The community where I live have a large elderly population, with many retirement villages and old age homes, so quite a large part of the clients that are referred to me tend to be older drivers. Over the years I have been in many conversations with family members that have loved ones with dementia or Alzheimer’s disease. There has always been a common thread in the questions being asked in terms of driving. I hope to provide some information about dementia, how it can affect driving and also how to navigate this challenging journey. I will also share some resources and links to other websites where you can find more information. What is dementia? There are different types of dementia and it affects people differently. Alzheimer's disease is also classified as a type of dementia, with dementia being the umbrella term. Because of the way that dementia affect people differently, no two people will present in the same way and therefor recommendations and assessments for driving may vary. People also have different driving habits and needs where some may only drive to a few shops and places and others are on the road frequently. This is often quite a difficult and tricky population group to work with and I will discuss some of the reasons why and ways to manage the different challenges. Changes in daily functioning Referrals to an occupational therapist for a driving evaluation will often come from family members or from a medical professional. Concerns about driving are usually identified when there are declines that become more apparent in other areas of daily life. This can include: Changes in how the person functions at home. The person may become more disorganized Struggles with short term memory that affects daily functioning Struggles to manage medications and appointments and/or   Self care and being able to look after themselves and keep themselves clean, neat and organized as they used to. An example can include wearing the same clothes everyday, or clothes being dirty. Concerns about driving When these concerns are being identified, family members will often consult a medical professional like a neurologist, psychiatrist or their GP and often either early on in the dementia journey or later on people might start asking the question about driving. Family members may become concerned due to observed scratches and dents on the car, or when driving with the person and noticing errors, poor judgement or missing vital information. A referral to an occupational therapist is then often the next step. Sometimes these concerns are amplified due to a sudden crisis situation that resulted in a near miss or a crash and so the bigger concerns about driving presents itself. This usually necessitates quick action in terms of assessment due to safety concerns and risks. How can dementia or Alzheimer's disease affect driving? Dementia or Alzheimer's disease can affect cognitive, visual and motor functions that progresses over time. The progression of dementia can also be different depending on the type of dementia and the age of the person when they are diagnosed. Therefore, trying to determine prognosis and rate of progression can influence future planning in terms of the driving journey and eventual driving cessation. Cognitive impairments that can significantly affect driving include: Executive functions Attention (being able to maintain focus on the road) Alternating attention (being able to attend to multiple things at once) Short-term memory (getting lost in familiar areas) Orientation to time and place - this refers to knowing the day and date and knowing where you are. Reasoning and decision making (quick decision making and taking appropriate action) Judgment (manaaging hazards and navigating other road users safely) Processing ability and speed of processing of information (slower reactions and responses) Insight - (being aware of own impairments in driving and noticing errors on the road) Changes in executive functions raise the biggest concerns, especially when a person's ability to judge safety on the road becomes impaired. Cognitive changes also affect abstract thinking, and becomes more concrete and focused on the present, resulting in an inability to think further ahead or consider the consequences of actions and decisions being made. Limited insight or awareness often lead people to say things like, "My driving is perfectly fine, I'm functioning well, I have no problems or concerns". On the other hand, the family is extremely concerned. There is a mismatch between how the person perceives their own functioning and how they are perceived by their next of kin and loved ones. The person may struggle to understand and comprehend feedback about their driving, and receiving feedback after an assessment may elicit strong emotions. It is important to anticipate this and to be prepared. The occupational therapist can provide support for the family and the client during the feedback session. The family needs to navigate the person's need for independence and self-identity in driving, with their and other's safety and this can be difficult to balance and navigate.   When is it still safe for a person with dementia to drive? It is possible for people in the earlier phases of dementia to still continue to drive. Many people start limiting their driving and cut down on driving as they get older, or their health declines. People might drive in their local area to a few places like shops, church or community centers and also start limiting how often they drive. However some still continue to drive on highways and busy roads without realizing the inherent risks. As dementia progresses, driving may thus become unsafe and an evaluation by an occcupational therapist or a family conversation with the person may need to be the next step. Recommendations may include limiting driving or driving cessation and needs to be considered carefully. Examples of warning signs Family members should drive with the person in their vehicle and observe them on the road in order to identify warning signs. Warning signs to look out for may include some of the following: Getting lost in familiar areas Bumps and scrapes on the car Becoming disorienated and flustered Struggling with judging safe gaps in traffic Impulsive behaviour Risk taking