Putting the Brakes on Driving

Individuals with Dementia Shouldn't Drive, But How Can You Stop Them?

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.

Because driving is a learned skill, a confused person can still appear to be driving well when he/she is not really a safe driver. Driving requires a highly complex interaction of eyes, brain and muscle and the ability to solve complicated problems quickly. A person who is still apparently driving safely may have lost the ability to respond appropriately to an unexpected problem on the road. He/she may be relying entirely on the habits of driving and may not be able to change quickly from a habitual response to a new response when the situation demands it.

Considering the person's feeling 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 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% of patients studied had been in an accident after a diagnosis of the disease. In addition, 11% had caused accidents; 44% had gotten lost routinely; and 75% continually drove below the speed limit.

In California, preliminary road and laboratory studies (at Sepulveda VA and UCLA) indicate that even persons with early Alzheimer's have markedly eroded driving skills.

In another study of Alzheimer's patients still driving, common mistakes included:

Incomplete stop at stop sign
Not utilizing turn signals
Failure to check blind spots
Not looking side-to-side (scanning)
Not keeping the car in proper lane
Driving too fast for existing conditions
Making wide right turns
Improperly using the gas and brake pedals.

Action Steps

As a caregiver of a person with AD, you are in a difficult position. You need to balance two important considerations: keeping the AD person as independent as possible, and the need to protect everyone's safety.

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.

Assess the person's ability to drive

Look for the following behaviors:

Gets lost while driving in familiar locations
Drives at inappropriate speeds
Fails to observe traffic signs and signals
Makes slow or poor decisions in traffic
Becomes angry, frustrated or confused when driving
Has been involved in or caused an accident.

One or more of these behaviors may mean it's time for the AD person to limit or stop driving.

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

If you believe the person can no longer drive safely, you have several options. You may have to try more than one to be successful. First, be sensitive to what a great loss giving up driving represents. If possible, formulate a "driving" plan early on and seek help from family, friends and the AD person's health care providers.

Encourage the person to voluntarily stop driving. You may be more successful in this if you plan ahead and can reassure the person that a ride will be available when they need to go somewhere.

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 their safety.

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. 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.

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 and oil, and maintenance cost to pay for public transportation, including taxi cab 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.

Consider reporting the driver to authorities.

The following comments were made by people with Alzheimer's or other dementia in a group for those in the very early stage in Colorado:

Talk with family and keep communication open.
I only drive to places close or that I know well.
My family told me to stop.
My family worries about me driving, so I don't do it for them.
I began to feel less secure at night first, now I only drive during the day.
I'd love to be driving but I know it's not a good idea.
It made me happy to give my car to my grandson.
It was the most difficult decision I ever made.
At first you think you will never get over it, but after awhile you get over it and it's a bit of a relief.

Lynn M. Rankin, MD, put it this way:
Which Alzheimer's patients are unsafe? Almost all!

Removing Driving Privileges:

Some with Alzheimer's will give up driving as their confidence wanes, while others will stop driving at family members' urging. Still others remain in denial and may not even accept the news from a figure of authority. Here are a few suggestions to help ease the transition:

Remove driving privileges gradually.
The physician should put it in writing.
Hide the car keys.
Emphasize the safety of all concerned and be supportive.
Reduce the need for driving.
The acid test for knowing if the person with Alzheimer's is safe to drive: Would you let your grandchild in the car with them driving?

Remember: while this is a difficult, complicated problem involving the self esteem and independence of the impaired person, the safety of your loved one and others is at stake.

This article was taken from several excellent articles prepared by Chapters of the Alzheimer's Association.