Rain I work with families with loved one with Alzheimer's Disease some of the same problems are associted with there driving abilities as stroke patients. I have copied the document that we hand out, there are other but this is a start just ignore the word Alzheimer's and replace it with stroke. It is a diffucult thing to do and required your entire families support. It may even require you disabling the car or having his insurance canceled. If you need any references in your state let me know we network with many agencies all over the country.
[QUOTE]Driving
Driving is a complex activity that requires quick thinking and reactions, good perceptual abilities, and split-second decision-making. For the person with Alzheimer’s disease, driving becomes a safety issue. While he or she may not recognize that changes in cognitive and sensory skills impair driving abilities, you and other family members will need to be firm in your efforts to prevent the person from driving when the time comes that he or she is no longer able to drive safely.
Considering the person’s feelings of loss of independence can aid families in their actions to help the person understand why he or she can no longer drive safely. Assisting the person with dementia to make the decision to stop driving can be useful in helping to maintain a positive
sense of self-esteem.
Study results
Studies have been conducted to better understand the effects of Alzheimer’s on driving. Two of these studies have been conducted at the Alzheimer’s Disease Research Center at Washington University in St. Louis, Missouri.
One study conducted in 1997 (1) demonstrated that poor driving performance increases with increased dementia severity, however, not all people with Alzheimer’s necessarily are unsafe drivers at a given point in time. As a result, the study validates the use of an in-car, on-the-road evaluation or other functional test to assess driving skills in dementia.
A second study conducted in 2000 (2) indicates that actual crashes do not necessarily occur more frequently in drivers with dementia compared to non-demented elderly drivers, suggesting that the diagnosis of dementia should not be the sole justification for suspending driving privileges.
Assess the person’s ability to drive
• Have the person’s driving ability tested. Some state agencies have special drive tests to determine how well a person sees, judges distance and responds to traffic. Ask the person who administers the test to explain the results to you and the person with dementia. If your state does not offer special testing, alternative assessments (generally fee-for-service) may be available. Your local Alzheimer’s Association may be able to provide a list of these assessment programs.
• Look for signs of unsafe driving such as forgetting how to locate familiar places, failing to observe traffic signs, making slow or poor decisions in traffic, driving at an inappropriate speed, or becoming angry or confused while driving. Keep a written record of your observations to share with the person, family members and health care professionals.
• Learn about your state’s driving regulations. In some states, such as California, the physician must report a diagnosis of Alzheimer’s to the health department, which then reports it to the department of motor vehicles. That agency then may revoke the person’s license. Your local Alzheimer’s Association may have information available on driving regulations in your state.
Strongly discourage driving if the person with dementia cannot drive safely
• Involve the person with dementia in the decision to stop driving if possible. Explain your concerns about his or her unsafe driving, giving specific examples, and ask the person to voluntarily stop driving. Assure the person that a ride will be available if he or she needs to go somewhere.
• Transition driving responsibilities to others. Tell the person you can drive, arrange for someone else to drive, or arrange for public transportation such as taxi service or special transportation services for older adults.
• Find ways to reduce the person’s need to drive. Have prescription medicines, groceries or meals delivered to the person’s home.
• Solicit the support of others. Ask your physician to advise the person with dementia not to drive. Involving your physician in a family conference on driving is probably more effective than trying by yourself to persuade the person not to drive. Ask the physician to write a letter stating that the person with Alzheimer’s must not drive. Or ask the physician to write a prescription that says, “No driving. You can then use the letter or prescription to tell your family member what’s been decided.
• Ask a respected family authority figure or your attorney to reinforce the message about not driving. Also ask your insurance agent to provide documentation that the person with dementia will no longer be provided with insurance coverage.
• Experiment with ways to distract the person from driving. Mention that someone else should drive because you’re taking a new route, because driving conditions are dangerous, or because he or she is tired and needs to rest. Tell the person he or she deserves a chance to sit back and enjoy the scenery. You may also want to arrange for another person to sit in the back seat to distract the person while someone else drives. If the disease is in an advanced stage, or there is a history of anger and aggressiveness, it’s best not to drive alone with the person.
• If the person with dementia wanders, he or she can wander and get lost by car. Be prepared for a wandering incident and register the person in Alzheimer’s Association Safe Return®. It is a nationwide identification, support and registration program that provides assistance when individuals with dementia wander and become lost locally or far from home.
• In the later stages, when the person is no longer able to make decisions, substitute his or her driver’s license with a photo identification card. Take no chances. Don’t assume that taking away a driver’s license will discourage driving. The person may not remember that he or she no longer has a license to drive or even that he or she needs a license.
• Be firm and positive about driving. Avoid arguing with the person or giving long explanations for why he or she cannot drive. Spend your time and energy helping to preserve the person’s dignity by focusing on the activities he or she can still do and enjoy.
If the person insists on driving, take these steps as a last resort
• Control access to the car keys. Designate one person who will do all the driving and give that individual exclusive access to the car keys.
• Disable the car. Remove the distributor cap or the battery or starter wire. Ask a mechanic to install a “kill wire that will prevent the car from starting unless the switch is thrown. Or give the person a set of keys that looks like his or her old set, but that don’t work to start the car.
• Consider selling the car. By selling the car, you may be able to save enough in insurance premiums, gas and oil, and maintenance costs to pay for public transportation, including taxicab rides.
• In some states, it might be best to alert the department of motor vehicles. Write a letter directly to the authority and express your concerns, or request that the person’s license be revoked. The letter should state that “(the person’s full name) is a hazard on the road, and offer the reason (Alzheimer’s disease). The state may require a statement form your physician that certifies the person is no longer able to drive.
Resources
“At the Crossroads: A Guide to Alzheimer’s Disease,
Dementia, and Driving. A publication produced by The
Hartford. To obtain a free copy, download it from
Hartford’s Web site:
www.thehartford.com/alzheimers or
write: The Hartford, Dementia and Driving Booklet, 200
Executive Blvd., Southington, CT 06489.
Alzheimer’s Association Safe Return® is a
nationwide identification, support and registration program that provides assistance when a person with Alzheimer’s or a related dementia wanders and becomes lost locally or far from home.
To find out more about Safe Return or to
obtain a registration form, contact your local Alzheimer’s
Association, call 1.800.272.3900 or register online
at
www.alz.org/safereturn.
References
(1) Hunt, Linda A., et al. Archive of Neurology 54: 707-
712, 1997.
(2) Carr, D.B., et al. Journal of the American Geriatric Society 48: 18-22, 2000.
The Alzheimer’s Association, the world leader in Alzheimer research, care and support, is dedicated to finding prevention methods, treatments and an eventual cure for Alzheimer’s.
24/7 Helpline 1.800.272.3900 TDD Access 312.335.8882 Web site
www.alz.org e-mail
info@alz.org
Fact sheet updated October 11, 2004 [/QUOTE]
