Dementia and the older driver.

Many demented patients continue to drive who, as a group, appear to be at increased risk for crashes, when compared with controls. Some studies have shown significant relationships between cognitive and functional measures, driver status performance on driving tests, and crash data. A number of methodologic problems in the studies reduce the level of confidence to which the data can be generalized. Diagnosis is not an adequate predictor of function. There is great heterogeneity of the rate of progress as well as the cognitive strengths and weaknesses among patients with dementing disorders. Performance-based guidelines for driving competence are essential rather than dependence on diagnostic labels. Ultimately, there would be no concern if there were no injury. There would be little concern if our cars and roadways were designed in such a way that the driver played little role in the traffic interaction. The potential for such systems exists but is expensive and unlikely to be built on a large scale. Therefore, it is necessary to identify the characteristics of the drivers who pose "unacceptable" risk to themselves and others. Functional information obtained from the family should be supplemented by an observational assessment of the patient, ideally by a trained specialist. The health care team's goal is to help the aging patient maintain autonomy in the face of declining health and psychosocial status. This outcome relies on a close alliance between physicians, nurses, occupational therapists, psychologists, social workers, and others to understand and manage the functional aspects and complex interactions between aging, disease, and social support systems. Treatment teams with skills in functional assessment and knowledge about the available social services are invaluable in caring for the functionally declining elderly patient. Recommendations to withdraw driving privileges on the basis of a diagnosis of dementia may ultimately be borne out by appropriate studies, but these studies have not been conducted. There is a great need for a consensus process to identify dangerous drivers, ideally with performance-based measures. This would then support uniform laws across the country that protect the patient, the physician, and the public. Education of the medical and lay community of the "warning signs" of declining driving skills could do much to heighten awareness in the community, much as the warning signs of cancer have been publicized. With the aging of our nation's population and the strong association of aging with dementing disorders, there is reason to be concerned, especially when dementing illnesses affect judgment. Demented drivers may pose a significant public health problem.(ABSTRACT TRUNCATED AT 400 WORDS)