[13] Dementia Horizons: Driving Concerns

Dementia Horizons™ | Workshop 13 | Driving Concerns

Video Module [13] Transcript

Welcome. For many of us, driving means a sense of independence, freedom, self-reliance, autonomy, and adventure. Being told that you can no longer drive after 50-60 years of doing so, can be very hard on a person's sense of ego and independence. This video will focus on how to address safety concerns for people who are beginning to show signs of minor cognitive impairment, or possibly are in the very early stages of a diagnosed or undiagnosed disease, that is manifesting as the syndrome of Dementia.

Let's start by pointing out that driving is a complex task requiring life and death decision-making, and all sorts of other important cognitive and physical capabilities. As a refresher, Dementia is not a disease. Instead, it is a cluster of progressive symptoms that result from one or more underlying brain diseases or disorders. Medically, it's a syndrome if the symptoms progress to the point of requiring help to complete one or more activities of daily living. That alone, coupled with other cognitive deficits that a doctor can assess, is usually enough to be diagnosed as Dementia.

To be clear, if someone has been diagnosed with cognitive impairments advanced enough to be called Dementia, they should not drive, period. Full stop. In fact, most state motor vehicle laws prohibit a person from maintaining a driver's license in such cases. We agree.

As our bodies age, it is common for changes to impact our ability to drive safely, and those changes can be downright dangerous for those whose brains are declining a bit faster than what we consider normal for one's age. Moreover, when it comes to driving, there are other people's lives to consider in addition to our own. These changes in ability include problems with depth perception, estimating distance and spacing, narrowing of peripheral vision, difficulty discerning shapes, staying in a lane and understanding road signs, remembering directions and rules of the road, knowing when to stop or speed up, having the motor reflexes to stop suddenly or change direction, keeping impulses in check under stressful conditions or situations.

If someone is in the very early stages of cognitive impairment, it does not mean that the person must automatically stop driving. However, when there are noticeable declines in ability, discussing any concerns about driving is essential. Some individuals with minor cognitive impairment continue to maintain insight and self-awareness, and can recognize the need to limit their driving. It may mean that they stick to driving on very familiar roads, avoid days and times that usually have heavy traffic, avoid driving in the rain, sleet, or snow, or driving at dusk or at night.

Recognize Any Driving Concerns When Being a Passenger

Are they becoming lost in familiar places? Have they successfully used GPS directions on their phone, but now they're getting confused using the apps?

As a passenger, observe if they mix up the brake and gas pedals, or have a hard time dealing with four-way stops. Do they drive too slowly and impede traffic, fluctuate in levels of alertness and drowsiness, see things or people that do not exist, become nervous and aggravated while driving, have difficulty changing lanes as well as entering or exiting the highway, have unexplained dents or scrapes, experience frequent fender benders, or damage the wheels or tires by bumping into curbs?

What can you do?

• You may be able to obtain a formal driving evaluation by contacting your State Department of Motor Vehicles. Follow the guidelines for your state, but this type of evaluation should be repeated at regular intervals. Also, it's not uncommon for doctors and hospitals to refer individuals to occupational therapists. They should be able to help with various functional assessments, including driving skills.

• Make a list of transportation alternatives. Ask friends and family to offer car rides, and find out if there are any community volunteer groups that offer transportation help. Use on-call smartphone apps that summon a driver to the person, along with taxis.

• Eliminate the need to drive by using online shopping for home delivery of groceries and more. Some individuals and families even find ways for a barber or hairstylist to make home visits.

• Consider having a transportation buddy for socialization and support. You can also contact your Area Agency on Aging to determine what transportation services may be available in your area.

It can become problematic if the person living with minor cognitive impairments progresses to Dementia and starts to lose the insight or knowledge that they are no longer safe to drive. They can resist. They can refuse to stop driving. Or maybe they agree to stop, but forget what they decided days later.

Sometimes the only thing that makes them stop is having their doctor or medical professional take the blame, and write on the prescription pad a note that clearly states in large capital letters: DO NOT DRIVE. Alternatively, a private conversation with a non-medical authority figure, such as their faith leader, attorney, accountant, or financial advisor can make a difference. Getting them to come to grips with the change may take more than one approach. However, there are times when the spouse, adult child, or advocate must step in, to maintain the safety of the driver, passengers, other drivers, bicyclists, or pedestrians.

Before it's too late, consider hiding the keys, disabling the car, or taking it to the repair shop for work to be done, work that never seems to end. It may become necessary to find secure storage, or sell the vehicle. Selling the car to a family member at a good price benefits both the seller and the buyer. Donating it to a nonprofit, or giving it to a friend in need, may ease the pain of getting rid of it.

This is often a tough time: parenting a parent, a reversal of roles. It is also a good opportunity to seek support to address your conflicted feelings, which can often include guilt, anger, and resentment. This is the time to remember that the overall goal is safety for the person with Dementia and other drivers or pedestrians on the road. This safety supersedes the person's anger and desire to drive.

Addressing driving safety now is much easier than having to possibly address all that would be involved if someone is seriously injured or even killed on the road. When you are the one who takes away the keys or car, know that you are caring for that person in a way that fills in for the insight that is now lacking.

By approaching driving concerns thoughtfully and proactively, you can help ensure the safety and well-being of individuals with Dementia while maintaining their dignity and independence and allowing them to live a more worry-free life.

The subject of driving is stressful for all involved. Thank you for listening and watching. You are taking positive steps to help keep your loved one and others safe. Thank you again. I wish you peace on your journey.

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