Sometimes some of life’s most important values clash in strange places. This is the case when safety and independence become competing claims. They meet head on at life’s intersections – literally and figuratively. This question is a biggie in a family’s management of Alzheimer’s disease: “Is it safe for my loved one to drive?”
Our mother had experienced a few small incidents with driving improprieties, but no real harm was done. The matter became an unavoidable issue when she tried to make a left turn on a four lane highway. The spot she chose was a passage meant to be used by drivers in the two oncoming lanes. The mishap produced no calamity, just a ding in a nice man’s car; he was gentle and forgiving. But the message was becoming clear to us. Her judgment was diminishing, and her safety and independence needs had collided at that intersection.
When a primary caregiver feels discomfort (or even before) he/she should be aware of changes that occur in Alzheimer’s patients which should be carefully monitored in regard to driving:
· Slowing responses/reactions to visual cues (e.g. brake lights),
· Increased difficulty making decisions (e.g. choosing a turn lane),
· Demonstrating fear in unfamiliar surroundings,
· Becoming confused by excessive stimuli (e.g. lights, noise, billboards),
· Misinterpreting written messages (e.g. road signs),
· Exhibiting flawed judgment of distance and space,
· Having difficulty remembering directions to familiar places,
· Losing focus and concentration,
· Showing increased agitation and frustration, and
· Making incorrect turn signals.
Obviously these changes indicate that the loved one is most likely becoming an unsafe driver. When the time comes that this important activity must be adjusted, it is traumatic for both the “patient” and the caregiver. This reality makes it all the more important to plan for such a time to make it easier, NOT easy. Driving a car in our culture is an ultimate symbol of freedom and independence. Not to be able to drive clinches our worst fears: isolation, dependency, loss of control, regression, boredom and the thought that “I am sick.” The denial of the privilege of driving a car must be handled with great empathy and wisdom.
I like to think of this task as a process.
PHASE 1: For awhile it may be possible to discuss the driving safety question with the loved one. If so, he/she could drive in less complex settings with someone in the car who can help calmly and supportively.
PHASE 2: Begin to plan for a longer term situation. Arrange for family and friends to offer to go with him/her to the grocery store, beauty/barber shop, church, etc. This should be approached as “a chance to visit with you,” but should not come through as manipulation or deception.
In this phase, the caregiver and family can begin objective evaluations which will deter anyone from making a decision based on hunch or emotion, then living with guilt and second guessing.
One type of test is self-assessment, such as tests available on the internet or in workbooks. These should NOT be used as a final decision-making tool, but only as a flag or one indicator.
A second approach can be facilitated by a physician. The physician can assess the patient’s skills and make recommendations about driving. The American Medical Association has approved certain of these screening tests. Tests in your community may be available through the Area Agency on Aging. AARP also has a helpful test. After appropriate tests are administered and the decision is made to prohibit the loved one’s driving, his physician may be willing to write a “no driving prescription.”
PHASE 3: The day will eventually come when someone must convey the message in whatever way is appropriate considering the degree of dementia. If possible a professional outside the family should tell the Alzheimer’s patient he/she no longer can drive. This will help the caregiver and family members absorb and manage the grief that will follow. The patient’s physician is a probable candidate.
Several ideas are floating around in Alzheimer’s literature to help with the practical side of the driving withdrawal syndrome.
1. Make the car less accessible by changing the parking spot (maybe out of sight), trading the car for another color/model, or deactivating the car with a disability switch. (Be sure to notify neighbors and the car service company in case the patient asks for help in starting the car.)
2. Take the loved one for rides and suggest you will drive so he/she can enjoy the scenery.
3. Procure a photo ID to replace the patient’s driver’s license (from the department of motor vehicles).
4. Replace car keys with other keys if your loved one is agitated from “losing his/her keys.”
5. Use other modes of community transportation to distract the loved one from his/her loss.
6. Recognize and deal with the grief (and extra load) the caregivers and other family members face in this benchmark change and loss.
(For internet help search the subject “Alzheimer’s and Driving”.)