Mr. D, age 75, presents to your office with a 5-year history of gradually declining memory. His wife reports he is having difficulty with word finding, managing his finances, and shopping, and he needs supervision when using the stove. Nonetheless, he enjoys playing golf and drives himself to the golf course 3 times a week. He is compliant with his chronic medical therapy for hypertension, hypercholesterolemia, and asthma. Patients with dementia who continue to drive pose a potential danger on the road, worry their families, and present challenges to clinicians. Most people would agree that patients with moderate or severe dementia should not drive, but a careful evaluation is required to assess whether a patient such as Mr. D with mild dementia remains fit to drive. This article explores how dementia exacerbates age-related changes in driving ability and discusses how to assess driving in patients with dementia. Our goal is to help clinicians sort through data from in-office physical and cognitive assessments, family caregivers/informants’ reports, and (when available) on-road testing. We also discuss: * guidelines for assessing older drivers that can help balance patients’ need for autonomy with public safety; * strategies for discussing driving cessation with patients and their families. (Author/publisher)
Samenvatting