Electronic letters to:

Research:
Nathan Herrmann, Mark J. Rapoport, Robert Sambrook, Réjean Hébert, Peter McCracken, Alain Robillard for the Canadian Outcomes Study in Dementia (COSID) Investigators
Predictors of driving cessation in mild-to-moderate dementia
CMAJ 2006; 175: 591-595 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] Driving and dementia - balancing mobility and safety
Desmond O'Neill   (11 October 2006)

Driving and dementia - balancing mobility and safety 11 October 2006
Top
Desmond O'Neill
Trinity College Dublin

Send letter to journal:
Re: Driving and dementia - balancing mobility and safety

arhc{at}amnch.ie Desmond O'Neill

As a result of Herrman et al's work (1), we now have an improved understanding of the factors involved in driving cessation among those with dementia, a topic of considerable interest around the world (2). Of particular interest was the finding that lving in a jurisdiction with mandatory reporting did not have an impact on driving cessation, raising the issue of the utility of mandatory reporting, which may have the potential to deter patients with dementia from reporting to their physician.

However, perhaps we are missing a more important issue if we focus unduly on driver cessation in terms of safety rather than on mobility. Withdrawal from driving is associated with a significant difficulty with accessing services (3), and is an independent risk-factor for nursing-home entry (4). Transportation is a key factor in maintaing health and independence for older people, promoting social inclusion: in the 2005 White House Conference on Ageing, older people prioritized access to transport as their third priority, ahead of concerns over Medicare and Medicaid (5), a priority mirrored by international organizations such as the OECD (6).

Concern has been expressed that older people are not accorded the same mobility/balance ratio as younger people in public discussions on driving and health (7). As physicians, we need to be vigilant that we are mindful of enabling aspects of driving assessment, as well as the need to actively support other forms of facilitated transport (those who cease driving are usually not able to manage the rigors of public transport) (8). It is also important that we shape any public health discourse to reflect an appropriate support for outdoor mobility and transportation for our patients.

Desmond O'Neill Associate Professor Dept Medical Gerontology Trinity College Dublin

1. Herrmann N, Rapoport MJ, Sambrook R, Hebert R, McCracken P, Robillard A; Canadian Outcomes Study in Dementia (COSID) Investigators. Predictors of driving cessation in mild-to-moderate dementia. CMAJ. 2006 Sep 12;175(6): 591-5.

2. Talbot A, Bruce I, Cunningham CJ, Coen RF, Lawlor BA, Coakley D, Walsh JB, O'Neill D. Driving cessation in patients attending a memory clinic. Age Ageing. 2005 Jul;34(4):363-8.

3. Taylor BD, Tripodes S. The effects of driving cessation on the elderly with dementia and their caregivers. Accid Anal Prev. 2001 Jul;33(4):519-28.

4. Freeman EE, Gange SJ, Munoz B, West SK. Driving status and risk of entry into long-term care in older adults. Am J Public Health. 2006 Jul;96(7): 1254-9.

5. White House Conference on Aging; 2005; Washington DC. White House Conference on Aging.

6. OECD. Ageing and transport: Mobility Needs and Safety Issues. OECD, Paris, 2001.

7. Martin A, Balding L, O’Neill D. A bad press: older drivers and the media. British Medical Journal 2005; 330:368.

8. FreundK.Independent transportation network: alternative transportation for the elderly. Transportation News 2000; 206:3–12.

Conflict of Interest:

None declared