A 97-year-old man gets into a car accident, flipping his SUV and injuring a driver in another vehicle. One week later, he is stopped by police for driving without a seatbelt.
This scenario would cause concern for many readers. Surely, having a collision and not following the rules of basic driving safety, like wearing a safety belt, should be cause for charging a fine, giving demerit points, even suspending the license. When the identity of the driver is revealed, one Philip Mountbatten, Duke of Edinburgh, aka Prince Philip, does this change your reaction? What if the driver were your own grandad or father?
Driving while royal
The reported details of Prince Philip’s driving escapades are few, but the story we do know raises an interesting and sticky point when it comes to the driving skill of seniors: preserving driver dignity while ensuring public safety. When age brings physical and cognitive changes that affect function, many of the safety challenges are more noticeable to others, rather than to the person who is experiencing the changes.
Others may notice the stained clothing, the unwashed hair, the spoiled food in the fridge, before the person with dementia (who may never develop the insight to recognize these changes). A family member may also notice changes in driving skill, such as inattention, hesitation, or geographic disorientation. If a senior must stop driving because of dementia, this can place the care partners in a very difficult position.
As a doctor, my role is to determine if there is a medical condition that could affect fitness to drive, and to inform the Ministry of Transportation, and the person with the medical condition. In the case of dementia, it is also important that the care partner be informed about this finding, as it is often their responsibility to restrict the driving activities (by disabling or removing the vehicle or keys, reminding the person that they can no longer drive due to medical reasons, or taking over the wheel themselves).
Loss of driving privileges
Losing driving privileges can result in anger, depression, interpersonal conflict, and lifestyle change. It can disrupt the doctor-patient relationship and can strain family bonds. The latter can be the most challenging part of the driving cessation process. Here are a few tips that may help to soften the blow:
Focus on health changes other than cognition.
Often, the need to stop driving is related to multiple medical challenges, not just cognitive change. It can be more acceptable to be told to stop driving because of failing eyesight, a heart rhythm irregularity, or changes in physical strength and reaction time. Emphasizing these changes may be easier to understand for the person with dementia.
Blame the doctor.
Some family physicians will refer to me, a specialist who may only see the patient once or twice, to discuss driving. This can help to preserve the vital therapeutic alliance between the family doctor and the patient. The specialist is the “heavy” who bans driving, and that is fine by me when safety is at stake. Remember that the doctor doesn’t actually “pull” the licence, the government does that, but the doctor is usually seen as having the authority in the situation. This can help to remove the perceived responsibility of the care partner, and the driving cessation can be part of “the doctor’s orders”.
Emphasize the advantages to retiring from driving.
It can cost less to take public transportation or taxis than it can to maintain a vehicle, when all the costs of fuel, parking, insurance and repairs are considered. Getting rides from family can also be a way to spend more time together. After decades of driving others around, this can be an opportunity to be chauffeured
for a change.
Ask for help when needed.
If the person who has been advised to stop driving doesn’t comply with the doctor’s or Ministry’s instructions, it can be necessary to call police. This is a last resort, but could save a life, and could help to indicate the importance of the driving cessation to the person. Sometimes, the authority of the police can have an impact that a doctor or family member lacks, particularly to one from a senior generation. Preservation of the care partner relationship with the senior is second only to public safety in importance. Sometimes family counselling is needed to successfully adjust to this huge change in lifestyle and function.
It would be ageist to assume that Prince Philip’s driving mishaps are typical of senior drivers. I don’t know if he has a medical condition that could affect his driving, or simply has had some bad luck. However, I suspect that given his status as a member of the Royal family, if he does have a medical reason to stop driving, it would be a challenge to override his regal prerogative to get behind the wheel. Even if your family member is not married to a monarch, take heart in knowing that you are not alone in going through this journey to keep everyone safe, and help is available if needed.
The Wrinkle Can Help
We can help if you think your loved one should no longer be driving.
The Driving and Dementia Toolkit: For Patients and Caregivers
Champlain Dementia Network and Regional Geriatric Program of Eastern Ontario, 1st ed., August 2011.