Driving is important

The ability to drive enables us to have the freedom and independence to travel and access our community so that we can perform the personal, social and professional tasks and responsibilities in our everyday lives. Driving ensures that we are less isolated and have the flexibility to move around as we please. As driving carries with it great responsibility, it is imperative that drivers with medical conditions are properly assessed to ensure that they are safe to continue to drive. This article will outline what is involved in NSW when a driver becomes diagnosed with Alzheimer’s disease.

Alzheimer’s and driving

Unfortunately, as some people get older, they may develop illnesses such as Alzheimer’s disease, which can start to affect their driving ability. Alzheimer’s and driving, unfortunately, do not often go together. Driving is a complicated skill that requires coordination and cohesion between one’s visual, physical and cognitive abilities. A diagnosis of Alzheimer’s can often impact on the person’s concentration, memory, awareness, judgement (decision-making) and visual acuity. In later stages of the disease, it can start to decrease physical functioning such as balance, swallowing or affect control of the bladder and bowels.

In NSW, any medical condition that may potentially alter a person’s driving competence must be declared to the RMS (Roads & Maritime Services). When a person receives an Alzheimer’s diagnosis, their treating doctor informs the RMS of this new medical condition, by way of completing the RMS medical fitness to drive form. Essentially, it is up to the person’s doctor to decide if the person should continue driving, and when completing the form, the doctor makes one of three decisions:

a) That the condition is not currently affecting fitness to drive, and the person can continue to drive as usual
b) That the condition may be affecting fitness to drive, and the person requires an Occupational Therapy (OT) driving assessment to fully determine this
c) That the condition is impacting fitness to drive, and the person is unsafe to drive. The doctor will recommend the cancellation of the person’s licence.

woman driving lesson with modified driving

It is also important to note that although the person’s doctor has a responsibility to advise the RMS of the person’s medical condition, the primary responsibility lies with the driver to let the RMS know of any medical diagnosis (or other change in their situation) that may affect their driving.

Helping the person make the transition

Often, the person’s closest family and/or friends need to be involved in the discussion about how Alzheimer’s will change their ability to drive. In some cases, the person’s family or friends may be the ones to raise initial concerns about the person’s mental condition or change in behaviour. As Alzheimer’s disease is a degenerative condition that typically worsens over time, the conversation about eventually having to stop driving will need to occur.
When having this conversation, it is important to try to normalise what is happening for the person, and to offer as much support as possible. It is also crucial to reinforce that safety (of the person and other road users) is of utmost priority. To offer assistance and support to a driver who has to start preparing for a life without being able to drive, their family and friends can:

– Making time to drive them to social events, access to shops and other services, appointments
– Encourage and support them to use public transport (trains, buses, taxis, Uber vehicles) where possible
– Offer more options such as local community transport (e.g., RSL buses)
– Support, encourage and/or organise the use of home delivery services where possible, e.g., for groceries, food, medicines

It is not uncommon for a person who has recently stopped driving to withdraw from social outings and engagements, as driving is heavily linked to one’s personal autonomy. Thus, it is pivotal that family and friends try to sustain the person’s ordinary routine as much as possible.

OT driving assessment

As it is often difficult for a doctor to confidently determine how Alzheimer’s may be influencing the person’s current driving capacity, it is common for the doctor to refer the driver to have an OT driving assessment. As the person’s doctor does not actually observe the person driving, an OT becomes involved and makes this determination.

An OT that assesses fitness to drive is a university-trained allied health professional that has acquired the specific qualification to be able to complete these assessments. If your doctor has referred you to an OT to assess your Alzheimer’s and driving, you will need to contact an appropriate OT service.

The OT driving assessment occurs in two parts:

1. The off-road assessment where the OT tests your vision, cognitive and physical capacity.
2. The on-road assessment where you drive for 1 hour with the OT and driving instructor (in a dual-controlled car).

The focus of the assessment is to find out the current state of your Alzheimer’s and driving. Small errors that you make related to being nervous about the test, unfamiliar with the vehicle, or borne of poor driving habits will generally not adversely affect the outcome of the assessment, granted that they do not cause a collision or accident. As the driving instructor is present, the general rule of thumb is that as long as they do not have to physically intervene (i.e., by taking control of the steering wheel or activating the emergency brake), you have not made a critical error in the assessment. If the driving instructor has needed to intervene, it denotes that you were unable to safely respond to a situation yourself and may have caused an accident without the instructor’s intervention.

After the 1-hour drive, the OT informs you of the outcome of the assessment and their recommendations. They will then prepare the report, which will be given to the RMS and your referring doctor. It is also vital to note that Alzheimer’s and driving will mean that you will need to have regular medical and OT driving assessments to monitor the progression of the illness in relation to your fitness to drive. Typically, this means needing a driving assessment every 6-12 months. Again, once a diagnosis of Alzheimer’s has been formed, it is important to begin speaking with the person as soon as possible about how it is likely to transform their driving ability.