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Mobility and safety issues in drivers with dementia

Published online by Cambridge University Press:  26 June 2015

David B. Carr  and
Desmond O’Neill Open the ORCID record for Desmond O’Neill [Opens in a new window]
David B. Carr*
Affiliation:
Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University in St. Louis, 660 Euclid Dr. St. Louis, MO 63110, USA
Desmond O’Neill
Affiliation:
Tallaght Hospital and Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland
*
Correspondence should be addressed to: David B. Carr, Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University in St. Louis, 660 Euclid Dr. St. Louis, MO 63110, USA. Phone: 314-286-2706; Fax: 314-286-2701. Email: [email protected].
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Abstract

Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients’ fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients’ social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.

Keywords

older adultdementiaAlzheimer’s diseasecognitive impairmentdrivingautomobiletransportationassessment
Type
Review Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 10: Psychosocial and Ethical Aspects of Dementia , October 2015 , pp. 1613 - 1622
Copyright
Copyright © International Psychogeriatric Association 2015 

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