Driving tired is mad and bad

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An elderly patient of mine has recently started showing signs of dementia. One of the more annoying elements of his disease is that he is losing his normal diurnal pattern, which means that he is waking up in the middle of the night and thinking that it's daytime. However recently he took things a step further when he woke in the night and decided to go for a drive. He still has a license, but this does raise the ethical dilemma of those people with early dementia and when to "hand in the license".


This is an unusual case of how accidents might happen to people with mental disorders and raises the question how far must we go to prevent such events happening. In this case, although the man still had his licence his wife had not allowed him to drive for several months because of the changes in his mental status. Now she has to increase the home security to make sure that this otherwise healthy and active man does not "escape" again. Studies have shown that "patients with dementia are 3 to 5 times more likely to be involved in a motor vehicle accident than age-matched control individuals".

But there are many people who continue to drive, most of them quite well, but who take very strong medications for their mental disorders and these medications do alter the patients level of alertness. Further studies have shown that "drowsy driving is associated with fatality rates and injury severity on par with that of alcohol-related crashes". But it's not just people on medication who may pose a risk, "shift workers or people who work long or uneven hours and those with sleep apnea or narcolepsy may also be unsafe driver" according to Christine Marchionni, MD, psychosomatic medicine fellow in the Department of Psychiatry and Human Behavior at the Thomas Jefferson University in Philadelphia

Having rules and regulations for "fitness to drive" are all well and good, but enacting them is a whole different ball game and often the burden of responsibility will fall on the family Doc to make a difficult call: after all, taking away a person/couples mobility will severely impact on their lives and making affect correct decision making.

But for medico-legal purposes, it is imperative that these situations should be openly discussed,  all the options fully explored and all the details fully documented.
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