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  1. #1
    Senior Member randya's Avatar
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    Driving While Demented

    April 13, 2010, 12:50 pm
    Driving While Demented
    By PAULA SPAN

    You might hope that when the American Academy of Neurology reviews and updates its decade-old guidelines on driving and dementia, the experts would come up with clear-cut recommendations: a specific score on a specific test means someone can head for the mall without much concern, or a particular behavior means it’s too risky to be on the road, so hand over the keys.

    You might hope that, but on Monday, when an academy subcommittee presented its report at an annual meeting in Toronto, its findings demonstrated once more how complicated this question can be.

    The report (here’s a news release that summarizes it) was systematic and thorough, analyzing 422 good-quality studies in an attempt to figure out how neurologists should handle this issue with their patients. And the findings tells us a lot about what experts still can’t (or won’t) say with authority.

    Take the question of whether people with mild dementia — not just older drivers in general — should be behind the wheel at all. “Clinicians may present patients and their caregivers with the data showing that, as a group, patients with mild dementia . . . are at a substantially higher risk for unsafe driving, and thus should strongly consider discontinuing driving,” the report suggested.

    Yet it also noted that several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test. Given that, in many parts of the country, not being able to drive can lead to isolation and a host of other real problems, should those people have to give up their cars?


    “We don’t have a blood-alcohol level for dementia,” Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York, said in an interview. “We don’t have that kind of standard.” But just as drivers who drink show some impairment, dementia accelerates the risks older drivers face from declining vision, hearing and reaction time, he pointed out.

    In fact, the American Association for Geriatric Psychiatry, of which Dr. Kennedy is a past president, uses a stricter standard: “Our recommendation is that you stop driving once you have a dementia diagnosis.”

    Less formally, he relies on “the grandchild rule”: If a patient’s children don’t want the grandchildren in the car when the patient is driving, he or she needs to relinquish the keys before hurting someone else’s grandchildren.

    What the academy’s report does provide is a relative ranking of which factors most accurately identify an increased risk of unsafe driving. They include a higher rating on a test called the Clinical Dementia Rating, a history of crashes and traffic tickets in the past few years, and “aggressive or impulsive personality characteristics.” (Personally, I’d like those people off the highways even if they don’t have dementia, but being a hothead is not illegal.)

    One of the more accurate predictors of trouble, the report emphasizes, is a caregiver’s assessment. If you report that your parent or other relative with dementia is driving unsafely, you’re likely to be correct. So stick to your guns.

    “If I had written the report, I would emphasize to family members that you’re the best judge of when the risk is unacceptable, and you can ask the doctor to use his or her authority to say so,” Dr. Kennedy said. “We’re the ones who should take the heat.” He has written letters to patients telling them to stop driving when his advice during office visits proved ineffective; he also keeps the online forms handy to send to the state division of motor vehicles if a letter doesn’t work.

    That’s because one of the decidedly unreliable factors, the report found, is a demented driver’s own judgment of his ability. It cited a study of patients with mild Alzheimer’s, 94 percent of whom rated themselves as safe drivers. Only 41 percent could pass a road test, however.

    “A patient’s self-rating . . . is established as not useful for determining that the patient is safe to drive,” the report concluded. But you probably already knew that.
    http://newoldage.blogs.nytimes.com/2...e-demented/?hp

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    OHHHH, you were talking about CLINICAL dementia! I thought it was average, everyday nutball driving!

    My bad.

    One thing I gleaned from the article: the old tests were 'less than accurate', and incomplete. BIIIIIG surprise there! That's liable to ACCOUNT for the nutballs!

  3. #3
    Seņior Member ItsJustMe's Avatar
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    Quote Originally Posted by DX-MAN View Post
    OHHHH, you were talking about CLINICAL dementia! I thought it was average, everyday nutball driving!
    I thought the same thing. And I thought that there may not be any such thing as a non-demented driver. I'm increasingly of the opinion that simply putting a steering wheel in their hands makes absolutely anyone a little crazy.
    Work: the 8 hours that separates bike rides.

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    Cycle Year Round CB HI's Avatar
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    Careful, they may figure out that zoobombers are too demented to be on the road (or shopping mall) as well!

