Just the Facts and More: Driving

Driving is a complex activity which necessitates quick reactions, clear sensory abilities, and split-second decisions. 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.

Considering the person's feelings of loss of independence can aid families in their actions to help the person understand why he/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

To better understand the effects of Alzheimer's on driving, research is focusing on people with early Alzheimer's disease. Results from studies conducted at Johns Hopkins University and at the National Institute on Aging (NIA) support the belief that people should not be allowed to drive after a diagnosis of Alzheimer's disease.

In the Hopkins study, more than 40 percent of patients studied had been in an accident after a diagnosis of the disease. In addition, 11 percent had caused accidents; 44 percent had gotten lost routinely; and 75 percent continually drove below the speed limit.

In California, preliminary road and laboratory studies (at Sepulveda Veterans Administration Medical Center and University of California at Los Angeles - UCLA) indicate that even persons with early Alzheimer's have markedly eroded driving skills.

As a caregiver, it is important that you take time to evaluate the person's driving ability and be aware of methods you can use to discourage the person from driving.

Action Steps

Assess the person's ability to drive.

• Consider having the impaired 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 Alzheimer's.
• Look for signs of driving problems. Be concerned if he forgets how to locate familiar places, doesn't observe traffic signs, makes slow or poor decisions in traffic, drives at an inappropriate speed, or becomes angry or confused while driving.
• 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 Chapter of the Alzheimer's Association may have information available on driving regulations in your state.

Strongly discourage driving if the person with dementia cannot drive safely.

• Instead of allowing the person to drive, tell him or her that you can drive or arrange for someone else to drive. If you don't know how to drive, investigate drivers' education courses and defensive driving programs designed for adults. For more information on these courses, contact the American Association of Retired Persons (AARP).
• Solicit the support of others. Ask your physician to advise the impaired person not to drive. Involving your physician in a family conference on driving is probably more effective than trying by yourself to persuade him/her 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 your loved one 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; because he/she is tired and needs to rest. Tell him that he/she deserves a chance to sit back and enjoy the scenery; or that you don't want him/her to drive because you're concerned about his safety. You may also want to arrange for another person to sit in the back seat to distract your family member 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.
• Control access to the car keys. Designate one person who will do all the driving and give that individual exclusive access to the keys.
• Disable the car. If the person with Alzheimer's is insistent about driving, remove the distributor cap or the battery or starter wire. Or 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 her old set, but that doesn't work to start the car.
• Move the car. Drive the car to another block, a neighbor's driveway, a private garage or lot.
• 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 from your physician that certifies the person is no longer able to drive.
• Substitute the person's driver's license with a photo identification card. Take no chances. Don't assume that taking away her driver's license will discourage driving. The person may not remember that she no longer has a license to drive, or even that she needs a license.
• Consider selling the car. By selling the car, you may be able to save enough in insurance premiums, gas, oil and maintenance costs to pay for public transportation, including taxicab rides.
• Be firm and positive about driving. Avoid arguing with the person, or giving long explanations for why he/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.
  

References

• Lucas-Blaustein, M.J., et al (et alia). (1988). Journal of American Geriatrics. 36:1087-1091.
• Friedland, R.P., et al (et alia). (1988). Annals of Neurology. 24:782-786.
• Fitten, L.J., et al (et alia). (1991). Gerontological Society of America, Annual Meeting. Abstract.
  

Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was L. Jaime Fitten, MD, Associate Professor Psychiatry and Medicine/Geriatrics, UCLA (University of California at Los Angeles) School of Medicine and Chief Geriatric Psychiatry, VA (Veterans Administration) Medical Center, Sepulveda, California.

Special thanks to the following Chapters of the Alzheimer's Association:

Northern Virginia; Greater Philadelphia; Midlands Chapter (formerly Omaha and Eastern Nebraska); Honolulu, Hawaii; New York City.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.