Revised medical guidelines on fitness to drive now mean more people are permitted to drive with a variety of conditions than in the past, according to Director of the National Office for Traffic Medicine.
Des O’Neill, who is also a Consultant Geriatrician at Tallaght University Hospital, said many years ago a person was off the road for three months after a stroke, but now that is down to one month.
He added that regarding a transient ischemic attack (TIA), also known as a mini stroke, the time off driving can be down to one week.
Doctors were issued with better advice on how to sensitively discuss with patients, when it might be time to stop driving under updated guidelines to reflect the needs of an ageing population and more drivers with long-term health conditions.
The Road Safety Authority and National Office for Traffic Medicine recently updated the Fitness to Drive Guidelines to allow healthcare professionals to assess if someone is medically fit to drive following a medical diagnosis, injury or treatment.
The aim is to balance keeping roads safe, while allowing people to maintain their independence and mobility fairly.
Mr O’Neill said the encouraging news is that over the past 20 years, as more evidence is available from research, the guidelines have been liberalised.
Driver rehabilitation is a key element of the new guidelines, which state that a significant acquired disability “should not mean automatic exclusion from driving rather an enabling approach should be taken to help a person explore their goal of driving”.
This rehabilitation will focus on things like vehicle adaptations, such as hand controls and gaining experience in their use.
The guidelines say after rehabilitation, a person may be assessed as safe to drive as long as they abide by certain conditions, such as adaptations and restrictions.
There may be restrictions to daytime driving only, or limits on mileage. It could mean not being permitted to drive on motorways.
The guidelines advise doctors about talking to individuals about stopping driving, with a number of measures to support a person to come to terms with it.
Professor O’Neill said the approach in a case of early dementia would be to assess the person every six months, but also say at the start of the process that there will come a time when they cannot drive.
Preparing people for when they are no longer allowed to drive, may include, offering a re-evaluation at a reasonable time interval, agreeing to re-check a visual field in nine months to see if sight improvement has occurred – even if improvement is unlikely, which can help someone in their immediate distress.
New information on specific conditions like epilepsy, diabetes, sleep problems and heart issues have been clarified and updated based on the latest medical knowledge.
For people with diabetes, while continuous glucose monitoring devices have been available for some time, Mr O’Neill said it is not regarded as safe enough for monitoring while driving.
The advice for drivers with diabetes who are taking insulin, is that the traditional blood test is still advised before driving, as well as having snacks on hand.
Among the areas updated are information on neurological, cardiovascular and psychiatric disorders; alcohol and substance misuse and dependence as well as visual, respiratory and sleep disorders.
The RSA said if someone is medically unfit to drive for at least a year, the Government offers a free travel pass for at least 12 months to help them stay mobile.
Professor O’Neill said the evidence shows that generally speaking, older drivers are much safer compared to younger drivers and are very good at managing their conditions when they drive.
Barry Reid, Advice and Tuition Service Manager at the Irish Wheelchair Association, said the aim of the organisation in this area is to try and keep as many people on the road as possible.
The association sees two categories of people: a person who wants to drive and learn to drive from scratch, and also a person who has acquired a disability and needs to get back on the road again.
“That getting back on the road again can mean going back to exactly the way they were, going back with a different type of car, or a different type of car with adaptions,” he said.
Mr Reid said unfortunately for some clients the time for driving has finished.
He said adapting a vehicle can be expensive, depending on what sort of adaption is needed. Some are basic from €500 or more to much higher amounts of money, he said.
The IWA said cars have cost between €50,000 to €70,000 to adapt, but added some adaptions can be done for between €2,500 to €3,000.
The higher the disability, normally the higher the cost.
The IWA does around 500 assessments for driving a year.
“We are now seeing a large number of wheelchair users being able to get back on the road again,” he said, adding that “20 years ago, people who maybe had a stroke were unable to go back driving”.
But he explained we are seeing a lot more people back on the road earlier due to “medication, medicine, early intervention”.
He said driving is one thing that everybody wants to be able to do, for social reasons, for work and for independence.
The IWA sees around 400 to 450 students for lessons and it provides around 1,800 hours of tuition a year.
The association recently launched a new drive-from-chair adapted vehicle, the only driving school vehicle of its kind in the country.
It can assess someone who uses a power wheelchair to see if they are able to return to driving, or if they can learn to drive.
It provides a driving tuition and assessment service to those who wish to drive from their power wheelchair.
The Ford Tourneo Connect vehicle used is equipped with a wide variety of adaptations, including hand and infra-red controls, a restraint system and rear ramp, which both enable the driver to drive from their wheelchair with ease.
Niall McDonnell from Saggart in Co Dublin is 57 years old.
He had a motorbike accident at the age of 22 and has been a wheelchair user since 1991.
Mr McDonnell began to learn how to drive later that year and said that being able to drive gives him great freedom.
“It allows me to get to and from my house where public transport is not available to me,” he said.
“Even if I was to get public transport, I need to be able to get from my house to it,” he added.
Mr McDonnell said being able to drive has enabled him to travel around the world.
He has driven in Australia, America and regularly in France.
He said that with public transport, buses are accessible but there are limited spaces, especially if a chair user has boarded a bus already.
He said the Dublin Luas system is great and there is a good service where he lives.
But trains can be a challenge as the space has to be booked in advance, so going to, for example, Co Galway or Co Kerry would need to be planned well in advance.
“The car will allow me to do all this,” he explained.