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    Elitest Murray Owner Mos6502's Avatar
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    Yet it also noted that several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test.
    Huh, the correlation is odd - to me it seems that about 76% of people driving shouldn't be.


    Further proof that getting your driver's license is a joke?

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    Seņior Member ItsJustMe's Avatar
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    Quote Originally Posted by Mos6502 View Post
    Huh, the correlation is odd - to me it seems that about 76% of people driving shouldn't be.


    Further proof that getting your driver's license is a joke?
    Yeah, I was thinking that myself - the driving test is such a joke that most people with clinical dementia can still pass.
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    I've thought that the test is easier now than it was when I first took it.
    Many older drivers will only take routes that they are very familiar with. This is a really good sign to me that they are no longer competent to drive, but I don't think that is widely recognized. It's too bad public transportation stinks so badly in most of the country, losing the ability to drive is a really harsh thing.

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    Randomhead
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    dupe
    Last edited by unterhausen; 04-14-10 at 11:55 AM.

  9. #9
    Senior Member Shimagnolo's Avatar
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    An odd experience I (and two other cyclists) had on a MUP that runs parallel to Broadway in Boulder on Sunday;
    We encountered an old man coming from the opposite direction, and hogging the whole path...with his car.

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    Senior Member Seattle Forrest's Avatar
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    Yet it also noted that several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test.
    Well, it's the same test everybody else takes. The government has decided that the driving test ( written and behind the wheel ) is the standard for determining who is competent to drive, and who isn't. If somebody passes that test...

    Should deaf people not be allowed to drive? We all know how important hearing is to driving - this is why you aren't allowed to use headphones while driving a car.

    There's a lot of hand-wringing around here over how to improve cyclists' image. Don't wear lycra, make it boring, etc. Does anybody think that "picking on" the disabled is going to win over the hearts and minds of America?

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    Randomhead
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    Quote Originally Posted by Seattle Forrest View Post
    There's a lot of hand-wringing around here over how to improve cyclists' image. Don't wear lycra, make it boring, etc. Does anybody think that "picking on" the disabled is going to win over the hearts and minds of America?
    this line of thought makes no sense at all. Cyclists are the first to get run over when someone that is incompetent to drive gets behind the wheel. Our society does a horrible job at getting people away from driving once they are no longer competent. My father stopped driving voluntarily, but only after he rear-ended someone. Then 5 years later when his condition had degenerated to the point that he could barely steer his electric wheelchair, he started obsessing about getting his license back. What if he had gotten "lucky" and not hit that other car? It could have been devastating. There are all sorts of emotional and practical reasons people don't want to give up their license. Most people do it later than they should

  12. #12
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    As long as they don't ban cycling while demented, I should be okay.

  13. #13
    Senior Member Seattle Forrest's Avatar
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    Quote Originally Posted by unterhausen View Post
    this line of thought makes no sense at all.
    Which line of thought? Do you mean that advocating people should have their licenses to drive taken away from them because of illnesses they didn't ask for ( dementia and deafness ) will make cyclists look like bullies, makes no sense at all?

    I'm not saying that it's wonderful to have people driving who shouldn't be ... but if they're able to pass a driving test, and if being accepted is an important goal for most cyclists - it's important to most people here, and it's the only reason a lot of cyclists don't like Critical Mass - than maybe a little more tact would be a good idea in this case...
    Last edited by Seattle Forrest; 04-14-10 at 04:15 PM.

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    Randomhead
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    Quote Originally Posted by Seattle Forrest View Post
    Which line of thought? Do you mean that advocating people should have their licenses to drive taken away from them because of illnesses they didn't ask for ( dementia and deafness ) will make cyclists look like bullies, makes no sense at all?
    You were the one who introduced deafness into this. It's sad that dementia makes people bad drivers, but yes, I see no issue in taking people off the road because they are dangerous due to dementia

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    Elitest Murray Owner Mos6502's Avatar
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    Quote Originally Posted by Seattle Forrest View Post
    Which line of thought? Do you mean that advocating people should have their licenses to drive taken away from them because of illnesses they didn't ask for ( dementia and deafness ) will make cyclists look like bullies, makes no sense at all?

