Abstract
BackgroundDriving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility.MethodsPatients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated.ResultsRespectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use.ConclusionsAdherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.
Highlights
Driving is related to social participation; older drivers may be reluctant to cease driving
Severity of cognitive impairment is very relevant for fitness to drive and predictive for driving cessation
Clinical tools such as the Clinical Dementia Rating (CDR) should be used to stage the severity of cognitive impairment in the context of driving recommendations
Summary
Driving is related to social participation; older drivers may be reluctant to cease driving. Some patients with dementia cease driving suddenly, e.g. from one day to another, or as a result of an accident, diagnosis, or other critical event, while others cease driving gradually [19]. A proportion of patients with dementia continues to drive despite evidence of a decreased fitness to drive [20]. According to the last group, the assessment process was ‘not fair’ and did not accurately reflect their fitness to drive [13, 16, 21]. These findings suggest that fitness-to-drive assessments should be comprehensive, comprising several types of tasks and sources of information, and that guidance for patients with dementia in interpreting a recommendation about driving is essential [25,26,27,28]
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