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Driving and Parkinson's Disease-When is it Time to Give up the Keys?

As baby boomers age and life expectancy rises, increasing attention is turning on how to determine when and if older people - and people with health problems - should stop driving. This topic is especially important in light of a 1999 study by the National Center for Injury Prevention and Control that cites motor vehicle injuries as the number-one cause of injury-related deaths for people aged 65 to 74, and the number-two cause (after falls) of injury-related deaths for those aged 75 to 84. The issue hits home for people with Parkinson's since both the symptoms of the disease and the medications designed to ease them can affect driving ability. If you are struggling with the decision of whether or not to stop driving, or if you are a caregiver for someone who is wrestling with this problem, this article may help you explore your options.

How does Parkinson's disease affect driving?

People with Parkinson's disease may eventually experience a decline in both motor skills and cognition. These problems can make driving unsafe. For example, a decrease in visuospatial skills - the kind that are necessary to determine distance and distinguish shapes - is not uncommon in PD. A driver with decreased visuospatial skills may be unable to gauge the distance to a stop sign or a traffic light or keep a car in the correct lane. Some people with Parkinson's also may have cognitive difficulties and at times become confused. Unfortunately, patients with dementia may not realize that their driving has become a problem and must rely on a physician, family members and friends to bring it to their attention. Another common symptomatic problem for people with Parkinson's is muscle tightness, which can make reacting quickly difficult. Delayed reaction time is dangerous because drivers need to be able to react swiftly, both mentally and physically, to avoid accidents and adapt to changing traffic patterns.

Additional complications come from the medications that are used to treat PD. Common medications - including carbidopa/levodopa (Sinemet), amantadine, dopamine agonists and anticholinergics - may produce side-effects such as sleepiness, dizziness, blurred vision and confusion. Anticholinergics are especially dangerous as they can cause confusion and sedation along with memory impairment. However, not every patient experiences these side-effects and they may be decreased with simple adjustments in dosage. You should note any changes and report these to your physician.

Assessment options for people with Parkinson's

It is important to remember that while not every person with Parkinson's experiences problems with driving, disease symptoms and treatments can make driving dangerous for you and others. Driving is a sign of independence and freedom and you may be reluctant to stop, but being responsible is also important. To help you determine your driving risk, the American Medical Association (AMA) has recently published The Physician's Guide to Assessing and Counseling Older Drivers. It includes extensive information about diseases that may affect driving ability, such as Parkinson's. This guide, accessible at www.ama-assn.org/ama/pub/category/10791.html, is an outstanding resource. Although it was developed primarily for doctors, it will help laypersons make their own assessment of their driving ability and determine a course of action.

The guide features a questionnaire, Am I a Safe Driver? to help you evaluate your driving. If you score poorly on this and are still reluctant to stop driving, refer to the Tips for Safe Driving sheet and consider speaking with a doctor about the issue. The guide includes suggested tests on cognition, mobility, reaction time and visual ability for physicians to perform on patients to determine if a person is driving safely.

During an examination to determine medical fitness for driving, your doctor may discuss several options. One is to visit a Driver Rehabilitation Specialist (DRS). The Association for Driver Rehabilitation Specialists (ADED) certifies a DRS to assess driving skills with on-road tests, provide rehabilitation based on the results of the on-road tests and recommend modifications on your vehicle to help you drive more safely. This service can be costly, averaging $200 to $400 for an assessment and about $100 an hour for rehabilitation. Expenses increase substantially if you decide to include adaptive equipment for a vehicle, and Medicare may not cover any of this. Before signing up for services, talk with the DRS and your insurance company to determine what will be covered. To find a DRS near you, call ADED at (800) 290-2344 or check the directory at www.driver-ed.org. You can also inquire at hospitals, driving schools, rehabilitation facilities and state motor vehicle departments in your area.

A less costly, although less thorough, option is to enroll in a driver safety class, such as the AARP 55 ALIVE Driver Safety Program, (888) 227-7669, and the AAA Safe Driving for Mature Operators Program (contact your local AAA for details). While these classes are not specifically tailored for people with Parkinson's, they can provide helpful tips for safe driving. An instructor will lead the class through various ways of enhancing driving skills and safety but often will not make individual assessments. One potentially useful new resource will be the creation of the National Older Driver Research and Training Center, a joint project of the University of Florida and the American Occupational Therapy Association. The center will train more Driver Rehabilitation Specialists and develop better off-road tests for driver safety.

Finally, you can always visit the Department of Motor Vehicles and ask to take a driving test. Of course, if you were to fail the test, your license would be revoked.

What can family members and friends do to help?

Understandably, most people are reluctant to give up the opportunity to drive. Because of this, it is often up to family members and caregivers to spot a problem first. If you are a family member or caregiver for a person with Parkinson's and you think it may be time for them to stop driving, remember that this is a very sensitive issue and you must help the person see that his or her driving has become dangerous. The AMA doctor's guide features several helpful materials to make it easier to approach a person about his or her driving. Before bringing up the subject, look at the How to Help the Older Driver tip sheet, which is extremely relevant for Parkinson's patients. This can help you determine if your concerns are valid and if so, how you might address them.

Another way to help your loved one with this decision is by stressing that giving up driving does not mean giving up mobility. Your support is crucial in helping a person with Parkinson's admit that his or her skills have decreased without feeling stripped of power. To help people with Parkinson's with their decision to stop driving, provide them with transportation alternatives. The Getting by Without Driving tip sheet in the AMA guide identifies other possible modes of transportation, including taxis, buses, subways and getting a ride from family members. Some cities also provide travel assistance for people unable to use public transportation. If you know someone with Parkinson's who has had to give up driving, provide him or her with bus routes, taxicab phone numbers, and offer to give rides. For more transportation alternatives, call the ElderCare Locator at (800) 677-1116 and ask for your local Office on Aging, or visit the website at www.eldercare.gov. This may help a person with Parkinson's adjust and realize that stopping driving does not mean losing independence.

What's the bottom line?

Having Parkinson's does not necessarily result in giving up driving. However, whether you are a person with Parkinson's or a loved one, it is important to be responsible and remember the potential dangers that Parkinson's presents to driving. Ignoring the effects of the disease and its medications on driving will only create a more dangerous environment for you and other drivers. The best way to be a responsible driver is by paying attention to your driving skills and reporting any changes to your physician. If you have concerns, don't avoid voicing them out of fear of losing your license. Doctors and family members are often happy to help you exhaust rehabilitation options before asking you to give up driving. If it does come to the point where family, doctors and driving coaches ask you to give up your keys, realize that it is in your best interest to stop driving and explore other transportation options.