By Ann Julian, LCSW-R, MSW
Special to Alzheimer's Weekly
Week of October 7 - October 13

Carol was a sales executive who spent a great deal of time on the road in the course of her business.  Because her services were much in demand, Carol rarely had much time to visit with her children and grandchildren, but holidays were the exception. She always drove her son’s family to her daughter’s home in the next town, even in the worst weather.

That changed the day Carol became confused on the road, telling her son she didn’t recognize the highway and must have taken a wrong turn. It was Christmas Eve, and Carol had driven that stretch all her life, but now it looked strange and it worried her. She refused to go any farther, and insisted her son take over.

For the first time Carol and her  family began to think about whether she could continue to drive, but the doctor was not surprised. He had expected this day.

When should a person with Alzheimer’s disease stop driving? Is it always necessary? After all, to some people it can represent a devastating loss of independence.

The answer varies with each person, but yes, there comes a time when every person with Alzheimer’s has to hand in the keys. Sometimes they don’t, and the family is forced to take them away, gently or surreptitiously, in order to keep their loved one and everyone else safe on the road.

Research studies found that people with Alzheimer’s usually continue to drive for at least two years after receiving the diagnosis. This is something to play close attention to. The respected journal, “The Lancet”,” reported that researchers found approximately half of all drivers age 65 and older who died in traffic accidents had symptoms or an actual diagnosis of Alzheimer’s disease.

This frightening statistic highlights the struggle over when and why a person with Alzheimer’s has to stop driving. This struggle came alive recently on the Alzheimer’s Weekly Boards. A lady wrote to Ann, “My mother-in-law says, ‘You can say what you want and I will do what I want. I will keep driving’”. Click here to browse our readers’ suggestions and advice. Also, a formal article from the Mayo Clinic eloquently addresses the issues faced by families who must convince their loved ones to hand over the keys.

On the other hand, some people with Alzheimer’s, ready to stop driving at the right time are still in the early stages, where they should not have to. They recognize their driving ability is deteriorating but are unsure about whether they are at the point where they need to give it up.

Often the person can continue to drive, albeit in a more limited fashion, by reducing their time behind the wheel in accordance with their coordination or ability to make decisions on the road.

What are the specific warning signs for drivers with dementia that indicate it may be time to give up the wheel? The Hartford Insurance Company has a wonderful website that answers this and many other questions about driving and Alzheimer’s disease, including a separate page devoted to tips for drivers with Alzheimer’s and their caregivers.

Whether the transition is a slow one, initiated by the person with Alzheimer’s who is able to understand the dangers involved, or a sudden decision by family members after an enlightening experience, the bottom line remains the same. At some point, earlier rather than later, a person with Alzheimer’s will reach the stage when he should no longer drive.

If the person with Alzheimer’s does not responsibly hand in the keys, the government may be forced to step in. In the State of Florida, physicians are authorized to report patients with dementia to the Department of Motor Vehicles (DMV) but reporting is not mandatory. This is in contrast to California where the physician does have to report their patients. The former law has the advantage of fostering the confidentiality between the doctor and patient, respecting individual rights, whereas the latter places societal interests above those of individuals.

There is no simple test clearly separating safe from unsafe drivers. For people with very mild or mild dementia, the physician should warn the patient and family that the driver may be at increased risk, and advise that they be tested to verify that he or she is a safe driver. The family should understand that the patient's ability to drive may deteriorate over time and that they should continue to monitor this ability. When a physician warns a patient that they are at increased risk of hurting others or themselves, it is time to voluntarily give up driving. If you are a caregiver advising a person to give up driving but they decide to continue anyway, try suggesting they contact the DMV or a private agency and be tested for safe driving. In patients who you are aware are unsafe drivers but refuse to give up driving, tell the family and then report the patient to the DMV. You should always do this with the family's knowledge because everyone may have a very difficult situation with which to deal.
If possible, it is best for the family to discuss this eventuality together, early on. Facing the loss of one’s easy mobility and independence is only one of the many trials an Alzheimer’s victim will have to cope with, but the love and support of family and friends will make the transition easier to bear.

More Information:

Specialists and Self-Assessments to Evaluate Your Driving Fitness

The Mayo Clinic discusses “When to Stop Driving”

The Hartford Group’s Practical Guide to Alzheimer’s, Dementia and Driving

The U.S. Department of Transportation’s National Highway Traffic Safety Administration Talks About Driving Safely and Alzheimer’s Disease

Sources:

Johansson K, Bogdanovic N, Kalimo H, Winblad B, Viitanen M.: "Alzheimer's disease and apolipoprotein E epsilon 4 allele in older drivers who died in automobile accidents [letter]." Lancet; 349:1143-4.

Graff-Radford, Neill R. MBBCh, MRCP, Professor of Neurology at Mayo Medical School and Mayo Clinic Jacksonville. Alzheimer’s Disease. dcmsonline.com

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