behaviour Struggling to manage intersections safely Sudden stops in the middle of traffic Missing important information e.g. pedestrian, uncoming car or road sign. For more information including a checklist with warning signs, the Driving with Dementia Roadmap is a very useful resource. https://www.drivinganddementia.ca/knowingwhenitbecomesunsafetodrive As dementia progresses, driving may become unsafe and an evaluation by an occcupational therapist or a family conversation with the person may need to be the next step. Driving retirement - who should have the conversation? As dementia progresses, at some point driving retirement may be indicated. This can be facilitated by the occupational therapist to help determine timing for driving retirement. This can include an assessment, future reassessment, or family education. If you are planning to have the conversation, do so when you start noticing any of the warning signs. Follow some of the guidelines provided in the Hartford handouts. https://www.thehartford.com/resources/mature-market-excellence/dementia-driving or https://www.drivinganddementia.ca/talkingaboutstoppingtodrive# Transportation planning for driving cessation Statistics show that driving cessation can lead to depression and isolation, and therefore  negatively affect the person's health and well-being. It is extremely important to have a plan in place when driving retirement is recommended, so that alternative options are available. It is not a question of if, but of when the person with dementia will retire from driving.   Often when the person needs to retire from driving, they will need assisted transportation options like a family member, a friend, a carer or companion to assist and accompany the person when they go out. One of the benefits of using alternative transport is that this can potentially open up new opportunities and avenues for the person to be engaged within their community, and in a safe way. The family's involvement in the planning process is extremely important. The therapist will guide the family through identifying relevant and appropriate options for alternative transportation. I have found in my community over the years that there are more and more options becoming available, making it increasingly viable for people to navigate without a car. The way that feedback and future planning is navigated is extremely important so that the transition to non-driving can be as gentle and painless as possible.

How can a stroke affect your driving? Returning to Driving Warning signs that someone might not be ready to return to driving Vehicle Adaptations and Modifications Driver training Common questions A  question individuals recovering from a stroke often ask is, "When can I start driving again?" or "Will I be able to drive after my stroke?" Understanding how a stroke can impact your driving ability is essential to determine if and when you are ready for a safe return to the road. How can a stroke affect your driving? A stroke can lead to various impairments that can impact driving in several ways. These impairments may vary depending on which part of the brain was affected, and the severity of the stroke. Every person is different and may be affected differently Left Hemisphere (left side of the brain):  May include apraxia (difficulty with motor tasks) and planning), aphasia (language impairment), and mathematical difficulties. Right Hemisphere (right side of the brain):  Often includes impulsivity and challenges with spatial awareness. Motor symptoms Sensation Vision Visual perception and processing Cognition Motor Symptoms Strokes affect individuals differently, but common symptoms include paralysis or weakness on one side of the body, which may affect coordination and control. This can include weakness in the face, arm, hand or leg and can differ in severity.   Sensation Impaired sensation can hinder your ability to feel the pedal or judge the pressure of your foot needed while driving. This may include some numbness or total loss of sensation and position sensation (proprioception). Vision Strokes can cause visual impairments, such as: Hemianopia (loss of half of the visual field) Visual neglect (difficulty noticing one side) Blurred vision Double vision Changes in eye muscle movements and coordination This may affect visual search abilities, visual scanning and can also result in slower visual processing, which can significantly affect driving. Visual perception and processing Visual perception and processing refers to how the brain processes and makes sense of what you see. Here are a few examples of how this can affect driving. Spatial orientation: Keeping the car in the lane, also called lane maintenance, while driving straight,going around corners and parking. Depth perception and perception of speed : E.g. judging safe gaps in traffic in order to turn right. Judging speed aand distance of uncoming cars. Visual search: Difficulties can affect your ability to effectively scan the environment for hazards and other road users. Slower visual processing: Taking longer to see and perceive in order to respond e.g. a pedestrian crossing the road, or brake lights of the car in front. Cognition Cognitive impairments can include slower information processing, attention deficits, executive functions like planning problem-solving, judgment and insight can significantly impact driving. Returning to Driving Returning to driving is typically one of the final goals in rehabilitation, alongside returning to work and independent living. The rehabilitation team can include occupational therapists, physiotherapists, and speech therapists who will work on improving the different skills needed for safe driving. It is recommended that the person is referred to an occupational therapist trained in driving to do an independent assessment and return to driving rehabilitation.  The occupational therapist will evaluate your readiness to return to driving and recommend any necessary vehicle adaptations or driving modifications.   