April, 12, 2010 -- Having mild dementia is no longer a reason to take away an elderly person's car keys, according to newly revised guidelines from the American Academy of Neurology.
Citing new evidence that 76 percent of drivers with dementia could still pass on-road skills tests, the AAN changed guidelines that previously discouraged any driving once someone was diagnosed with mild dementia or Alzheimer's. The updated guidelines were unveiled an the AAN's annual meeting in Toronto.
"The previous recommendation was that patients with mild dementia should not drive, and that recommendation has been softened," said Dr. Donald Iverson of the Humboldt Neurological Medical Group, Inc., and lead author of the guidelines.
The guidelines cast some light on what is often a contentious issue within families -- when to take away an elderly parent's car keys. It often pits public safety against life fulfillment, as an elderly person's social life has been linked with well being and a longer existence.
The guidelines give more latitude to families and doctors caring for patients with mild dementia or Alzheimer's. But Iverson said further discussion is still needed on what steps to take with elderly drivers as skills worsen with the progression of the disease.
"A demented person behind the wheel of a vehicle can be equivalent to that person having a loaded weapon," said Dr. Sam Gandy, Associate Director of the Mount Sinai Alzheimer's Disease Research Center. "Many news reports of 'out of control' vehicles driven by elderly drivers and plowing into crowds of bystanders are examples of one of the worst outcomes of failing to recognize this problem."
Red flags include driving fewer miles, collisions, moving violations, avoiding driving at night or in the rain and displays of "aggressive or impulsive personality traits."
The revised guidelines also discuss steps doctors can take in the clinic. Iverson said the guidelines are not a directive but rather a resource for physicians to help them determine how to handle patients and their automobiles.
"One should not make arbitrary decisions about stopping driving based on a somewhat arbitrary label of 'mild' dementia," said Steven Ferris, a professor at New York University's Alzheimer's Disease Center. "Actual driving competence varies considerably in mild dementia and such decisions should be made based on observation of actual driving performance, and in close consultation with an experienced professional who has good knowledge about dementia and the particular patient."
Added Ferris, "Driving can also be phased out gradually as the illness progresses, such as by limiting driving to daytime and to familiar locations near home."
New Medical Guidelines on Driving With Dementia
Dr. Jason Karlawish, associate director of the Memory Disorders Clinic and fellow of the Center for Bioethics at the University of Pennsylvania, said it helps to give dementia patients' families some perspective.
"In my practice, I recommend that family members and friends ask themselves a simple question," he said. "'Would you let your relative with Alzheimer's disease drive the grandchildren, or someone else's grandchildren, to an event?' If they answer to this is anything less than a simple 'Yes,' then it is sensible to consider at least a driving evaluation or even taking away the keys."
Surprisingly, some patients are relieved to stop driving, finding it a stressful activity, said Karlawish. For those who resist having their keys taken away, Karlawish requires a driver's evaluation as an unbiased and expert assessment. Patients and their families often resist the idea, citing the cost and hassle of arranging the evaluation.
"I simply ask them how much they would pay and the time they would take to maintain the car's mechanical function. Cast in this light, most families are willing to spend the time and money to make sure the driver is functioning," Karlawish said.
But the doctor's office or the family room is not the place where decisions on driving are to be made in some states.
California is one state where the law has set guidelines on when someone has to stop driving.
"In California, physicians are required to report when a patient is diagnosed with dementia, and the Department of Motor Vehicles retests their driving skills," said Dr. Gary Small, director of the UCLA Center on Aging. "Even though some patients with dementia are safe drivers, I advise caregivers to get an objective driving assessment for any family member with cognitive impairment whenever there is a doubt about driving safety."
Pennsylvania, Oregon and the province of Ontario, Canada, also have policies mandating this kind of reporting by physicians to the state.
So while guidelines may give more leniency to doctors when helping patients decide whether to take away a parent's car keys, the state may not.
"There are legal issues as well that can play a role," said Iverson. "A physician doesn't want the power or have the power to make a patient stop driving."
For AAA.com's advice and tools to help you decide if someone you know shouldn't be driving click here.
And for a list of local resources to help keep someone independent after their keys have been taken away click here.