Thank you, Lu, for sending the information about this podcast last week, listening to it, AND sending this summary for us!
This podcast available through www.VoiceAerobicsdvd.com with Dr. Howard Kalter, neuropsychologist, creator of the Cognitive Behavioral Driving Inventory
October 3, 2014, Noon
Should You Be Driving?
Capacity vs. Competency
Capacity is the ability to be able to communicate a choice and the reasoning behind it. It also allows one to remember conversation, to identify their illness and their treatment options. It requires Executive Function (see below). Competency means functionally adequate, to have enough knowledge, strength, skill and the ability to navigate.
The Frontal Lobe is where Executive Functioning occurs. If the frontal lobe is affected, one is unable to use learning strategies, to have the ability to repeat back information, to respond appropriately socially, They can be behaviorally labile which means they cry easily, demonstrate apathy, are unable to see tasks through and show personality changes.
Some seniors can drive safely into their 80’s. Physical issues that can affect driving include vision problems , like cataracts, macular degeneration, and glaucoma, and hearing issues. Can they hear a siren? A horn? Someone accelerating around them? Do they have necessary motor skills like the range of motion in the head and neck to scan for traffic? Can they turn the steering wheel? But there is a greater association between cognitive function and safe driving than physical issues.
Parkinson’s Disease Cognitive Issues
People with Parkinson’s Disease can cause deterioration of Executive Functioning (in the frontal lobe of brain). This affects problem solving, making plans, forming goals, anticipating consequences and being able to both form strategies and make changes. All of these skills are critical in driving. Parkinson’s can make it hard to apply full attention to driving. It can cause bradyphrenia, a neurological term referring to slowness of thought which makes it take longer to process information. A full half to two-thirds of Parkies have memory issues affecting registration (entering data into memory), encoding (organizing it) and retrieval (getting it back when needed). It can also affect prospective memory which means you remember to remember something, like take a shower, perform a task, take your medicine or remember the route home.
Most Common PD Medicines that Impact Executive Function.
Mirapex can cause sudden sleepiness Other medicines that can cause sleepiness or a fall risk include zanax, clonopin (which relieve anxiety), cough medicines with codeine, tranquilizers and pain medications. It should be a red flag when new medicines are introduced. There should be a waiting period on driving to see how new meds affect a person.
Obviously, alcohol should not be used with meds and driving.
If there’s concern, you can have motor speed and executive function tested.
Signs that its time to take away the keys
- Eyesight issues such as sensitivity to light, blurry or double vision
- Do they slow up to see a traffic sign?Can they respond to someone changing lanes?
- How’s their hearing?
- Are their reflexes slowing?
- How is their range of motion? Can they look over their shoulder?
- Have they mistaken the gas and brake pedals?
- Are they doing more aggressive driving? Road rage?
- Can they back up?
- Do they get lost often?
- Do they use the turn signal?
- Have they had close calls, almost crashing?
The Good News
The good news is that there are steps you can take if they are some of those issues. If you see motor or cognitive issues, address them early. For example, some cognitive re-training is possible. Lumonisity brain exercises, created by scientists to help with attention, concentration and motor speed.
Occupational Therapists exist who are driving specialists. They can also help decide what if any, assistive devices would be useful. Early intervention by doctors can include functional capacity tests. Being pro-active can keep one driving longer. Use the driving assessment instead of being in denial, and use Luminosity and/or OTs. Doctors can use a form to send to the DMV, as can spouses.
Transportation Services that Serve Senior Clients include
• www.eldercare.gov , Office on the Aging, 1-800-677-1116
• ACCESS, 1-800-659-6428