ALL ABOUT ALZHEIMER'S: Driving  (Part 1 of 2)     
By Betty Weiss

For a long time I sat in the passenger seat noticing that my husband's driving habits were changing.  He drove slower, didn't follow as close to other cars, avoided the freeways, frequently asked me directions--and I had no thought that anything was wrong--that he had become a dangerous driver.  Along the way, he'd been diagnosed with 'short-term memory loss,' and on my own I thought he had dementia, but I never connected any of it to changes in his driving. 

As his dementia worsened, we went to another doctor who reported him to the Department of Motor Vehicles (DMV).  That's the law in California, doctors have to report drivers with dementia and I'm glad.  When his license was replaced with an identification card that looked exactly the same, he knew he could no longer drive and he never challenged that.  He still had enough reasoning power that he told me it was a good thing.  If he had an accident, even if it wasn't his fault, and they got his medical records - which legally they can--we could be sued for everything we had.  He knew all along that something was wrong.  I was the dolt.  

Some warning signs of unsafe driving problems are: confusing the gas and brake pedal; failing to notice stop signs or signals; loss of confidence while driving; riding the brake; others honking their horns; hitting curbs; scrapes on the car, mailbox or garage; driving too slow; confusion at exits; using a co-pilot; getting lost in familiar places.  Other telltale signs of driving safety do not have to happen on the road.  If someone is having trouble reading, cooking, getting dressed, using the TV remote or the phone, unable to find things they always found before, trying to repair things in an inappropriate way - and certainly if there has been any decline in any mental tests doctors administer--all these things transfer to the inability of safely operating the car.   It usually becomes obvious to the driver and to his family, but what to do about it - what to do?  It is not surprising that many try to hide it and don't think it is all that serious.

In the very early stages of Alzheimer's, many people are still safe drivers, but when does that change and they become unsafe?  Some caregivers admit that they have allowed someone with dementia to continue driving after they felt it was unsafe!  Others overreact in the beginning, blaming the disease when the person may have always been a bad driver, or just out of fear.  Caregivers should take the time to observe the loved one while driving; keep a written record of driving behaviors that change.  Share what you see with your loved one, other family members and doctors. 

It is often easier to raise the subject of driving with your loved one in the early stages and discuss possible plans to stop when it becomes dangerous.  Your loved one may agree to plan to give up driving in the future, even sign a paper to that effect, but then back out when it comes right down to it.  Try to find an opportunity to talk about dangerous driving before it becomes a problem.  Don't wait until there is an accident or ticket when the driver may dismiss it as a common thing not related to declining abilities. 

It is hard for adult children to tell parents to stop driving and the average spouse doesn't want a confrontation.  The person closest to the driver, who has seen the changes, is the best one to do this, although the authority of a doctor sometimes works well.  A prescription that says 'Do Not Drive' can carry a lot of weight.  The doctor may also say that it's only until the patient gets better - or until he sees how the new medications are working.  Then it's not so final and chances are the subject will eventually be forgotten.  A good time to talk about driving issues is when there's a license renewal needed, a change in medications or some other specific event like a visit to an attorney or accountant - alert that person beforehand about your concerns.  Then it can be brought up as part of the planning and what the financial consequences will be if there is an accident.  You have to stay flexible about it all but don't lose your focus.

Family members may disagree about not driving.  Disagreements can result when one member is aware of the decline while others, who have not ridden with the person, will not see the problem.  It is good to have them experience the same things, drive with the person, get on the same page.  It has happened that other family members who do not understand the dangers involved have helped an unsafe driver get another key and keep it hidden from the caregiver.  You are lucky if friends and family members are with you on this - enlist such help.  But too often someone tells a dangerous driver that it's OK to drive. They really do not understand the dangers.  And too often, Mom wants Dad to continue to drive because it's easier, Dad doesn't trust Mom to drive and how can they otherwise do the marketing.  And don't be surprised if both conveniently forget the doctor's 'Do Not Drive' prescription.  Ask the doctor to send a formal letter about not driving; it is something your loved one can refer to when he forgets.  Try to keep it the doctor's fault, not yours.  

Get a Handicap Parking Permit for your loved one from your DMV.  It will make your life so much easier.  (Driving Part 2 will appear next month with hints about taking away the key.)

Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice.                           
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