Getting a driver’s license is a rite of passage on the road to adulthood. For a growing population of older drivers with mild dementia and their families, the question is, When is it time to hang up the keys?
“This is one of the most challenging and emotion-laden decisions with which older drivers with dementia, their family caregivers, health professionals, policy-makers and licensing authorities struggle,” says Dr. Mark Rapoport, a geriatric psychiatrist at Sunnybrook.
Older drivers are the fastest-growing segment of the driving population and will make up one in four drivers by 2030. (NHTSA 2012; Turcotte, 2012)
The number of drivers with dementia is dramatically increasing, with a predicted estimate of close to 100,000 drivers with dementia by 2030 in Ontario alone.
Drivers with dementia have a two to three times higher risk of crashes, many of which result in injury or death.
While driving is clearly a danger for people with moderate or severe dementia, some with mild dementia can continue to drive safely for a period of time. But it’s not just about getting from A to B. No longer being able to drive can have significant effects on the health and quality of life of these seniors and their families, including loss of independence and lifestyle, lower activity levels, social isolation, loss of self-esteem, depression and an increased burden on family caregivers.
A team of researchers at Sunnybrook, Baycrest and the University of Toronto are working on developing an intervention program to support older drivers and their caregivers in deciding when it’s prudent to give up the driver’s seat, and how to manage their emotional and transportation needs afterwards. The researchers reviewed existing findings to identify effective approaches to help older adults, both with and without dementia, on their journey to “driving cessation” and “post-cessation.”
The existing research was limited, with only three studies with control groups that described interventions – all delivered in a group setting to support older adults through the transition.
One used a coping group for drivers with dementia who had lost their driving privileges, compared with a traditional dementia support group. A second used an educational approach for the caregivers of drivers with dementia. And the third tried an education and support group for older drivers, not specifically selected for dementia, who had either stopped or were planning to stop driving.
While benefits included reduced symptoms of depression, more trips out of the house, greater likelihood of discussion between the caregiver and the former driver, and better handling of the process, the research team found that specific outcomes and their extent varied across the three studies.
This literature review will help shape the program content and how it’s delivered. Pilot tests will then evaluate the intervention. Does it improve the perceived sense of control and satisfaction about deciding when to give up driving, both for older adults with mild dementia and for their caregivers? Does it increase trips out of the house, social participation, mood and quality of life while reducing depressive symptoms for ex-drivers and their caregivers? In other words, is the intervention road-worthy?