Dementia can often become a debilitiating medical condition and over time, the person’s ability to function indpendently becomes increasingly eroded.
Effects on driving
As dementia is a cognitive condition, it can impact on a crucial component of driving: the person’s thinking skills. Specific ways dementia may affect driving is causing deficits with attention and concentration, short-term memory, decision-making, processing speed and becoming disorganised. It is a serious medical condition potentially impacting driving and thus, when someone receives this diagnosis, their condition must be monitored by their doctor. Usually, once a medical condition has been identified, the person requires annual medical reviews (but may be more frequent depending on the situation).
When an individual has a diagnosis of dementia, they have a legal requirement to notify the Roads and Maritime Service (RMS) of their condition. This also applies for any medical issues potentially affecting driving. Many people do not realise this and it is common for their treating doctor to make the RMS notification on their behalf. The doctor will complete the ‘RMS medical fitness to drive form’, where the doctor will make a decision regarding the person’s suitability to continue driving due to their medical condition. The doctor will perform their medical assessment on the person, then decide between one of 3 options when filling out the form:
- The condition is not currently affecting the person’s driving and they can continue to drive as normal.
- It is unclear if the condition is affecting driving and the person must undergo an Occupational Therapy (OT) driving assessment to investigate further.
- The condition is affecting the person’s driving and they are no longer medically fit to drive. Their licence will be cancelled.
Due to the nature and severity of a dementia diagnosis, doctors will often choose the second option and refer the person for an OT driving assessment. With new diagnoses of dementia, doctors will not usually recommend to cancel the person’s licence immediately, unless the illness is at an advanced stage. As driving is a practical activity, doctors are limited in their ability to assess the specific impact of Dementia on individual’s driving capacity. A medical assessment is an effective way to determine certain aspects of a person’s cognitive functioning, however to fully discover the effects of any cognitive decline on driving, a practical driving assessment is necessary. Therefore, doctors will often state on the Fitness to Drive form that the person requires an Occupational Therapy driving assessment.
The driving assessment
Once the doctor has referred the person for an OT driving assessment, they will need to organise an appointment with a qualified Driver Trained OT. It is important to note that these OTs are specialized and have done specific qualifications to be able to complete these assessments. The primary aim of the Occupational Therapy driving assessment is to determine if the person is driving safely and making the correct decisions. Its focus is specifically on how dementia may be affecting driving at this point in time. The Occupational Therapist is not too concerned about minor errors or poor driving habits. They are most concerned about how the illness is affecting factors such as the person’s decision-making, processing, attention and reaction time when driving.
The following are common examples of driving tasks that the Occupational Therapist will assess during the assessment:
- Changing lanes
- Stopping at controlled and uncontrolled intersections
- Entering and exiting roundabouts
- Observing and responding to hazards e.g. pedestrians crossing the road
- Responding to road signs