To Drive or Not to Drive that is

To Drive or Not to Drive – that is the question? Gregory Winkelmann Rhonda Preston-Jones Memory Team

Where would you place yourself as a clinician on this continuum ? Hesitant Confident Reluctant Assertive to stop someone driving

Assessment Tools § Addenbrooke’s Cognitive Assessment –III (ACE III) § Rowland Universal Dementia Assessment Scale (RUDAS) § Montreal Cognitive Assessment (MOCA) § Frontal Assessment Battery (FAB) § Trail Maker § SIMARD § Drive Safe, Drive Aware app for an Ipad

What went wrong? § Seen in a outpatient clinic with his wife (without his EPOA/daughter) § Told to stop driving but continued anyway § GP advised to cancel his licence but did not § No letter sent to NZTA § Advise by hospital staff to stop driving but forgot § Wife very reluctant for him to stop driving

So often we have: § Reluctant clients § Reluctant families § Reluctant GPs § Reluctant clinicians

Reactions: § “Thank God you’ve stopped him driving” (Grateful and relieved family) § “You’ve cut my legs off you bastard!” (Disgruntled client) § “Oh my God !!!!” (daughter watching her father fail at the Trail Maker) § “What the F@#k do you think you are doing – we’re going to have to sell her house and move her now !!!!”. (son whose mum lives way out on a rural road in South Auckland) § “What about all those drunks and hoons out there ! I’m a much better driver than they are !!!!!” § “But I’ve been driving for 50 years !” “Sorry Dad not any more!”

Powers of Persuasion: Techniques to help clients and families with acceptance § We have to be at the peak of our game to drive a car § In a car you only have seconds to avoid a catastrophe § It’s not about your driving skills but your reaction times, being able to think under pressure and cope with multiple stimuli § If you are struggling to cope with complex tasks like cooking or paying bills then driving is the most complex skill you do and it is the most dangerous § If a doctor said your eyes were not sharp enough to drive anymore how would you react? § In the end if we have the good luck to live long enough we will all have to hang up our driving keys at some point § Imagine the legacy you could leave if you had an accident and killed someone else § You may be a really careful driver but what if someone else does something stupid in front of you – could you react fast enough? § It’s better to hang up your car keys with dignity than wait till you have your licence removed

Safety to continue to drive Moral Legal Ethical

Where would you place yourself as a clinician on this continuum now?