I want to consider how you move an older person from driving to not driving. If you have read my story, you'll know that my father was suffering from some pretty strong dementia. His ability to reason was no longer "reasonable". By the time I realized this, he was living separate from his car. I did take actions to make sure he did not regain physical access to that car.
But during the process, I had conversations with Alexa and staff at his assisted living facility about what I could do to get him to stop. I investigated some of those options. None really offered any hope for me.
Let's start with the obvious choice: my dad's long term doctor. You may recall that the year before my story begins, I had gone in with him for his check up. His doctor had told me he was fine. I know because I had seen my mother tested, the doctor probably used the MOCA. A MD friend suggested the following year to ask for a longer (several hours) test. But I also know because I had watched my mother's MOCA with the same doctor, that the doctor never used the first three questions on the test. I suspect he skipped them because they took longer because they required the patient to physically mark the paper and draw. Here's what those questions look like:
I later saw Dad's attempt at these. They looked a bit like Salvador Dali's art work. Thanks to our current political race (presidential, summer 2020). I have read several articles not just about the MOCA but about how doctors interpret the results. Here's an excellent article on that. Here's what that article says about this section of the test.
"Patients who have problems with these functions can fall easily, not recognize familiar objects or faces, misjudge distances, get lost easily, and struggle with driving skills; all issues that can face patients with dementia.
"The test also measures the ability to understand images. But it also measures “executive function”; that is, the “set of cognitive processes and mental skills that help an individual plan, monitor, and successfully execute their goals.”
"Now, “executive function” in this case doesn’t mean making C-suite decisions for a Fortune 500 company, but more practical tasks like, say, cooking dinner.
"In order to score on the Trails Test, the subject must be able to quickly switch between counting numbers and ordering letters, and tests similar skills to what is needed when switching between folding laundry and checking on a boiling pot on the stove. This requires activation of the frontal lobes, and subjects with frontal lobe damage from a stroke, tumor, or brain injury, or with the dementia subtype of “fronto-temporal dementia”, especially have difficulty with this task."
So here's my appeal to the medical community. First, administer this section of these tests. Score them fairly, and if a patient fails, talks need to begin not just with the patient but also with family members or state licensing agencies about this patient's ability to drive. I understand older patients won't be happy when you do this, but this is a matter of not just this one patient but public safety. I suggest that you think carefully about what results on the MOCA or similar tests would cause you to raise this issue. Write a policy for yourself and those in your practice and stick with it.
Next on my list is my state's licensing agency. An initial search turned up a review process. Here's what their website says:
"The Division of Motor Vehicle's Medical Review Unit evaluates a driver when there are concerns that certain medical conditions might have an impact on their ability to safely operate a motor vehicle. These conditions include: Neurological disorders (Parkinson's disease, dementia, neurodegenerative disorders)."
I thought that sounded helpful. So I clicked the link to the page with the form to fill out for my dad. So first thing I notice is that when they list who such requests come from they include, doctors, police officers, wreck reports, and courts. (I do wonder if the wreck investigation officer who came to see my mom reported her as problematic.) There is nothing about family. However on this page, I was given a link to a form to fill out. There was a sternly worded warning that they did not take anonymous reports. I was fine with that, so I turned to the form. It was a one page form with three roughly equal sections: information about the person being reported, a medical professional's section, and a concerned citizen's section. I had two lines to express or document my concern about my dad's driving. At the top the form said this:
"This request must provide specific information regarding the medical/visual condition and/or driving
ability of the person in question and must be made only in the interest of public safety. Advanced age
alone cannot be considered the sole reason for a re-examination request."
I'm wise enough to know I would have needed to write a longer document about what I saw as problematic in my dad's driving. I'm not sure every concerned daughter would understand that two lines would probably not be enough to start an investigation; it would be nice if the state instead of implying that two lines are enough asked for an attached statement.
For my state legislators, you must address this issue. It would be relatively easy to set up a simple method and standard for state medical professionals to submit patients who have troublesome cognitive or physical problems. Then another simple and clear test could be devised for those so flagged.
