- © 2007 Canadian Medical Association or its licensors
As a result of the work of Nathan Herrmann and colleagues1 we now have an improved understanding of the factors involved in driving cessation among people with dementia. Of particular interest was the finding that living in a jurisdiction with mandatory reporting did not significantly increase the risk of driving cessation. This leads one to question the utility of mandatory reporting, which may deter patients with dementia from relaying concerns about deterioration in their level of functioning to their physician.
Perhaps we are missing a more important issue associated with driving cessation if we focus unduly on safety rather than on mobility. Driving cessation is associated with significant difficulty in accessing services2 and is an independent risk factor for entry to a nursing home.3 Easy access to transportation is a key factor in maintaining the health and independence of older people and promotes social inclusion.4,5
Concern has been expressed that older people are discriminated against in public discussions about driving and health because of the emphasis on safety at the expense of a balanced perspective of the importance of both mobility and safety to health and social inclusion.6 As physicians, we need to be mindful of the enabling aspects of driving assessment (e.g., by an appropriate focus on arthritis, vision and medication review7), as well as the need to actively support other forms of facilitated transport (people who stop driving are usually not able to manage the rigours of public transportation).8 It is also important that any public health discourse support outdoor mobility and transportation for our patients.