DIMENSIONS Spring 2007

Early-Onset Alzheimer’s Disease and Driving

by Cat Olcott

Q. My mother, at 63, has been diagnosed with early-stage Alzheimer’s disease. She is still driving herself on errands, to appointments, and to meet with friends but she suffers from short-term memory loss. She has said that she is willing to give up driving “when the time is right.” How will we know when that time has come, or has it come? What signs should we look for? The family is divided on how to handle this sensitive issue.

A. Unfortunately there is no simple answer to your question. Those with early-stage Alzheimer’s disease (AD) may be currently experiencing only mild impairment. They can still be working and need only minimal assistance with certain activities of daily life. Individuals in this stage are often concerned about their diagnosis, so this can be a good time to start the conversation about when it may become necessary to limit or stop driving.

Giving up driving is a difficult and life-altering transition for anyone. Fear of isolation and loss of freedom are big issues for those diagnosed with AD. Families and caregivers may hesitate to suggest that the loved one curtail driving for fear that it will create conflict, particularly if the person with AD does not feel their driving has become unsafe. Caregivers may also be concerned about how they will juggle the increased responsibilities of having to help their loved one get to his or her appointments and activities.

Opinions are divided as to the emotionally charged issue of Alzheimer’s and driving. Some say that driving should be curtailed as soon as a diagnosis is made. Others feel that for most individuals, “easing” the transition by monitoring the person’s actual driving ability and gradually restricting driving to familiar roads or conditions is a more reasonable approach. However, it’s imperative to realize that driving is a complex activity that requires split-second decision making. Even the best driver is faced with challenging situations on the road. Diminished judgment due to slower reaction times, distractibility, changes in vision or motor coordination skills, trouble with predicting upcoming traffic problems, or side effects of medications are tremendous safety concerns. Look at controllable issues such as updating an eyeglass prescription or making sure your mom’s car seat and mirrors are positioned properly (and that her car is in good working order). The decision to avoid driving in more dangerous situations -- at night, at dusk and dawn, in inclement weather, during peak traffic times, and at high speeds (i.e. freeway driving) -- will put everyone’s mind more at ease.

You should regularly ride with your mother in her car and observe her driving. Specific signs that can indicate that driving skills have diminished include:

  • becoming disoriented or lost on familiar routes,
  • driving too slowly or too fast,
  • trouble reading or obeying traffic signs,
  • failing to use turn signals – or leaving them on without changing lanes,
  • increased anxiety, confusion or anger with other drivers,
  • exhaustion after a seemingly simple trip
  • “dings” on bumpers or garage doors,
  • and of course, close calls, warnings, tickets.
  • Family members do not always agree about whether a loved one needs to curtail his or her driving. It can be helpful if you keep a diary of your impressions about your mom’s driving ability, based on actual observations and on what she or other persons in the family tell you. This written record can be a good family reference when talking about your mom’s driving safety. It can also provide important information to share with your mother’s healthcare provider. Some physicians will “prescribe” a driving restriction for persons with dementia. When someone who has become unsafe refuses to stop, concerned family members can also work with the person’s doctor to request a driving evaluation by the local Department of Motor Vehicles.

    Fortunately your mother is open to discussion. Suggesting other ways to maintain regular activities will help her retain her independence and sense of self-confidence. Include her in planning for social activities that do not require driving. Arrange for family and friends to take your mother on errands or for a pleasurable drive. Investigate public transit in your area including senior van routes. Churches, senior centers and some social service agencies offer volunteer drivers for seniors. You may be able to establish a payment account with a taxi service. Find ways of reducing the need to drive by combining trips. Groceries and even prescriptions can be home-delivered. Mail-order catalogs or ordering products on-line can be a fun way to stay home and shop!

    Grieving the loss of independence, whether sudden or more gradual, is natural. Patience and knowledge are instrumental in keeping everyone involved focused on the self-respect of the loved one with AD and the safety of those on the road.

    The websites below offer a variety of information on driving and dementia.

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