Not sure if its time for a parent or an older relative to stop driving? If you’re reluctant to let your kids get into a car driven by them, then this is an indicator that there may be problem. I recall getting to this stage with my dad when he experienced cognitive decline. Continue reading to learn how to keep seniors safely behind the wheel.
I recently had a conversation with one of my clients about his concerns with his mother’s ability to drive safely at night. He was reluctant to raise the topic with her because driving represented her freedom. Driving was central to her social network and day-to-day independence. What advice did I give him?
Are seniors considered to be high-risk drivers?
According to the Transport Canada's National Collision Database, there were 25.6 million licensed drivers in Canada in 2016 (latest available data). Seniors (+65 yrs.) accounted for 18% of Canadian licensed drivers, totalling 4.49 million.
Of the 1,898 driving-related fatalities reported by Transport Canada in 2016, 24% (or 446 people) were seniors. The next highest fatality rate was amongst drivers aged 25-34 yrs., with a fatality rate of 17% (or 321 people). While the numbers often don’t tell the whole story about what makes a driver high-risk, this data highlights that we need to be aware of the increased risk ageing has on a senior’s safety behind the wheel.
How to start the conversation with older relatives about their driving?
Don’t underestimate how challenging it is to broach this critical topic with older relatives. If you’re not sure how to start this conversation, I strongly recommend you download the ‘Driving and Dementia toolkit for patients and caregivers, produced by the Regional Geriatric Program of Eastern Ontario. It will help you plan for these discussions with loved ones and what red-flags to watch out for.What is the risk of increased social isolation when seniors stop driving?
My dad had driven for over sixty years. Taking away his car and driver’s license impacted his independence and sense of identity. Have a plan in place to address increased social isolation. Finding replacement transportation options, particularly if the older relative lives in a smaller community and/or if friends/family cannot committed to assisting with driving-related activities like appointments, going to church, shopping and social visits. Taking the bus/subway or navigating car-share services for seniors, especially those with cognitive challenges, may not a feasible option. We tried to introduce a taxi-chit arrangement for my parents to use the local taxi service. We found it was too complicated to manage pick-up and drop-off.
When does a healthcare practitioner report a medically unfit driver?
Observing your loved ones having problems following road rules, changing lanes, maintaining road speed, turning, stopping, and avoiding collisions? Then it may be time to raise the problem with their family doctor. One of the challenges we encountered was understanding the role of healthcare practitioners when it came time to for my dad to stop driving. Back in 2018, Ontario medical reporting requirements for healthcare practitioners to report a medical unfit driver changed. There are two types of reporting – mandatory and discretionary. Let’s focus on mandatory reporting.
What are the Mandatory Reporting Requirements for unfit drivers?
Under section 203 of the Highway Traffic Act, mandatory reporting requirements for high risk medical conditions, vision conditions and functional impairments that make it dangerous for a person to drive apply to:
- Physicians
- Optometrists
- Nurse Practitioners
These individuals are not required to report a person whose impairment is, in the prescribed person’s opinion, of a distinctly transient or non-recurrent nature. They are also not required to report modest or incremental changes in ability that, in the prescribed person’s opinion, are attributable to a process of natural aging, unless the cumulative effect of the changes constitutes a condition or impairment as described in the Act. Note: Optometrists are only required to report with respect to visual impairments.
What are the reportable medical conditions, functional impairments and visual impairment?
For the purposes of subsection 203 (1) of the Act, the following are the prescribed medical conditions, functional impairments and visual impairments that a prescribed person required to report:
Cognitive impairment: a disorder resulting in cognitive impairment that,
- affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and
- results in substantial limitation of the person’s ability to perform activities of daily living.
Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.
Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.
Visual impairment:
- A best corrected visual acuity that is below 20/50 with both eyes open and examined together.
- A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.
- Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching.
Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.
Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.
Want some more information? Read this
The Ontario government published as booklet 'Ontario's Licence Renewal Program for Drivers 80 and Above'. I encourage anyone who wants more information to read it and share it with a loved one. Covering relevant topics such as the effects of medication on driving and identifying high-risk driving situations, it would be a handy tool to provide to a senior to help them better understand the how ageing impacts driving.
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