People who recover well after a stroke may be able to return to driving without any further intervention or assessment. Your treating occupational therapist will guide you through the process. Others may need the services of an occupational therapist to assess the need for vehicle adaptations and driver training. For some, driving may not be a realistic goal, necessitating a shift to alternative modes of transportation and support. Warning Signs that someone might not be ready to return to driving When considering a return to driving after an illness or injury, it is crucial to assess whether you are truly ready to get back on the road. Here are some important red flags that might indicate you're not quite prepared to resume driving: Neglect of one side of the body or visual space:  Difficulty in noticing or responding to objects or stimuli on one side of your body or in your field of vision could pose serious risks while driving. Poor attention and impulsivity:  Challenges with maintaining focus or controlling impulsive behaviors can impair your ability to drive safely and make sound decisions on the road. Cognitive impairments affecting daily function:  If you are experiencing memory problems, difficulties with problem-solving, or other cognitive issues that impact your daily activities, these may also affect your driving abilities. Visual Perception impairments:  Issues with interpreting visual information, such as depth perception or the ability to judge distances, can significantly affect driving performance and safety. If you recognize any of these signs in yourself or a loved one, it may be wise to consult with a healthcare professional before resuming driving. Your safety, and the safety of others on the road, is paramount. Vehicle Adaptations and Modifications Depending on your specific needs, some adaptations may be required. The occupational therapist will guide you through this process to determine the best fit for you. Manual Transmission: Driving a manual car requires good recovery of both arms and legs. Coordination for operating the clutch, brake, and accelerator, as well as managing the gear lever, is essential. Automatic Transmission:  For those with mobility impairments affecting your leg or arm, an automatic vehicle may be necessary. Left-Foot Pedal Conversion: If the right side is affected but the left side is functional, a left-foot pedal conversion of an automatic car may be needed. This adaptation requires specialized training and strong cognitive skills to relearn driving techniques. Secondary controls: Adaptations may be needed if the controls are out of reach or too difficult to manage. Consider the left or right position of the indicators. Seating: Correct set-up for seating, steering wheel and mirrors may be needed. Practice getting in-and-out of the car, managing the seatbelt and walking aids may be needed. For more information on vehicel adaptations https://www.auto-mobility.co.za/driving-after-stoke-or-head-injury/   Driver training Driver training can help individuals regain their driving skills through various methods. This will be provided by the driving occupational therapist. Clinic or home based exercises:  Improve cognitive, visual and motor skills for driving. Passenger exercises:  Practice driving-related tasks as a passenger with exercises provided by your occupational therapist. This can include visual scanning and hazard detection exercsises. and is a safe way to train before getting behind the wheel yourself. Stationary vehicle : Before going on the road, motor skills like managing the pedals or basic steering can be practiced safely. Behind-the-Wheel training:  Practical driving sessions with a qualified instructor or occupational therapist.   Common Questions How Long Should I Wait Before Driving After a Stroke?   The South African Society for Occupational Medicine (SASOM) recommends waiting at least one month post-stroke before resuming driving. It is recommended that a person may only resume driving after showing sufficient recovery (satisfactory clinical recovery) aand may need to be determined by the relevant health professional. Do I Need to Change My License?   You may need to update your driver's license if: You are only able to drive an automatic vehicle. You use vehicle adaptations such as a left-foot pedal conversion or a steering knob. Consulting with your healthcare provider and rehabilitation team will help determine the safest approach for returning to driving.

Welcome to OT Drive! As an occupational therapist with a passion for driving, I am excited to welcome you to my blog where we will explore this important occupation. Through my years of experience in helping individuals overcome challenges and lead fulfilling lives, I have witnessed the transformative power of driving for people with disabilities. In this blog, my goal is to offer valuable advice, suggestions, and resources to empower individuals dealing with different obstacles to confidently navigate the world, whether you are embarking on your driving journey, considering a return to driving, or aiming to extend your time behind the wheel while prioritizing safety and confidence on the road. Join me as we embark on this journey together. I look forward to connecting with you and sharing meaningful stories, practical advice, and a sprinkle of humor along the way! My own journey into driving In a recent radio interview, I was questioned about my decision to incorporate driving into my practice. This prompted me to reflect on my early days of assisting individuals in their rehabilitation and recovery journey, particularly in helping them return to driving. I came to realize that driving is not just a means to an end, but a crucial aspect of one's self-identity and autonomy. Reintegrating driving has been recognized as a significant goal in rehabilitation post-injury or stroke, serving as a strong motivator for recovery.Not being able to drive, or also called driving cessation can lead to isolation and depression for older adults, and there may be ways to prolong driving years, or identify and support use of alternative means of getting around. I had the privilege of receiving international training in this area and have since been involved in training and empowering fellow occupational therapists. This field is rapidly evolving in South Africa, and I am grateful to contribute to its growth and development. Come along with me and join the journey “Sometimes the most scenic roads in life are the detours you didn’t mean to take.” – Angela N. Blount End.