Living without a car

Some of the most difficult physician-patient discussions revolve around the issue of driving. Driving is a part of everyday life in America – a necessity that allows you to go to work on a regular basis, visit friends and family, and manage everyday activities, such as shopping for groceries, going to church and transporting children and grandchildren. Unless a person lives in a metropolitan area with well-developed public transportation, living without a car can be difficult and inconvenient.

But many individuals develop limitations in their ability to continue to drive independently. Vision problems interfere with a person’s ability to see the road and avoid objects and other vehicles. Hearing problems hinder the ability to modify driving at the sound of car horns or police/fire department sirens. Arthritis, Parkinson’s disease and the effects of stroke can impair a person’s ability to perform the mechanics of driving. Cognitive impairment or dementia can interfere with a person’s ability to remember directions to familiar locations or the rules of the road.

Concerns about driving ability noticed by the individual or by family should not be ignored. Family members refusing to allow an individual to drive them or their children should be considered red flags. Unexplained dents and scratches on the car, new traffic citations for accidents and running through red lights and stop signs are also clues that there are driving problems. Often, individuals with driving limitations will self-limit their driving to familiar locations, good weather and daytime, and avoid highways and heavy-traffic areas. The problem arises when an individual does not recognize that there is a problem at all.

Just like any other medical problem, a loss or impairment in a person’s ability to drive should be broached with a person’s physician. Underlying causes, particularly vision and hearing problems, mobility limitations and cognitive impairment, should be sought. Though the findings of a physician’s office evaluation may be associated with higher risk of getting into an accident, the gold standard for evaluating safety and the ability to drive independently is an occupational therapy driving evaluation. An evaluation with a physician may identify deficits, but the therapist may also identify situations where limited, low-risk driving will still be reasonable for the individual – hence, complete cessation of driving may not be necessary.

As much as possible, attempts should be made to allow driving with the minimum restrictions necessary for safety. Loss of driving ability has been associated with depression and worsening physical impairments in older persons. It should also be pointed out, though, that if an individual is told to stop driving completely, the recommendation should be followed. In circumstances where an individual continues to drive despite recommendations against it, the person’s physician may ask the state department of motor vehicles to suspend the driver’s license. Individuals who continue to drive without a valid driver’s license are at risk for fines or jail time associated with this violation. Additionally, some auto insurance companies may refuse to cover any liability for damages to a person’s vehicle or the other vehicle (including injury to the other driver) involved in an accident if the driver who was cited was driving against the recommendations of their physician.

The recommendation to stop driving is not easy for physicians to make, but greater success in preserving safety can be achieved through involvement of an occupational therapist and with support from the patient’s family.

Article by www.usnews.com