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DRIVING AND DEMENTIA TOOLKITS

Frank Molnar MDCM MSC FRCP(C)


Anna Byszewski MD MEd FRCP(C)
William Dalziel MD FRCP(C)

Regional Geriatric Program of Eastern Ontario, Ottawa, Canada


Podium Presentation
26th International Conference of Alzheimers Disease International
March 28, 2011, Toronto, Canada
Acknowledgements/Kudos

Co-Authors
Fara Aminzadeh RN MScN GNC(C), Advance Practice
Nurse (Community Research), Regional Geriatric
Program of Eastern Ontario
Kelly Robinson RSW, The Alzheimer Society of Ottawa
and Renfrew County
Major contributions
Leslie-Ann Baillou MD BScPT CCFP(CoE), Care of the
Elderly Department, Bruyere Continuing Care
Malcolm Hing MD FRCP(C), Regional Geriatric Program
of Eastern Ontario
Lynn Hunt OT, The Rehabilitation Centre, The Ottawa
Hospital
Shawn Marshall MD FRCP(C), The Rehabilitation Centre,
The Ottawa Hospital
Our Partners, Colleagues, Patients and Their Caregivers
OBJECTIVES

At the end of the presentation the attendees will


appreciate:

1. The challenges of assessing fitness to drive


in PWD (Persons with Dementia)
2. The proposed assessment algorithm
3. Issues around communication with the PWD
and their caregivers
4. Contents of the Health Professional Toolkit
and PWD and Caregiver Toolkit:
METHODS

Toolkit for Health Professionals:


Produced with input: geriatricians, nursing,
occupational therapy, physiatry
Needs assessment with family physicians
Office based tools and resources gathered
for use and application

Toolkit for PWD and Caregivers:


Additional Input from PWD and Caregivers
3 focus groups
CONTENT AREAS
Page

3 1. GENERAL STRATEGIES
4 INTRODUCTION
5 ASSESSMENT ALGORITHM / ROAD MAP
6-7 FREQUENTLY ASKED QUESTIONS FOR HEALTH
PROFESSIONALS

8 2. ASSESSMENT
9 PHYSICIAN / HEALTH PROFESSIONAL 10 MINUTE OFFICE
BASED DEMENTIA AND DRIVING CHECKLIST
10 HOW TO EFFECTIVELY FILE THE REPORT TO THE
PROVINCIAL REGISTRAR

11 3. AFTER THE ASSESMENT NEXT STEPS


12 GENERAL PRINCIPLES
13 STILL SAFE BUT NEEDS FOLLOWUP
13 PREPARATION FOR DRIVING CESSATION
14 UNCERTAIN STRATEGIES
15 UNSAFE TO DRIVE
15 DISCLOSURE MEETING
16 HOW TO EMOTIONALLY SUPPORT THE PATIENT/CAREGIVER
17 SAMPLE - WRITTEN STATEMENT TO THE PATIENT

18 4. USEFUL RESOURCES
19 LIST OF RESOURCES
20 REMOVABLE FOLDER
INITIAL CONTACT WITH DRIVER WITH DEMENTIA

Do the 10 minute Office Dementia and Driving Checklist - page 10

Clearly unsafe Driving risk is uncertain

Appears
safe
Inform the patient to stop driving IF there are
(give patient/family written dementia-related
notification and document in chart) IF driving is the
issues other than
(page 17) only dementia-
driving which require
related issue to
assessment and
assess.
treatment (or if
Notify the Provincial Registrar, if patient truly cannot
required (page 10) afford on-road test).

Follow up regarding: (page 16) Refer to local If still Follow Up


Confirmation of multidisciplinary unsure
Refer to health
driving cessation dementia assessment professional led (every 6 12
re:
Isolation site (could include fitness
comprehensive months)
Depression occupational therapy to drive
driving evaluation- ( page 13)
Use of alternative or neuropsychology on/off road
transportation evaluation) (see end of Toolkit)
Page 16
SAMPLE - WRITTEN STATEMENT TO THE PATIENT

Date:
Name:
Address:

Dear Mr (Mrs):
I realize that this is a difficult recommendation for you, but based on the results of
tests performed, I am recommending you do not drive. You have undergone assessment
for memory/cognitive problems. It has been found by comprehensive assessment that
you have ___________________ dementia. The severity is _________________.
Even with mild dementia, compared to people your age, you have an 8 times risk
of a car accident in the next year. Even with mild dementia, the risk of a serious car
accident is 50% within 2 years of diagnosis.
Additional factors in your health assessment that raise concerns about driving
safety include:

As your doctor, I have a legal responsibility to report potentially unsafe drivers to


the Provincial Registrar. Even with a previous safe driving record, your risk of a car
accident is too great to continue driving. Your safety and the safety of others are too
important.

_________________________ M.D. __________________________ Witness


PWD & Caregiver Perspective

What is the impact of dementia on driving safety and


what are the warning signs?
I was given no feedback from my testingno
feedback, no report, absolutely no communicationhow
does a decision like that get made with no feedback?
That was my biggest issue, I didnt understand the
process.

How to make the right decisions?


red flags would be helpful.assessment should be in
phases, not just a one-time deal .more than one
opportunity to show skills, strengths and weaknesses
SAMPLES OF FAQ FROM THE TOOLKIT
SAMPLES OF FAQ FROM THE TOOLKIT
SAMPLE ADVANCE DIRECTIVE FOR
DRIVING CESSATION

Agreement with My Family about Driving

To my family:

The time may come when I can no longer make the best decisions for the safety of
others and myself. Therefore, in order to help my family make necessary decisions, this
statement is an expression of my wishes and directions while I am still able to make
these decisions.

I have discussed with my family my desire to drive as long as it is safe for me to do so.
When it is not reasonable for me to drive, I desire ________________ (persons name)
to tell me I can no longer drive. I trust my family will take the necessary steps to prohibit
my driving in order to ensure my safety and the safety of others while protecting my
dignity.

Signed ______________________________
Date ______________________________

Copies of this request have been shared with: ________________________________

www.thehartford.com/alzheimers 2000 The Hartford, Hartford, CT 06115


Conclusion

Toolkits (Health Professionals and


PWD/Caregiver) will be used by health
professionals who deal with this challenging
area of dementia care as well as PWD/CG

Toolkits will be available in French and on the


web at www.rgpeo.com