Driving a car provides individuals with independence, freedom and quality of life. In the past, it was suggested that a diagnosis of dementia indicated the need to stop driving immediately. However there is now sufficient evidence to suggest that not all persons with dementia are hazardous drivers, and that some may continue to drive with regular re-evaluation.
Current method of driving assessment in Ireland.
A study published in the Irish Medical Journal in 2015 surveyed the experiences of 125 GPs in assessing ability to drive for those with cognitive impairment across Galway, Mayo and Roscommon. The study found that over ¾ of the GPs surveyed in the study said they referred on to other services for specialist assessment when dealing with the difficult decision of certifying a patient as fit to drive. This is in line with new guidelines published by the Irish Road Safety Authority (2016) which state that “decisions regarding fitness to drive (in patients with dementia) should be based on medical assessment and further specialist assessment by an occupational therapist…”
Dementia & Driving Ability
With dementia, one or more complex cognitive functions (brain functions) required for safe driving may be affected:
- Visuospatial perception
- Attention and concentration
- Insight and understanding
- Adaptive strategies
- Reaction time
- Planning and organisation
- Ability to self-monitor
- Muscle power and control
Research studies suggest that an elderly person who no longer drives is less likely to receive the services they need and more likely to enter a nursing home. Therefore the decision should not be taken lightly, especially in rural Ireland where so many rely on driving for independent living.
Able Ageing Off-Road Driving Assessment
The Nottingham Assessment for Drivers with Dementia (NADD), developed as part of a research study conducted at the University of Nottingham, is recognised as the most reliable method used in clinical practice to determine safety to drive in those with dementia. The NADD was developed as part of a research study investigating the effect of cognitive impairment on driving. Patients who had a diagnosis of dementia and were driving were referred to the research study and were asked to complete a series of cognitive tests and an on-road assessment. Their results were compared to a group of participants without dementia who were given the same tests and instructions. Several cognitive tests were identified (which form the NADD), that correctly classified 88% of drivers with dementia as safe or unsafe to drive. Additionally, this result was confirmed by independent researchers to ensure its reliability.
What does the NADD involve?
The NADD comprises of a series of time limited tasks such as pictorial traffic problems (see below), various written memory tests, speed tests, and visual-perceptual tests. Clients are encouraged to attempt tasks and persevere when encountering difficulties and no feedback about performance is given until the very end. The test is completed in a quiet room with client and therapist seated at a table where we take the time to build rapport to reduce the impact of potential performance anxiety.
The purpose of the NADD is to determine whether or not a client is likely to be safe to continue driving. The NADD is used in conjunction with the therapist’s clinical judgement on individual circumstances. It is not intended to provide a final decision on safety to drive – the client’s GP has the ultimate authority to certify somebody as fit to drive.
How is this different to a standard driving test?
The standard driving test is about assessing the practical skills necessary for safe driving on the road where an approved driving instructor assesses a learner driver’s suitability for a full driving licence. The NADD, on the other hand, helps to determine whether an already licenced driver is fit to drive based on the assessment of specific brain functions which may have deteriorated in those with dementia. As mentioned, the NADD has been shown to correctly predict on road driving safety in 88% of cases. However, if a client fails the NADD it is possible to complete an additional on-road assessment. It is at our sole discretion whether we feel it is in the client’s and public’s best interest for an on-road driving assessment to take place. This decision is based on performance on the NADD and various other factors which will be discussed in detail.
Able Ageing On-Road Driving Assessment
This assessment is for qualified fully licenced drivers who may have failed the NADD and have been deemed appropriate for further assessment by the client’s therapist. It includes a range of driving situations such as high and low speed zones, controlled and uncontrolled intersections, and parking and manoeuvring. An on-road assessment should last for 45 minutes in duration and longer if required. It may be shorter if the therapist considers it unsafe to continue. The drive will include situations that normally faced when driving in the client’s local area but if relevant may also include motorway or dual carriageway driving.
As health care professionals who emphasize participation in daily activities, Able Ageing want to ensure that individuals are given every opportunity to enjoy the independence and freedom associated with driving for as long as possible. From a legal perspective, we are also responsible for ensuring the safety of all road users by making sure drivers have maintained the skills necessary for safe driving.
Our overall aim is to:
1. Ensure the safety of our clients on the road
2. Ensure the safety of other road users
3. Reassure clients and their families
4. Assist the GP in making an informed decision regarding somebody’s ability to drive
Occupational therapists have the science-based knowledge to understand progressive conditions and life changes that can affect driving. Because we take the time to understand the role that driving plays in our clients’ lives, we are in a position to help individuals make a smoother transition to using other forms of transportation if deemed unsafe to drive. In doing so, we want to help our clients to maintain their autonomy and independence.
Please contact us if you would like to discuss a particular patient’s needs or suitability for assessment. If referring a patient to our service, please provide a medical history by forwarding to firstname.lastname@example.org. Thank you.