To Drive or Not to Drive: How to Make the Call
List TWO classes of medication that can affect ability to drive, other than opioids.
List FIVE history questions to determine whether a patient can drive.
List the gold standard for driving ability assessment.
Answers are in the blog post below.
Dementia and Driving
Drivers with dementia are at an increased risk of crashes. If driving SAFETY is suspected, use the mnemonic SAFE-DRIVE and use the following questions to make your assessment:
S – Safety record: In the last year, have you had any accidents or near misses or tickets for driving violations (driving too slowly, failure to stop)?
A – Attentional skills: Have there been occasions where you have gotten lost or have been unable to find your way?
F – Family report: (Ask patient's family member) Would you feel comfortable with your children being a passenger when the person is driving?
E – Ethanol: What is your alcohol intake?
D – Drugs: Let’s review your medications to make sure we aren’t prescribing anything that could be affecting your cognition and driving skills (Benzos, anticholinergics, excessive opioids).
If alarm features are present, ask the patient to return for a full exam and look for RIVE:
R – Reaction time: Perform neurologic and musculoskeletal screen.
I – Intellectual impairment: Complete MMSE.
V – Vision: Test for visual acuity.
E – Executive function: Trails A and B, clock draw, pentagon draw/cube draw.
What is the gold standard test if your assessment is not clear?
comprehensive on-road assessment
Moderate or severe dementia is a contraindication to driving (inability to perform 2 or more (ADLS or any basic ADL).
Patients with mild dementia should be reassessed q 6-12 months
USEFUL RESOURCES: Wiseman EJ, Souder E. The older driver: a handy tool to assess competence behind the wheel. Geriatrics 1996;51:36-45.
CMA Driver's Guide https://shop.cma.ca/products/dg9d (Free for CMA members at time of writing)
CCMTA Medical Standards for Drivers http://ccmta.ca/images/publications/pdf/Determining-Driver-Fitness-In-Canada-Final.pdf