The signs of forgetfulness had been there for a while: Alexandra’s father started sticking sticky notes everywhere with notes to himself. Sometimes he told the same story several days in a row. He took money from the ATM and hid it in the house. On a trip to Spain, with the caravan behind the car, he got hopelessly lost. “He couldn’t solve it with the navigation. And he didn’t want to listen to my mother. So someone had to go to him to guide him further to the campsite.”
He also got lost in the car once in the Netherlands. The police tracked him down and escorted him back home. “He was scolded, but he forgot about it an hour later,” says Alexandra.
Not safe, yet extended
In January 2022, a doctor made the final diagnosis: Alzheimer’s. But her father himself refuses to accept that. According to him, nothing is wrong. “And he can be a little cross-eyed and stubborn,” says Alexandra. “So when the letters from the CBR started coming that he had to renew his driver’s license, and we wanted to dissuade him from that idea, he made it his mission to get that driver’s license.”
Her father underwent an examination by a doctor, and also passed a driving test. “To our amazement, his driver’s license was renewed. Despite the fact that my mother, my sisters and I have expressly indicated that we do not think it is safe. He is also awaiting cataract surgery. We are stressed. We are constantly concerned that he causes an accident and kills someone.”
It happens very regularly that someone with dementia is still granted a driving license, says Ruud Bredewoud, head of medical affairs at the CBR. But the inspection, he says, is careful and comprehensive.
“From the age of 75, an inspection is mandatory,” he explains. “Such examinations are done by doctors and according to established rules (de Suitability Requirements Regulation 2000). Everything that affects driving ability is tested: can this person operate the vehicle safely? Such as the ability to see, the motor skills, and also cognitive ability, so the mental state.”
If ‘something comes to light that could affect safety’, for example eye problems, arthrosis, dementia, gout, neck problems, other motor disorders, etc., then a targeted examination by a medical specialist, for example a neurologist or an ophthalmologist, will follow if necessary. Depending on the opinion of the specialist, the holder of the driving license must take a compulsory driving test. An expert determines whether the driving license will be renewed.
Testing in heavy traffic
“The driving test is a thorough procedure and focused on the condition,” says Bredewoud. “Someone with eye problems is challenged with many traffic signs and smaller streets. Someone with dementia goes past roundabouts. And they often have to turn left to test how they behave in busy traffic.”
It will then be examined on a case-by-case basis whether and for how long the driving license will be extended. For someone with a progressive disease such as dementia, this is no longer than one year. Someone with a cataract, for example, can hope for three years.
Take away mobility
“I don’t know this specific example,” says Bredewoud, “but dementia is not necessarily a reason to withdraw a driver’s license. Science is increasingly able to diagnose dementia at an early stage. more people are diagnosed with dementia, but many of those people are still too good to take away their mobility.”
In addition, people with dementia can get lost, but according to scientific research this is not a quality that endangers safety. Bredewoud: “It is often the case that motor deficits are more dangerous. Someone with dementia who gets lost does not often carry out dangerous actions as a result. It is not the case that they reverse over the hard shoulder.”
The driver’s license: what are the rules?
In the Netherlands, a driving license is in principle valid for 10 years. From the age of 70 this becomes shorter, namely 5 years. When the driver’s license expires, anyone aged 75 or older will receive a call to complete a health declaration and to report to a doctor for a special driver’s license examination; this inspection is mandatory.
If necessary, the CBR can grant the new driving license for a shorter period than 5 years. For example, for someone with cataracts, this could be 3 years. In case of dementia or Alzheimer’s it is often 1 year; that is also the minimum term.
In addition, it can occasionally happen that a situation is misjudged, he admits. “Of course there are people who on a good day manage to create a beautiful facade for a doctor and an instructor. It remains human work.”
But in the vast majority of cases, “we really do it in a safe way,” he says. There is therefore no reason to make the rules stricter. “Of course people also have a responsibility themselves. If the condition suddenly deteriorates quickly, then you have to be wise enough not to get behind the wheel.”
‘Just drove onto a bike path’
Alexandra cannot deny that her father ‘drives well’, yet she, her mother and sisters do not think it is responsible. “Not so long ago he just drove onto a cycle path. That is just not safe. I think two things should change at the CBR. First, they should listen more to the family, they really know whether it is still responsible or not. And secondly, this is too dangerous to limit it to one test. Everyone knows that people with dementia have their better and worse days. I think that many people in the Netherlands do not know that these people can simply participate in traffic If everyone knew that, it would lead to more protest.”
Reaction Henriëtte Brons of Alzheimer Nederland:
“It is a complex dilemma between freedom and security. We sometimes find it difficult that such a test is a snapshot. Sometimes people do everything they can to still perform well. We think that the physical actions are more or less on autopilot can be done, but you can question the speed of reaction. You can also wonder whether people deliberately postpone the diagnosis by visiting a doctor a little later.”
“We often see children who are concerned about their parents. Our dedicated telephone number, the Dementia line, often asked. It’s hard to judge. In one case, children are right to worry, and sometimes the worry is unnecessary. We recommend that you discuss this with each other. Is it still safe? But we don’t think hiding the car keys is a good idea. Then people get confused.”
2023-08-30 14:45:17
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