From the Alzheimer's Association
National Newsletter, Volume 15, no. 3,
Driving is a complex activity that demands quick reactions, alert senses and
split-second decisions. For the person with Alzheimer's, driving inevitably
becomes difficult. "I was able to drive for a while, but recently had to
stop," says Thomas Cho, who was diagnosed with Alzheimer's nearly three years
ago. "Giving up driving was one of the hardest things I've ever had to do."
In our culture, driving is synonymous with adulthood and independence. "It's
devastating to be told you are no longer capable of driving'," says Jonathon
Trobe, M.D., a neurologist and researcher at University of Michigan's Transportation
Research Institute. "That's why many individuals with Alzheimer's, particularly
men, are reluctant to leave the driving to someone else."
There are conflicting opinions about whether someone with Alzheimer's should
drive. But a diagnosis of Alzheimer's does not mean the person has lost all
abilities. "Drivers rely on visual and spatial sensitivity, which is not
immediately impaired in all persons with Alzheimer's," says Trobe. "A
diagnosis of Alzheimer's doesn't mean a person should be automatically stripped
of their license."
Bernadine Wagner, who was recently diagnosed with Alzheimer's, feels comfortable
driving locally, but doesn't travel far from home. "I don't have any difficulty
driving," she says. "I'm very careful and only go to familiar places."
How long can someone with Alzheimer's continue to drive safely, and how do
caregivers know when to discourage driving? According to Trobe, researchers
are working to develop quantifiable tests (e.g., driver simulation) that
eventually will help determine whether or not a person is able to continue
driving. "Until then, they can only be monitored by caregivers," says Trobe.
"When driving becomes a safety issue, that's when it needs to stop," explains
Anne Lilla, director of family services, Detroit Area Chapter of the Alzheimer's
Associaton. "Caregivers need to continually evaluate the individual's driving
ability and be able to take the keys away before the person become a danger to
themselves or others." According to Lilla, caregivers should watch their driver
for the following "warning signs" of unsafe driving:
* is unable to locate familiar places
* does not observe traffic signs or drives at an inaappropriate speed
* makes poor or slow decisions in traffic
* becomes angry, frustrated or confused while driving
"One or several of these behaviors indicate that it's time for the person with
Alzheimer's to immediately stop driving," says Lilla. The following strategies
can help ease a person's transition from driver to passenger:
Acknowledge the loss. "Giving up the keys represents a loss of
independence an mobility, traits that individuals with dementia are striving
to maintain," says Trobe. Lilla suggests caregivers be especially sensitive
and supportive during this awkward period. "The former driver may be depressed
and angry," she explains. "Be reassuring and try to involve the person in
other aspects of travel. Put them in charge of the radio and temperature controls
and ask them to watch for important signs."
Arrange for transportation. People, including individuals with dementia,
often drive out of necessity. "Reassure the person with Alzheimer's that a ride
will be available whenever they need to go somewhere. Plan ahead, so that rides
can be arranged early and drivers secured. And make ceretain that the person
doing the transporting is the one who actually drives. "There's not much you
can do if you're sitting next to an impaired driver," reminds Lilla, "You have to
be the one driving."
Solicit the support of others. Most people will listen to their
doctor. Ask your physician to advise the person with Alzheimer's not to drive.
"My mother's doctor actually wrote a prescription that said, 'no driving'," says
caregiver Jan Wachter. "She respects the 'doctor's order' and no longer argues
with me over the keys." Relatives, a trusted friend, or even an insurance agent
can reinforce the message that driving can be dangerous.
Make the car less accessible. Keep the car keys with you at all times
and leave your "extra set" with a neighbor. If the car is not used, disable it
(by removing the distributor cap) or park it down the street, where the person with
Alzheimer's won't see it. If the car is not needed, sell it. The money saved
in insurance premiums, gas and maintenance could cover the costs of special
transportation arrangements and taxi cab rides.
Take the test. You may need to go directly to your state department
of motor vehicles for help. Explain to them your concerns and ask them to retest
the driver. It is often difficult for a person with dementia to pass the required
tests. As a last resort, in most states, you can even request that the person's
license be revoked. The state may require a letter from a physician that certifies
that driving is no longer an option. But don't assume that taking away a license
will necessarily discourage driving. You'll still have to make certain the person
with Alzheimer's doesn't have access to a car.
Be firm. Avoid arguments, and long explanations for why driving is
no longer an option. Focus on other activities that the person can still enjoy.
Formulate a driving plan early on and ask for assistance from family and friends.
From the Alzheimer's Associaton National
Newsletter, Volume 15, no. 3, Fall 1995
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