Laws on underdiagnosis of dementia and driver’s license

IIt’s uncomfortable to talk about seniors and driving, a fact that many families who are concerned about a loved one’s diminishing vision, reaction time, or driving cognition are well aware of. The ability to drive is not a right, but in many parts of the United States it has become a necessity, the only way to access the world outside the home. When the freedom of elderly people threatens their safety, who can choose to withdraw a car or revoke their license?

For a long time, the answer was an uncertain combination between the U.S. government, doctors and family members. But as the U.S. population over 65 grows at a faster rate than any other age group, so does the presence of seniors on the road. According to the Federal Highway Administration (FHA), there were 48 million licensed drivers aged 65 and older in 2020, almost 70% more than two decades ago. FHA data shows that older adults make up 20 percent of drivers on U.S. roads, where the types of impairments commonly associated with aging lead to greater crash risk.

Policies intended to ensure drivers remain capable as they age, such as stricter vision testing for license renewals and reporting requirements for dementia diagnoses, exist, but according to new research presented late October at the 2023 Alzheimer’s Disease Clinical Trials Conference, they could undermine or at least complicate the expected results. For example, some states require drivers (or their doctors) to notify the Department of Motor Vehicles if they are diagnosed with certain conditions that cannot be assessed at DMV facilities, such as diabetes, seizure disorders, and, most importantly, Madness.

Dementia not only directly affects driving abilities, but it also reduces a person’s ability to recognize their own impairments or dangerous behaviors. Concerned about this dual risk, particularly amid rising rates of dementia diagnoses, a team led by Hankyung Kate Jun, a researcher in the Department of Health Policy at Harvard Medical Schools, wanted to understand how dementia reporting policies had an impact on public health and driver safety. They found only one study ever published on the topic, looking at dementia diagnoses among people hospitalized after an accident, and found no real trends consistent with policy. So, the team decided to compare expected and actual dementia diagnoses in each state using a predictive model and found that doctors in the four states that require doctors to notify the DMV when they diagnosed a patient were significantly more likely to underdiagnose dementia. In California, Oregon, Delaware and Pennsylvania, the underdiagnosis rate was 14%, compared to 9% in the other states.

Fourteen other states require patients themselves to notify the DMV of their own diagnoses, but Jun’s team found no difference in diagnostic margins between those states and states without any mandate. The researchers next plan to examine how many reports were actually made to each state’s DMV, the license changes they caused, and traffic crash data. If they can obtain this information, they can potentially determine whether these unenforced self-reporting mandates are effective. .

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Jun thinks fear of losing the ability to drive could prevent people from reporting dementia diagnoses to the DMV. And in the four states with physician reporting mandates, she adds, that fear could discourage people from seeing a doctor in the first place. I believe the reason doctors underdiagnose is not because they want to underdiagnose, but because patients are reluctant, she says.

Although the study does not reveal whether these policies are effective in preventing accidents and injuries, it suggests that they may be part of the family and individual calculus determining whether older people with dementia receive the care they need and highlights the difficult balance between ethics and security. concerns that state DMVs are responsible for establishing in an aging country.