    Straw man argument, and a red herring to boot.

    First off, not letting people drive who shouldn't be driving has nothing to do cycling, or cyclists. It has to do with potential drivers and driving cars.

    Second off, driving is NOT A RIGHT it is a privilege - if you are not in a good enough condition to drive, then you shouldn't be driving, regardless of whether or not you asked for your condition. Period.

    Let me repeat this since so many Americans don't get it: Driving is not a right. Not a right. NOT A RIGHT. We need to stop thinking like it is.

  16. #16
    www.theheadbadge.com cudak888's Avatar
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    Quote Originally Posted by Mos6502 View Post
    Second off, driving is NOT A RIGHT it is a privilege
    Explain to me any one thing that is a right, and not a privilege.

    -Kurt

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    Senior Member Seattle Forrest's Avatar
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    So do you think deaf people should be allowed to drive? It would be illegal for you to drive wearing head phones, for obvious safety reasons. And it would be downright inconsistent to suggest that people suffering from dementia shouldn't be allowed to drive, but people suffering from deafness should.

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    Elitest Murray Owner Mos6502's Avatar
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    Quote Originally Posted by cudak888 View Post
    Explain to me any one thing that is a right, and not a privilege.

    -Kurt
    Nothing is a right, as guaranteed by nature. But as guaranteed by law, through others, some things are rights. Even so, driving is not amongst those rights.

  19. #19
    Elitest Murray Owner Mos6502's Avatar
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    Quote Originally Posted by Seattle Forrest View Post
    So do you think deaf people should be allowed to drive? It would be illegal for you to drive wearing head phones, for obvious safety reasons. And it would be downright inconsistent to suggest that people suffering from dementia shouldn't be allowed to drive, but people suffering from deafness should.
    How so? What makes you think that dementia and deafness are the same thing?

  20. #20
    Senior Member Seattle Forrest's Avatar
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    Quote Originally Posted by Mos6502 View Post
    How so? What makes you think that dementia and deafness are the same thing?
    Straw man argument, and a red herring to boot. ( Two can play that game. )

    Nobody said dementia and deafness are the same thing. I pointed out that hearing impairment, also, is dangerous behind the wheel. ( In this very forum, somebody complained about the audacity of a luxury car maker who ran a commercial for a car with a sound proof cab, preventing you from hearing the traffic police yell "stop!" )

    Care to answer the question, though? Do you think deaf people should be prevented from driving?

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    I think it has been demonstrated that deaf people can drive safely, so bringing them into the discussion is a total non-sequitur. I also have known a sufficient number of people that suffer from some level of dementia, and they are not safe drivers. Just because you can pull yourself together to pass a driving test does not mean that you will drive safely under uncontrolled circumstances. This has been demonstrated tragically over and over.


    I didn't say so before, but I reject the notion that we should sacrifice our needs to improve the image of cycling. I will continue to wear cycling specific clothing. I will continue to ride in the manner that is safest for me. I simply don't believe that those things have any effect on the image of cycling, and I don't think that trying to get unsafe drivers to stop killing cyclists would adversely impact the image of cycling.
    Last edited by unterhausen; 04-14-10 at 04:41 PM.

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    Elitest Murray Owner Mos6502's Avatar
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    Quote Originally Posted by Seattle Forrest View Post
    Straw man argument, and a red herring to boot. ( Two can play that game. )

    Nobody said dementia and deafness are the same thing. I pointed out that hearing impairment, also, is dangerous behind the wheel. ( In this very forum, somebody complained about the audacity of a luxury car maker who ran a commercial for a car with a sound proof cab, preventing you from hearing the traffic police yell "stop!" )

    Care to answer the question, though? Do you think deaf people should be prevented from driving?

    How is that a straw man argument? You are fallaciously relating two things to each other that have nothing in common except that they can hinder one from driving a vehicle properly. They are not the same thing, and so there is no reason for them to be treated the same way. You are confusing correlation with causation.

