Help assessing seniors’ driving

Thank you for your recent issue (March 2005) with articles and an editorial on the challenge of older patients and their driving.

I was disappointed that the scientific basis of DriveABLE assessment was not explored, particularly given the important work done by the program’s originator, Professor Allen Dobbs of the University of Alberta.¹ For most geriatricians—who have to decide whether to advise discontinuation of drivers’ licences virtually every week of our professional lives, fully recognizing that often a rural couple is condemned to isolation—a cheap, readily available criterion standard would be appreciated! In Nova Scotia, we have tried several times to get the auto insurance companies to pay for DriveABLE assessments; it is, after all, in their best interest to get inadequate drivers off the road.

A simple test, which is often useful in office assessment, is the “grandchild question.” Preferably this is addressed to the mother of the driver’s grandchild (or great-grandchild). In many drivers’ families there will be a 2- or 3-year-old child; the question, and one carefully looks at the mother of the child while asking the question, is, “Would you let your father (or grandfather) drive the car with your child in it?” The slightest hesitancy on the mother’s face often indicates that she would not be prepared for this to happen. Addressing the question to the driver’s wife (usually the grandmother of the child) is less informative, as she often fears that she will suffer the consequences if her evidence leads to removal of his licence.

One of the roles of a specialist geriatrician is to be the “whipping boy” for the bad news of driver’s licence removal. This enables the referring family doctor to collude with the patient and blame “that specialist” who took the licence away. This helps to preserve the patient–family doctor relationship, which often has to continue for many years, particularly if the licence was revoked in the early stages of dementia. Dementia’s progression will require continued support from the family doctor for both patient and family. Eventually, if institutional care is needed, it is salutary to be able to remind the family of how well they coped with the removal of the driver’s licence in the early stages of dementia.