Driving with Dementia
In my last blog, I concluded that people who develop dementia have got very little effective support available, if they still want to carry on driving, and it often comes down to family members to manage the situation. Not every driver is in a position to call on a family member for help and, therefore, have to try to cope by themselves.
Equally, family members who are keen to assist often don't know where to turn to as this situation can be quite a minefield, which can get more complicated as the illness progresses. Even when it gets to the stage where it is clear that their loved one is no longer safe to drive, they are not always in a position to take clear action to stop the driver getting into the car.
You see, one of the main problems with dementia is that their insight of the danger they pose is gradually lost. At this point, it may not matter how persuasive the family are in trying to get the person to stop driving, as it may not produce the required result. So, we need to ensure that a driver with dementia enters some system of driving assessment at an early stage, and before this happens.
The first guidance a driver diagnosed with dementia needs is that they must report the condition to the Driver and Vehicle Licencing Authority (DVLA). Although this is a legal requirement, many don’t do this, partly through ignorance of the law and partly because they are concerned about losing their driving licence.
On notification from a driver, or third party, DVLA will start a medical enquiry and may do one or more of the following:
Ask the drivers GP for guidance on fitness to drive.
Require a driving Assessment at a Driving Mobility Centre, conducted by an Occupational Therapist and a Driving Assessor.
Require a driving assessment at a Driving Test Centre, carried out by a Driving Examiner.
Require a copy of a recent standard driving assessment report carried out by a Driving Instructor.
As far as I know, the last two are fairly rare and the referral to a Driving Mobility Centre also probably only accounts for a small percentage, meaning the most likely option, by far, is to just rely on the doctor’s opinion.
The DVLA Medical Team will then use this information in their enquiry and, in the absence of any other information, may renew the licence for another 12 months. It is not unknown, however, for drivers to be kept waiting more than a year to find out the results of the enquiry.
This whole situation is clearly not ideal because some forms of dementia can change quite rapidly, which means that a driver that is relatively safe at the time of notification may not be so safe by the time they get a shiny new licence through the post! Furthermore, there is little to stop these drivers driving whilst this enquiry is in progress, unless a doctor or DVLA specifically tells them not to.
DVLA offer guidance to medical professionals on fitness to drive but this is by no means clear cut, using sentences such as ‘in early dementia, when sufficient skills are retained and progression is slow, a licence may be issued subject to annual review’. So, you can imagine that many GPs and even Consultants will convince themselves that they see no reason to tell the patient to give up driving, given the huge amount of resistance they are likely to face if they dare to suggest such a thing. After all doctors are only human!
Of course, it is highly unlikely that a GP will have seen their patient driving, which makes their job more difficult. Some will request a driving assessment by a local driving instructor, but this does not necessarily help much and, in some cases, is likely to create more problems by giving false confidence. A standard Driving Instructor may miss vital signs of concern on an otherwise fairly safe drive, or may not assess on important elements.
Research suggests that about two in 100 people aged between 65 to 69 have dementia, and this figure rises to one in five for those aged between 85 to 89.
There are around 5 million older people who hold a driving licence in the UK so it wouldn’t be too far-fetched to estimate that there may be up to 200,000 drivers who have dementia yet still hold a driving licence. Cognitive impairment can also be linked to Stroke and other medical conditions so this number may well be much higher.
It is likely, from my experience, that no more than 10 % of these are directed by DVLA for a driving assessment at the Driving Mobility Centres, the organisation who act as their agents for this. This leaves huge numbers of drivers, and their families, who are left to manage this potentially high-risk situation without much support. This is where the system needs to change in my view.
Equally, drivers are usually very reluctant to go to Driving Mobility for assessment, even if their doctor advises it. One of the main reasons for this is that older drivers tend to restrict their driving to roads they know well, and in a car that they are very familiar with. They, therefore, don’t see an assessment in an unfamiliar car, and on roads they don’t know, as being fair.
It is unlikely, for one reason or another, that this situation will change much in the near future which leaves the support available for drivers with dementia, and their families, in a situation which is wholly unacceptable. What is badly needed is a form of assessment using knowledgeable professionals, but which is delivered from the drivers’ own home address.
Although this is unlikely to work for the official assessments that DVLA require, of some drivers, due to fairness, consistency and legal constraints, it would be a means of helping the majority and is, therefore, something we seriously need to consider surely?
In the next blog we will look at how this could work within the same system, in order to get a sensible balance between the extremely important need to maintain a level of independence and road safety itself.
It would also help to ensure that those drivers who are becoming unsafe on the road are identified earlier, hopefully before they go on to have one of those catastrophic collisions that grab the headlines or affect public opinion on all the safe older drivers out there.
Hope to see you next time.
Graham Mylward November 2022