MANAGING CARE( continued)
When to Stop Driving: The Hard Conversation
Lissa Robins Kapust, MSW, LICSW
PSP and Driving Safety
Driving is a complex skill that demands high-level cognitive and physical abilities. Many view driving as a marker of independence. However, PSP will likely jeopardize safe driving at some point in the illness. Those with PSP and their family members will need to monitor the course of the illness and the impact of symptoms on driving safety. It is important to recognize that no two patients with PSP will progress in the same way: each situation is different. But because driving can impact personal and public safety, it is an issue that bears careful monitoring and in most people with PSP, is impaired early in the course of the illness, typically after only two or three years, often sooner. One way to monitor driving is for family members to ride as passengers with the person who has PSP. It can be a red flag when family members no longer allow the person with PSP to drive with others, especially with children.
PSP is an illness that affects motor and cognitive domains. Motor symptoms such as stiffness and slowness may limit the speed and accuracy of manipulating and switching between the gas pedal and the brake. For some people, eye movement problems lead to an inability to scan the environment actively and accurately. This may be further exacerbated by neck stiffness, which limits the ability to turn the head for compensatory scanning. The ability to judge distances is impaired early on in PSP.
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As important as the motor skills necessary for safe driving are cognitive and emotional factors. PSP can decrease speed of processing information, which is important in all aspects of driving and decision-making. This is especially true when unexpected situations arise and a decision needs to be made quickly. Poor sleep, a common issue in PSP, can contribute to problems maintaining attention. Judgment errors add to the risk of safe driving. Other contributing behavioral changes— such as impulsivity, depression, and anxiety— also negatively impact driving safety.
Our society values independence and the ability to drive. But when a person becomes a danger to themselves or others, it is time to consider giving up this privilege. Different physical and cognitive conditions may impair driving. It is advisable to ask physicians about conditions or medications that may affect driving ability. It is important for families to observe driving behavior over time.
Some of the warning signs of driving problems include:
• Hitting curbs
• Dents or scrapes on the car or garage
• Getting lost
• Diminished insight and judgment
• Impulsive behavior
• Driving too slowly for the conditions
• Incorrect signaling
• Making turns too widely or sharply( inability to judge a turn’ s radius)
• Changing lanes without looking
• Making wrong judgments, causing other drivers to constantly honk or take evasive action