I recently attended a seminar on developing a tool to evaluate driving competence in the elderly who suffer from dementia, put on by Sunnybrook Health Science Centre, Centre for Studies on Aging. It featured Dr. Allen Dobbs from Alberta, professor emeritus, University of Alberta, who is concerned about this issue.

I attended because I went through this with my father. He was driving when I knew in my heart he should not have been. I was always amazed when he returned home having passed his yearly test yet again. He had had a few minor fender benders -- his dementia was reducing his ability to react. Finally one night he hit a child and broke the child's leg. I'll never forget returning home to find my answering machine stacked with messages from a kind restaurant owner who gave dad coffee and support, and the police who briefly explained what had happened. I flew up to the house to find my father playing host to two wonderful psychologists from the police department who were staying with him till I got there. He was proudly showing them the family home and expounding on everything except the accident. I think he was in shock. Fortunately dad was not sued but he got the scare he needed -- a potential lawsuit.

The final solution came with help from our family doc who said he would play the bad guy and ask dad to hand over his license, which he did. The whole thing would have been much more difficult if there had been no accident; but I think even dad realized his driving years were over. It was tough; he used to meet his oldest friend at the coffee shop, his major social outing. Dad was never able to accept that taxis were available. I took him to all the places he had to go but both our lives were changed.

Nothing is more important to males in our society than the ability to drive. Whoever tells a senior he can no longer drive is never forgotten. Caregivers feel that taking away this privilege is the worst thing they have to deal with. It is hard for any of us to make this harsh judgment since we don't have the tools to make this decision fairly, whether dementia is present or not. It messes up the parent/adult child relationship.

In Ontario physicians are required by law to report any patients they feel should not be driving due to any medical condition. The doctor can be sued if his patient has a crash and he hasn't reported the patient. Consequently doctors now over-report.

Seniors who suffer from dementia and still drive are a very serious problem all over North America; the situation can only get worse as the population ages. Dr. Dobbs and his associates have developed a tool to help governments evaluate fairly the driving abilities of those over 65 with dementia because there has never been any data to justify taking away a senior's license. The test is being used in Alberta and is proving extrememly accurate in predicting those who should no longer drive. Seniors with dementia who are tested and who pass are retested every six months.

Studies show that:

• for those over 65 the no.1 killer is a car crash
• 30-40% of dementia sufferers drive
• 40-50% have a crash within a few years of diagnosis
• 80% of those who have a crash continue to drive
• 40% of these have at least one more crash
• 25% of those asked to stop driving are still on the roads

So what signs should caregivers watch for to help them evaluate the driving skills of their parents?

1. They drive too slowly for the conditions.
2. They make their turns too wide or too sharp (people with dementia cannot judge a turn's radius).
3. They change lanes without looking.
4. People are constantly honking at them (they are making too many errors).
5. They stop at green lights instead of red lights.
6. They run stop signs (they aren't the only ones!).
7. They get confused at freeway entrances and merges (too much visual complexity).
8. Even if another person is there to provide directions, male drivers don't like to be told what to do; if there is too much noise or other cognitive input, he can't concentrate on what the passenger is saying, in any case.

When asked how they drive, most seniors with dementia say they "do fine." According to Dr. Dobbs they have no insight into their driving ability.

If you know you have to take action, tell your parent the insurance company will no longer insure him (very powerful ammunition). Contact the company, explain the situation and get a letter. If your doctor reports a parent to the Ministry of Transportation, it takes at least 30 days before a license is suspended. The Ministry is the one to make the decision. They could call for a retest (your parent could pass) or suspend the license, an action which can be appealed.

Not every senior with dementia is a dangerous driver. Whatever your situation is, please be vigilant. A crash is serious for everyone. And it doesn't help the guilt.

For more information on the ethical issues around driving and dementia, visit the Alzheimer Society of Canada Web site (www.alzheimer.ca) and look under Alzheimer Care, Ethical Guidelines.