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Inequity in health: older rural driving and dementia
  1. Noha Ferrah1,
  2. Alfredo Obieta2,
  3. Joseph Elias Ibrahim3,4,
  4. Morris Odell5,
  5. Mark Yates6,
  6. Bebe Loff7
  1. 1Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Victoria, Australia
  2. 2Sub-acute Services, Ballarat Health Services, Ballarat, Australia
  3. 3Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
  4. 4Sub-Acute Services, Ballarat Health Services, Ballarat, Australia
  5. 5Clinical Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
  6. 6Sub-acute Services, Ballarat Health Services and Deakin Clinical School at Ballarat Health Services, Australia
  7. 7Michael Kirby Centre For Public Health and Human Rights, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Professor Joseph Elias Ibrahim, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Australia; joseph.ibrahim{at}monash.edu

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Introduction

The number of drivers with dementia is expected to increase exponentially over the coming decades. Most individuals with moderate-to-severe dementia (table 1) are unfit to drive.1 Drivers with moderate-to-severe dementia have higher rates of MVCs than age-matched controls.2 Identifying and preventing these individuals from driving is crucial, particularly in urban areas. The density of cars and pedestrians, and the complexity of traffic typically place greater demands on drivers in urban areas, and, therefore, require greater reactivity and forward planning than in rural environments.3 ,4 The ability to drive is a critical means of maintaining one's social inclusion, and is commonly a practical necessity. Therefore, decisions about the entitlement to drive should not unfairly restrict mobility or unnecessarily compound the disadvantages experienced by older people with mild cognitive impairment and early dementia (table 1), particularly as diagnoses are now being made earlier.1

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Table 1

Prevalence, types and clinical stages of dementia

This paper describes the difficulties inherent in addressing the question of when and in what circumstances a diagnosis of dementia might render a person unfit to drive and focuses on those who live in rural areas. We examine the consequences of dementia diagnosis on driving, driver testing requirements and licensing procedures, and the impacts of driving cessation. We then discuss how living in rural areas may alter the level of risk of drivers with dementia and practical implications for licensing policies.

Diagnosis and effects of dementia on driving

The risk of motor vehicle collisions due to drivers with early dementia is equivalent to age-matched controls,5 and it is estimated that 22%–46% of patients with mild-to-moderate dementia continue to drive.6 There is, therefore, an ill-defined window of time during which drivers with a diagnosis of dementia can drive as safely as other drivers of the same age. Most available evidence pertain to Alzheimer's …

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