Practitioner Strategies for Driving and Dementia – Supporting Successful Driving Retirement
Over the past two decades, our understanding of dementia care and management has evolved significantly. As a result, valuable insights into the complex world of dementia, driving, and cognitive decline have emerged. In this blog, I will share key insights and practitioner strategies for driving and dementia that have surfaced in recent years. I wish to share my journey encompassing research findings, assessment tools, and collaborative approaches in an effort to empower successful interventions by all practitioners.
First, a few practitioner insights & strategies:
- The Truth About Driving Retirement: One pivotal realization in dementia care is the inevitability of driving retirement for affected individuals. Surprisingly, this truth wasn’t widely researched and accepted until relatively recently, even as recently as 2000. The link between cognitive decline and compromised driving abilities has since become undeniable, prompting the need for informed interventions.
- Mild Cognitive Impairment (MCI): MCI has emerged as a critical syndrome, with various subtypes. Importantly, not all forms of MCI progress to full-blown dementia. This nuanced understanding allows us to differentiate between individuals who may require immediate intervention and those who can continue driving safely.
- Moderate to Severe Dementia and Driving Retirement: It is evident that individuals with moderate to severe dementia are the most susceptible to the need for driving retirement. As cognitive functions decline, so do driving abilities. Recognizing this correlation is crucial for timely interventions.
- Driving Retirement as a Process: Driving retirement is not a one-time decision; rather, it is a process that unfolds over time. This gradual transition necessitates careful planning, evaluation, and ongoing support for both the driver and their family.
- The Team Approach: Collaboration among healthcare professionals, families, and specialists is imperative. The collective expertise of a team can provide comprehensive support, addressing the multifaceted challenges associated with driving retirement.
- Reporting to State Licensure: While reporting cognitive impairment to state licensure authorities can be a step in the right direction, it alone is insufficient to solve the problem. Effective solutions require a more holistic approach.
- Early Intervention and Cognitive Assessment: In response to these revelations, I have established meaningful partnerships with neuromemory groups focused on early identification and diagnosis of cognitive impairment. Within these partnerships, comprehensive driving evaluations have been integrated as a critical assessment component. Engaging with individuals in the earlier stages of cognitive decline can lay the groundwork for informed decisions regarding driving retirement. During these initial assessments, I engage in candid conversations with clients and their families, addressing their abilities, discussing research findings, and preparing them for the future. As a result, when clients undergo reassessment (the timing of which varies based on diagnosis and input from neurologists), we either have a solid baseline for comparison or, increasingly, drivers are making the decision to retire voluntarily.
- Cognitive Testing – Beyond Screening: To gain a better understanding of cognitive functioning, I have explored various tests and assessment tools. My preferred approach combines the observation of instrumental activities of daily living with standardized testing. It is essential to ensure that the chosen test is sufficiently challenging and comprehensive, going beyond memory to evaluate executive function, attentional capacity, and working memory. I appreciate that each of us has our own preferred method for testing. If you wish to learn what I use, please reach out to me at email@example.com.
Practical Practitioner Strategies for Driving & Dementia:
Through early intervention and meticulous cognitive testing, I have gleaned valuable lessons:
- Cognitive testing (not merely screening tools) is imperative for understanding cognitive function, encompassing executive function, attention, and working memory.
- Collaboration with families and the medical team is essential for comprehensive support.
- Recommendations for driving retirement should involve multiple tests, input from diverse professionals, and ideally span multiple interventions.
- The “3 R’s of Driving Retirement” (remove access, replace the need, & remember the fun) serves as a foundational framework for driving retirement conversations.
- Conversations about driving retirement should commence as soon as an individual is diagnosed with a cognitive impairment.
Our evolving understanding of dementia care and cognitive decline has reshaped the way we approach driving retirement. Early intervention, cognitive testing, collaborative partnerships, and informed decision-making are at the forefront of this paradigm shift. By embracing these advancements, we can better support individuals with cognitive impairment and promote safe and responsible driving practices within our communities. As we continue to research and learn, the future of dementia care and driving retirement holds promise for improved quality of life and enhanced road safety.
