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Alzheimer's, Dementia, and Driving
 
The following information is mainly copied from a very excellent original by The Hartford Financial Services Group that they researched and wrote about 12 years ago. Not much has changed since then. Adult children still worry about their aging parents just like they always have. Included in this synopsis are links to the Utah Drivers License division where you can look up what Utah says about aging drivers and driving.
 

 
 
Why Driving and Dementia is a Difficult Issue

Driving represents independence, competence and control. It's a way to access healthcare, buy necessities, be productive and stay connected to family, friends and the community. Concerns about driving often surface during the early stages of dementia when individuals are still independent and able to manage daily activities.
 
This disease is not like other changes in later life that affect driving, such as eyesight problems and slow reaction times. Many older adults who don't have dementia can assess their driving without family intervention and make gradual changes to the way they drive. And most are able to continue driving safely throughout their lives.

However, it's different for those with Alzheimer's Disease and other dementias. The progression of this disease is usually gradual and somewhat unpredictable. It affects cognitive functions critical to driving, such as judgement, reaction time and problem-solving abilities. It can also cause physical and sensory problems that increase driving risk.
 
With dementia, an individual's capacity to assess his or her driving abilities may also diminish. People with dementia are especially likely to minimize the complexity of driving and overestimate their abilities. They may make excuses for their high-risk driving. Some common reasons that  people with dementia use to justify their continued driving include:
 
"Just because I got lost doesn't mean I can't drive."
"I make sure I look where I'm going."
"I've driven many, many years and haven't had an accident.
"
 
As driving and assessment skills decline, the risk of serious loss or injury increases. Caregivers must start to assume the responsibility for monitoring and regulating the driving of the person with dementia.
 
 
Assessing Your Concerns About Their Driving Behavior
 
Many caregivers report that they have allowed a family member with dementia to continue driving after they believed it was unsafe. At the other extreme, some family members overreact to common driving errors such as failure to complete a stop at a stop sign. They may blame these errors on the disease when the person may have exhibited this bad habit long before dementia. A single occurrence of poor driving usually is not cause to stop driving. It does, however, signal the need for increased monitoring.
 
These activities can help caregivers assess their concerns about the driving skills of the person with dementia:
 
  • Create opportunities to observe the person with mild dementia while driving.
  • Keep a written record of observed driving behaviors over time.
  • Share observations of unsafe driving with the person with dementia, other family members and healthcare providers.
 
 
 
Monitoring Driving Behavior
 
A diagnosis of Alzheimer's Disease or another kind of dementia is not automatically a reason to take away driving privileges. Families must determine when a person's attention span, distance perception or ability to process information makes it difficult for him or her to respond safely in driving situations.
 
Early warning signs of driving problems include:
 
  • Incorrect signaling.
  • Trouble navigating turns.
  • Moving into a wrong lane.
  • Confusion at exits.
  • Parking inappropriately.
  • Hitting curbs.
  • Driving at inappropriate speeds.
  • Delayed responses to unexpected situations.
  • Not anticipating dangerous situations.
  • Increased agitation or irritation when driving.
  • Mysterious scrapes or dents on car, garage or mailbox.
  • Getting lost in familiar places
  • Near misses.
  • Ticketed moving violations or warnings.
  • Car accident.
  • Confusing brake and gas pedals.
  • Stopping in traffic for no apparent reason.
 
Most families restrict driving after an accumulation of warning signs. Therefore, family members must frequently observe driving behaviors over time. Share your observations with the person with dementia, other family members and health care providers. Families need to consider the circumstances and seriousness of unsafe driving practices before choosing the next steps, which are to simply continue the monitoring, modify the loved ones driving, or stop their driving immediately.
 
 
Easing the Transition from Driver to Passenger
 
The most effective approach to limit or stop driving involves progressive steps and a combination of strategies that fit the family’s circumstances, resources and relationships. For people in the early stages of dementia, driving is best reduced over time rather than all at once. Families can help by finding ways to let others drive or reduce the need to drive. Caregivers and families should be sure to address the important social needs of the person with dementia that were met through driving. When possible, include the person with dementia when planning ahead to limit driving.
 
Fortunately, in many cases, people with dementia begin limiting where and when they drive. The following signs indicate that a person with dementia is modifying his or her own driving behavior:
 
  • Driving shorter distances.
  • Driving on familiar roads.
  • Avoiding difficult unprotected left-hand turns.
  • Avoiding driving at night, in heavy traffic, on heavily traveled roads or during bad weather.

Let Others Do the Driving
Some people with dementia are better able to adjust to not driving if others gradually assume more of the driving responsibilities.
 
Friends and Relatives
Friends, neighbors, relatives or caregivers can offer to drive the person with dementia to appointments or other social events. Other family members will be more likely to assist with the driving if caregivers make specific requests and schedule appointments at times that work for those requested to help.
 
Reduce the Need to Drive
Resolving the driving issue involves not only substituting other drivers or modes of transportation, but also addressing the reasons people want to go places. Caregivers can look for ways that others can help meet the physical needs of the person with dementia, such as:
 
  • Arrange to have prescription medicines, groceries and meals delivered, reducing the need to go shopping.
  • Have hairdressers make home visits.
  • Schedule people to visit regularly, either as volunteers or for pay.
  • Arrange for friends to take the person with mild dementia on errands or to social or religious events.
 
Balancing the Social Needs
While caregivers consider ways to reduce the need to drive, it’s very important to remember the social benefits the person with dementia derives from interacting with others.
If caregivers consider the social needs that were met through driving, the transition to not driving will be more successful.
The following questions can help families and caregivers identify the social needs and develop ways to address them to ease the transition to not driving.
 
