Mandatory reporting for health professionals to transport licensing authorities for conditions including dementia should be considered to ease confusion around the legal and licensing requirements when it comes to driving and dementia, a new discussion paper has found.
The discussion paper, Driving and Dementia, released today by Alzheimer’s Australia NSW, has found that there is still a lack of information and understanding around what is required by people who have a diagnosis of dementia and who hold a driver’s licence, little clarity around the role of doctors in this area and a lack of information and support regarding alternative transport options.
Alzheimer’s Australia NSW CEO The Hon. John Watkins AM said these all combine to make what is already a very difficult time in people’s lives more confusing, stressful and challenging.
“Driving, for many, represents freedom, independence and, for some, plays an important role in the formation of their identity,” Mr Watkins said.
“As people age, driving is often critically important to health care, personal happiness and social involvement. Carers and people living with dementia tell us that giving up a driver’s licence is one of the most challenging aspects of the dementia experience.
“To have the possibility of having your driver’s licence taken away, particularly after you’ve been given the devastating news that you have a diagnosis of dementia, can make an already highly stressful situation worse. The confusion and lack of information about what is legally required by the person with dementia once they have been given the diagnosis and the lack of information and support regarding alternative transport options for people who have given up their licence, or had it revoked, can then pile on more stress, uncertainty and confusion.
“Currently, in NSW, once dementia has been diagnosed, a driver has a responsibility to inform the Roads and Maritime Service and their insurer of their diagnosis, but many drivers are not aware of these requirements.
“We need to make this process smoother. We need clearer guidelines and information about just what is required by a person with dementia who holds a driver’s licence once they have been given a diagnosis of dementia and, importantly, we need a much clearer understanding of just what alternative transport options are available to a person who no longer holds a licence.
“The rights and needs of the person with dementia must also be considered in this. Many can continue to drive, albeit with some conditions, and with an annual assessment.
“But access to alternative forms of transport in order to be able to travel to things like medical appointments, the local shops, social gatherings, all those ‘every day’ activities that we all take for granted, is also critical for people with dementia to remain connected with their community.”
With the ageing of the Australian community, this issue is going to become more significant. In 2014, there were approximately 142,000 licence holders in NSW over the age of 80 and approximately 50,000 over the age of 85. It is not known how many of these older drivers had a diagnosis of dementia, but research suggests that the incidence of dementia increases significantly with age.
Mr Watkins said the lack of clarity around driving and dementia means medical professionals continue to be placed in a difficult position.
“At the moment, it is not mandatory in NSW for doctors to report that a patient has dementia to the Roads and Maritime Service (RMS),” he said.
“They only do so if they are concerned that a person with dementia is driving when they should not be. This can place them in a difficult position and can be seen by their patient as the cause, if their licence is revoked, which can impact on their on-going relationship with their patient.
“If reporting is made mandatory, if removes the need for this discretion and takes it out of the hands of the physician.”
Key recommendations from the discussion paper:
· Consider mandatory reporting for health professionals to the RMS for conditions that are likely to affect public safety;
· Improve the guidelines for medical professionals to support their role in the transition from driver to non-driver;
· The NSW RMS to develop a Driving and Dementia information pack for doctors in NSW to issue to patients with dementia at the time of diagnosis. This should include material highlighting the need to consider ceasing driving, the need to check their insurance liabilities and the need to disclose a diagnosis of dementia to the RMS. This material should also be made available to Aged Care Assessment Teams (ACATs), Dementia Advisors and other health professionals;
· Introduce policies that subsidise the issue of cost and accessibility of on-road driving assessments in order to make the service timely and affordable for people with dementia;
· Improve the process of driving cessation by streamlining communication between doctors, the RMS and occupational therapists who undertake on-road assessments for drivers with dementia;
A full copy of the discussion paper, along with the full list of recommendations, can be found at https://nsw.fightdementia.org.au/nsw/research. There is an estimated 115,000 people with dementia in NSW, which is expected to grow to 272,000 by 2050.
 Alzheimer’s Australia NSW and Deloitte Access Economics, August 2014