Older Driver Task Force Georgia

ALZHEIMER'S DISEASE AND DEMENTIA: THE DRIVING DILEMMA

Driving is a complex activity that requires quick thinking and reactions, good perceptual abilities and split second decision making. The person with Alzheimer's disease or related dementia may not recognize that changes in cognitive and sensory skills impair driving abilities; therefore, family members need to be firm and proactive in their efforts to prevent the person from driving.

People in the very early stages of dementia may still be able to drive safely. But everyone with dementia will eventually become an unsafe driver, because of impairments in memory, judgment, reasoning, spatial perception, and reaction time. In a Johns Hopkins Unversity study of drivers diagnosed with Alzheimer's Disease, more than 40% had been in an accident after the diagnosis was made; 44% had gotten lost and 75% continually drove below the speed limit. Studies also show that older drivers have a disproportionally higher rate of motor vehicle fatalities when compared with other adult age groups.

Family members are often the ones to take on the decision of when driving is no longer safe. It is a good idea to start the planning process early and to involve the person as much as possible. This includes discussing options for the time when they are no longer able to drive and how decisions will be made. Some families use a document designating an authorized person to take necessary steps to ensure driving safety. Despite this, the person with dementia may still refuse to stop driving, often as a resultof a decline in their insight and ability to understand their impairments. Family members then face a quandary: how do we get Mom or Dad to stop driving? How do we do this while maintaining as much of their dignity as possible? And how do we know when the time is right?

It is helpful to create opportunities to observe the person's driving skills over a period of time. Warning signs include:

* Increased agitation or irritation when driving

* Forgetting the destination or getting lost in familiar places

* Driving too slowly or too fast

* Confusing gas vs. brake pedals, and/or braking too frequently

* Trouble navigating turns, intersections, lanes, or parking spaces

* Deliberately avoiding unprotected left turns, unfamiliar or heavily traveled roads, longer trips, or night driving

* Delayed responses or confusion about what to do in traffic

* Scrapes or dents on car, mailbox, or garage

* Accidents and tickets for moving violations

* Incorrect or lack of signaling

* Trouble maintaining lane position and/or driving down the wrong side of the road

* Stopping in traffic for no apparent reason

Families are often highly reluctant to approach this subject with their loved ones. They worry about the anger and hurt the subject may cause. The safety of the person and other drivers must be considered, however. There are liability issues to consider as well. Under Georgia law, if a person is diagnosed with a disease which may foreseeably impair their ability to operate a vehicle, and they cause an accident resulting in serious bodily injury, the person could be charged with a felony and face imprisonment of 1-15 years. Similiarly, if caregivers who have such knowledge allow the person to drive a vehicle under their control, they may be held liable for such accidents as well.

As abilities decline, families can consider consulting a physician to talk to the person about driving. Because people with dementia are not reliable informants, it is very important for families to give their input, in advance if necessary. Physicians may recommend a driving assessment. Some physicians may write a "Do Not Drive" prescription that you can display prominantly for the person to see (i.e. the refrigerator). Sometimes the person will take a physician's advice when they will not listen to family members. In some states, physicians are required to report to the DMV when a patient is no longer safe to drive and face penalties if they do not do so and the person causes an accident.

The DMV also has a process of revoking a persons' license, which anyone can initiate. But even if the person's license has been revoked or the doctor has told them they are unsafe to drive, it still does not mean that the person will comply. Family members must be proactive in preventing the person from driving.

Here are some suggestions:

* Disable the car (remove distributor cap)

* Remove, replace or disable keys

* Remove the car (sell it or place it in a place where the person does not have access)

* Contact the DDS for license revocation

* Register the person in a Driver Assessment Program

Keep in mind, even these solutions do not always work, however, as people can hire someone to fix the car, or, in some cases, buy a new one.

As their loved ones' driving ability declines, families should develop an alternative transportation plan to ensure that their needs will continue to be met. Relatives, neighbors, caregivers, and church members are more likely to help if specific requests are made and appointments are scheduled at times convenient for the driver. Respite care agencies often offer transportation with caregiver supervision. There are many private medical transportation services available, but these are usually expensive and do not offer an escort.

For more information on driving issues, finding a driver assessment program and/or finding alternative transportation, you can contact the Alzheimer's Association at 1-800-272-3900.