To drive or not to drive?

Mum passed her driving test in her 50’s and has since delighted in the fact that she can drive. In actual fact she very rarely does drive. Her car which she bought brand new some ten odd years ago still has under 3,000 miles on the clock, but for her it has been important to know that she can get in the car and drive to wherever she wants, whenever she wants, if she chooses.

When it became clear that Mum was having difficulties with her memory and perception, the GP asked someone from the Older People’s Mental Health (OPMH) team to visit. We were familiar with this process as Dad had been through it, so we knew a memory test was on the horizon.

The most commonly used memory test is the MiniMental State Examination (MMSE). This test gives a score out of 30 and Mum scored 23 which highlighted some memory problems and in particular clearly showed a lack of spatial awareness – you are asked to copy a drawing of two interlocking 5 sided shapes and Mum just wasn’t able to do that exercise.

On reviewing the results, the community nurse attending immediately recommended that Mum give up driving but neither of us expected the reaction we got from Mum! She became extremely angry saying she had been tricked into taking the test, and shouted at us that she didn’t have to give up unless a doctor told her to.

The nurse tried to reassure her that it was just a recommendation and that nothing would be done officially until she had taken a more detailed test but at that Mum actually pushed us out of the house and refused to speak to me for some days! Oh dear, I was in such trouble for allowing ‘that woman’ into the house!

Some weeks passed before the nurse returned with the next test and thankfully by that time Mum had calmed down although she hadn’t taken the advice to stop driving. After the very nice nurse chatted with her for a while she willingly took the next test of 100 questions; the Addenbrooke’s Cognitive Examination – ACE-R.

I have to tell you that I’m not sure I’d pass this test! It requires quite some focus to remember some of the things asked but the part that again tripped Mum up was the drawings. You are asked to draw the same interlocking 5 sided shapes, along with a cube and a clock with the numbers in the correct place and hands set at a certain time.

Poor Mum, she just wasn’t able to do it and became very upset because at that point she realised there was a link between the test and how her driving abilities were viewed.

By the end of the visit Mum was threatening to go to a solicitor and again the nurse and I left the house in a whole lot of trouble!

Still Mum continued to drive even though she had now twice been told to stop. My sister and I became increasingly worried for her and for the public at large!

I have to say at this point that the support we’ve received from the OPMH team and from Mum’s GP has been excellent, however it seems they are so overloaded that everything takes a long, long time. My best tip is to make a bit of a nuisance of yourself, that tends to get things moving just a tad faster…

So the next step was an appointment with the Consultant in Old Age Psychiatry. By now it had become obvious that Mum was declining quite rapidly – not being able to complete a sentence without stopping to find her words and becoming increasingly paranoid (see our first blog about her belief that people steal her food and come into her home).

At the end of that appointment the Consultant advised DVLA about Mum’s dementia as it was clear she wasn’t going to listen to anyone’s recommendations. It was sadly time to make it official in order to ensure her safety and the safety of the public.

As it turned out we should have notified DVLA long before then had we known the process. Dementia is one of the health conditions that should be notified immediately. In Mum’s case it took months and a long process for the doctor to make that notification.

And still the story isn’t over! What happens next, coming soon…

Helpful note: once DVLA are notified of Dementia or a similar condition – see here for the list of conditions – the licence holder receives a letter asking their permission for DVLA to consult with their GP and/or Consultant. Following that investigation the licence holder may be required to undergo a medical examination or some form of practical assessment. Other than that they will be advised by DVLA if they can keep their licence or if it is to be revoked.