    And it would be downright inconsistent to suggest that people suffering from dementia shouldn't be allowed to drive, but people suffering from deafness should.
    You are implying that deafness and dementia are consistent in their effects on drivers operating vehicles, and so if one isn't barred then the other shouldn't be either. Except that dementia and deafness are not consistent with eachother. they are completely different things. They effect different abilities and have different consequences on driving.
    Last edited by Mos6502; 04-14-10 at 04:52 PM.

  23. #23
    Senior Member Seattle Forrest's Avatar
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    Quote Originally Posted by unterhausen View Post
    I think it has been demonstrated that deaf people can drive safely, so bringing them into the discussion is a total non-sequitur.
    It's been demonstrated that as many as 76 % of people who "have" dementia ( the article also mentions there not being a litmus test, so I'm not sure exactly what this means ) can demonstrate their ability to drive safely. Because passing a driving test is the only way we have to demonstrate that ( for purposes of being allowed to drive ) in this country. We've established the driving test as the gold standard ( backed up by things like points on a license, etc ) we judge against, and apparently a lot of people with dementia pass that standard.

    Quote Originally Posted by unterhausen View Post
    Just because you can pull yourself together to pass a driving test does not mean that you will drive safely under uncontrolled circumstances.
    Then we need to improve the driving test, not pick out specific groups of people we'd like to exclude from driving. Apart from the obvious PR benefits ( no headlines saying "Bike riders hate Grandma" etc ), that would actually prevent other people who can "fake it" through the driving test, but injure or kill people on the streets. And it would be fair.

    Quote Originally Posted by unterhausen View Post
    I didn't say so before, but I reject the notion that we should sacrifice our needs to improve the image of cycling.
    Whether we need to or not is a whole other discussion, and a big one. But if you look the threads on the front page of this forum, there's one about "The cultural implications of bike clothing." There's another one, locked due to bickering, about "Cycling should be boring." Both of these threads seem to have the gist of "If we just all stopped wearing spandex, everybody would like cyclists." There are a few others about how to make friends and influence people. Then there's the VC forum, which is basically about "If we just acted exactly like cars, people would like us."

    I'm not convinced that we need to do anything so drastic to improve our image, either. But, obviously, a lot of other people are. And as fun as it can be to get caught up in the excitement of some new idea ( like banning people with dementia from the road ), everybody seems to have lost track of how that conflicts with another very popular goal around here. Which I pointed out ... whether I believe improving our image is a worthwhile or necessary goal at all.

  24. #24
    Elitest Murray Owner Mos6502's Avatar
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    Quote Originally Posted by Seattle Forrest View Post
    Then we need to improve the driving test, not pick out specific groups of people we'd like to exclude from driving.
    So basically, what everybody else was saying. Until you brought up deafness for no apparent reason.

  25. #25
    Senior Member Seattle Forrest's Avatar
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    No - everybody else seems to be saying "We need to prevent people from driving when they 'have' dementia." I'm saying this is a bad idea, we need to move more tactfully, and not have a unified cycling movement where we try to arbitrarily make peoples' lives more difficult for belonging to a certain group that bothers us.

    Quote Originally Posted by Mos6502 View Post
    How is that a straw man argument?
    I'm guessing you don't know what 'straw man argument' means. Forgive me if I'm wrong here, but based on your message, I think we need to clear things up a bit. The term comes from military drills; people would set up a straw man ( like a scare crow ) and attack it, ie with bayonets, in ways you can't attack a real human. People borrowed the term and applied it to master debating; a "straw man" is when you set up an argument nobody is actually making, with all sorts of flaws, and then tear it down.

    I never said that dementia and deafness are identical; that's a claim you made because it's easy to attack, but showing that deafness and dementia are actually two different things is neither here nor there. By definition, you've set up a straw man argument.

    Quote Originally Posted by Mos6502 View Post
    You are implying that deafness and dementia are consistent in their effects on drivers operating vehicles, and so if one isn't barred then the other shouldn't be either. Except that dementia and deafness are not consistent with eachother. they are completely different things. They effect different abilities and have different consequences on driving.
    All of that is equally true of drunkenness and schizophrenia. I'm sure it's not your position that drunks should be allowed to drive but schizophrenics shouldn't ( or vice versa ).

    Anyway, I'm not going to stick around and debate this.

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