Download Health Enough to Drive - Edmonton Seniors` Council

Acknowledgements
Are You Healthy Enough to Drive ?
The Medically At-Risk Driver
Dr. Bonnie M. Dobbs
Associate Professor
Director, the Medically At-Risk Driver Centre
Director of Research, Division of Care of the Elderly
• Edmonton Seniors Coordinating Council
• Government of Alberta Seniors and
Community Supports
• Conference Sponsors
Department of Family Medicine
Silver Surge Seniors Services Conference
Edmonton, Alberta, September 24-25, 2009
Improving public safety through
research and innovation
Aging of the Canadian Population
Impact on Driving Patterns
• Baby Boom generation will have a significant
impact on our society
• By 2020, 1 in 4 drivers will be age 65+
• Older drivers are driving more (exposure is
increasing) and driving longer into old age
• Projections are that this increase will continue
with the baby boom population
Driver Fatality Rate (per 100 million VMT)
10
Crash Rate by Age*
9
8
6
Crashes/km driven
Fatality Rate
7
5
4
3
2
Risk
Medical
1
Source: FARS 2001 and NHTSA 2001
-8
4
30
50
Driver Age Group
Who Is Most At-Risk?
• Not ‘Older Drivers’ but Medically AtRisk Drivers
• A number of chronic medical
conditions put individuals at risk
(those conditions can occur at any age
but are more likely to occur as one gets
older)
• Also need to take into consideration
the medications that are used to treat
those illnesses
70
Age
80
-7
4
70
-5
4
-6
4
60
50
-3
4
-4
4
40
30
-2
4
18
16
20
16
0
* Taking exposure into account
Increased Crash Risk
(At-Fault Crashes)*
• Pulmonary
• Visual Acuity
• Diabetes
• Psychiatric
• Epilepsy
• Neurological
• Alcohol
• Cognitive Impairment
* From Diller et al., 1998 (Unrestricted drivers)
1.3
1.5
1.5
1.9
2.0
2.2
2.2
3.3
Scope of the Problem
• 8% of Canadians 65+ have a dementia, another
17% have some form of cognitive impairment
• All individuals with a progressive dementia will
become unsafe to drive at some point in their
illness
• Diagnosis alone insufficient for revocation of
driving privileges
What is Dementia?
• Dementia is not a disease itself but rather
a group of symptoms that may
accompany certain diseases or conditions
• Over 100 ‘causes’ of dementia (Boxer’s
dementia, Alcohol dementia, AIDS
dementia complex)
Types of Dementia
Types of Dementia
• Non-degenerative (Reversible)
–
Treatment results in cognitive functioning returning to normal
/near normal
• Thyroid disease
• Meningitis
• Nutritional deficiencies
– Vitamin B12/B6
• Renal failure
• Some types of brain tumors
• Many more…
• Degenerative (Irreversible)
– Cognitive functioning does not return to
normal/near normal
Irreversible Dementias
(Presenting to a Memory Clinic)
2% 13%
5%
9%
47%
Alzheimer disease
Mixed Dementia
Vascular Dementia
Frontotemporal
Lewy Body
Other
Dementia
• Alzheimer’s disease the most common
• Today:
– 1 in 11 of Canada’s seniors has Alzheimer’s disease or a related
dementia
– Projected to increase by 50% in next 5 years
– Alberta has the highest number of early onset dementia (17,000)
(Alzheimer Society, 2009)
24%
Feldman et al. (2003)
Normal Aging vs. Dementia
Normal Aging
Occasional wordfinding difficulties
Occasional
misplacing of objects
Dementia
Frequent wordfinding pauses and
substitutions
Frequently
misplacing objects
(or putting them in
inappropriate
locations)
Normal Aging vs. Dementia
Normal Aging
Dementia
Able to operate
common appliances but
may have trouble with
new devices
Becomes unable to
operate common
devices and simple
new devices
Does not get lost but
may have to pause to
remember direction
Gets lost in familiar
territory
Dementia
• All result in the loss of intellectual
functions (such as thinking, memory,
reasoning, decision making) of sufficient
severity to interfere with a person’s daily
functioning
How does dementia affect
driving?
• Basic skills for driving remain intact to
quite some time
• But, several mental abilities affected
– Quick decision making
– Attending to several events at once
– Judging distances (lane changes, merges)
Types of Driving Impairments
• Alberta Driving Project
• All licensed drivers
• All currently driving
• Went to see their doctor for reasons other
than driving
• Video Clips shown
Consequences are Real
Santa Monica Farmer’s Market Crash
• 10 killed
• 73 injured
• 86 year old
driver charged
with 10 counts of
manslaughter
• Convicted of 10
counts of
manslaughter
What Can You Do?
• Driving is a privilege
• Identifying medically at-risk drivers
important for both personal and public
safety
Physicians Play an Important Role in
Identifying At-Risk Drivers
• In Canada, physicians are required by law to
report drivers who may no longer be fit to
drive in 7 of the 10 provinces and all
territories
• Can be held legally liable for not reporting
• Many barriers including fear of damaging
physician patient relationship
Warning Signs
•
•
•
•
•
•
•
•
•
Unaware of driving errors
Getting lost or confused while driving
Other drivers honking
Trouble navigating turns
Difficulty staying in lane
‘Missing’ traffic signs
Near Misses
Unable to keep up with speed of traffic
Scrapes or dents on car/garage
Becoming Engaged
• Health care professionals
– Make conversations about driving a routine
part of your assessment
– Become familiar with resources in your
community
• Driver Fitness and Monitoring
– Tel: (780) 427-8230 Fax: (780) 422-6612 [email protected]
• Alzheimer Society of Alberta and NWT
– Provincial office Tel: (780) 488-2266
–
Becoming Engaged
• Community Organizations/Family/Friends
– Start discussions about driving early in the
course of the illness
– Look for signs of declines in driving
competency
– Encourage the individual to talk with his/her
family doctor about driving
– Become familiar with resources in community
Driving Cessation Support
Groups
• Theoretically-based support
groups for individuals with
dementia and their caregivers
• Groups available for
individuals and spouses/
caregivers
• Participants attend
weekly/one hour sessions
• No charge/Transportation
provided
Help When You Can No
Longer Drive
Driving Cessation Support Groups
• Contact Medically At-Risk Driver
Centre (Cheryl Ford) for more
information
Resources that Can Help
Available from http://www.thehartford.com/talkwitholderdrivers/
Dobbs, B.M., Dobbs, A.R., & Triscott, J. (2007). The senior driver myths and facts: Information for physicians on assessment and
referral issues (2nd Ed.). The DR Group, Edmonton.
Questions
• Medically At-Risk Driver Centre
Phone: 780-492-6273 (Cheryl Ford)
Website: www.mard.ualberta.ca
• Dr. Bonnie Dobbs
Phone: 780-492-0374
Email: [email protected]