Driving

The ability to drive a car is a powerful symbol of independence that is closely tied to self-esteem and self-efficacy. Driving is often important economically, to get to and from work. It can also be important socially, to visit friends and engage in activities.

While the symptoms of Parkinson’s disease (PD) and the side effects of its medications may affect a person’s driving ability, the diagnosis alone does not tell the whole story. Many people with PD continue to drive safely long after their diagnosis. Much depends on specific symptoms, along with other changes that may come with aging.

The Impact of PD on Driving Skills

Driving is a complex task that can be affected by changes in our physical, emotional and mental condition. It requires visuospatial processing (the ability to judge the distances between objects in the environment); physical strength; agility; good reaction times and reflexes; and intact eyesight and hearing. It also requires the ability to keep track of several things at once, including the speed of your car, the presence of other cars and objects in a rapidly moving environment, and the controls inside the car. Most people have honed these skills over time and are able to automatically integrate the complicated tasks that are needed for driving. However, the aging process affects driving skills, and several PD-related symptoms may impact driving ability:

Movement symptoms: Tremors and dyskinesias (abnormal, involuntary movements) may make it difficult for people with Parkinson’s disease to get into the car, or to control it. Bradykinesia, or slowness of movement, can make it dangerous to drive, because driving often requires quick reaction time.

Cognitive changes: Changes in executive function (the ability to manage multiple tasks) and impaired visuospatial processing have the greatest impact on driving. People with PD may have difficulty multi-tasking — for example, driving while listening to the radio. Impaired visuospatial processing can result in veering towards the side of a lane, impaired ability to park, misjudging turns, clipping side view mirrors, and misjudging the speed of other vehicles. Visuospatial impairment is a key reason that passengers become concerned about a driver’s abilities. Lastly, memory difficulties may make it hard for people with PD to focus, particularly when you are driving in unfamiliar places.

Vision changes: People with PD may have trouble with contrast sensitivity, which means being able to visually separate objects from their backgrounds. This is particularly important at night, or when driving in fog or glare. In addition, it may be difficult for people with PD to visually scan the environment quickly enough to anticipate and react to a change — for example, having to suddenly step on the brakes if a car ahead of you quickly changes lanes.

Drowsiness: Sleep difficulties and the side effects of medications can cause a person to become suddenly and unpredictably tired or sleepy. Research shows that sleepy drivers can be dangerous drivers, whether or not you have PD.

Are You a Safe Driver?

One way to find out how you are driving is to ask a trusted person to observe you at the wheel. Then review your own record. Have you had any crashes or near misses in the last year? Are other drivers honking their horns because your driving is unpredictable?

Red flags
• Dings on car
• Getting lost
• Attention/memory problems
• Significant “off” periods
• Family concern
• Crashes

Testing Driving Skills

If you are having difficulty driving, talk to your doctor. You may want to undergo a formal driving assessment.

Some tests may be administered in an office setting. These tests focus on visual abilities, capacity for multi-tasking, speed of response, ability to maintain focused attention, and mental flexibility. Visual and motor reaction times are measured with computer tasks and physical activities, such as pressing down on a mock brake pedal when a red light comes on.

A more common option is to take a road test, with an instructor in the front seat and sometimes an occupational therapist in the back. The road test will include driving on large and small roads, making turns, and stopping at signs, and will evaluate your ability to maintain a steady speed and stay in the correct lane.

Where to Find a Specialist
Ask your hospital’s occupational therapy department if they offer assessments, or if there is a driving remediation instructor affiliated with the hospital. You can also call the Association of Driver Rehabilitation Specialists at 1- 866-672- 9466 (toll free in the U.S. and Canada) or go to their website at www.aded.net. Health Insurance does not typically cover a driving assessment.

When to Give up Driving and Who Decides?

The decision to give up driving is much less welldefined than the decision to get a license. The “older driver” is defined differently from state to state, and each Department of Motor Vehicles varies in terms of how it handles license renewal for older drivers. Most people do not want to be told they can’t drive anymore. And no one wants to be the “bad guy” who tells a person that he or she is not driving safely. But if there are concerns, it is important to start these conversations early. The decision to stop driving can evolve over time, rather than being made suddenly.

A driving assessment can help you and your family make a decision about whether to give up the car keys while avoiding the tension that comes from involving loved ones. If and when the decision is made to stop driving, there are programs available to help you get where you need to go:

• Call the ElderCare Locator at 1-800-677-1116 and ask for your local Office on Aging, or go to their website at www.eldercare.gov and search under the topic “Transportation.”
• Senior centers, religious organizations, and other local service groups often offer transportation services for older adults in the community.

You may also work out a schedule to get rides with family and friends or consider taxis or ride-sharing services like Lyft and Uber.

Conclusion

The biggest challenge is finding the right balance: you do not want to deny yourself the privilege of driving sooner than is necessary, but you do not want your driving to put yourself or others in harm’s way. All of these decisions can be less stressful if you plan ahead.

Adapted from information provided by Margaret O’Connor, PhD, ABBP, and Lissa Kapust, LICSW.

For more insights on this topic, listen to our podcast episode “Driving with PD: Limitations, Risks & Adjustments”

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