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Should he still be driving?

A driving issue for the 21st Century

By Kay Nelson, Manager, Helpline/Safe Return, Minnesota/Dakotas Chapter

More and more folks are going to be dealing with “the driving with dementia issue” with their parents, spouses, in-laws, neighbors and themselves. A prominent neurologist recently commented that he would rather give his patient a cancer diagnosis than tell them they may no longer drive. Now that comment suggests the problem is BIG.

Caregivers and the individual with dementia must weigh the potential safety considerations against the person’s with dementia sense of independence, pride and control. Many folks feel driving is an inalienable right and experience a death of a lifestyle when they are no longer able to get behind the wheel. Relationships between family and friends can become strained to the breaking point when dealing with this issue. No one wants to take their rights away, even if their life and the lives of innocent others on the highway with them is at risk.

If family members do not agree on taking away the car keys, the following questions might be asked:
--Would you be comfortable with your grandchild riding in the same car?
--Would you be comfortable stepping out into a pedestrian crosswalk in front of their car?

The Massachusetts Chapter of the Alzheimer's Association published a Family Care Guide that contains a chapter on driving. They reinforce what we hear on the Alzheimer's Association Helpline whenever the subject of driving comes up: "Some persons with the disease claim that they 'don’t drive very far from home,' ‘drive slow,' or 'use only familiar routes'. While these claims appear reassuring, most crashes occur at lower speeds, at intersections and near home.”

Another classic Helpline story is, “But I am a “co-pilot” for my spouse (with AD). He/she never drives alone!” The Guide says, “This is a risky and unreliable fix, since it cannot repair the central problem of the driver’s progressively declining memory, reaction time, visual-spatial ability and judgment.” Unless the co-pilot has access to dual controls, this is not a good idea.

Abilities during the early stages of dementia may allow a person to drive safely for a time. But until medical treatment can prevent or slow the progression of dementia, these individuals must eventually stop driving. Unfortunately the timetable for each person’s disease progression is different. If you know one person with Alzheimer’s disease, you know one person with the disease. This begs the question, “When is it time to stop driving?”

Some of the warning signs of unsafe driving:
--Forgetting how to locate familiar places
--Failing to observe traffic signals
--Does the person become easily angry and confused while driving?
--Speed not right for conditions
--Poor judgment of distance (turns that are too wide or too tight, running over curbs)

Tips on limiting driving:
--Have someone the person respects and trusts recommend he/she stops driving.
--Ask an attorney or insurance agent to reinforce the no driving message by explaining the potential for liability. Sometimes money talks.
--Have the driving skills of the person with memory loss assessed through a driving
fitness evaluation program.
--Ask a doctor to write a “do not drive” prescription.
--Offer to drive the person or arrange for other transportation.
--Park the car on another block or in a neighbor’s driveway.
--Hide the car keys or disable the car by removing the distributor cap or battery.
--Contact the Department of Public Safety. In a letter, describe the driving problems or incidents you have observed. The letter must be signed. They will review the information and decide on appropriate action, which may include retesting. A person’s age alone is not cause for action.

Loss of driving privileges and effects on the person
Restricting driving privileges signifies a loss of independence and mobility for the person. He/she may feel forced to rely on others and community services for transportation. The desire for independence may prevent people with dementia from giving up the car keys.

Ease the transition from driver to passenger:
--Be sensitive and supportive during the nondriving transition; the person may feel angry and depressed. Tell him/her that there is a problem with their memory and it is not safe to drive.
--Try to limit driving in progressive steps rather than all at once.
--Consider a written agreement between diagnosed person and family regarding driving. (Visit www.thehartford.com/alzheimers/index.html for an example.)

Seek help from professionals:
--Have doctor write a prescription to stop driving.
--Obtain an independent driving evaluation through an independent driving school or rehabilitation program. (Understand that there are no uniform standards for these programs and evaluations will vary from program to program.)
--Call the Alzheimer’s Association at 1-800-272-3900. We have a 24/7 Helpline that can help you problem solve this important issue.

Be firm, but avoid arguments about driving. This is “tough love” advice, necessary to everyone’s safety and sanity.

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