Q The spouses of two of my friends have Alzheimer’s disease. Unfortunately, they continue to drive despite dents in their cars and periodically getting lost. My friends are doing nothing and are waiting for their doctors to take on the problem. None have done so. To me, it is a moral responsibility to keep our loved ones safe, out of accidents and situations that can cause harm to others. Is this something I can talk with my friends about or do I need to keep biting my tongue?
A Dear E.F.:
I vote for having a conversation with your two friends for the very reasons you noted. Driving, particularly in Southern California, is a license for freedom and self-reliance that makes the topic a sensitive one.
When is the right time to hang up the keys? That depends on the stage of the disease. According to the Family Caregiver Alliance, individuals in the early stages of dementia (Alzheimer’s is the most common) may have the necessary skills to drive. The bad news is that since most dementia is progressive, the necessary skills such as visual-spatial orientation and cognitive function get worse as the disease progresses.
To drive safely, one should have the following skills and abilities:
• Quick reaction time that may be needed to stop as children chase their ball across the street or the car in front stops short.
• The ability to divide your attention as an emergency vehicle with a siren passes by and pedestrians are crossing the street at the same time.
• Exercise good judgement regarding when to pass a car or enter the freeway from an on ramp.
• Understand and recall the rules of the road. Examples are remembering the speed limit, stopping at cross walks and knowing to stop at a blinking red light.
• Finding your destination, particularly on familiar roadways.
• Having adequate eyesight and hearing.
• There are warning signs. Be on alert if the individual receives tickets for driving too fast or too slow, fails to stop or makes improper turns, has accidents that include fender benders or near misses, gets lost or has passengers who feel uncomfortable or unsafe.
According to the State of California Department of Motor Vehicles, physicians are required by law to report disorders characterized by lapses of consciousness, as well as Alzheimer’s disease and related disorders. Yet, physicians may not have the full information to assess the situation. They see their patients for a limited amount of time and not behind the driving wheel, often having to rely on information from the family that may or may not be accurate. Other physicians may be reluctant to make the decision to avoid spoiling the patient-doctor relationship and possibly angering the patient who may not return for a visit.
Some individuals with Alzheimer’s disease are relieved when others encourage them to stop driving, feeling relief from their confusion and lack of confidence. If possible, it is useful to involve the individual in the discussions and decisions that ultimately lead to a better adjustment according to the Caregiver Alliance. Yet even with this awareness and participation, individuals often feel a sense of loss.
In extreme situations, the Alzheimer’s Association suggests asking a police officer to intervene and perhaps issue a citation. Another suggestion is to ask a doctor to write a prescription of “do not drive.” If all else fails, one might disable the car by removing the battery or by moving the car out of sight.
One of the best ways to determine whether an individual is a safe driver is to have an evaluation conducted by an occupational therapist trained in assessing drivers with cognitive problems and in particular dementia. The Providence Little Company of Mary Medical Center San Pedro has an excellent program. Purnima Karia, an occupational therapist certified in driving evaluation, says their program is useful particularly when a family cannot persuade a loved one to stop driving. She adds: “An objective assessment and feedback for next steps takes the burden of making the decision from the family.” For more information, call 310-514-5370.
One must have a current driver’s license. Unfortunately, the $550 cost is not covered by insurance.
Another recommendation is The Dementia and Driving Resource Center at www.alz.org/care/alzheimers-dementia-and-driving.asp. It provides advice on how to talk about driving and ways the person with dementia may react.
E.F., thank you for your important question. By having the conversation, you are being a good friend to your friends and their mates. So don’t “bite your tongue” and carry on.
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