Last February, the media gave headline-grabbing coverage to the fact that many older drivers are on the road despite problems with their cognition, and it was claimed that doctors are not doing enough to address the problem.
Reports in the Toronto Star and on CTV News stated that the rising proportion of aging drivers with cognitive impairments, according to a Queen’s University study, is expected to double from its current 45,000 to almost 100,000 in 2028. In response, some letters to the editor called for swift action, while others said we should be careful not to be “ageist” and turf safe older drivers off the road.
Those of us involved in the care of the aged are aware that driving can be a critical issue in an older person’s life in terms of self-respect, independence and the ability to carry out some of their ordinary and necessary activities, such as shopping. This is especially true for those who do not have a supportive family or friend network or live in rural areas. But it’s not an easy task for health-care providers who are entrusted to carry out the Motor Vehicle Act, as it pertains to medically compromised patients, and it carries enormous responsibility and implications.
During a recent clinic, my medical trainees and I saw three patients in a row whose reason for being there included the question of their suitability to drive. As I listened to the case histories presented by the trainees, I realized that there might be an issue with driving. As noted in the Star article, many of these people, like the patients being evaluated that afternoon, were sent to me because of a concern about their cognitive function. When their histories revealed that they were either still driving or had stopped “temporarily,” I could anticipate a difficult interview, depending on how much of a “shock” it would be that the issue of driving would be broached when some thought they were coming to me for a “general geriatric checkup.”
What was of interest in this cohort of patients, all of whom were accompanied by family members, was that bringing up the issue of driving did not seem to come “out of the blue.” Some were cognitively intact enough to be aware that there was some “stuff in the news” about driving and older people.
One patient had stopped driving “temporarily” because of what was deemed a short-term medical problem, which in fact was related to cognitive decline, and another said she had already “given thought” to no longer driving. I was taken aback, because she used terms that I often use to help convince patients who are reluctant to make the change while they still think they have a choice. She responded to my mention of driving with, “I am paying a lot of money to keep the car to get me to the supermarket and back.”
It is important for everyone to recognize, especially the families of elders for whom driving may become an issue because of cognitive decline, that physicians will have to become more diligent in dealing with patients with cognitive decline. There can no longer be an acceptance of overlooking the issue and trying to “protect them” from the harsh reality of no longer being able to drive. This has to be done in as sympathetic, supportive, but also law-abiding manner as possible. Public safety must always be the highest priority.
Dr. Michael Gordon is medical program director of palliative care at Baycrest and co-author with Bart Mindszenthy of Parenting Your Parents (Dundurn Press). His latest book, Moments that Matter: Cases in Ethical Eldercare, follows his previous book, Brooklyn Beginnings: A Geriatrician’s Odyssey. All can be researched at his website: http://www.drmichaelgordon.com.