Sunday, January 30, 2011

When to make stop driving decision for Alzheimer’s Patient?

If your loved one has Alzheimer's, he or she may not be safe on the road. You need to help to assess the risk of continuing driving for him or her, and for other people around as well. Explain the potential risks, and if the risks are too big, provide alternative ways to get around.

Driving is a powerful symbol of competence and independence, besides being a routine part of adult life. But the focused concentration and quick reaction time needed for safe driving tend to decline with age. Alzheimer's disease accelerates this process dramatically. If you're caring for a loved one who has Alzheimer's, you may need to limit your loved one's driving — or stop his or her driving completely.

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More than memory problems

Dimmed short-term memory makes it easy for a driver who has Alzheimer's to get lost, even in familiar territory. Perhaps more dangerous, however, is a decline in the ability to judge distances and predict upcoming traffic problems. A driver who has Alzheimer's may also have trouble prioritizing visual cues. An irrelevant sight, such as a dog jumping behind a fence, may distract the driver from important cues — such as brake lights or traffic signs.

Statistics Risks of Driving with Alzheimer's

There are a number of research studies that illustrate the dangers of driving and Alzheimer’s Disease. For example, a Swedish study by Johansson and others found between 47-53 per cent of drivers over 65 years who died in accidents showed either early signs or actually had Alzheimer’s disease. In another example, Carr showed that people with Alzheimer’s were at a significant higher risk of having motor vehicle accidents. It is known that people with Alzheimer’s disease drive, on average, 2.5 years following diagnosis but that certainly does not mean that everyone with Alzheimer’s should as it affects people in different ways and some more quickly than others. People with early stage, very mild Alzheimer’s disease, can and do drive safely, however when the disease progresses to the moderate or severe stages, then driving must stop.

About 600,000 elderly adults stop driving for some health reason every year, according to the National Institute on Aging. But there's little clear guidance for the roughly 2 million people estimated to be in Alzheimer's early stages, and the disease is poised to skyrocket in two decades as the population grays.

States have varying laws on when aging drivers must pass a road test for a license renewal, but they seldom address specific diseases; California requires reporting of Alzheimer's diagnoses so driving can be assessed. The Alzheimer's Association tells families warning signs of unsafe driving.

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Rates of deterioration

To better determine the rate at which driving skills deteriorate in people with early Alzheimer’s, researchers at Brown University conducted a longitudinal study of 128 drivers, consisting of 84 patients with early Alzheimer’s and 44 healthy older drivers who served as controls. The average age was 75. Patients with a clinical dementia rating (CDR) of 0.5 were diagnosed with very mild Alzheimer’s, while those with a CDR of 1 were diagnosed with mild Alzheimer’s. The researchers excluded patients with moderate or severe dementia, as well as those with mild cognitive impairment (which raises the risk of Alzheimer’s).

All healthy controls passed an initial on-road driving test, compared with 88% of patients with very mild Alzheimer’s, and 78% of those with mild Alzheimer’s. At a subsequent road test 18 months later, driving skills in all participants — even healthy controls — had deteriorated, and many patients had stopped driving for safety reasons. However, patients with mild Alzheimer’s became unsafe drivers about twice as fast as those with very mild Alzheimer’s, based on tests conducted every six months. Patients with mild Alzheimer’s failed the driving test after roughly 11 months, while those with very mild Alzheimer’s failed the test after roughly 20 months.

This suggests that patients with mild Alzheimer’s may be able to continue driving safely for a time. But it’s important for clinicians, family members, and drivers themselves to remain vigilant for signs of deterioration and to reassess skills regularly.

General Safe Driving Tips

  • Drive shorter distances.
  • Stick to familiar routes.
  • Use GPS navigation for any unfamiliar destinations.
  • Don’t drive at night.
  • Don’t drive in bad weather.
  • Don’t travel on busy roads.
  • Avoid driving on weekdays or in peak traffic flow.
  • Always try use the same vehicle.

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When to stop driving

Opinions vary on whether driving should be allowed at all after an Alzheimer's diagnosis. For some people, it may be easier to give up the wheel early on, when they can still grasp the potential hazards. On the other hand, people in the early stages of the disease may be able to safely limit their driving to short daytime trips in familiar surroundings.

If your loved one continues to drive, pay attention to warning signs of unsafe driving, such as:
  • Difficulty navigating to familiar places, changing lanes or making turns.
  • Confusing the brake and gas pedals.
  • Failing to observe traffic signals.
  • Making slow or poor decisions.
  • Hitting the curb while driving.
  • Driving at an inappropriate speed.
  • Becoming angry or confused while driving.
If you're not sure whether it's safe for your loved one to drive, ask yourself whether you feel safe riding in a vehicle driven by the person who has Alzheimer's — or if you'd feel safe having your loved one drive your children or others. If the answer is no, then you know it's time for him or her to retire from driving.

How to ease the transition

When your loved one stops driving, arrange for alternative transportation. Perhaps family members and friends can run errands with your loved one, or you can arrange transportation through a senior van route. You may be able to establish a payment account with a taxi service so that your loved one can go places but won't have to handle money.

Also consider ways to limit your loved one's need to drive. Many items — such as groceries, meals and prescriptions — can be delivered to your loved one's home. Some barbers and hairdressers make house calls as well.

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Remain firm as the disease progresses

If your loved one wants to continue driving despite the hazards — or begin driving again after a period off the road — consider these strategies to keep him or her out of the driver's seat:
  • Get a note from the doctor. Sometimes it helps if an authority figure — physician, lawyer, or insurance agent — tells your loved one to stop driving. Having something in writing can be a useful reminder.
  • Involve law enforcement. Encourage law enforcement to issue a citation.
  • Keep keys out of sight. Park the vehicle around the corner or in a closed garage, and don't keep keys in plain sight. If your loved one insists on carrying a set of keys, offer old keys that won't start the vehicle.
  • Disable the vehicle. Remove a battery cable to prevent the car from starting, or ask a mechanic to install a "kill switch" that must be engaged before the car will start.
  • Sell the vehicle. If you can make do without your loved one's vehicle, consider selling it.
  • Have the alternative solution handy. Assure the person that a ride will be available if he or she needs to go somewhere. Have a list of contacts who can provide transportation, such as family members, friends, taxis or community transportation services.

Whether your loved one stops driving all at once or in stages, he or she will probably grieve the loss of independence. Be as patient as you can, but remember to stand firm. The consequences of unsafe driving can be devastating.

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