driving be directed by a physician who is trained and experienced in working with people with dementia. Otherwise they may simply rely on whether the resident can pass an on-road driving test, which studies have shown the majority of high-risk drivers with mild dementia can do. Instead, the physician should use useful and reliable tools, such as the Clinical Dementia Rating (CDR) scale, to help identify people with dementia who are at an increased risk of unsafe driving. Information about the CDR can be found at the CDR website. The CDR scale should be used in conjunction with information provided by the caregivers and family members that are concerned about the resident.
The physician should share the results of testing with the resident and encourage him or her to surrender their keys, as indicated. If the resident continues to insist on being able to drive, the provider should seek medical documentation and advice from their legal representative regarding further actions.