For Ron Posno, 82, driving was a source of pride. The resident of London, Ont., started driving on a farm at age 12. He was a competitive rally driver as a young adult, and often deliberately picked the smallest parallel parking spaces to test his skills.
But recently, Mr. Posno, who now has Alzheimer’s disease, decided to stop driving because he doesn’t ever want to be in an accident that harms other people.
“I don’t want to run the risk any more,” he said.
What prompted Mr. Posno to permanently hang up his car keys was his participation as a consultant for a free website, launched last week, that provides guidance on the decision to stop driving. The site, Driving and Dementia Roadmap (www.drivinganddementia.ca), is aimed at older adults with dementia, their caregivers and health care providers. It brings together tools and information from various vetted sources, including videos from the U.S. Alzheimer’s Association, tips for having conversations on the topic and checklists for recognizing when it’s unsafe to drive.
Toronto geriatrician Gary Naglie and geriatric psychiatrist Mark Rapoport led a team of researchers to develop the website after years of seeing how much tension the issue causes.
Addressing an older patient’s inability to continue driving safely is one of the most dreaded parts of his job, said Dr. Naglie, vice-president of medical services and chief of staff at Baycrest, an academic health sciences centre that provides care for older adults. He and Dr. Rapoport have seen families torn apart when patients don’t want to stop. And even though health care professionals are required to report conditions that could impair a patient’s driving ability, both doctors have had people refuse to see them again after being reported to the Ministry of Transportation.
“Frankly, many physicians will choose to ignore it because you don’t want to get involved with it because it’s so emotionally charged,” Dr. Naglie said.
Yet neglecting the issue can be disastrous. Studies have found people with mild dementia have a marked deterioration in their driving skills compared with healthy control subjects, and double the risk of crashing, according to Dr. Rapoport, acting head of geriatric psychiatry at Sunnybrook Health Sciences Centre.
While all the resources they’ve compiled were available prior to the launch of the site, users would have had to sift through a lot of material to find what they needed, Dr. Rapoport said. “Nobody has time – and especially physicians.”
The new website directs users to different pages, depending on whether they’re the person with dementia, a caregiver or a health care worker. It then further directs them to resources such as alternative transportation options or information about how dementia affects driving.
It can be tricky to recognize when it’s no longer safe to drive, since the loss of skills tends to be gradual and varies from person to person, Dr. Rapoport said.
The aim of the site is to not only help people decide when it’s time to stop, Dr. Rapoport said. It’s also to help them have a fulfilling and enriching life after they quit driving, since people with dementia can experience depression, faster placement in nursing homes and even faster death once they hand over their car keys.
The team also included guidance on how to deal with the grief and other complex emotions involved.
The key is to have discussions early, and to encourage people with dementia to either voluntarily stop driving or be better prepared when the time comes, “so it doesn’t come as a sudden shock to them and they’re very resistant to any attempts to stop driving,” Dr. Naglie said. “That’s the big hope.”