Driving Skills and Safety

As a person ages, driving skills change due to both muscle and vision degeneration, slowing reaction time, and the effects of illnesses or medications. Although older drivers are among the safest drivers in the United States, car crashes are the leading cause of injury-related fatalities in 65-74 year olds and the second leading cause of fatalities for those 75 years of age or older - after falls. In 1995, one out of every 11 drivers was over age 70. By the year 2020, one out of every 5 drivers will be over age 65.

Studies suggest that older drivers with dementia are at greater risk for accidents compared to other drivers. On-road tests of driving skills have shown that drivers with mild dementia were more prone to errors than a control group. Other surveys note that drivers with dementia had twice as many "close calls" as other drivers, perhaps because they have significant problems, for example, in processing visual information.

So - when should a person with dementia due to Alzheiemr's disease stop driving? Is a diagnosis of AD an automatic signal that a driver's license should be surrendered?

While there are no "right" answers to these questions, recent studies suggest that a diagnosis of mild or early stage AD is not necessarily the moment that a driver's license should be forfeited. Caregivers must monitor their family members driving closely, because the progressive nature of dementia will eventually affect driving ability. Dementia slowly erodes cognitive functions critical to driving, including attention, judgment, reaction time, spatial skills, and problems-solving abilities.

Once a diagnosis of dementia has been made, regular assessments of driving capability should be conducted by trained staff at the State motor vehicle department. Even if the person with dementia demonstrates safe driving, driving should gradually be limited to avoid more challenging situations, such as heavy traffic, unfamiliar roads, night driving or long distance highway driving.

The following are warning signs that may indicate the need to seriously evaluate a persons ability to safely operate a vehicle:

> Driving too slowly

> Stopping for no reason

> Failing to observe traffic signs or signals

> Becoming lost in familiar territory

> Lacking good judgment or not anticipating dangerous situations

> Having trouble navigating turns (Particularly unprotected left turns), lane changes, or highway exits

> Drifting into other lanes or driving on the wrong side of the street

> Signaling improperly or not signaling at all

> Difficulty seeing pedestrians, objects, or other vehicles

> Falling asleep while driving or becoming drowsy

> Parking incorrectly

What course of action is open to the caregiver of a person with Alzheimer's disease when faced with clear evidence that driving should stop? How can the caregiver avoid confrontation when suggesting that a driver's license should be surrendered? How does the caregiver balance the dignity of the person with AD with the safety of others?

Taking away the car keys is one of the most difficult decisions facing caregivers of people with AD. Planning and honest communication are key. Involve the driver and other family members in discussions. To prepare for this discussion, imagine what it would be like if you had to stop driving. Fear of loss of independence, freedom and control. Most of us would find this unacceptable. Open discussion with family presents an opportunity for all to voice opinions and concerns. Caregivers must also be careful to guard against two extremes: over-reacting to a minor incident and ignoring alarming trends.

> Build a record.

Before confronting a person with AD with accusations of dangerous driving, it is helpful for caregivers to document incidents, to present a record of observations of driving behavior. The record should note time, date, place and a brief description of the occurrence. Of-course, a serious crash,traffic tickets for moving violations, scrapes and dents, and other physical evidence of accidents are indicators that driving needs to cease immediately.

> Limit driving gradually.

Slowly limiting driving is better than a sudden halt. As part of the plan, the family can use a document such as the one created by The Harford Insurance Company, called "The Agreement with My Family about Driving." This document involves the person with mild dementia while that person is still capable of sound reasoning and can designate someone to be responsible for taking steps to curtail or stop driving when safety becomes an issue.

> Help from Professionals

When caregivers encounter opposition to pleas to stop driving, they can turn to professionals for help. Physicians, attorneys, care managers, financial planners, support groups and the department of motor vehicles offer objective, third-party opportunities for guidance. A call to the State motor vehicle department to arrange for a driver's test is usually confidential. Attorneys and other planners can help by offering an objective assessment of driving skill, allowing the caregiver to defer to an expert's opinion. Doctors are perceived as authority figures whose opinions may be taken more seriously than those of a caregiver or family member. If patients are clearly a risk to themselves or others, the physician should take action to "presribe" that driving cease, using the prescription pad. The discussion should be open and sensitive to the issues involved, particularly the perceived threat to independence.

> Finding Alternatives

The perceived loss of freedom from loss of a license can cause depressed mood and social withdrawal. To divert attention away from the loss of driving privileges, caregivers should focus instead on other activities the person may still be able to enjoy. If the car is used to maintain social contact, then the plan must address how to continue those contacts. Trips to see friends, family or visit the library, barbershop, hairdresser or grocery store can continue by seeking alternate forms of transportation, so that the person with AD doesn't feel abandoned, isolated, or restricted.

The best course of action for caregivers is to use common sense, communicate openly and frequently, and seek help from professionals. Poor driving by a person with dementia is unlikely to improve. When all else fails, and the person with dementia insists on driving even if he or she poses a hazard, caregivers can:

>Hide the car keys

>Replace the keys with a set that won't start the car, or file down the ignition key

>Disable the car or sell it

>Move the car out of sight

>Have the police confiscate the person's drivers license.

For more information and tips to assist caregivers, contact the Alzheimer's Association at (716) 626-0600.

For information regarding the programs and services offered by ElderWood Senior Care, please contact (716) 633-3900.