Monday, February 18, 2008

Alzheimer's Disease: When Is the Right Time to Take the Keys?

Driving demands good judgment, quick reaction times and split-second decision making. For a person with Alzheimer’s, judgement and visual perceptions are effected in the middle stages of the disease.

Driving inevitably becomes difficult, and your loved one may become unsafe on the roads. Families often struggle over when to take the keys from a person with limitations, including the limitations brought on by Alzheimer's Disease. Families anticipate that the person may be upset by the loss of independence and the need to rely on others for going places. This sense of dependence may prevent people with dementia from giving up the car keys.

A diagnosis of Alzheimer’s disease alone is not a reason to take away driving privileges. However, caregivers are not always best at determining if it is safe for a person with dementia to continue driving. They may be in denial about the person's impairment or may not be comfortable assessing the person's driving skills.

The American Academy of Neurology recommends that driving evaluations should be conducted every six months for individuals with Alzheimer's Disease.

Warning signs of unsafe driving

  • Forgetting how to locate familiar places

  • Failing to observe traffic signals

  • Making slow or poor decisions

  • Driving at inappropriate speeds

  • Becoming angry and confused while driving

  • Hitting curbs

  • Poor lane control

  • Confusing the brake and gas pedals

  • Returning from a routine drive later than usual.

  • Getting lost on a short drive in previously known route

Once it’s clear the person with Alzheimer's disease can no longer drive safely, you’ll need to get him or her out from behind the wheel as soon as possible. If possible, involve the person with dementia in the decision to stop driving. Explain your concerns about his or her unsafe driving, giving specific examples, and ask the person to voluntarily stop driving. Assure the person that a ride will be available if he or she needs to go somewhere.

Transition driving responsibilities to others. Tell the person you can drive, arrange for someone else to drive, or arrange a taxi service or special transportation services for older adults. Find ways to reduce the person’s need to drive. Have prescription medicines, groceries or meals delivered.

Ask your doctor to advise the person with Alzheimer's disease not to drive. Involving your doctor in a family meeting on driving is probably more effective than trying by yourself to persuade the person not to drive. Ask the doctor to write a letter stating that the person with Alzheimer’s must not drive or a prescription that says, “No driving.” You can then use the letter or prescription to tell your family member what’s been decided.

Ask a respected family authority figure or your attorney to reinforce the message about not driving. Also ask your insurance agent to provide documentation that the person with dementia will no longer be provided with insurance coverage.

Experiment with ways to distract the person from driving. Mention that someone else should drive because you’re taking a new route, because driving conditions are dangerous, or because he or she is tired and needs to rest. You may also want to arrange for another person to sit in the back seat to distract the person while someone else drives.

If the person with dementia wanders, he or she can also wander and get lost by car. Be prepared for a wandering incident and enroll the person in MedicAlert® + Alzheimer’s Association Safe Return®.

In the later stages, when the person is no longer able to make decisions, substitute his or her driver’s license with a photo identification card. Take no chances. Don’t assume that taking away a driver’s license will discourage driving. The person may not remember that he or she no longer has a license to drive or even that he or she needs a license.

If the person insists on driving, take these steps as a last resort:

  • Control access to the car keys.

  • Designate one person who will do all the driving and give that individual exclusive access to the car keys.

  • Disable the car. Remove the distributor cap or the battery or starter wire. Ask a mechanic to install a “kill wire” that will prevent the car from starting unless the switch is thrown. Or give the person a set of keys that looks like his or her old set, but that don’t work to start the car.

  • Consider selling the car. By selling the car, you may be able to save enough in insurance premiums, gas and oil, and maintenance costs to pay for public transportation, including taxicab rides.

  • Write a letter directly to the Department of Motor Vehicles in your state and express your concerns, or request that the person’s license be revoked. The letter should state that “(the person’s full name) is a hazard on the road,” and offer the reason (Alzheimer’s disease). The state may require a statement form your physician that certifies the person is no longer able to drive.