Demented drivers a growing hazard

By Jennifer Campbell
Local News - Thursday, July 15, 2004 @ 07:00

The testing system for Ontario drivers fails to keep the roads safe from drivers who have dementia, warns a study led by a Kingston researcher.

Dr. Robert Hopkins estimates that in roughly two decades, the number of people with dementia who are regularly getting behind the wheel will triple to 100,000.

The study, published in the July issue of the Canadian Psychiatric Association Journal, concludes the testing system, which screens drivers over the age of 80 every two years, is inadequate.

Hopkins is a neuropsychologist at Providence Continuing Care Centre’s Mental Health Services site at King Street and Portsmouth Avenue and a professor at Queen’s University.

He says some elderly drivers have severe problems that limit their ability to make good decisions while behind the wheel.

“After a proper assessment, you can see where they’re at and often it’s not very pretty,” he said.

The projected increase in the number of drivers with dementia, said Hopkins, is attributable to the growing number of elderly people, the demographic most susceptible to dementia.

The condition is characterized by a decline in intellectual functioning that is severe enough to interfere with the ability to perform routine activities.

Crash studies show drivers with dementia are two to five times more likely to be involved in a collision than drivers without the condition.

“We know that there are a lot of demented people out there, but how many people suffering from dementia are on the road?” Hopkins asked. “We were trying to put a number on this.”

In the most extreme cases, these people forget how to operate the car itself. But those who can go through the rote of starting the vehicle and getting it on the road, based on years of experience, can find themselves in dangerous situations.

Police have reported finding dementia patients driving in the wrong direction on Highway 401. In one case, they picked up a Mississauga man in Kingston. He had left his neighbourhood, wound up on the highway heading east, and didn’t stop until he was stopped in Kingston.

“He was totally lost when the police picked him up,” Hopkins recalled. “This man was able to get all that distance but had no idea where he was.”

For many with dementia, it’s not just about operating the vehicle, either.

Getting the car out of the garage and going to the corner store is the easy part. The problems arise when they get confused by an emergency, or even a busy intersection where people are walking in different directions and cars are blocking traffic.

They also fail to make cognitive connections. “If you were driving along a quiet street and suddenly a ball comes rolling onto the street, most people would immediately stop the car because they expect a child to be following it,” Hopkins said. “Dementia patients would fail to make that connection.”

The researchers looked at Ontario Ministry of Transportation census data from 1986 and 2000 and studies on the prevalence of dementia.

Hopkins said they had to make a few assumptions – employ “logical reasoning” in bridging the sources of data – but he’s comfortable the number is a good estimate.

“I’ve spent a lot of time myself trying to determine just how many there are,” he said, adding that he runs a clinic to assess the levels of brain damage in dementia patients.

“We know that people drive when they’re demented, but nobody knew how many demented people are likely out on the road or at least licensed to drive,” he said.

A road test, vision test and written test were part of Ontario’s annual relicensing process prior to 1996, but now the road test is no longer mandatory and testing occurs every two years instead of yearly.

Hopkins’s study doesn’t propose solutions, but he said there needs to be “some serious consideration to various types of tests and methods of detecting this.”

The solution should come from the transportation side, he said, but health-care professionals will have to be involved in designing the policy as it is a mental-health issue as well as one of safety.