there is a particular group of patients I am wary of, they are 75-80 years old and turn up for the first time in the practice for an eye examination. On chatting to them they have been living in the same place for a long time. This type of person normally returns to an existing practitioner, but they may have fallen out with them or just fancy a change, who knows?
As the consultation proceeds it is obvious their vision is failing. Towards the end of the consultation the question ‘My vision is good enough for driving, isn’t it?’ is slipped in. The frank answer is no. That is why they are seeing me for the first time they are shopping for a practitioner who will say ‘Yes. They may well find one. The issue of whether someone is fit to drive due to poor vision is not clear cut. The public assume it is an easy answer; they are or they aren’t.
The 20m Rule
The obvious question is can they see a car number plate at 20 metres? If you trot your aged parent into the street, point at a car and say can you read that and they do, job done. Sorry – it ain’t that simple. It may surprise you to know but it is perfectly possible to read a number plate at 20 metres and be legally blind.
‘Doh that’s ridiculous’.
No, legal blindness is not the same as the public’s perception of blindness.
Imagine picking up an old fashioned Smartie tube punching out both ends and looking down it as you did as a child. If you cover up one eye and look down the tube you can read the car number plate no problem.
Would you drive a car squinting down a Smartie tube with only one eye? Some people try. They have no idea what is happening apart from immediately in front of them. Cyclists, pedestrians crossing the road, cars overtaking or turning left or right? Would you get into a car with such a driver?
This form of visual loss is common, it is the second part of the MOT requirement that is overlooked or not understood ‘You must also have an adequate field of vision – your optician can tell you about this and do a test.’ This is where it gets marshy – what is an adequate field of vision?
The tightrope of driving in old age in Dorset
Optometrists and GP’s walk a tightrope with driving; there are all sorts of issues, confidentiality, road safety, trust in the professional/client relationship. In Dorset if you say a person is no longer fit to drive there are consequences, it is equivalent to chopping their legs off.
My view is that we should all be forced to retake our driving test at 80, ‘Quelle horreur’, ‘I have a right to drive’. ‘Prince Philip is driving horse carriages at 96’ etc etc. This is a question of personal liberty and responsibility deep issues. You could say my grandchild is sensible and can fire a rifle responsibly therefore she should have a gun licence. Yes, but would you give a gun licence to all 12 year olds? Society has to look to the common good, if they can prove by doing the test again fine.
The rural idyll
Many people retire to their dream cottage in the country, roses round the door. At sixty they have a ball. They get involved in village affairs, join the lunch club, take up bowls, tennis, walking, organise the local Am dram, make tea at church. When they get to eighty they aren’t as sprightly but they are organised. Unfortunately, this organisation is often built around their car, it is an indispensable part of life. They need it for shopping, the doctor, the hospital, the library, a social life.
The purpose of forcing a driving test is to make them face up to the elephant in the room. ‘Can I continue living where I do if I can’t drive’? Too often this question is dodged until it is impossible to ignore. If they face moving, having just lost their sight, the stress level is astronomic.
To suddenly have to reorganise is distressing. ‘How do I use the buses, when are they? It’s expensive using taxis! How do I get my shopping home? I give a lift to Daphne on Thursdays I can’t let her down’. This is where you can try and help, either nudging them towards a move to a more suitable location, or easing the transition away from driving by researching the options open to them. It is the change in habits that is difficult to cope with particularly when there is a whole lot of changes simultaneously
So, what’s the alternative
The cost of maintaining a car is now about £5000 per year when all expenses are added up. This would go a very long way on taxi fares, but taxis are regarded as a luxury item for the older generation and not for everyday purposes, this needs to be talked through.
There are a lot of schemes available for transport in Dorset go to https://www.dorsetforyou.gov.uk/travel-dorset/public-transport-bus-and-rail there is information on public as well as community transport, it is worth spending a few minutes as you may find a really useful piece of information.
An attendance allowance may be payable if they are no longer coping this is not means tested and would go a long way to paying for transport. Go to https://www.gov.uk/attendance-allowance
I am a great advocate of creating a team around someone if they need help. One team member could take responsibility for transport, not necessarily providing it, but making sure it is available. Getting the information and sorting it out, is often all that is needed.
Get a professional view
Using a professional’s advice can be a great way to tip the balance if you feel they should no longer be driving. Vision is just one component of the skills needed for driving, it is a cocktail of mental reaction time, visual perceptions, physical abilities including the ability to turn the neck left and right. Because these components degrade slowly we adapt to them and don’t realise we are no longer who we were.
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