  • Where does the person with dementia normally go? When and how often (e.g., grocery store, barbershop, appointments, library or religious activities)?
  • What services can be brought to the home (e.g., groceries delivered or in-home barber)?
  • Who can offer to provide transportation (e.g., neighbors running errands, relatives for doctors’ appointments or a friend going to religious services)?
  • Can visits from family or friends include outings (e.g., eating out or going to a park)?
 
 
Take the Keys as a Last Resort
Taking away the car keys or a driver’s license, or selling or disabling the car should be a last resort. To the family member in the early stages of the disease, such actions seem extreme, disrespectful and punitive. And people with mild dementia can ignore, undo or maneuver around those strategies by driving without a license, enabling the disabled car or buying a new car to replace one that was sold. As one person with dementia noted, "If they disabled my car, I would call someone to fix it."
Once a person has stopped driving, caregivers must decide whether taking away the keys, license and car will help the person adjust or make it more difficult. Some caregivers remove the keys or the car from sight to avoid having the driving issue resurface. Others allow people to keep their keys, car and license to help them maintain a sense of dignity. Some people with dementia stop driving but carry their license as photo identification.
 
 
Seeking Help From Outside Sources
 
Caregivers often achieve better results by seeking support from professionals outside the family.
 
Healthcare Professionals
Healthcare professionals may be more likely to discuss driving issues with a patient if a caregiver has met with him or her privately and shared observations of driving behavior. This input can help because physicians do not have tests to determine definitively when a person in the early stages of dementia should not drive. And some doctors may hesitate to bring up a topic as emotionally charged as not driving for fear of jeopardizing their relationship with a patient.
 
Doctors may request that a patient not drive for a period of time while trying new medication that may produce drowsiness. When a physician is concerned about someone’s driving safety, writing a prescription to stop driving may give added weight.
 
Independent Driving Evaluations
These assessments may be available through rehabilitation programs. The Utah Department of Public Safety has some good information on their website  and even a Driver Review Form you can fill out asking for a review.   Driving tests are not uniform, and the evaluations vary depending on the extent of the tests and the evaluators’ familiarity with cognitive impairments and other conditions that affect driving. Nevertheless, such tests may provide families additional input and support. Home Healthcare professionals may know how to arrange for an independent driving evaluation.
 
Other Sources of Support
Lawyers, financial planners and care managers may be in a position to raise questions about driving safety. Caregivers can enlist their assistance by asking them to mention the subject as part of planning. Alzheimer’s support groups offer opportunities for caregivers and persons with dementia to share concerns and explore options.
 
 
Understanding How Family Relationships Affects the Decision
 
"There are six of us in the family – some still deny there is a problem, some tend to panic and the rest of us feel caught in the middle."
 
No two families dealing with dementia resolve transportation issues in the same way. Roles and relationships within families can affect decisions about when and how a person should stop driving.
Individual responses of family members may vary. For example, a caregiving spouse may try to protect the person with dementia by withholding information about driving incidents from adult children. An adult child may intervene on matters of safety, even though this might affect the relationship with the parent. One person may avoid confronting the driving concerns of the family member, while another may take charge of the situation and act without input from others.
Caregivers need to remember that family members follow long-established patterns for making decisions. It is unrealistic to think that patterns will change when handling a difficult issue like driving safety. Caregivers can work to minimize friction by listening to different opinions and appreciating what each person can contribute, even if it differs from their point of view.
Disagreements in families are often the result when individuals do not have the same opportunities to assess driving abilities. Having factual information about driving behavior does not guarantee families will reach consensus on when to limit driving. However, frequent, open communication about specific, observed behaviors and concerns may help to lessen differences. Everyone involved in caring for the person with dementia can help by focusing on the key issues – the self-respect of the person with dementia and the safety of everyone on the road.
 
 
 
Advice From Caregivers Who Have Been There
 
1. There is no easy answer; no right way.
Caregivers need to consider the personality and the abilities of the person with dementia when making decisions over the course of the disease. They must take into account the roles and relationships within the family that affect decisions and their outcomes. Each family must select strategies that will work within its unique situation.
 
2. Begin discussions and planning early and involve the person with dementia.
Ideally, a person with dementia should make the transition from driver to passenger over a period of time. Open, early and continual communication can help the person with dementia and the family to agree on a course of action before a crisis occurs.
 
3. Base decisions on driving behavior observed over a period of time.
Regular monitoring and assessing of driving helps caregivers respond appropriately. A diagnosis alone may not be sufficient reason for a person to stop driving. However, when it clearly is no longer safe for a person to drive, caregivers must not delay in taking necessary steps. In hindsight, many caregivers regret permitting a loved one to drive longer than it was safe. The result was prolonged anxiety for caregivers and placing others at risk.
 
4. Get support when making and implementing decisions about driving.
It is not healthy for the caregiver, the person with dementia or the family as whole, when one person shoulders all of the responsibility for making and implementing decisions about driving and dementia. Caregivers can make reasonable requests of family members and those outside the family. Neighbors, friends and relatives can contribute by providing for the emotional, social and transportation needs of the person with dementia.
 
Doctors, lawyers, care managers, financial planners and local Alzheimer’s support groups offer information, guidance and perspective. People in authority outside the family can reinforce the family’s efforts to ensure the safety and dignity of a person with dementia. The more people who are asked to help, the less any one person has to do and the greater the likelihood that the person with dementia will get the best support.
 
 

 
 
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