Doc, You Want My Car Keys…? Driving and Dementia

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Doc, You Want My Car Keys…? Driving and Dementia

November 23, 2019 | Family Med Exam Prep | CCFP

It’s your SOO. You walk into the next room – you have an 89-year-old man. His wife has expressed concern about his driving ability.

Will you cut up his driver’s license? Call the police? Report him to the MTO?

Does driving and dementia make you lost for words? Are you thinking that you’d better brush up on your reading before SOO time? No need to search too far – we’ve summarized a comprehensive CFP article for you right here! Here is the article for your reference.

“Doc, how serious are my symptoms?”

On your SOO, remember to ask:

  • Have you been involved in a car accident recently? Have you had any near misses?
  • Have you ever forgotten where you were going while driving?
  • Does anyone ever refuse to drive with you?
  • Do people honk at you when you drive?
  • Do you ever struggle to get ready, feed yourself, or move around? Are you able to bathe and use the bathroom independently?
    • For the “basic activities of daily living,” remember “DEATH” – Dressing, Eating, Ambulation,Toileting, Hygiene
  • Do you ever struggle with social events, housework, cooking, or using tools? Are you able to keep track of your banking and your medication?
    • For “instrumental activities of daily living,” remember “SHAFT” – Shopping & Social functioning, Housework & Hobbies, Accounting (banking, bills, taxes, handling cash), Food preparation, Telephone, Tools, & Transportation, and Medication Management

Collateral information is important: ask family members, friends, etc.

“Doc, is it safe for me to drive?”

There is no single test that can answer this question. Some tests to consider:

  • Road test (patient arranges)
  • MoCA
    • Potentially unsafe: score of ≤18 (associated with greater likelihood of failing road test)
  • TMT-A
    • Unsafe: > 2 min or ≥ 2 errors
  • TMT-B
    • Unsafe: > 3 min or ≥ 3 errors (“3 or 3” rule)
  • Copying two intersecting pentagons or cubes
  • Clock-drawing test

Important points to remember:

  • According to the CMA, people with moderate to severe dementia should not drive
    • Defined as a new inability to independently perform 1 “basic activity of daily living” or 2 “instrumental activities of daily living”
  • Contact the MTO if you have concerns
  • Keep the patient’s emotional response in mind
  • Re-assess fitness to drive every 6-9 months for patients with mild dementia who have passed the above tests

Remember: You have a responsibility to report to the MTO if you have concerns. FMEP wants you to be well-equipped for the CCFP exam and for REAL LIFE in practice!

 

Written by Maria Veinberg. Reviewed by Dr. Prokubovskaya & Dr. Premji.

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