Q. I recently traveled with a friend to Alaska and noticed she seemed a bit confused. Shortly after arriving home, we made some social engagements; she couldn’t keep the dates, times or locations straight, even after I reviewed them with her about four times. My friend is being evaluated by a neurologist. My guess is for dementia. Her children are aware there is a problem, yet they say nothing to her about her driving. Is it appropriate for me to mention my concern to her children? I don’t want to be intrusive. E.R.
You are facing a difficult decision. I would strongly recommend mentioning the concern to your friend’s children. The worst outcome is that you will be the recipient of some anger or annoyance. If you do nothing and your friend has a terrible accident, you might have to live with that outcome for many years. My vote is to take a chance and be intrusive. Actually, I would rephrase “intrusive” as “caring and responsible.”
Hopefully, the cause of your friend’s confusion is not due to a form of dementia. Just for clarity, dementia is defined as a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Alzheimer’s disease is the most cause of dementia.
Several years ago, The Hartford Financial Services Group and the MIT AgeLab developed a guide to help people with dementia and their families prolong independence while encouraging safe driving. Much of the following information is based on this valuable guide.
We know the brain receives information through sight and hearing. It prioritizes information, recalls past experiences, anticipates likely scenarios, analyzes options, plans ahead, uses good judgment, synchronizes movements and juggles more than one task at a time. When driving, these tasks must be accomplished with adequate speed.
Depending on the individual, one or more parts of the brain responsible for these functions may be impaired.
Many individuals function well during the early stages of dementia. They are socially engaged, manage their daily activities and drive safely. However, those with irreversible dementia will eventually become unsafe to drive because of the degenerative, progressive nature of the brain disease. The big question is at what point in time does the individual become an unsafe driver?
All of us experience some changes as we age that affect our vision, reaction time and hearing. These changes vary with each of us ranging from just a bit to changes that are very noticeable. Most of us can accurately assess and regulate our driving ability and compensate for change. We do this by avoiding certain roads, eliminating night driving and being aware if we are too tired to drive. That’s not the case for someone with dementia, a condition that is gradual and unpredictable. Eventually, dementia victims lose the capacity to determine for themselves if they are safe drivers.
Trying to make excuses or rationalizing for the changes is common. Here are several such remarks:
“Just because I got lost doesn’t mean I can’t drive.”
“I always look where I am going.”
“I’ve driven many years and haven’t had an accident.”
“The dents in the car are from years ago.”
“There’s nothing wrong with me.”
Finding a balance is important. A family member or caregiver may choose not to intervene to avoid hurting the person’s feelings. In contrast, one can overreact to common driving errors. Just because a person goes through a red light, fails to stop at a stop sign or has trouble parking does not mean the individual is an unsafe driver.
A single occurrence should not require a person to stop driving. That person may always have been a bad driver. However, such incidents may send a signal to observe and assess if they occur repeatedly.
Here are some tips to help older adults – with or without – a cognitive disorder, accommodate their changing skills as suggested by the guide.
•Drive shorter distances
•Drive on familiar roads
•Avoid difficult, unprotected left turns
•Avoid driving at night, in heavy traffic, or during bad weather
Thank you, E.R. for your important question. In all likelihood, most of us will be confronted with “giving up the keys” at some point as we live a long life. Given the importance of this subject, next week’s column will identify several signs of unsafe driving and alternative sources for transportation.
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