When is it time to give up the keys?

Dear Bloggers,

This blogs subject is about driving and Parkinson's Disease

As baby boomers age and life expectancy rises, increasing attention is turning on how to determine when and if older people and people with severe health problems should stop driving. This topic is especially important in light of a agtng group in our country as a lot of them are on the search for injury prevention and we should get in control that our elderly people are involved by vehicle injuries. As the number one cause of injury related deaths for people aged 65 to 74, and the number two cause (after falls) of injury

related deaths for those aged 75 to 84. The issue that hits home for people with Parkinson's since both the symptoms of the disease and the medications designed to ease them can affect driving ability. If you are struggling with the decision of whether or not to stop driving, or if you are a caregiver for someone who is wrestling with this problem, this blog may help you explore your options.
 

 
How does Parkinson's disease affect driving?

People with Parkinson's disease may eventually experience a decline in both motor skills and cognition. These problems can make driving unsafe. For example, a decrease in visuospatial skill. Let me explain:This is the kind of skills that are necessary to determine distance and distinguish shapes which is not uncommon in Parkinson’s Disease. A driver with decreased visuospatial skills may be unable to gauge the distance to a stop sign or a traffic light or keep a car in the correct lane. Some people with Parkinson's also may have cognitive difficulties and at times become confused. 

Unfortunately, patients with dementia may not realize that their driving has become a problem and must rely on a physician, family members and friends to bring it to their attention. Another common symptomatic problem for people with Parkinson's is muscle tightness, which can make reacting quickly difficult. Delayed reaction time is dangerous because drivers need to be able to react swiftly, both mentally and physically, to avoid accidents and adapt to changing traffic patterns.

Additional complications come from the medications that are used to treat Parkinson’s Disease. Common medications including carbidopa/levodopa (Sinemet), amantadine, dopamine agonists and anticholinergics may produce side-effects such as sleepiness, dizziness, blurred vision and confusion. Anticholinergics are especially dangerous as they can cause confusion and sedation along with memory impairment. However, not every patient experiences these side-effects and they may be decreased with simple adjustments in dosage. You should note any changes and report these to your physician. It is your life and you decide.

 Assessment options for people with Parkinson's

It is important to remember that while not every person with Parkinson's experiences problems with driving, disease symptoms and treatments can make driving dangerous for you and others. Driving is seen as a priveliged right of independence and freedom and you may be reluctant to stop, but being responsible is also important. To help you determine your driving risk, the medical association advice is to report your Parkinson’s at CBR (the Dutch bureau for driving licences) Especially for older drivers with difficulties in traffic and they can give extensive information about diseases that may affect driving ability, such as Parkinson's. Although these guidelines were developed primarily for doctors, it will help laypersons to make their own assessment of their driving ability and determine a course of action.

The question is: “Am I a Safe Driver?” If you just take a driving lesson just to help you evaluate your driving. If you score poorly on this and you are still reluctant to stop driving, refer to the driving school to get some tips for safe drving and really consider speaking with a doctor about the issue. The doctor can run some tests on cognition, mobility, reaction time and visual ability for physicians to perform on patients to determine if a person is driving safely. Yes you might not only kill yourself but also someone else!

A less costly, although less thorough, option is to enroll in a driver safety class, such as the driving  schools are offering to elderly people. While these classes are not specifically tailored for people with Parkinson's, they can provide helpful tips for safe driving. An instructor will lead the class through various ways of enhancing driving skills and safety but often will not make individual assessments.
Finally, you can always visit the CBR and ask to take a driving test. Of course, if you were to fail the test, your license would be revoked.

What can family members and friends do to help?

Understandably, most people are reluctant to give up the opportunity to drive. Because of this, it is often up to family members and caregivers to spot a problem first. If you are a family member or caregiver for a person with Parkinson's and you think it may be time for them to stop driving, remember that this is a very sensitive issue and you must help the person see that his or her driving has become dangerous. Before bringing up the subject, look at the possibilities how to help this older driver, being prepared as they have a million excuses to keep their freedom which is extremely relevant for Parkinson's patients. This can help you determine if your concerns are valid and how you might address them.

Another way to help your loved one with this decision is by stressing that giving up driving does not mean giving up mobility. Your support is crucial in helping a person with Parkinson's admit that his or her skills have decreased without feeling stripped of power. To help people with Parkinson's with their decision to stop driving, provide them with transportation alternatives. The Getting by Without Driving tip is to highlight all other possible modes of transportation, including a partner that is still able to drive, taxis, buses, subways and getting a ride from family members. Some cities also provide travel assistance for people unable to use public transportation. (We got something that is called the Plusbus.) If you know someone with Parkinson's who has had to give up driving, provide him or her with bus routes, taxicab phone numbers, and offer to give rides. For more transportation alternatives, check on the internet for options in your region.This may help a person with Parkinson's to adjust and realize that stopping driving does not mean losing independence.

What's the bottom line?

Having Parkinson's does not necessarily result in giving up driving. However, whether you are a person with Parkinson's or a loved one, it is important to be responsible and remember the potential dangers that Parkinson's presents to driving. Ignoring the effects of the disease and its medications on driving will only create a more dangerous environment for you and other drivers. The best way to be a responsible driver is by paying attention to your driving skills and reporting any changes to your physician. If you have concerns, don't avoid voicing them out of fear of losing your license. Doctors and family members are often happy to help you exhaust rehabilitation options before asking you to give up driving. If it does come to the point where family, doctors and driving coaches ask you to give up your keys, realize that it is in your best interest to stop driving and explore other transportation options. They love you and don’t want to loose you.

The Old Sailor,