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Assessing fitness to drive in dementia and other psychiatric conditions: a higher training learning opportunity at a driving assessment centre

  • Matthew P. Sheridan (a1)
Summary

With an ageing population and expected rise in cases of dementia, driving safety will become increasingly important. Doctors have a professional obligation to identify patients who are unsafe to drive and in cases of dementia this decision is often complex. As a result, many centres in the UK offer driving assessments for people with medical conditions that may affect their on-road performance. I aim to identify a valuable learning opportunity for psychiatrists in training, particularly those working with older adults, to improve their knowledge of driving assessment. I also provide an overview of the Scottish Driving Assessment Service and reflect on my visit there.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Matthew Sheridan (m.sheridan@doctors.org.uk)
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Declaration of interest

None.

Footnotes
References
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1 Royal College of Psychiatrists. A Competency Based Curriculum for Specialist Training in Psychiatry: Specialists in Old Age Psychiatry. Royal College of Psychiatrists, 2010.
2 King's College London, London School of Economics and Political Science. The Rising Cost of Dementia in the UK. Alzheimer's Society, 2007.
3 Department for Transport. National Travel Survey 2009. Department for Transport, 2009.
4 Iverson, DJ, Gronseth, GS, Reger, MA, Classen, S, Dubinsky, RM, Rizzo, M. Practice parameter update: evaluation and management of driving risk in dementia. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74: 1316–24.
5 Anstey, KJ, Wood, J, Lord, S, Walker, JG. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev 2005; 25: 4565.
6 Brown, LB, Ott, BR, Papandonatos, GD, Sui, Y, Ready, RE, Morris, JC. Prediction of on-road driving performance in patients with early Alzheimer's disease. J Am Geriatr Soc 2005; 53: 94–8.
7 McKenna, P. Fitness to drive: a neuropsychological perspective. J Ment Health 1998; 7: 918.
8 Harris, M. Psychiatric conditions with relevance to fitness to drive. Adv Psychiatr Treat 2000; 6: 261–9.
9 Drivers Medical Group DVLA. For Medical Practitioners: At a Glance Guide to the Current Medical Standards of Fitness to Drive. DVLA, 2011.
10 Hawley, C. Road Safety Research Report No. 91: The Attitudes of Health Professionals to Giving Advice on Fitness to Drive. Department for Transport, 2010.
11 Folstein, MF, Folstein, SE, McHugh, PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
12 Hodges, JR. Cognitive Assessment for Clinicians, Second Edition. Oxford University Press, 2007.
13 General Medical Council. Confidentiality: Reporting Concerns about Patients to the DVLA or the DVA (Supplementary Guidance). GMC, 2009 (http://www.gmc-uk.org/Confidentiality_reporting_concerns_DVLA_2009.pdf_27494214.pdf).
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Assessing fitness to drive in dementia and other psychiatric conditions: a higher training learning opportunity at a driving assessment centre

  • Matthew P. Sheridan (a1)
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eLetters

Driving in a crisis

Dr Febronie Nkunzimana, Registrar (CT1)
27 April 2012

We wholeheartedly commend Matthew P Sheridan (1) on his recent article on fitness to drive and thank him for highlighting such an important issue. All drugs acting on the central nervous system can potentially impairalertness, concentration and driving performance. This is particularly so at initiation of treatment, soon after and when dosage is being increased.Driving must cease if adversely affected. Doctors have a duty of care to advise their patients of the potential dangers of adverse effects from medications and interactions with other substances especially alcohol.The Driver and Vehicle Licensing Agency (DVLA) has published a list of psychiatric conditions and the requirements for notification. Its directives make clear distinction between group 1 (cars and motorcycles drivers) and group 2 (lorries and buses). In order to regain the licence, the DVLA must be satisfied that animprovement in the mental state has been achieved and also a period of stability must be fulfilled which varies for every condition and also whether is group 1 or 2 drivers (2).Crisis resolution team deal on a daily basis with most of the psychiatric conditions which should be declared to DVLA such as severe anxiety states or depressive illness, acute psychotic disorders of any type, hypomania/mania, chronic schizophrenia, personality disorders, and substance misuses. In addition, driving can be used as a suicidal mean or as a mean to harm others, which emphasises the need of a thorough assessment, accurate documentation and regular review. We have a number of incidences including the tragic event of a mental health service user, back in 2007 in East Midlands who lost control behind the wheel killing herself and 2 members of the public (3).

I believe the assessment of fitness to drive should be incorporated in day to day risk assessment and clearly documented at each contact with crisis team service user. This is core business of every professional who comes in touch with patients. Patients deserve to be advised with regards to DVLA regulations and indeed to stop driving if deemed unsafe and advised to contact the DVLA accordingly. The General Medical Council advises clinicians to tell patients with conditions which are likely to impair their ability to driveto inform the DVLA. If however the clinician does not assess and monitor with regards to the particular risk, they would be failing in their statutory duty, irrespective of their need to break confidentiality or not(4).

References1.Sheridan M.P: Assessing fitness to drive in dementia and other psychiatric conditions: a higher training learning opportunity at a driving assessment centre. The Psychiatrist 2012; 36:113-116.

2. DVLA at a glance to Medical aspects of fitness to Drive (http://www.dft.gov.uk/dvla/medical/ataglance.aspx)

3. Independent Investigation Report Case Reference 2007/197 conductedby East Midlands Strategic Health Authority 2010: (http://www.eastmidlands.nhs.uk/about-us/publications/indinvmh/published-independent-investigations/)

4. Confidentiality: reporting concerns about patients to the DVLA orthe DVA (http://www.gmc-uk.org/Confidentiality_reporting_concerns_DVLA_2009.pdf_27494214.pdf)

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Conflict of interest: Both authors work in crisis and liaison teams.

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