Well there's a estimate that by 20 years from now there's going to be almost
98,000 thousand drivers with dementia
on Ontario roads alone. So nationally
we're talking in the hundreds of thousands
of drivers with dementia as time progresses and driving with dementia
can be quite unsafe in the later stages patients'
memory, their reaction times, visual spatial skills and problem solving skills are all
very poor
and pose a great rest to driving.
In most of Canada
and certainly in Ontario there's legislation that says that physicians
must report patients
that have medical conditions that impair their driving ability.
Even international guidelines recommend that
in cases of mild dementia
patients be referred for specialized on-road driving tests
and that's what we try do as physicians. We're mandated to report but we also
when patients are uncertain we are meant to
suggest an on-road driving test but that process is not so easy at present.
Right now as a physician we can certainly ask the patient a lot of questions,
we can test their memory and their reaction time in the office,
but what we can't do is see them drive.
There have been a lot of studies done looking at tests that you can do in the office but
no one test has been shown to accurately predict real-world collision. So you can ask the patient's
opinion
and that's just about as good as chance a lot of patients,
because driving is so important to them, most say they're perfectly fine drivers
even in the late stages when they're causing lots of accidents. Family members do somewhat
better but in a recent study, very experienced neurologists
tried to rate whether someone would pass
or fail a road test on the basis of all available information
and they were able to successfully categorize three out of four.
But that means that one of every four patients they were unable to predict whether they
would safely or unsafely drive. So we are recommending, and certainly internationally the
recommendations are, that we should have an available road test. Un ontario it's
very expensive. It costs about five hundred dollars and it's not subsidized at present.
The physician has a divided duty. The physician has to care for the patient but also protect
society and driving is a
privilege, it's not a right. So we recommend these tests but I believe that it's
unfair that were asking the patients and families to pay for the test and
I don't believe it's fair for the physicians to have to do that assessment when our
tools in the office are very limited.
Our first recommended solution
was to
enhance and make available and affordable
the on-road tests to make them
subsidized by the government or by private insurance survey private car companies
so that's safe drivers can remain on the road and unsafe drivers can be taken off the
road. I'd like to use the analogy that physicians should be able to order a road test
the same as they order lab tests or an MRI.
It should be made that easy. Second of all when people have to give up the wheel we
want to maintain their independence and their dignity
and in order to do that we need elder-friendly driving
alternatives, so for example
in Ontario, in Toronto we often will ask people to take a public mode of transportation
that will privately pick them up.
But it doesn't pick them up at their door. They have to go to the curb,
the time of pickup is unpredictable, unreliable, and the duration is very long.
Other recommendations include educating physicians about the importance of asking their patients
does your patient drive, does your family member drive and what are
the concerns to raise it in the discussion. That's often not being done
and to remind them of the legislation and the guidelines that we need to assess their
driving on the road.
I also think that funding is needed urgently
to develop better office based tools so in the future
perhaps we could find
something in the office to predict
driving ability. We don't have that right now.
We need to study other factors cognitive and non-cognitive that can
predict driving safely and unsafe driving.
Eventually all patients with dementia will become unsafe to drive.
We need to take the patients with mild dementia assess them and then we assess them
overtime every six months at least every year
to see whether their driving becomes unsafe
so this becomes a very practically difficult
situation if we are going to maintain the independence. We want to maintain it
but make sure we're not harming people or harming the public along the way.
I think it's really important that clinicians work together with governments, with insurance,
and with the physician educating bodies and the medical schools
to advocate for
an evidence-based, practical and affordable way of assessing the safety or lack of safety
of elder drivers who have dimension.