By Carole Larkin and Max WallackHow do families convince someone suffering from Alzheimer's disease that they need to stop driving?
Alzheimer's Reading Room
Editor note: Carole Larkin is a geriatric care manager who specializes in dementia in the Dallas -- Ft.Worth area. One of the routine issues she addresses with her clients and their families is:
When does a person with dementia need to stop driving and how to tell them to stop driving in a respectful and considerate manner.The part two of a two part series where Carole discusses her many experiences in dealing with this difficult problem -- Driving and Alzheimer's disease.
Max Wallack conducted the interview.
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Max: How do families convince someone suffering from Alzheimer's disease that they need to stop driving?
Carole: The most effective method is with several short conversations centering on health and safety. That way a pattern of open, calm, non-threatening dialogue has been started. There is no direct confrontation, no strain of asking them to change their driving behaviors. Opportunities to open discussion might be shortly after a car accident or near miss, or after seeing the doctor and new medicine has been prescribed for your family member.
Things that you can say to open dialogue might be:
“Have you talked to your doctor about the effects of your new medicine on yourOf course, the comments should be appropriate to your loved one’s personal situation.
driving?”
“That was a close call yesterday. I worry about your safety on the road.”
“Driving isn’t what it used to be. There is so much more traffic nowadays, and people are driving more aggressively than ever. I read about road rage accidents and incidents in the paper all the time now”
“I worry about your getting lost.”
Be prepared for negative reactions.
After all, your loved one knows where these conversations are leading. They understand that a big portion of their independence is at risk. They know that they will be more dependent on family members and others and that they will have fewer social opportunities. They might become depressed or even angry at the thought of giving up their driving privileges, even if they secretly agree with the assessment of their driving ability.
Max: Who should be the one to start these conversations?
Carole: A Harvard/MIT survey concluded that married drivers prefer to hear about driving concerns first from their spouses. Those living alone prefer to have these conversations with their doctor, their adult children or a close friend, in that order. Adults over the age of seventy-five allow their adult children to have more influence than younger seniors. Older drivers DO NOT want to have conversations with police officers on this subject. Would you?
How does a person prepare for these talks?
First, do your homework before you ask your loved one to restrict or stop driving.
Make sure that you have observed them behind the wheel a number of times over an extended period of time.
Have the knowledge. Learn the warning signs of driving problems and cite them in your discussion.
Speak to your family members’ doctor to see if they would be willing to help. Some doctors may take an active role in giving an opinion or writing a prescription to stop driving.
Others may refer a concerned patient and their family to a driving rehabilitation therapist (OT) for assessment.
Make ready other options for transportation.
Offer yourself or other family members to drive to doctor’s appointments, to the grocery store or for other errands, to social events, as your schedule allows.
If your loved one can still take public transportation find out what’s available to them. Many cities and towns have special buses for disabled adults. Prearranging for a regular pick up and drop off to the same location may work for awhile. Offer to pay for a taxi if your loved one can still handle that. Make sure the taxi driver knows not to let them off anywhere other than the designated location and watches them to ensure that they go in the door of the designated building. Private transportation is available as well. Look for companies offering rides for seniors. The same instructions would be given to the operator of the senior ride as are given to taxi drivers.
Be calm and supportive. Always let your loved one know that your concern is for their safety and well-being and that you love them. You might use some of the following direct appeals to your loved one.
“Even if you were not at fault in an accident, you could be seriously injured or die.”
“I know you would feel terrible if someone was hurt when you were driving.”
“I’m afraid to let the grandchildren ride with you”
“Let’s talk with your doctor about this.”
Max: What if your family member refuses to stop driving?
Carole: Sometimes it takes more than just conversations. Maybe not renewing their driver’s license or canceling insurance will be enough.
The State licensing authority can be notified in writing of your concern about the ability of your loved one with dementia’s ability to drive safely. Ask them to retest in all three areas: vision test, written test and driving test.