Practitioner Strategy: Use the 3 R’s of Driving Retirement
- Remove access to the vehicle: If you don’t want someone to eat the chocolate cake, you can’t leave it in plain sight on the counter. The same holds if someone should not be driving. Visibly removing the vehicle helps to curb focus and attention on the vehicle.
- Replace all community mobility needs: Think about where this individual goes and make a set, predictable plan to support their routine community mobility needs. For example, Jane picks up Mom on Tuesdays at 9:30 AM for grocery shopping. The neighbor picks up Jane at 8:45 AM on Sunday for church. Etc. No one wants to ask for a ride. No one wants to be a burden. Remove that obstacle by creating a routine that just happens for this individual.
- Remember the fun: Driving is more than getting done those things we need to do. Driving is also about connecting us to the fun things in life – the things we want to do. The spontaneous trips for coffee, visiting friends, going to the park, enjoying the change in seasons, etc. Help families and friends support the transition from driving to passenger by remembering to do the fun things in life as well.
Learn More: YouTube 3 R’s of Driving Retirement
Case Study Reinforcing Practitioner Strategies for Driving and Dementia
Joel is a 63-year-old male recently diagnosed by his neurologist with mild cognitive impairment. He has been started on donepezil and referred for a comprehensive driving evaluation.
Joel called and scheduled his initial comprehensive driving evaluation.
Clinical testing showed intact visual skills, strong motor skills – including fast/accurate brake reaction time, and grossly intact cognitive skills – processing was slightly slower but within normal standards and memory was marginally impaired, while attentional capacity, working memory, and executive function were grossly intact. The cognitive test was suggestive of mild cognitive impairment – amnestic subtype.
Joel was seen for a geographic on-road assessment. He lives in a demanding area outside of Philadelphia and demonstrated a strong pattern of safe driving behaviors with intact operational, tactical, and strategic skills.
During his initial evaluation, Joel demonstrated fitness to drive and was recommended for reassessment in 6-12 months as guided by his referring neurologist.
Joel and his family were also counseled on preparing for driving retirement, and signs to watch for – such as getting lost, discussed sharing locations on their smartphones, and he was recommended for both occupational therapy and speech therapy for home safety and cognitive intervention strategies.
One Year Later…
About a year later, Joel’s neurologist noted significant changes in Joel’s executive function, advanced his diagnosis to dementia, and recommended him for a driving evaluation versus driving retirement.
This time Joel’s partner reached out to me by email to discuss a driving reassessment. His partner shared the following:
- Joel had recently become a victim of a financial scam costing him $10,000;
- His partner has taken over all finances and is now ensuring medication compliance.
- While Joel presents with no tickets, no accidents, and no instances of getting lost, the frequency of his driving has reduced to no more than 1-2x/week.
- In addition, his partner is concerned about Joel being alone in the community – primarily because he is easily persuaded and has already been taken advantage of.
I shared with his partner my concerns, especially with the significant change in at least two IADLs.
After considering the risk, and discussing all options with myself and the neurologist, Joel decided to retire from driving rather than pursue a driving reassessment.
I shared with Joel and his family the 3 Rs of driving retirement, and resources for turning his license in for a state-issued identification card.
To support this process, the neurologist submits the necessary reporting paperwork to the state.
Mansbach WE, Mace RA, Clark KM. Mild cognitive impairment (MCI) in long-term care patients: subtype classification and occurrence. Aging Ment Health. 2016;20(3):271-6. doi: 10.1080/13607863.2014.1003283. Epub 2015 Jan 30. PMID: 25633202.
Croston J, Meuser TM, Berg-Weger M, Grant EA, Carr DB. Driving Retirement in Older Adults with Dementia. Top Geriatr Rehabil. 2009 Apr 1;25(2):154-162. doi: 10.1097/TGR.0b013e3181a103fd. PMID: 20161565; PMCID: PMC2805829.