Knowing When To Give Up Your Car Keys: Transportation Issues In Parkinson’s Disease

By Dr. Stephen Grill

In modern society, driving gives us the independence to go to the places we want to or need to, whenever we want. For most of us, transportation is a necessity in order to get to work, to do errands and for social events.  Those of us who need to stop driving for medical reasons suffer a significant loss. Unless alternate transportation can be reliably arranged, people’s lives can be disrupted. I discuss here how to assess whether you are a safe driver and how to continue to travel if you are no longer able to drive.

Parkinson’s disease may affect your ability to operate a motor vehicle due to both motor and cognitive deficits.  Predictors of impaired driving in PD include older age, longer duration of disease, slowed movements and cognitive impairment (Classen et al 2015). Some of the warning signs that you might recognize include that you get lost driving, that your friends and family are concerned, that you feel other drivers drive to fast or frequently “honk” at you, or that you are stressed when driving. You may also feel drowsy because many people with PD have sleep problems and several medications to treat PD can cause tiredness. Frequently the family of a person with Parkinson’s disease recognizes that there is a problem.  Care-partner perception is actually a good predictor of driving ability (Classen and Alvarez 2016). However, they and the patient are often reluctant to bring this up at a physician visit.

We should all be very aware of how powerful a car is. For a seat-belted driver going at 30 miles per hour and crashing into a tree, the driver experiences about 2 tons of force! Most of us know people who have been in serious accidents. If you are not a safe driver, you should not be driving. If there is some suspicion that you are not a safe driver, it is therefore imperative that this be brought up to your physicians.

Despite that physicians are asked to judge whether a patient should be driving, the examination we do in the office is a poor predictor of driving ability. Therefore, any concern about driving should trigger a referral for a comprehensive driver evaluation by a certified driver rehabilitation specialist. This includes a series of tests including an on-the-road assessment. In this, the driver drives on a predetermined course while the rehabilitation specialist sits in the passenger seat observing for driving errors. The outcome may not be simply pass/fail but instead can also include “pass with recommendations”, “fail-remediable”. These rehabilitation specialists are highly trained and we should respect their recommendations.

The decision to stop driving is a difficult one but in reality it is one that most of us, regardless of whether we have PD, will have to face at some point in our lives. So, what can you do if you are there?  Just because you may not be able to drive should not prevent you from going where you want to or need to go. Most people, but not all, who are considered unsafe drivers are not working. The car is being used mostly for errands, appointments and social occasions. You will need to consider how often and how far you plan to travel.

If you mostly go places with your partner or family, then having them do the driving is an obvious choice. If you live alone or your family is not always available, then you may need to pay for rides. People are of course concerned about the costs and the convenience of such alternate transportation. Let’s first consider the operating costs of a car. According to the Automobile Association of America (2013) the cost per mile of operating a medium sedan, assuming 15,000 miles per year, is 61 cents per mile.  This reflects maintenance costs (about 5 cents per mile), fuel costs (about 15 cents per mile), insurance costs ($1029/year), and depreciation costs ($3571/year) resulting in a total cost per year of about $9,151. Note that the depreciation and insurance costs are fixed per year regardless of how little you drive.

If you are not working and only use the car for local errands, appointments and social events, alternatives to driving may be economical. For example in Howard County, Maryland there is a volunteer driver program called Neighbor Ride. It does require that you schedule a trip 2 days in advance. The round-trip fee is based on distance; to a location up to 4 miles away it costs $8.00. A person using this service three times a week would spend $1248 per year, much less than the costs of operating a car. There are of course other more convenient but more costly options including taxis and services like Uber; these are more convenient in that you do not have to arrange them in advance. The point is that it is possible to find economical alternatives to driving if you are no longer able to drive.  Try contacting your local department of aging office or senior center for suggestions.

If you are not safe driving, then you really do not want to take a risk of being involved in a serious accident which could injure you or anyone else. You should stop driving and then plan to find alternate modes of transportation.



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