Sometimes the prospect of being tested will make your loved one give up the keys voluntarily.
Sometimes they can’t pass all the tests. Even if they do pass all the tests, you can ask that your loved one be tested again, say in 3 months or so.
You may have to consider disabling the car, filing down the keys, or removing the car from their premises.
These are drastic measures only to be taken when all other interventions have been tried and have failed. They probably will be very angry with you, but usually in time the anger fades. It’s really a small price to pay to keep your loved one safe and alive.
Max: What dangers arise for families who do not address their loved ones with dementia’s declining driving skills?
Carole: The danger that always is cited first is that their loved one will get lost.
People with dementia get lost driving every day. The longer into the disease they drive, the higher the chance that they will get lost.
Often they get lost driving to very familiar places such as the closest grocery store or drug store.
Nonprofits such as the Alzheimer’s Association as well as a variety of corporations have systems for finding lost dementia patients. Technology can be used such as GPS or cellular tracking.
They are good of course, but it is like closing the door after the horse is already out of the barn.
The real answer is for the family to be proactive and monitor their loved one with dementia’s driving skills and stop them from driving before they reach the point of getting lost.
Another danger to the person with dementia and the family is the much higher risk of liability from causing an accident -- causing property damage, injury or even death.
The family should check the limits of their loved one’s liability insurance, and increase the coverage as much as they can afford. Even then, there may not be enough coverage to protect the person from losing their income, home and retirement savings and other assets. If your loved one hits a bus full of people from the retirement home up the street, or a school bus full of children, will their insurance cover the costs from law suits that families of those injured or killed will file against them?
One of these days, a judge somewhere will rule that the other family members (meaning adult children) are liable as accessories, if they knew that their loved one should not be driving, yet took no action to stop them.
The likelihood of this ruling will rise with the number of people killed or injured by demented drivers. As more and more people enter older adulthood, and the epidemic of Alzheimer’s and other dementias continues, this result seems inevitable.
When the ruling occurs, it will have an immediate impact on the income and assets of the family members who knew and did not take action. That would be devastating to all the family members affected.
Carole: Max, now it’s your turn to talk. Tell us about Puzzles to remember.
Puzzles To Remember is a 501c3 organization that I founded about two years ago. Puzzles To Remember collects puzzles and distributes them to facilities that care for Alzheimer’s patients.
So far, I have collected over 4600 puzzles and distributed them to over 300 Alzheimer's care facilities.
Research indicates that working jigsaw puzzles can be very helpful to Alzheimer’s patients by engaging them in a type of mental activity that can help slow down the disease progression as well as provide a calming activity. Since the portion of the brain that deals with creative activities such as art, music, and puzzles is one of the very last affected by Alzheimer’s disease, jigsaw puzzles may represent a great means of communication with more advanced patients.
I have been working for some time at having jigsaw puzzles made specifically to meet the needs of Alzheimer’s patients, and I am happy to announce that these puzzles, being made by Springbok, will become available this fall.
Bye, Carole. Thanks again for your devotion to Alzheimer’s patients and their caregivers!
Bye, Max and Thank you for your devotion to Alzheimer’s patients and their caregivers!
Also see part one of this series -- Warning Signs of Decreased Driving Abilities in People Who Have Alzheimer’s (Podcast, Text).
Driving and dementia: Health professionals can play important role
Carole Larkin MAG, CMC, DCP, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementia issues. She also trains caregivers in home care companies, assisted living, memory care, and nursing home communities in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.
Max Wallack is a student at Boston University. His great grandmother, Gertrude, suffered from Alzheimer's disease. Max is the founder of PUZZLES TO REMEMBER. Puzzles To Remember has already distributed 40,406 puzzles to over 2778 Alzheimer’s caregiving facilities in all 50 states and around the world. With our help, many similar programs are being launched in Portugal, Australia, and elsewhere. All donations are tax deductible.
Original content Carole Larkin and Max Wallack, Alzheimer's Reading Room