UK: Confused About Driving With Dementia?

One in three people with earlier-stage dementia still drives, and it is critical for those diagnosed with dementia to maintain their quality of life and dignity....But some people diagnosed with dementia do not necessarily want to start a process that might ultimately lead to their licence being revoked....I do not believe that the current system strikes the right balance in mitigating the risk.1

Following proposals under the Driving (Persons with Dementia) Bill to require doctors to inform the appropriate driver licensing agency of a diagnosis of dementia and ensure that drivers diagnosed with dementia undertake a supplementary driving assessment, we consider the current position, the proposals put forward and whether this will adequately protect road users. 

How does dementia affect driving?

Dementia refers to a group of symptoms that affect and deteriorate brain functions - including recognition, memory, language, and planning. There are 850,000 people in the UK currently living with dementia2. As our population continues to increase in age, so too will the prevalence of dementia in the UK, which is estimated to reach over 1 million by 2025 and 2 million by 20503.

Driving is a complicated task that involves a combination of complex split-second thought processes as well as sensory (vision, hearing) and manual skills. Dementia can affect all of these skills and indeed there is evidence of an increased risk of dementia patients being involved in road traffic accidents4

A diagnosis of dementia is not in itself a reason to stop driving. In fact, one in every three people with dementia still drives5. What matters, from both a legal and a practical point of view, is whether the person is still able to drive safely.

What is the current position?

A licence holder who is diagnosed with dementia must contact the relevant licensing agency promptly, or risk a fine of up to £1,0006. In England, Wales and Scotland this is the Driver and Vehicle Licensing Agency (DVLA). In Northern Ireland it is the Driver & Vehicle Agency (DVA).

The doctor who has diagnosed the person's dementia should talk to them and anyone attending the appointment with them about driving. The doctor should make it clear that the person needs to tell the DVLA/DVA. A driver with a diagnosis of dementia should also immediately tell their car insurance provider. If they do not, their policy may become invalid.

In some cases the doctor will tell the licence holder that they should stop driving immediately. The person may need to stop driving permanently, perhaps because their dementia is more advanced, they lack insight, have poor visuospatial awareness or are having hallucinations. Or the doctor's advice to stop may only be as a precaution until further assessments are carried out. Many people diagnosed with dementia will decide for themselves that they wish to stop driving and voluntarily surrender their licence. 

However, the current system has been subject to criticism as some people diagnosed with dementia do not necessarily want to start a process that might ultimately lead to their licence being revoked. It is common for the person with dementia to lack insight into their own loss of capacity. It is also the case that GPs may not be prepared to notify the DVLA, for the same well-intentioned reasons. A GP does not always see their patient behind the wheel, and if they have known the person for years, it is a difficult and unwelcome conversation for them to have.

What is being proposed?

The Driving (Persons with Dementia) Bill 2017-19 would legally require doctors to inform the appropriate driver licensing agency of a diagnosis of dementia and ensure that drivers diagnosed with dementia undertake a supplementary driving assessment.

Under the system proposed in the Bill, the doctor would be required to notify the DVLA automatically, which would then require the person to take the driving assessment at an appropriate juncture. 

Importantly, the Bill does not seek to prevent those diagnosed with dementia from driving if they can do so safely and recognises that driving can be critical for those diagnosed with dementia to maintain their quality of life and dignity.

Dementia patients would not be required to retake a full driving test, but rather a supplementary assessment looking at the overall impact that dementia is having. The outcome of the test might suggest modifications to the vehicle or driving behaviour that could extend the period someone could drive safely following a diagnosis. It would become the norm for the DVLA to be notified and for a supplementary test to take place at an appropriate interval following the diagnosis.

Detecting the point at which driving becomes unsafe for a dementia sufferer can be a problem for individuals and family members. The assessment would present the patient with the opportunity to actually demonstrate to their carers and the community that they are in fact safe to drive. 

What next?

The Bill is a Private Members' Bill and was introduced to Parliament under the Ten Minute Rule. The next stage for this Bill, its second reading, is scheduled to take place on a date to be announced7

Whatever the outcome of the Bill, it is hoped that the underlying intention of the legislation will encourage sometimes difficult conversations about how to better support those with dementia and address the wider impacts on society, including protecting the safety of everyone on the road.

Footnotes

1. Extract from MP Rachel Maclean's first reading of Driving (Persons with Dementia) Bill 2017-2019

2. https://www.alzheimers.org.uk/about-us/news-and-media/facts-media

3. https://www.alzheimers.org.uk/about-us/policy-and-influencing/dementiauk-report

4. https://www.alzheimers.org.uk/sites/default/files/migrate/downloads/driving_and_dementia_factsheet_439.pdf

5. https://www.alzheimers.org.uk/sites/default/files/migrate/downloads/driving_and_dementia_factsheet_439.pdf

6. https://www.gov.uk/dementia-and-driving

7. https://services.parliament.uk/bills/201719/drivingpersonswithdementia.html

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